Profits over Care, Fear over Sense

At least ten years ago I watched a brief interview with Michael Moore (certainly on MS-NBC) highlighting the distributed medical system at use in Cuba at that time. Cuba was in dire economic straits, with the fall of the Soviet Union and a punitive American economic embargo. Yet all kinds of their public health measures were good by world standards: Infant mortality, death in childbirth, viral outbreaks, safe food, and the like. Sure, they had malnutrition and an inability to maintain highly dense cities, tied directly to American’s capitalists wanting to “prove” Cuba a “failure”, and willing to kill and starve to build their false case. And like we see today in Yemen, Iraq, Syria, Africa, and now Venezuela, willing to punish the most vulnerable to suffering and painful death. Actually, today with more frequency we see death and suffering in America as part of the Capitalist “victory lap”; the logical outcome of the profits gleaned from service denial and usury, over zero profit earned from “public health”.

Cuba had a system of “neighborhood nurses”, who literally walked about their village, or neighborhoods. They all were assigned a similar size of population, manned a neighborhood clinic part time, but also made “house calls”. They were given free housing (often above or behind the clinic), needed no transportation (could walk or bike). They worked with district level doctors and regional specialists and hospitals. The “neighborhood nurse” was Cuba’s first line of defense, like much of the world.

Argue onto Deaf Ears

I used to love advocating for this very successful system whenever rising US healthcare costs were discussed. This was back when “doubling and doubling again” was just a fearful prediction (that had not yet come true). Back then overpriced specialists had no time to see patients, whipped like animals by time study accountants from profit centric “health care” corporations, eyes first on the quarterly returns. These companies increase income by denying (not providing) service, and encouraged multiple small paid visits (many co-pays) rather than a single large visit, or the zero income of good health.

I would always discuss with libertarians and Corpro-Anarchists the hidden macro costs of lost time, lost productivity, sick children spreading illness, not to mention the ridiculous insurance payments (both from individuals and their employers) that then require that patients call and write and petition for denied but obviously needed services. There is no “profit” in “health care” in the “for-profit health care” model.

The Original Physician’s Assistant

In Cuba, your “neighborhood nurse” knew you; talked to you at the market, the post office, the coffee shop. They knew if you smoked, caroused, beat your wife, or neglected your children. They knew why some kids were always late or absent from school, were hungry, or why their laundry was dirty. Nobody saw a harried “case worker” at an overbooked “social services” organization. Your “neighborhood nurse” watched for problems with food, diseases, public safety, public health. They loved their neighbors as their own family, like America’s community doctor of old. They treated fevers and burns and rashes, all kinds of first level concerns. They did triage care to upgrade patients to Doctor’s care if required, or to be sent directly to the regional hospital for an emergency. And the district doctor might send a patient with a complex or difficult case up the chain as well. In for-profit America, we see huge duplication of profit generating complex technology, high overhead, sometimes across the street from each other.

I loved to hear RWNJ’s scream at me. “If you love Cuba, go live there, YOU COMMUNIST!” and, of course, “Why do you hate America?” Like any trained parrot, they would all immediately repeat the tired saw that people fly from Europe and Canada to the USA for “Expensive Treatment and Care” (often citing kings, billionaires, prime ministers). Yet, no discussion of across the board public health or community. Such absurd anecdotes were (and still are) paid for by for-profit health care companies, and support the billionaire agenda. I would just laugh, “are you a king?” But tribal belonging is a strong human trait, long manipulated in the lowest classes by the one-percent.

A Radio Ad

So just today, in 2019, I heard a radio ad for the “Society of Physicians Assistants”. I’ve been talking about America’s PA’s for eight years now, comparing them to the Cuban public health system. They are America’s half-solution, co-opted by for-profit insurance and care vulture corporations. They create the three-tier cost control and access (that’s good!), but neglect preemptive monitoring and distributed neighborhood relationships (no money in that!). People must still have expensive insurance (cha-ching), take time off work (cha-ching), and go to a for-profit clinics (cha-ching). Only now they see a lower paid PA while paying for a higher cost Doctor (Brilliant! Bait and Switch!).

Sure, the PA can take “more time” than a harried doctor.  But can they? PA’s are still being monitored by the same cost accountants (patients per day, week, month). Sure, costs dropped at the beginning, allowing the illusion of patient care and costs savings. But the annual doubling of patient cost & corporate profit has already recaptured that. Don’t believe me? Show me one insurance or care company going bankrupt, losing money, or simply not showing EMBARRASSINGLY high profits and executive bonuses in the year 2019. Show me EVEN ONE.

Who’s Your Daddy?

The PA society is running ads (maybe paid by big insurance and big healthcare?) to recommend that we enjoy and support their strategic mid-tier care. You don’t need to tell people in Cuba to enjoy their “neighborhood nurse”; medical professionals with the same skill set and purpose as a PA. These professionals are medical experts that can diagnose simple issues and recognize serious one, write low-level prescriptions and hand off serious ones. But in Cuba, they are people that live with you and see your lifestyle, and your family and neighborhood relationships. Like the pastor, the cop on the beat, the butcher and the baker, the school teacher; the “Neighborhood Nurse” is part of the backbone of a community once held dear in America.

In America, a PA is a corporate profit center, tucked away in centralized “medical clinic” with a big logo and billboards on the highway encouraging you to pony up your cash at their neighborhood for-profit ER. In America, a PA generates income for billionaires, while in Cuba a “Neighborhood Nurse” generates community, and maintains public health; which is a public asset that cannot be monetized into the pocket of billionaires and executives. Therefore, the billionaire class that owns America’s media (and those brainwashed by it) simply say that public health and well being “doesn’t exist”.

Supporting local distributed care and public health as a measurable outcome (instead of community profit & GDP) is the same to them as “hating America, hating our troops, and using the flag for toilet paper”. Sure, support your P/A, but really support your “neighborhood nurse”, once America figures out what is important.


American Assn of Physicans Assistants:

Your PA Can Handle It: 


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