Health on the ballot as Argentina poised to elect 'anarcho-capitalist' bent on slashing social protections

The front-runner heading into Argentina’s presidential vote on Oct. 22 is prone to wielding a chain saw – both physically and metaphorically.

Javier Milei, a right-wing libertarian whose brash demagoguery has drawn comparisons to Donald Trump and Brazil’s former President Jair Bolsonaro, likes to brandish the power tool at campaign events as a symbol of what he intends to do if elected: cut back on government.

Milei has promised to take his chain saw to the ministries of education, environment and women’s rights, to name but a few, and to ax funding for scientific research. The country’s central bank would also cease to exist, if Milei fulfills his pledge to “dollarize” Argentina’s economy – that is, to scrap the country’s peso and replace it with the U.S. currency.

Milei promises a radical change to Argentina’s current trajectory. And his attacks on science and education form part of a troubling anti-intellectual, right-wing populism that threatens liberal democracies worldwide.

However, as an expert on the history of public health in Argentina, I believe Milei could face stiff resistance if he tries to undo a long-standing consensus on the need for the government to provide universal health care and other social services.

A shock to the political system

A former economics professor, Milei is a relative political newcomer, having served just one term in the national congress. As with other right-wing populists, he casts himself as a political outsider.

When it comes to public spending, Milei styles himself as an “anarcho-capitalist.” His plans include eliminating both the Ministry of Health and Conicet, the agency that funds most academic research in Argentina, and folding them into a new Ministry of Human Capital, with a fraction of their current budget and personnel.

Milei’s rhetoric taps into a deep well of discontent among Argentinians with the current government led by Alberto Fernandez, a member of the Peronist party, which has held power for most of the past three decades.

Since assuming power in 2019, Fernandez has presided over runaway inflation, rising poverty and accusations of official corruption.

The government’s handling of the COVID-19 pandemic saw an initial boost in public support for Fernandez. But by the middle of 2021, frustration with the government was starting to boil over – due in part to accusations of preferential priority for COVID-19 vaccinations for Peronist officials and their friends and families.

Meanwhile, for Milei, the pandemic proved to be a catalyst for his rise to political fame. Fanning the flames of public discontent, he appeared frequently on television and in social media to call out a “political caste” for imposing what he deemed unnecessary and economically damaging pandemic restrictions. His popularity has since skyrocketed among young people in Argentina, attuned to “anti-progressive” messaging online and exhausted by economic crisis and political corruption. Milei polls much better among men, in part because many women are alarmed by his intention to reverse the country’s 2021 legalization of abortion.

Health as a social right

Evidently, Milei has tapped into a thirst for sweeping political change.

But there is reason to believe that his proposals to reduce the government’s role in the health sector would run into strong headwinds, given the longer-term pattern in Argentina and across the Latin America region.

Today, there is a broad public acceptance of a strong role for government in guaranteeing and protecting the right to health care, along with other “social rights” like education and gender equality.

As I explain in my new book, “In Pursuit of Health Equity,” a hemispheric “social medicine” movement has, over the past century, played a key role in the construction of welfare state institutions in many Latin American countries. Led by progressive doctors, left-wing academics and health activists, social medicine – which sees health as being intrinsically tied to socio-economic factors – has sought to build robust health systems as part of a strong social safety net. Social medicine advocates see health as a right rather than a commodity.

In Argentina, Juan Domingo Perón, the founder of the populist Peronist movement that Milei now hopes to dislodge from power, understood social medicine. To make Argentina’s population healthier and more productive, in the 1940s Perón expanded the government’s role in health care while advancing policies to improve labor conditions, nutrition and housing

Later, politically active academics took on prominent roles in health planning in the leftist governments of Brazil, Argentina and Bolivia in the late 1990s and early 2000s, opposing market-based reforms and the incursion of a U.S. health care model that critics say puts profit over people.

Healthy approval ratings

Milei’s popularity suggests another swing in the pendulum of Latin American politics, which has tended to oscillate between state-centered and free-market-oriented models.

Clearly, a large contingent of Argentine voters agree with his basic contention that the current government has provoked an economic crisis with overly generous spending.

Yet his more extreme proposals are likely to meet resistance.

As Argentinian scholar Maria Laura Cordero and I found in our survey during the pandemic, Argentinians have mostly positive feelings toward public health institutions and the people who work in them, coupled with intense disdain for the political class. Around 67% of those we surveyed approved of the performance of the health sector, compared with 22% approval of political leadership during the pandemic.

Dismantling the public health sector in favor of market mechanisms like a voucher system to pay for health care or putting public hospitals in competition with one another, as Milei has suggested, may prove to be unpopular.

There is broad consensus about a fundamental right to health care in Argentina, as elsewhere in Latin America. And the public, by and large, understands that government intervention is necessary to make health care accessible to the poor and to respond to public health emergencies like the recent pandemic.

Health workers, deeply invested in the precepts of social medicine, are sure to resist Milei’s attempts at health reform. In response to Milei’s plans, the president of the Argentine Public Health Association stated that “solidarity and the building of the common good are present in the DNA” of health personnel in Argentina. The public is also likely to worry at the prospect of increased fees and the lack of coverage for basic health care needs.

Research under attack

Milei hasn’t won anything yet, nor is there a clear rightward tilt in Latin American politics – in the past two years, leftist presidential candidates have prevailed in countries as varied as Brazil, Chile, Colombia and Guatemala. But even if he fails to push through his radical agenda, the rhetoric of his campaign could serve to undermine confidence in Argentina’s health and science institutions.

Milei capitalizes on the politics of resentment, vilifying “unproductive” researchers who receive support from Conicet, especially social science and humanities scholars.

Such attacks on government support for scientific research, health care and education are consistent with a global right-wing ideology, typified by the likes of Viktor Orban of Hungary or Ron DeSantis, a Republican presidential candidate in the U.S.

Within the bottom-line mentality of neoliberalism – a political ideology that preaches free-market reforms over state involvement – such research is seldom viewed as profitable, nor does it tend to offer the possibility of new therapies or technologies produced by “hard” sciences and modern biomedicine.

But as the history of Latin American social medicine shows, social scientists can counter that, with time, their approach has helped build more just, free and healthy societies. And that legacy is now at stake as Argentinians head toward the polls.