General Augusto Pinochet took power in Chile following the 1973 coup, and appointed the Chicago Boys to preside over economic affairs.
CRIS BOURONCLE/AFP/Getty Images
CRIS BOURONCLE/AFP/Getty Images
This is the second part in our series on Marxism and capitalism in Chile. You can find the first episode here.
In the early seventies, Chile, under Marxist President Salvador Allende, was plagued by inflation, shortages, and a crushing deficit. After a violent coup in 1973, the economy became the military’s problem.
Led by Augusto Pinochet, the military assigned a group of economists to help turn around Chile’s economy. They had trained at the University of Chicago. They came to be known as the Chicago Boys.
Today’s show is about the economic “shock treatment” they launched. It eventually set Chile on a path to prosperity, but it did so at an incredible human cost. One that Chileans are still grappling with today.
In the Tennessee capitol, state Rep. Matthew Hill took heat from abortion-rights proponents last month who had gathered to protest a bill he favored that would ban abortions after about six weeks’ pregnancy. That legislation was eventually thwarted in the Tennessee senate, however, when some of his fellow Republicans voted it down, fearing the high cost of court challenges.
The new anti-abortion tilt of the U.S. Supreme Court has inspired some states to further restrict the procedure during the first trimester of pregnancy and move to outlaw abortion entirely if Roe v. Wade ever falls. But the rush to regulate has exposed division among groups and lawmakers who consider themselves staunch abortion opponents.
On Thursday, Ohio became the latest state to ban abortions after a fetal heartbeat can be detected. For a long time, Ohio Right to Life supported a more gradual approach to restrict the procedure and deemed what’s come to be called a “heartbeat bill” too radical — until this year. Restricting abortions after a fetal heartbeat can be detected basically bans the procedure after six weeks’ gestation — before many women know they’re pregnant.
“We see the Court as being much more favorable to pro-life legislation than it has been in a generation,” spokeswoman Jamieson Gordon says. “So we figured this would be a good time to pursue the heartbeat bill as the next step in our incremental approach to end abortion-on-demand.”
The Ohio law contains no exception for pregnancies that are the result of rape or incest; it does have an exception for the life of the mother.
Some say the rush to pass these bills is about lawmakers competing to get their particular state’s law before the Supreme Court. The state that helps overturn Roe v. Wade would go down in history.
More than 250 bills restricting abortions have been filed in 41 states this year, according to the Guttmacher Institute, a reproductive rights research and advocacy group.
“After the appointment of Justice [Brett] Kavanaugh, there really is just an environment in state legislatures to roll back abortion rights. And so we’re seeing these bans just fly through,” says Elizabeth Nash, who monitors state laws at Guttmacher.
But the speed of passage of some of these laws masks divisions about strategy and commitment to the cause within the anti-abortion movement.
Tennessee infighting over ‘heartbeat bill’
In Tennessee, for instance, there’s a philosophical split between pragmatists and idealists.
A heartbeat bill in the state has had high-profile support, including from the Tennessee’s new governor. But the Republican attorney general warned such a law would be difficult to defend in court. And several Republicans, swayed by that logic, voted no for the heartbeat bill.
“This is an issue that is extremely important to me. It’s the reason I got into politics many years ago,” Republican state Rep. Bill Dunn said as the House approved the measure over his objection earlier this year. Dunn says he wants to stop abortion, but that will require strategy. He points out that no heartbeat bill has ever been enforced. And recent laws in Iowa and Kentucky have been immediately blocked in court. The same is expected for Ohio.
“Number one, it’ll probably never save a life if we go by what’s happened in the past,” Dunn argued on the Tennessee House floor.
But it’s money that ultimately stopped the heartbeat bill this year in Tennessee. Senate Speaker Randy McNally says he’s pro-life too, but has no interest in wasting tax dollars to make a point.
Even worse, in the view of Republicans who voted against the heartbeat bill, the state could end up paying the legal fees for groups that defend abortion.
“That is a big concern,” McNally says. “We don’t want to put money in their pockets.
The last time Tennessee had a case that went to the U.S. Supreme Court, it cost roughly $1.9 million. The experience was enough to give a few anti-abortion crusaders some pause. They voted this week with Democrats for a one-year delay on a heartbeat bill, vowing to study the issue over the summer.
Name-calling in Oklahoma
Even if it doesn’t result in a case that upends abortion law, heavily Republican legislatures like Oklahoma’s want to be ready.
“If Roe v. Wade ever gets overturned, we won’t be prepared,” Republican Senate Pro Tempore Greg Treat said while explaining his so-called “trigger bill” at a committee hearing in February.
Treat’s legislation, modeled after existing laws in a handful of states, would “trigger” a state ban on abortion and make it a felony if Roe were overturned. A handful of states, including Arkansas, Kentucky, Louisiana, Mississippi, North Dakota and South Dakota, already have trigger laws on the books.
Oklahoma has some of the strictest abortion laws in the nation, such as mandatory counseling and a 72-hour waiting period. But the most conservative anti-abortion activists in the state want more immediate action. So they targeted Treat and other self-described pro-life Republicans with protests, billboards and fliers, accusing them of not being anti-abortion enough.
“I’ve been called every name in the book these past few weeks,” Treat says. “I’ve had my Christianity questioned. I’ve had a member of my own caucus hold a press conference and call me a hypocrite.”
In response, Treat abandoned the trigger bill.
Now he’s trying something else — an amendment to the state constitution that would reinforce that nothing in Oklahoma law “secures or protects” the right to abortion. But that’s still not anti-abortion enough for some.
“It’s going to add on to that legacy that we have of death and just status quo pro-life policy that does nothing,” says Republican state Sen. Justin Silk.
Not far enough in Georgia
In Georgia, a heartbeat bill passed the legislature, but has paused at Gov. Brian Kemp’s desk. Supporters of abortion rights don’t want him to sign it, of course, but some anti-abortion activists aren’t happy either.
“It really just does not go far enough in the protection of innocent human life,” says Georgia Right to Life executive director Zemmie Fleck. Fleck argues that certain exceptions in his state’s bill — for abortions after rape or incest if the woman makes a police report — make it weak.
Gov. Kemp has until May 12 to sign or veto the measure.
Cost as no object in Kentucky
The American Civil Liberties Union in Kentucky sued the day after a heartbeat bill was signed into law by Gov. Matt Bevin. But even during his annual speech to the Kentucky legislature in February, Bevin acknowledged his intent to challenge Roe v. Wade.
“Some of these will go all the way to the U.S. Supreme Court. But at the end of the day, we will prevail because we stand on the side of right and we stand on the side of life,” Bevin said.
Kentucky has become accustomed to defending abortion restrictions in court. Currently, one law that makes it a felony for a doctor to perform a common abortion in the second trimester has been suspended indefinitely.
It is unclear how much it costs Kentucky to defend abortion laws that are immediately challenged. In an emailed statement, Bevin administration spokesman Woody Maglinger writes that the state is using in-house lawyers, and hasn’t hired outside counsel. He declines to provide a cost estimate on hours spent on these cases.
“It is impossible to place a price tag on human lives,” Maglinger writes.
This story is part of a reporting partnership that includes NPR, Kaiser Health News and member stations. Blake Farmer is Nashville Public Radio’s senior health care reporter, and Jackie Fortier is senior health care reporter for StateImpact Oklahoma. Marlene Harris-Taylor at WCPN in Cleveland, Lisa Gillespie at WFPL in Louisville and Alex Olgin at WFAE in Charlotte, N.C., also contributed reporting.
Immunizations are one of the most cost-effective health interventions. Yet some vaccines are too expensive to be distributed in low- and middle-income countries.
Jürgen Bätz/Getty Image
Jürgen Bätz/Getty Image
The price of pharmaceuticals around the world can vary dramatically depending on who’s paying for the drugs and where those patients happen to live.
Take the pneumonia vaccine. Doctors Without Borders just struck a deal on it for refugee children in Greece. The aid group will pay $9 per immunization for a drug with a list price of $540. In local Greek pharmacies, the vaccine costs $168. France pays $189 for the inoculation while the far less-wealthy nation of Lebanon pays $243 for it, according to the group. In India you can get it for roughly $60.
The global drug pricing system is “broken,” says Fatima Suleman, a professor of pharmaceutical sciences at the University of KwaZulu-Natal in Durban, South Africa. “Affordability used to be an issue primarily for low- and middle-income countries, but it’s now a global issue,”
This weekend, Suleman is participating in the Fair Pricing Forum, a conference sponsored by the World Health Organization. The event brings together pharmaceutical executives, government health officials, academics and advocacy groups to look at ways to make global drug prices more affordable — while also benefiting drug manufacturers.
We called up Suleman, who specializes in pharmaceutical policy, to ask her how the global health community could help patients get access to medicines they need and allow drug companies to reach much larger markets. This interview has been edited for length and clarity.
Why not just let the free market sort out the price?
Well, because we are looking at a free market that’s failing. Otherwise, why would something like insulin — that’s almost a century old — still be priced so high that people are going into poverty not just in the U.S. but in countries like Tanzania and elsewhere to get access to their medicines? If this market was working, something like insulin would now be at an affordable price. But it’s not.
There’s something in the system of medicine pricing that’s broken and it’s something that we need to really look at and figure out how we can fix.
Part of what you are arguing is that changes in global pricing could potentially benefit pharmaceutical companies by giving them increased access to billions of new customers in low- and middle-income countries. Have you seen an example of this?
Absolutely. We saw this with hepatitis C, where at first, the treatment was priced so high in the U.S. and in Europe it was unaffordable in most of the world. [The hepatitis C treatment released by the biopharmaceutical company Gilead in 2014 cost more than a thousand dollars a pill, and a single course of treatment was approximately $80,000.]
Other manufacturers in certain regions of the world [were allowed] to produce the medicines and supply them to certain areas at a much lower price. [Gilead granted licenses to two companies to produce generic versions of the drug to sell only in low-income countries. These were markets where few customers could afford the original list price.] And we saw the price of the hepatitis C medicines fall dramatically.
How do you address the fact that some medicines, no matter what you do, are going to be incredibly expensive to produce?
We want transparency from the industry. Tell us what your research and development costs are, whether it’s an expensive way of production that you can’t get away from or whether it’s a failed production line or a failed [clinical trial].
As long as everybody is aware about that, people will be much more inclined to say OK, I’m ready to pay a little bit extra for this medicine because I know that it will help fund something that’s going to help me further down the line.
But at the moment there’s all this murkiness. Part of the concern is the kickbacks, discounts, rebates, the perverse incentives in the system that are also unclear. So all we’re saying is: can we get transparency?
Any final thoughts on the push for fair pricing globally for drugs?
We need more dialogue [for example, at the current forum]. At the end of the day, we have patients saying, “I want access to these high-cost medicines. Why am I not getting it?” And I think people need to understand that changing systems is slow. It doesn’t happen overnight, but that there is a global attention on this issue and we are hearing their voices and we do want change. And that’s why these forums take place.