Medical Care, Welfare State, and Deindustrialization in the Southern Cone

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Abstract
The Spanish-speaking countries of the Southern Cone (Argentina, Chile, and Uruguay) have long been characterized as the welfare states of Latin America. This myth is challenged by reviewing the role of the state in the financing of medical care. The Bismarkian model of medical-care financing is reexamined through the theoretical insights derived from bureaucratic authoritarianism. State concessions to the labor force in the form of medical-care benefits are now less crucial to labor's relationship with the state than they have been at any other time in the postwar period, and they remain independent of whether the military remain in power. Comparative aspects of medical-care financing, industrialization policies, and state–labor relations indicate that structural constraints—in the form of securing export-product niches, labor costs, and the threat of military intervention—have cast medical-care benefits in a relatively inferior position when the labor force bargains with management or with the state. Deindustrialization has forced thousands of workers into jobs that lack the comprehensive medical benefits that once characterized the traditional industrial sector. The welfare-state concept has given way to a new ideology that emphasizes individual choices in life-style and encourages medical-program affiliation according to income levels.

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