Health Care

DB: So I guess you're finished with the sports pages and ready to get into a day's work.

Only some of the sports pages. There's still the weeklies. (chuckles)

DB: It's becoming increasingly difficult to do interviews with you. That's because I don't know where we left off in conversations that we have and what we've talked about during interviews. So sometimes there's this blurring. Do you do all these interviews in your office upstairs in your home?

They're mostly here. Sometimes people come to my office at work, the ones with television cameras and stuff.

DB: I don't suppose you can see the Boston skyline from your home in Lexington. But if you could, do you know the two tallest buildings in Boston?

Yes.

DB: What are they?

The John Hancock and the Prudential.

DB: And what does that tell you? They happen to be two types of what?

They're going to be running our health program if Clinton has his way.

DB: There is a general consensus that the U.S. health care system needs to be reformed. How and why did that evolve?

It evolved very simply. Healthcare is never fully privatized. It can't be. It's not a commodity. But on the spectrum we have a relatively privatized health system. As a result it's hopelessly inefficient and extremely bureaucratic, with huge administrative expenses, and it's geared towards high-tech intervention rather than public health, prevention, and so on. It's just gotten too costly for American business. In fact, a little bit to my surprise, Business Week, the main business journal, has come out recently with several articles advocating a Canadian-style national government insurance program, what we call a single-payer program.

DB: What is that Canadian-style single-payer program?

The Canadian style is one of various plans that exist around the industrial world. It's basically a government insurance program. Health care is still individual, but the government is the insurer.

DB: The Clinton plan is called "managed competition." The big insurance companies are backing it in one form or another. What is managed competition and why are the big insurance companies supporting it?

Managed competition essentially will drive the little insurance companies out of the market, which is why they're opposed to it. It will mean that the big insurance companies will put together big conglomerates of health care institutions, hospitals, and clinics, labs, and so on. They will be in charge of organizing your health care. Various bargaining units will be set up to determine which of these conglomerates to work with. That's supposed to introduce some kind of market forces. But in effect, the big insurance companies will be pretty much running the show. It means an oligopolistic system, a very small number of big conglomerates in limited competition with one another and doubtlessly micromanaging health care, because they're business operations, they're in business for profit, not for your comfort.

DB: According to a Harris poll, Americans prefer, by a huge majority, the Canadian single-payer health-care system. Those results are kind of remarkable, given the minimal amount of media attention.

Polls, of course, depend on exactly how the question is asked. But there have been some surveys of polls over the years. The best work on this that I know is by Vicente Navarro. Have you ever interviewed him on this? You should if you haven't. He's extremely good.

DB: Yes. He's at Johns Hopkins.

He's done a lot of work on this. He has among other things surveyed many poll results. He has pointed out that even putting aside the variations depending on phrasing, there has been quite consistent support for something like a Canadian-style system ever since polls began on this business, which is now over forty years ago. In fact, Truman tried to put through such a program in the 1940s that would have brought the U.S. into line with the rest of the industrial world. It was beaten back by a huge corporate offensive with tantrums about how we were going to turn into a Bolshevik society and so on. Every time the issue has come up there has been a major corporate offensive. Occasionally it fails. One of Ronald Reagan's great achievements back in the late 1960s was to read the messages written for him by the insurance companies over radio and television about how if Medicare was passed we would all be telling our children and grandchildren decades hence what freedom used to be like.

DB: David Himmelstein and Steffie Woolhandler also cite another poll result: When Canadians are asked if they would want a U.S.-style system, only five percent say yes.

By now, even the business community doesn't want it. It's just too inefficient, too bureaucratic and too costly for them. The auto companies estimated a couple of years ago that it was costing them about $500 extra per car just because of the inefficiencies of the U.S. health system, as compared with, say, their Canadian operations. When business starts to get hurt, then the thing moves into the public agenda. The public has been in favor of a big change for a long time.

The public is sufficiently out of the political system so it doesn't matter much. There's a nice phrase about this sort of thing in a recent issue of the London Economist, the British business journal. It was about Poland. Their constituency is apparently worried about the fact that Poland has degenerated into this system where they have democratic elections, which is sort of a nuisance. The populations of all the East European countries are being smashed by the economic changes called "reforms" -- that's supposed to make them sound good -- that are being rammed down their throats. The Poles are opposed to the reforms. They voted in an anti-reform government. The Economist pointed out that this really wasn't too troublesome because "policy is insulated from politics." And that's a good thing. That's the way it is here, too. Policy is insulated from politics. People can have their opinions. They can even vote if they like. But policy goes on its merry way, determined by other forces.

DB: You have commented on another term, called "politically unrealistic."

What the public wants is called "politically unrealistic," meaning, when you translate that into English, that the major centers of power and privilege are opposed to it. A change in the health care system is now politically realistic because major systems of power, including the U.S. corporate community, want a change, since it's harming them. As I mentioned, it's striking that even Business Week, representing large sectors of the corporate community, wants to go over to a Canadian-style system because even the residual inefficiencies and expenses of the Clinton-style system will also, they assume, be harmful to them.

DB: Vicente Navarro says that a universal and comprehensive health care program is "directly related to the strength of the working class and its political and economic instruments."

That's certainly true of the Canadian and European experience. Take Canada, which had a system rather like ours up until the mid-1960s. It was changed first in one province, Saskatchewan, where there was a fairly strong labor-based NDP (New Democratic Party) government. It was able to put through a provincial insurance program, driving the insurance companies out of the business. It turned out to be very successful, very effective. It was giving good medical care and reducing costs and much more progressive in payment. That's a crucial fact. It was mimicked by other provinces, also under labor pressure, often through the NDP as an instrument. It's a this kind of umbrella political party with a mildly reformist character and labor backing. Pretty soon it was adopted across Canada nationally.

The history in Europe is pretty much the same. Working-class organizations have been one of the main, but not the only, mechanisms by which people with very limited power and resources can get together to participate in the public arena. That's one of the reasons why unions are so hated by business and elites generally. They're just too democratizing in their character. And Navarro is surely right: The history has been that the strength and organization of labor and its ability to enter into the public arena is certainly related, maybe even decisively related, to an institution of social programs of this kind.

DB: There may be a parallel movement going on in the U.S. today. In California there's a ballot initiative to have single-payer health care.

There are several states that are toying with it. This is still very much a business-run society. Here business is still playing an inordinate role in determining the kind of system that will evolve. Unless there are significant changes inside the U.S., that is, unless public pressures and organizations mount well beyond what we now see, including labor, the outcome of this will once again be determined by business interests.

DB: I'm not quite clear about how to formulate this question. It has to do with the nature of U.S. society as exemplified in such comments as "Do your own thing," "Go it alone," "Don't tread on me," "the pioneer spirit," all that deeply individualistic stuff. What does that tell you about American society and culture?

It tells you that the propaganda system is working full-time, because there is no such ideology in the U.S. Business, for example, doesn't believe it. It has always insisted upon a powerful interventionist state to support its interests -- still does and always has -- back to the origins of American society. There's nothing individualistic about corporations. Those are big conglomerate institutions, essentially totalitarian in character, but hardly individualistic. Within them you're a cog in a big machine. There are few institutions in human society that have such strict hierarchy and top-down control as a business organization. Nothing there about "Don't tread on me." You're being tread on all the time. The point of the ideology is to try to get other people, outside of the sectors of coordinated power, to fail to associate and enter into decision-making in the political arena themselves. The point is to atomize everyone else while leaving powerful sectors integrated and highly organized and of course dominating resources.

That aside, there is another factor. There is a streak of independence and individuality in American culture which I think is a very good thing. This "Don't tread on me" feeling is in many respects a healthy one. It's healthy up to the point where it atomizes and keeps you from working together with other people. So it's got its healthy side and its negative side. It's the negative side that's emphasized naturally in the propaganda and indoctrination.

DB: Have you thought about why the U.S. is such a violent society?

The U.S. does have many different features than other societies. Part of it is just that it is relatively weak in terms of social and community bonds. So if you travel around Europe, for example, you find that for one thing mobility is simply far lower. People are much more likely to be where they grew up, to be living and working pretty near to where they were. The countries themselves are small by U.S. standards. Moving across borders is much less likely than moving from one place to another in the U.S. But even within a country people tend, I've never seen statistics on this but you see it traveling around, much more than here to be part of ongoing, continuing communities.

Here societies have been very much broken up. Furthermore, communities have simply been dissolved. The forms of organization that do bring people together to work together, like unions, are quite weak in the U.S. The main ones that survive are churches. I think that that has a highly disruptive effect, along with the ideology that you mentioned earlier. The ideal is, get what you can for yourself. That's the ideal that's drummed into people's heads. Bayard Rustin, the civil rights activist, made a point about this back in the early 1960s, when he was asked about why black kids were stealing cars. He said, That's what they're told to do every day on television. They are told all the time that what you're supposed to do is maximize your own consumption any way you can. So they're doing it. Those are the options available to them. They don't have the options that are available to relatively privileged white kids, namely, go to work in a corporate law firm and rip people off that way. So they're ripping people off in ways that are open to them. But they're basically following the ideology that's not only presented but drummed into your head day and night: maximize your own consumption and don't care about anyone else.

DB: And you have the attending media focus on symptoms rather than the causes. Do you know what "smash and grab" is? This is something I discovered last night watching TV news from Chicago. When your car is in traffic or at a stop light, people come along and smash in the window and grab your purse or steal your wallet.

Right around Boston the same thing is going on. There's a new form. It's called "Good Samaritan robbery." You fake a flat tire on the highway and when somebody stops, jump them, steal their car, beat them up, if they're lucky. If they're unlucky you kill them and take the car off.

There's again a good deal of focus on the symptoms. The causes are deep-seated. For one thing, there are social causes that we've just been barely alluding to, but there are much more immediate causes. One is the increasing polarization of the society that's been going on for the past twenty five years and the marginalization of large sectors of the population who are simply being rendered superfluous. They're superfluous for wealth production, meaning profit production, and hence have no human value, since the basic ideology is that a person's human rights depend on what they can get for themselves in the market system.

Larger and larger sectors of the population are simply excluded and have no form of organization or no viable, constructive way of reacting and therefore pursue the available options, which are often violent. Indeed, those are the ones that are encouraged to a large extent in the popular culture.

DB: It's not just the underclass. A recent Census Bureau report stated that there has been a fifty percent increase in the working poor, that is, people who have jobs and are nonetheles below the poverty level.

That's part of the Third Worldization of the society. It's not simply unemployment, but also wage reduction. Wages have been either stagnating or declining, actually declining, since the late 1960s. In the Reagan years they declined. Since 1987 real wages have been declining for college-educated people, which was a striking shift. There is supposed to be a recovery going on. There is a kind of recovery going on, that's true. It's at about half the rate of normal postwar recoveries. Job creation during this recovery is less than a third of the rate of preceding postwar recoveries from recession. There have been half a dozen of them.

Furthermore, the jobs themselves are, out of line with any other recovery, low-paying jobs. Wages are not going up. In addition, a huge number of them are temporaries, again out of line with earlier history. This is what's called "increasing flexibility of the labor market." "Flexibility" is like "reform." It's supposed to be a good thing.

Flexibility means insecurity. It means you go to bed at night and don't know if you have a job tomorrow morning. That's called flexibility of the labor market, and any economist can explain that's a good thing for the economy, where by "the economy" now we understand profit-making. We don't mean by "the economy" the way people live. That's good for the economy, and temporary jobs increase flexibility. Low wages also increase job insecurity. They keep inflation low. That's good for people who have money, say, bondholders. So these all contribute to what's called a "healthy economy," meaning one with very high profits. Profits are doing fine. Corporate profits are zooming. But for most of the population, very grim circumstances. And grim circumstances, without much prospect for a future, may lead to constructive social action, but where that's lacking they express themselves in violence.

DB: It's interesting that you should say that. Most of the examples of mass murders are in the workplace. I'm thinking of the various post office killings and fast food restaurants where workers are disgruntled for one reason or another or have been fired or laid off.

Not only have real wages stagnated or declined, but working conditions have gotten much worse. You can see that just in counting hours of work. Today we happen to be talking on May 2. Yesterday was May 1, which throughout the world has been a working-class holiday, everywhere except in the United States. May Day was initiated in solidarity with American workers who were suffering unusually harsh conditions in their effort to achieve an eight-hour day. This was back in the 1880s. The efficiency of U.S. ideological controls, business controls, is such that this has remained the only country where the day of solidarity with U.S. labor was never even known. U.S. workers finally did, in the 1930s, achieve elementary rights, including the right to an eight-hour day, which had long been achieved elsewhere.

But since then that's been eroded. They've long lost the eight-hour day. Juliet Schor, an economist at Harvard, had an important book on this called The Overworked American. It came out a couple of years ago. She studied things like working hours. They have been increasingly steadily. If I remember her figures correctly, by around 1990, the time she was writing, workers had to put in about six weeks extra work a year to maintain something like a 1970 real-wage level.

Along with the increasing hours of work comes increasing harshness of work conditions, increasing insecurity, and reduced ability to protect oneself because of the decline of unions. In the Reagan years, even the minimal government programs for protecting workers against workplace accidents and so on were reduced in the interest of maximizing profits. Furthermore, since the Reaganites regarded the government they ran as basically just a criminal enterprise in the service of the rich, they simply didn't enforce laws on safe working conditions and the like. That again leads to violence. In the absence of constructive options, like union organizing, it leads to violence. It's not very surprising.

A last comment about this May Day story: This morning, May 2, way back on the back pages of the Boston Globe there was a little item which said -- I was surprised when I saw it, I don't think I've ever seen this here in the U.S. -- "May Day Celebration in Boston." So I naturally looked at it. It turned out that there indeed was a May Day celebration, of the usual kind, by immigrant workers -- Latin American and Chinese workers -- who have recently come here. They organized to celebrate May Day and to organize for their rights. That's a dramatic example of how efficient business propaganda and indoctrination has been in depriving people of even any awareness of their own rights and history. You have to wait for poor Latino and Chinese workers to have a celebration of a couple hundred people of an international day of solidarity with American workers.

DB: Let's go back to talk a bit more about the health issue. There had been some media attention on AIDS but very little to breast cancer. A half a million women in the U.S. will die in the 1990s from breast cancer. Many men will die from prostate cancer. What are your views on that? Those are not considered political questions, are they?

If you mean by that there's no vote taken on them, yes, there's no vote taken on them. But obviously all of these things are political questions, if we mean by that questions of policy. You might add to that calculation the number of children who will die or suffer because of extremely poor conditions in infancy and childhood, prenatal and early postnatal.

Take, say, malnutrition. That decreases life span quite considerably. If you count that up in deaths, that outweighs anything you're talking about. I don't think many people in the public health field will question the conclusion that the major contribution to improving health, meaning reducing mortality figures and improving the quality of life, come from simple public health measures, like ensuring people adequate nutrition and safe and healthy conditions of life, water, sewage, and so on. You'd think in a rich country like this these wouldn't be big issues. But they are for a lot of the population.

Lancet, the British medical journal, the most prestigious medical journal in the world, recently pointed out that forty percent of children in New York City live below the poverty line, meaning suffering conditions of malnutrition and other poor conditions of life which mean very severe health problems all through their lives and very high mortality rates. One of the American medical journals pointed out a couple of years ago that black males in Harlem have about the same mortality rate as people in Bangladesh. That's essentially because of the extreme deterioration of the most elementary public health conditions. That includes social conditions, incidentally.

DB: The government is often fond of declaring war on drugs, war on crime, but there's been no attendant war on breast cancer, for example.

There is a war on cancer generally. A lot of the biological research is funded with curing cancer as its goal, although not specifically breast cancer.

DB: Some people have linked the increase in breast cancer and prostate cancer to environmental degradation and also to diet, the increase of additives and preservatives. What do you think about that?

It's presumably some kind of a factor. How big or serious a factor it is I'm not sure.

DB: Are you at all interested in the so-called natural or organic food movement?

Sure. I think there ought to be concerns about the quality of food. This I would say falls into the question of general public health. It's like having good water and good sewage and making sure that people have enough food and so on. All of these things are in roughly the same category, that is, they have to do not with, say, high-technology medical treatment but with essential conditions of life. These general public health issues, of which eating food without poisons is a part, naturally, are the overwhelming factors in quality of life and mortality, for that matter.

DB: I was at a conference a couple of weeks ago in Washington, D.C. A woman in the audience got up and in addition to attributing all sorts of power to the left, which is total fantasy, she also decried the fact that you are in favor of nuclear power. Does that accurately describe your views?

No. I don't think anybody's in favor of nuclear power, even business, because it's too expensive. But what I am in favor of is being rational on the topic. Rationality on the topic means recognizing that the question of nuclear power is not a moral one. It's a technical one. You have to ask what the consequences are of nuclear power versus alternatives. I don't think this is true, but imagine that the only alternatives were hydrocarbons and nuclear power. If you had to have one or the other, you have to ask yourself which is more dangerous to the environment, to human life, to human society? It's not an entirely simple question.

For example, suppose that fusion were a feasible alternative. It could turn out to be non-polluting, in which case it would have advantages. On the other hand, any form of nuclear power has disadvantages. There are problems of radioactive waste storage which are quite serious. Technical problems might be overcome. There are problems of the dangers of how this contributes to nuclear weapons proliferation. Those are negative factors.

On the other hand, there are also potentially positive factors, like lack of pollution. There are other negative factors, like the high degree of centralization of state power, centralized power that's associated with nuclear power. But on the other hand, that's also true of the hydrocarbon industry. The energy corporations are some of the biggest in the world. The Pentagon system is constructed to a significant degree to maintain their power. There is a range of other alternatives, including conservation, decentralized power, options such as solar and so on. They have advantages. But across the board these are problems that have to be thought through.

DB: Let's talk along these lines about the whole notion of economic growth and development. The U.S., with five percent of the world's population, consumes forty percent of the world's resources. You don't have to be a Nobel Prize winner or a genius to figure out what that's leading to.

For one thing, a lot of that consumption is artificially induced consumption. It's not consumption that has to do with people's real wants. A huge amount of business propaganda, meaning the output of the public relations industry, advertising and so on, is simply an effort to create wants. This has been well understood for a long time, in fact, it goes back to the early days of the Industrial Revolution. There's plenty of consumption, and much of that is artificially induced. People would be probably better off and happier if they didn't have it. Also, the consumption is naturally highly skewed.

Consumption tends to be more by those who have more money, for obvious reasons. So consumption is skewed towards luxury for the wealthy rather than necessities for the poor. That's true not just within the U.S. but on a global scale. That leads to the figures that you describe. The richer countries are the higher consumers by a large measure, but internally to the richer countries, the wealthy are higher consumers by a large measure. And much of that consumption is artificially induced. It has little to do with basic human interests and needs and concerns. It's also in the long term very dangerous. It's healthy for the economy if you measure economic health by profits. If you measure economic health by what it means to people it's very unhealthy, particularly in the long term.

DB: There have been some proposals put forth about something called "sustainable development." There's a social experiment in the Basque region of Spain, in Mondragon. Can you describe that? Have you been there?

I haven't been there, but I know what you mean. Mondragon is a basically worker-owned cooperative of a very substantial scale and economically quite successful with many different industries in it, including manufacturing industries of a fairly sophisticated nature. However, remember, it's inserted into a capitalist economy. So it's no more committed to sustainable growth than any other part of the capitalist economy is. Internally it's not worker-controlled. It's manager-controlled. So it has a kind of a mixture of what's sometimes called industrial democracy, that means ownership, at least in principle, by the work force, mixed together with elements of hierarchic domination and control, which means not worker-managed. So it's a mixture. I mentioned before that businesses, say, corporations, are about as close to totalitarian structures, to strict hierarchic structures, as any human institutions are. Something like Mondragon is considerably less so.

Incidentally, before we entirely leave the health-care issue, there's another point that ought to be mentioned. The usual concern is the one that we discussed, namely the fact that all the programs, whether it's from Clinton over to the right, essentially vest power in the hands of huge insurance companies, which means that they will try to micromanage health care to reduce it to the lowest possible level, because naturally they're profit-making. They will also tend away from things like prevention and public health measures, which are not their concern, towards the technical side. It also means that the public has to pay for the enormous inefficiencies involved, such as huge profit, big corporate salaries and other corporate amenities, to big bureaucracy to control in precise detail what doctors and nurses do and don't do. So there are a lot of inefficiencies and inequalities and in my view just immoral elements to it. But that's only one factor.

There's another factor that's rarely discussed. That is that the Clinton program and all others like them are radically regressive. Just ask who pays and how much they pay. In a Canadian-style system, a government insurance system, the costs are distributed as the tax costs are distributed. So to the extent that the tax system is progressive, meaning rich people pay more and in fact pay a higher percentage, which is assumed, correctly, to be the only ethical standard in all the industrial societies, the costs of health care are distributed with heavier costs to the more wealthy.

All the systems being proposed here are radically regressive. They essentially are flat, meaning that a janitor in the corporation and the CEO pay the same amount. That's as if they both paid the same taxes, which is unheard of in any civilized society. That's rarely discussed. If you look at it, it's even worse. It's going to turn out that the janitor will probably pay more. The reason is that the janitor will be living in a poor neighborhood somewhere and the executive will be living in a rich suburb or a downtown highrise, and they will belong to different health groupings. It will turn out that the one that the janitor belongs to includes many more poor and high-risk people. The insurance companies will demand higher rates from them than from the executive, who will be from lower-risk wealthier people. So it will turn out that the poor person will probably pay more in the long term. These are just incredible features of any form of social planning. And they're all built into all of these plans. It's very rarely discussed.

DB: Speaking of taxes, there's a new book out by a couple of Philadelphia Inquirer reporters called America: Who Pays the Taxes? Apparently they are producing evidence in that book which shows that the amount of taxes paid by corporations has dramatically declined in the U.S.

That's for sure. That's been very striking through the last fifteen years. Actually, the whole tax system is an extremely complex one. People have looked into it for years. Joseph Pechman was one of the leading specialists who pointed out that despite the progressivity that was built into some of the tax system, there are other regressive factors which enter in in all sorts of ways that end up making it very near a fixed percentage.

DB: Let's talk about Richard Nixon briefly. His death generated much fanfare. Henry Kissinger in his eulogy said: "The world is a better place, a safer place because of Richard Nixon." I'm sure he was thinking of Laos, Cambodia and Vietnam. Let's focus on one place that was not mentioned at all in the media hoopla, and that is Chile, and see how it is a "better and safer place." In early September 1970, Salvador Allende was elected President in a democratic election. What were Allende's politics?

Allende was basically a social democrat, very much of the European character. He would have fitted very well into the democratic socialist spectrum in Europe. Chile was a very inegalitarian society. He was calling for redistribution, for help to the poor. He was a doctor, and one of the things he did was to institute a free milk program for half-a-million very poor children to overcome these problems of child malnutrition and deficiency that are the major health issues, as we have been discussing. He called for nationalization of major industries, the major extractive industries, for social regulation, for a policy of international independence, meaning not simply subordination to the U.S., but more of an independent path, programs of that kind, which are not unfamiliar throughout the general social democracy.

DB: Was that a free and democratic election?

Not entirely, because there were major efforts to disrupt it, mainly by the U.S. That goes way back. For example, in the preceding election, in 1964, in the preparation for that election, which was under Kennedy, and the actual election, which happened to be under Johnson, the U.S. intervened massively to try to prevent Allende from winning. When the Church Committee investigated this years later, it discovered that the per capita expenses for the ultimately winning candidate, the one the U.S. supported, were higher than those of both U.S. candidates, Johnson and Goldwater, in the U.S. elections in the same year. That's a measure of the extent of the U.S. intervention to disrupt the election of 1964.

Similar measures were undertaken in 1970 to try to prevent a free and democratic election. They were very substantial. There were huge amounts of black propaganda about how if Allende won mothers would be sending their children off to Russia to become slaves, and so on. The U.S. threatened to destroy the economy, which it could and in fact did do. So the election was not free and democratic in that sense. There was extensive outside intervention to try to disrupt it.

DB: Nevertheless Allende did win. A few days after his electoral victory, Nixon called in CIA Director Richard Helms, Kissinger, and others for a meeting on Chile. Can you describe what happened?

That's the meeting of what was called the "40 Committee" that Kissinger chaired. As Helms reported it in his notes, there were two tracks, the soft track and the hard track. The soft track was to "make the economy scream." Those were Nixon's words. The hard line was just to aim for a military coup. These were called track one and track two. Much of this later came out, in part in the Church Committee.

Ambassador Edward Korry, who was a Kennedy-liberal type, was assigned the task of implementing track one, the soft line. Let me quote you his own words as to what track one was: The soft line was to "do all within our power to condemn Chile and the Chileans to utmost deprivation and poverty, a policy designed for a long time to come to accelerate the hard features of a Communist society in Chile." That's the soft line, namely to really make them suffer utmost deprivation and poverty so they'll know from now on they'd better vote the way we tell them. That's the soft Kennedy liberals. The hard line was just to have a military coup.

DB: There was a massive destabilization and disinformation campaign. The CIA planted stories in El Mercurio and fomented labor unrest and strikes.

They really pulled out the stops on this one. Later, when the military coup finally came and the government was overthrown, you had thousands of people being slaughtered, imprisoned, and tortured. Then the U.S. changed its position and gave massive support to the new Pinochet government as a reward for its achievements in reversing Chilean democracy and instituting a murderous terror state of the Brazilian style. So economic aid which had been cancelled immediately began to flow. The U.S. had blocked international aid. That came in. Huge credits were given for wheat. All possible help was given.

The question of torture was brought up to Kissinger by the American Ambassador. Kissinger gave him a sharp lecture, something like, Don't give me any of those political science lectures. We don't care about torture. We care about important things. He also explained what the important things were.

He was concerned, he said, that an Allende success, the success of social democracy in Chile, would be contagious. It would infect southern Europe, like Italy, and lead to the possible success of what was then called Eurocommunism there, meaning the Communist parties were moving in a social democratic direction and hooking up with social democratic parties. Actually, the Kremlin was just as much opposed to that as Kissinger was. So he was afraid that the contagious example of success in Chile under a democratic reformist system would infect places like Italy.

That really tells you what the domino theory is about, very clearly. Even Kissinger, mad as he is, didn't believe that Chilean armies were going to descend on Rome. It wasn't going to be that kind of an influence. The influence would be the demonstration effect of successful economic development, where here the economy doesn't just mean profits for private corporations, but the state of the general population. That's dangerous. If that gets started, it will have a contagious effect. So Kissinger's thinking was quite accurate. Also it's revealing. In those comments he revealed the basic story of U.S. foreign policy for decades.

DB: You see that pattern repeat itself in Nicaragua in the 1980s, the threat of a good example.

Everywhere. The same was true in Vietnam, in Cuba. It was true of Guatemala, of Greece. Always. That's the basic story: The threat that there will be a contagious effect of successful development.

DB: Kissinger also said, again speaking about Chile, that "I don't see why we should have to stand by and let a country go Communist due to the irresponsibility of its own people."

This is the Economist line, that we should make sure that policy is insulated from politics. If people are irresponsible, they should just be cut out of the system. Kissinger is just an extreme example of what Jefferson called an "aristocrat," with utter contempt for democracy and complete dedication to service to power.

DB: I'm also reminded of Seymour Hersh's description of Kissinger sitting in the Oval Office while Nixon was ranting and raving about Jews, making very anti-Semitic remarks, and he was just sitting there, saying nothing.

He was also sitting there while even worse things were being said about blacks, in fact, he was participating in them. The racism of the Nixon administration was appalling. When Nixon gave Kissinger instructions as to how to write his first State of the Union address, according to people there, he said, "Put something in it for the jigs." Kissinger apparently nodded approvingly or quietly. Jigs being blacks.

DB: What about the role of the CIA in a democratic society? Is that an oxymoron?

You could imagine that a democratic society would have an organization that carries out intelligence gathering functions. But that's a very minor part of what the CIA does. The CIA is mainly a branch of the executive to carry out secret and usually illegal activities that the executive branch wants. It wants them to be kept secret because it knows that the public won't accept them. So it's highly undemocratic even domestically. The activities that it carries out are quite commonly efforts to undermine democracy, as the Chilean case through the 1960s into the early 1970s demonstrates with great clarity. It's by far not the only one. Although we talk about Nixon and Kissinger, similar policies were being carried out by Kennedy and Johnson in the earlier Chilean election.

DB: Is the CIA an instrument of state policy or does it formulate policy?

You can't be certain. My own view is that the CIA is very much under the control of executive power. I've studied those records fairly extensively in many cases, and there are very rare examples when the CIA undertook initiatives on its own. It often looks as though it's undertaking initiatives on its own, but that's because the executive wants to preserve deniability. The executive branch, say, Kennedy, doesn't want to have documents lying around saying, I told you to murder Lumumba. That's Eisenhower in that case. Or, I told you to overthrow the government of Brazil. They don't want such documents around. Or I wanted you to assassinate Castro. Or whoever it may be. The executive would like to be protected from such exposure. As a result, they try to follow policies of plausible deniability, which means that messages are given to the CIA to do things but without a paper trail, without a record. When the story comes out later it looks as if the CIA is doing things on their own. But if you really trace it through, I think this almost never happens.

DB: Let's stay, in Henry Stimson's words, in "our little region over here which has never bothered anyone," Latin America and the Caribbean. Let's move from Chile in the 1960s and 1970s to Haiti in the 1990s. Jean-Bertrand Aristide is elected President in December 1990 in what has been widely described as a free and democratic election. I think he got 67% of the vote. Seven months after taking office he is overthrown in a coup d'état. Do you see any connections there in U.S. policy?

When Aristide won it was a big surprise. He was swept into power by a network of popular grass roots organizations, what was called Lavalas, the flood, which outside observers just weren't aware of. They don't pay attention to what happens among poor people. There had been very extensive and very successful organizing. Out of nowhere came this massive network of organized grass roots popular organizations and managed to sweep their candidate into power. The U.S. expected that its own candidate, a former World Bank official named Marc Bazin, would win the election. He had all the resources and support. It looked like a shoe-in. The U.S. was willing to support a democratic election, figuring that its candidate would easily win. He lost. He got fourteen percent of the vote, and Aristide got about 67%. The only question in anybody's mind at that time should have been, how is the U.S. going to get rid of him, for very much the reasons that Kissinger explained in the case of Chile. That is so uniform and invariant that the basic question was, What will be the method for getting rid of this disaster?

The disaster became even worse in the first months of Aristide's office. During those seven months there were amazing developments. Haiti, of course, is an extremely impoverished country, with awful conditions. Aristide was nevertheless beginning to get places. He was able to reduce corruption extensively, to trim a highly bloated state bureaucracy, winning a lot of international praise for this, even from the international lending institutions, the IMF and the World Bank, who were offering him loans and preferential terms because they liked what he was doing. He was getting independent support outside the U.S. Furthermore, he cut back on drug trafficking. The flow of refugees to the U.S. virtually stopped. Atrocities were reduced to way below what they had been or would become. They were very slight. There was a considerable degree of popular engagement in what was going on, although the contradictions were already beginning to show up. There were constraints on what he could do, external constraints.

All of this made the democratic election even more unfavorable and unacceptable from the point of view of U.S. policy, and indeed the U.S. moved at once to try to undermine it through what were naturally called "democracy-enhancing programs." The U.S., which had never cared at all about centralization of executive power when its own favored dictators were there, all of a sudden became involved in trying to set up alternative institutions that would undermine executive power in the interests of greater democracy. A number of those groups, which were alleged to be human rights and labor groups, survived the coup and became the governing authorities after the coup. This went on for a couple of months. On September 30, 1991 the coup came. The Organization of American States declared an embargo. The U.S. joined it but with obvious reluctance. The Bush administration was really dragging its feet. It was perfectly obvious. The government focused attention on alleged atrocities or undemocratic activities of Aristide, downplaying the major atrocities that were taking place right then, and the media went along.

While people were getting slaughtered in the streets of Port-au-Prince, the media were concentrating on alleged human rights abuses under the Aristide government, the usual pattern. We're familiar with it. Refugees started fleeing again because the situation was deteriorating so rapidly. The Bush administration blocked them, instituted in effect a blockade to send them back. Within a couple of months, in early February (the embargo was instituted in October), the Bush administration had already undermined the embargo by instituting an exception, namely, that U.S.-owned companies would be permitted to ignore the embargo. The New York Times called that "fine-tuning" the embargo to improve the restoration of democracy. The fine-tuning meant that U.S. companies could continue to proceed without any concern for the embargo.

Meanwhile, the U.S., which is known to be able to exert pressure when it feels like it, found no way to influence anyone else to observe the embargo, including the Dominican Republic next door. The whole thing was mostly a farce. Pretty soon Marc Bazin, the U.S. candidate, was in power as Prime Minister, with the ruling generals behind him. That year, 1992, U.S. trade with Haiti continued not very far below the norm despite the so-called embargo.

During the 1992 campaign Clinton bitterly attacked the Bush administration for its inhuman policy of returning refugees to this torture chamber, which is incidentally not only inhuman but also in flat violation of the Universal Declaration of Human Rights, which we claim to uphold. He announced that he was going to really change all this stuff. His first act as elected President, even before he took office, was to make the Bush blockade even harsher. He imposed even harsher measures to force fleeing refugees back into this hellhole. Ever since then it's simply been a matter of seeing what kind of finessing will be carried out to ensure that the popularly elected government doesn't come back into office. It only has another year and a half to run, so they've more or less won that game. Meanwhile the terror increases. The atrocities increase. The popular organizations are getting decimated. People are suffering.

U.S. trade meanwhile continues and in fact went up by about 50% under Clinton under the so-called embargo. In fact, Haiti, which is a starving island, is exporting food to the U.S., fruit and nuts, under the Clinton administration. This went up by a factor of about thirty-five under Clinton as compared with Bush. Baseballs are coming along nicely. This means women are working in U.S.-owned factories where, if they meet their quota, they get ten cents an hour. Since they don't usually meet their quota, their wages go down to something like five cents an hour. They don't last in it very long. Softballs in the U.S. are advertised as being unusually good because they're hand-dipped into whatever it is that makes them hang together properly. They're hand dipped by Haitian women into toxic substances with obvious effect. The work conditions are indescribable.

All of this continues, in fact has increased, under Clinton. Meanwhile, the conditions for forcibly returning refugees have gotten much harsher. The terror and the torture have increased. The U.S. tried for a long time to get Aristide to "broaden his government in the interests of democracy." Broaden the government is a phrase which means throw out the two-thirds of the population that voted for you. They're the wrong kind of people. And bring in what are called "moderate" elements of the business community, those who don't think you just ought to slaughter everybody and cut them to pieces and cut their faces off and leave them in ditches. Those are the extremists. The moderates think you ought to have them working in your assembly plants for fourteen cents an hour under conditions of the kind I described. Those are the moderates. So bring them in and give them power and then we'll have a real democracy. But unfortunately, Aristide, being kind of backward and disruptive and the whole series of bad words, has not been willing to go along with that. Therefore the U.S. has failed in its efforts to broaden the government and restore the democratic system.

This policy has gotten so cynical and outrageous that Clinton has lost almost all major domestic support on it. Even the mainstream press is denouncing him at this point. So there will have to be some cosmetic changes made. But unless there's an awful lot of popular pressure, these policies will continue in one way or another, and pretty soon we'll have the moderates in power. Then they'll even be able to run a democratic election, if people are sufficiently intimidated, popular organizations are sufficiently destroyed, and people get it beaten into their heads that either you accept the rule of those with the guns and the gold-plated Cadillacs or else you suffer in unrelieved misery. Once people understand that, you can have a democratic election and it will all come out the right way. Everybody will cheer.

DB: In this period of Aristide's exile, he has been asked to make concessions to the junta, to Cédras and François.

And the right-wing business community.

DB: This is kind of curious. For the victim, the aggrieved party, to make concessions to his victimizer.

It's perfectly understandable. The U.S. was strongly opposed to the Aristide government. It had entirely the wrong base of support and power. What he is supposed to do is to cede power to those who count. The U.S. has no particular interest in Cédras and François, but it does have a lot of interest in the sectors of the business world that are linked to American corporations. I mean the people who are the local owners or managers of those textile and baseball-producing plants. Those who are linked up with U.S. agribusiness. Those are the people who are supposed to be in power everywhere. When they're not in power it's not democratic and we therefore have to make concessions to bring them into power.

DB: Let's say Aristide is "restored." But given the destruction of popular organization and the devastation of civil society, what are his and the country's prospects?

Some of the closest observation of this has been done by Human Rights Watch, the Americas Watch branch of it. Back over a year ago they came out with a good report in which they described what was going on. They gave their own answer to that question, which I thought was plausible. They said that things are reaching the point (this is over a year ago) that even if Aristide were restored, the lively, vibrant civil society based on grass-roots organizations that had brought him to power would have been so decimated that it's unlikely that he would have the popular support to do anything anyway. I don't know if that's true or not. Nobody knows, any more than anyone knew how powerful those groups were in the first place. Human beings have reserves of courage that are often hard to imagine. But I think that's the plan. The idea is to try to decimate the organizations, to intimidate people sufficiently that it won't matter if you have democratic elections.

There was an interesting conference run by the Jesuits in El Salvador. Its final report came out in January of this year. They discussed questions of this kind. This is several months before the Salvadoran elections. They were talking about the buildup to the elections. They did discuss, as a lot of people did, the ongoing terror which was substantial and which was plainly designed to keep up front in people's minds that you better vote the right way or else. But they also pointed out something else which is much more important. That had to do with the long-term effects of terror. And they've had plenty of experience with this. The long-term effects of terror, they said, are simply to "domesticate people's aspirations" and to reduce their aspirations to those of the powerful and the privileged. Terror instills into people's minds the idea that there is no alternative. Drive out any hope. Domesticate aspirations. Subordinate yourself to the powerful. Once that achievement has been reached, perhaps by massive and horrifying terror, as in El Salvador, after that you can run democratic elections without too much fear.

DB: The U.S. refugee policy is in stark contrast. You mentioned it briefly. Cuban refugees are considered political and are accepted immediately into the U.S., while Haitian refugees are termed economic and are refused entry.

That's determined by ESP, since they never check with them. In fact, if you look at the records, people who are being refused asylum suffer enormous persecution. Just a couple of weeks ago there were two interesting leaks from the Immigration and Naturalization Service, INS. One is a Haitian desk officer who was discovered by Dennis Bernstein at KPFA, who interviewed him. He had been working in the Port-au-Prince embassy. He described how they were not even making the most perfunctory efforts to check the credentials of people who were applying for political asylum because they don't want them. At about the same time there was a leak of a document from Cuba, from the U.S. interests section in Havana, which checks asylum, complaining about the fact that they can't find genuine political asylum cases. The people who are claiming asylum can't really claim serious persecutions by international or even U.S. standards. At most they claim various kinds of harassment that wouldn't qualify them. They're worried about this. So here are the two cases, side by side. I should mention that the U.S. Justice Department has just made a slight change in U.S. law which makes the violation of international law and the Universal Declaration of Human Rights even more grotesque. It has just determined that Haitian refugees who reach U.S. territorial waters, by some miracle, can also be shipped back. That's never been allowed before. I doubt that any other industrial country allows that.

DB: Do you have a few more minutes?

I'm afraid I have another appointment. They are probably trying to get on the line right now.

DB: OK. Let's wind it up. Thanks a lot. Talk to you soon.