Upon receipt of a B.S. degree in biology, an acquaintance of mine -- let's call her Linda -- decided to spend the summer in Asia working at a small medical clinic that had a staffing shortage. The clinic was near a major river, on whose banks were crowded thousands of families living in small densely packed hovels.
The shacks, tents, and slapdash dwellings did not have access to electricity, indoor plumbing, nor cooking facilities. Consequently, hoards of people spent countless hours every day trekking to locate semi-private spots to undertake their toileting and to find materials that could be burned for outdoor pit cooking. They, also, spent an inordinate amount of time trekking to and from the river to collect water for food preparation, cleaning and baths, as well as for any livestock and small gardens that a minority of the households maintained.
In addition, many people would become unwell from drinking the river water, particularly because lots of fecal waste, garbage, and trash inevitably wound up in its currents. Especially young children whose immune systems were not fully functional and elders became stricken with intestinal infections, and would,doubled over with cramps,drag themselves to the clinic, a claustrophobic closet-like facility, for any sort of cure.
However, there was such a shortage of medicine that nothing of real value could be offered and, certainly, no one could suggest that avoiding the river in order to make the illness, whichever type it was, go away. As such, mostly sympathy could be offered.
These included antiseptic ointment and gauze for wounds, splints made from slender tree branches for broken limbs, several other items, and suggestions for bed rest, the latter of which was often an impossibility since one needed to move about to get the river water, fuel (primarily animal dung and small scraps of brush) and food from hawkers that included river fish and eels for meal preparation. Many people's health further deteriorated to the point that they prematurely died, and then, another problem arose.
This additional difficulty concerned a way to dispose of the bodies since the majority of the deceased persons' kinfolk did not have sufficient funds to carry out burials or cremations. As such, the waterway served another function, which was as a corpse recipient. Linda noted that, nearly every day, bloated water-logged remains could be seen quietly gliding downstream.
A compassionate person, she found the sight disturbing and, while she enjoyed aiding individuals as best as she could at the treatment center, she felt largely helpless during her experience there. She came to realize that, while she was grateful for the small remedies that she could provide in some instances, she really could not change much in the quality of life for the often desperate mobs, who patiently sorted themselves out so as to line up every day in a continual stream seeking help that, more often than not, couldn't be rendered.
Meanwhile, her realization of her limits was simultaneously sad, humbling and vexing. After all, it is demoralizing to have great hopes to help the world improve and then learn that certain troubles are so great that one will always feel insufficient, unless she focuses on the few small successes that she does occasionally manage to pull off. With such a conflicted understanding, she was relieved to return to the USA after her summer job abroad was over.
At the same time, she felt grateful for the medical care, reasonable homes, clean water, indoor plumbing and food stores available in America. In a flash, she came to realize the reason that so many legal and illegal migrants want to come to first world nations, even if those countries have job shortages.
It's really quite simple in the end. The alternatives seem dreadful.
Especially, she surmised, when their rivers and other water sources dry up after the glaciers that feed them disappear on account of climate change. She wondered about what they would do then.
Considering that the 18,000-year-old Bolivian Chacaltaya glacier, on which 77 million people rely for water, recently disappeared shocked her. She didn't wish to imagine that the many people who she'd met in Asia would, eventually, face the same plight.
Where would they all move? How would they eek out a living? Who would feed them and provide a new source of water? Where would they find homes and a sufficient number of healthcare clinics? She couldn't imagine any realistic answers to her questions.
==
At the time that Linda was embarking for Asia, another woman, who we'll call Anne, had just received her undergraduate degree in philosophy from a different college than Linda's. She, too, entertained an idea to engage in social service volunteerism for the upcoming summer months. Yet instead of Asia, her plans inevitably took her to Africa, where it had been arranged that she would work with the one doctor available in a region that covered roughly a hundred square miles.
In the territory, various interconnected tribes lived in small communities. Therefore, the doctor's job was to make the rounds and visit one site after another each month, after which he would repeat his tour unless an emergency, like a major fire at one of the locations, were to immediately redirect him.
At the same time, each village had at least one paraprofessional health care worker, generally a woman, who delivered babies and provided a modicum of aid in the doctor's absence. So she would be the first person with whom he would consult upon arrival at each tribal compound, so as to get an overview about what he was to do next.
Meanwhile, the American lived with one of the health workers near the doctor's hut so that she could learn further about medical intervention from the assistant. As a result, she learned many details about therapeutic care.
Likewise, she learned about its limits. For example, there was in this region, as there was in the area that Linda visited, a dire shortage of medical supplies. Therefore, they had to be doled out very sparingly and only to the recipients who best qualified (i.e., the ones who had the best chances of showing improvement upon receipt of intervention).
This choice naturally precluded people who were either too sick to get well or who were otherwise rejected, as were very old and very injured people. Moreover, the villagers all had a policy that, if someone were somehow grossly defective, he would be left to his own devices and shunned, as there simply was not enough food and other supplies to give any to anyone who was severely impaired.
With such a custom in place, it was regretful that approximately a decade earlier a mother, who noted that her child had infrequent seizures, was forced to place him in the dump near to her settlement and he, despite being thought of as doomed to die, managed to stay alive by eating garbage, small grubs, worms, bugs and other discovered fare. So he somehow coped year after year in the trash, outgrew his early childhood convulsions and was, nonetheless, an outcast due to his prior history.
In addition, no one openly communicated with him except for Anne, during which time she discovered that he felt ill. As such, she pleaded with the doctor to briefly visit with the boy, who was now a young teen.
In response, the physician got very angry with her and told her that he could get in trouble with the clan's rulers if he did so. Yet, she persisted and, finally, he reluctantly went to the dump and lightly examined the lad, after which he gave him a few tablets and told him to take one a day.
After leaving the youth, he told Anne that she should never ask him to do such an act again and that he only gave the teen sugar pills. Why?
He explained that, aside from having to save the "real" medicine for the strongest members of his community, he realized, upon checking the boy, that he had less than two months to live from parasites that were currently in his intestines, but that were slated to move throughout his body. In short, he was bound to die in short order. Moreover, there simply were no pain drugs to spare to help him through that two month crisis period. No, there were none at all.
He further added, "I neither have the time, nor the supplies, to spend on a hopeless case like him. I need to use my energy and treatments for people who I CAN help."
"Unfortunately, your country and other wealthy ones have lured our doctors and nurses away with promises of high salaries. I am sorry that you have such a scarcity, too, but it makes my time all the more difficult as I have far too many people to tend and not enough money to pay for life-saving medication, equipment and stores of simple things like thermometers."
"So if you pray, then pray for that boy. It is all that we can offer him."
==
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 program, since the 1959 Cuban Revolution, of sending Cuban medical personnel overseas, particularly to Latin America, Africa and, more recently, Oceania[1], 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."[2] Cuba provides more medical personnel to the developing world than all the G8 countries combined,[2] 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,[28] specifically targeting Cuban medical personnel and encouraging them to defect when they are working in a country outside of Cuba.[5]Â 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.[29]Â 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. [30]" [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." - George Kennan, former Head of the US State Department Policy Planning Staff, in Document PPS23
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 off-shored 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 United Health 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 inother 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 corresponds 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..." [2]
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.
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