To make up for shortfalls such as this doctor described, the Cuban government, thankfully, sends medical goods and personnel out of the country every year. "Cuban medical internationalism is the Cuban programme, since the 1959 Cuban Revolution, of sending Cuban medical personnel overseas, particularly to Latin America, Africa and, more recently, Oceania, and of bringing medical students and patients to Cuba."
“In 2007, ‘Cuba has 42,000 workers in international collaborations in 103 different countries, of whom more than 30,000 are health personnel, including no fewer than 19,000 physicians.’ Cuba provides more medical personnel to the developing world than all the G8 countries combined, although this comparison does not take into account G8 development aid spent on developing world healthcare. The Cuban missions have had substantial positive local impact on the populations served..."
"In August 2006 the United States under George W. Bush created the Cuban Medical Professional Parole program, specifically targeting Cuban medical personnel and encouraging them to defect when they are working in a country outside of Cuba. Of an estimated 40,000 eligible medical personnel, over 1000 had entered the United States under the program by October 2007, according to the chief of staff for U.S. Rep. Lincoln Diaz-Balart. However the promised fast-track visa is not always forthcoming, and some applicants are trapped in limbo, unable to enter the US and unable to return to Cuba.”1
Meanwhile, the plot to entice Cuban medical staff to the USA fits well with the overall vision held by many American officials. As George Kennan, former Head of the US State Department Policy Planning Staff, makes clear: "We have about 60% of the world’s wealth but only 6.3% of its population. In this situation, we cannot fail to be the object of envy and resentment. Our real task in the coming period is to devise a pattern of relationships which will permit us to maintain this position of disparity. We need not deceive ourselves that we can afford today the luxury of altruism and world benefaction. We should cease to talk about such vague and unreal objectives as human rights, the raising of living standards and democratization. The day is not far off when we are going to have to deal in straight power concepts. The less we are then hampered by idealistic slogans, the better."2
However, George Kennan, when he wrote this commentary, did not realize that American would be involved in a quiet class warfare in which the country would be increasingly divided between the haves and have-not. In other words, the nation is increasingly losing its middle class.
Left in its place are very affluent individuals and a rising number of poverty stricken ones whose homes have been foreclosed, whose jobs have been offshored or simply eliminated and whose medical coverage is nonexistent. What's more is that the latter group have as little worth to most of the wealthy crowd as do the nearly destitute, sick foreigners from whom the Cuban medical workers were enticed.
Who cares, after all, whether the destitute masses get any healthcare delivery abroad or in the USA? Instead, all's quite well, according to some politicians, as long as America can stick it to Cuba and pick up some great human resources along the way!
In a similar vein, the American healthcare industry, itself, is doing quite fine despite the economic downturn and loss of some customers who could no longer afford high premiums. A typical example is provided by the UnitedHealth Group with sales of $75.4 billion and a profit margin of $4.7 billion. This largess is particularly lucrative for its CEO, Stephen Hemsley, who received $744,232,068 in unexercised stock options.
If he seems out of the ordinary in terms of personal gain, then consider that prior BCBSMA chairman and CEO William Van Faasen received over $16 million as part of his overall retirement benefits in 2006 while BCBSMA President and CEO Cleve Killingsworth obtained over $3.6 million in payment for 2007. Of course, there's always plenty to spare for them both as the company produced almost $209 million in net income in 2007.
Even so, greed, itself, often has no boundaries. So when the insurer's net income dipped 49% a year later, Cleve Killingsworth was expected to have garnered around $4.3 million during 2008 at the same time that board members gained a 33% income increase to $40,000 for being on a few committees and going to occasional meetings.
Further, many health care insurers routinely deny required benefits to their customers. Yet, they managed to come up with more than $1.4 million a day and $40 million to date to lobby on the Hill in addition to coughing up almost $170 million to federal lawmakers in 2007 and 2008.
Like CIGNA’s Edward Hanway, who vacations in a $13 million beach house on the New Jersey shore, they'll fight like demons to keep their cushy compensations unless absolutely forced to yield up a few grudging concessions. After all, that's the American way.
As in other similar corporatist plutocracies, you get ahead by taking all that you can get for yourself regardless of the consequences for anyone else. You peddle influence, talk about trickle down effect and patience to placate the opposition, and make out like a crook in the meanwhile.
Indeed, this view correspond well with the positions held by many legislators. Certainly, they, too, are combating medical reforms as they do not want to see their own gargantuan profits shrink.
As Lindsay Renick Mayer states in "Congressional Lawmakers Invest in Their (Financial) Health":
"In past years, congressional debates over health care may have been shaped, in some instances, by such personal investments, said Charles Silver, a professor of law at the University of Texas. Campaign contributions and the revolving door between the private and public sector also play a role, Silver said.
"'Obviously, there is a conflict, unless the investment is in a blind trust or similar vehicle so the officeholder is not aware of it,' Silver said. 'The conflict may be mild or severe, depending on many factors, such as the nature of the investment, whether the company is publicly traded and, therefore, held by mutual funds, pension funds, and other funds in which large numbers of Americans participate.'"
"After hearing from experts, we talked to some of the lawmakers on the five committees that have been primarily responsible for drafting comprehensive health-related proposals. In 2007, 54 current members of these committees had between $31 million and $57.9 million invested in health companies (including in health sector targeted mutual funds). Here's how a few of their finances looked in 2008 and 2007, and their thoughts on whether they see any conflict of interest in these investments..."3
All in all, then, the US is much like the described locations that the two American volunteers visited. We simply will continue to have a shortage in health-care provision just as much as these other places do in which some receive adequate care while others are completely cast aside as discarded members of society much in the way that the homeless Americans, the street people and the tent-city dwellers, are treated today.
Even as this is the case, the USA differs from those foreign counterparts because their deficit in medical provision derives from real critical shortages in funds, medical personnel and supplies. In contrast, the American lacks arise from avarice, self-interest and corrupt legislative policies aimed to maintain the status quo entirely at the expense of the American public.
In the end, the heath-care debate is not about care at all. Instead, it's about the amount of money that government, HMO and pharmaceutical leaders are personally willing to give up.
Accordingly, it's clear that many Congressional representatives have no interest in evaluating even a few of the successful models of universal coverage that numerous other countries can provide. Instead, they are, typically, in collusion with big business to stymie any meaningful reforms.
As Thomas Paine succinctly put it, "Beware the greedy hand of government, thrusting itself into every corner and crevice of industry." It's a far stretching hand with an iron grip that won't let go of its gains until forced to do so.
Notes:
1 From Wikipedia's article on Cuban medical internationalism
2 George Kennan, former Head of the US State Department Policy Planning Staff, in Document PPS23
3 Congressional Lawmakers Invest in Their (Financial) Health
Emily Spence is an author living in Massachusetts. She has spent many years involved in human rights, environmental and social services efforts.