¡Cuba Sí!

Below is an article about Cuba from the Washington Post (reprinted without any editing, although there are some facts and interpretations that I would argue are not accurate). What is important to note is that it describes a system for political and social change that has been a fundamental part of the genuine socialist democracy in Cuba since the triumph of the revolution in 1959. It’s called twice down, twice up.

Basically, it works like this. The national government makes a proposal for a new “law” and sends it to various social and political groups (labor unions, farmer’s co-ops, community associations, etc.) at the local level. These groups discuss the proposed legislation in open meetings and offer suggestions and critiques, which are communicated back to the national government, which uses them to amend the legislation. They then submit the amended legislation to be voted on by the entire adult population.

When I was in Cuba in 1972, I saw just such a process being enacted over what was termed the “loafer law”. The law would require that every adult Cuban, who was able to work, have a job that contributed to the society. It was a result of the fact that a relatively small number of Cubans, who had accumulated significant wealth before the revolution, were not employed and were living off that wealth. Hence the title. The process was in its second stage, having been sent down for debate, and there was lots of debate while I was there. Interestingly, the most vigorous debate was whether the law was strong enough; many Cubans want to seize the wealth that was allowing the “loafers” to live without working; others wanted the “loafers” to be sent to labor camps.

The fact that this process is still in operation tells us a lot about what truly democratic socialism is all about, particularly when we note the various crises that the Cuban Revolution has faced over the past 60+ years, almost all of which have been a product of the US embargo and sanctions. But perhaps the most telling part of the Post article is the final comment by a researcher from the US based Human Rights Watch, attacking the process because the Cuban government is “asking people what they think about the rights of a minority”. Much better in his eyes to pass legislation to “guarantee” rights of a minority (or not, depending on whether Joe Manchin or the Supreme Court will go along) and then allow opposition to those rights free reign to deny them. That's the definition of rights in a liberal democracy. Given the choice, I opt for the Cuban's definition of rights in a socialist democracy.

Cuba sent gay men to work camps. Now it’s voting on same-sex marriage. 

by Mary Beth Sheridan

After 79,000 neighborhood meetings, months of discussion and an outpouring of more than 300,000 suggestions from citizens, Cubans will vote in a referendum Sunday that could redefine family rights — including legalizing same-sex marriage.

The proposed new Family Code would be among the most progressive in Latin America, defying a long tradition of machismo in Cuba. In addition to approving same-sex marriage, it would allow gay couples to adopt, and increase the rights of women, the elderly, and children.

Supporters call it a sign of the progress on LGBTQ+ issues under Cuba’s Communist government, which was once so hostile to gay men that it sent them to forced labor camps for “reeducation.” Yet leaders of the influential Roman Catholic Church and the island’s growing evangelical movement have expressed unusually vocal dissent.

“It reminds me very much of the debate we had in Canada and the U.S. 10 or 20 years ago, about the role of the family, the role of gay rights,” said John Kirk, a Cuba scholar at Dalhousie University in Nova Scotia.

What makes Cuba different is the political context. Gay rights activism has been channeled largely through the single-party system, rather than independent civil-society groups, which are restricted. The government has promoted the new law on billboards, at rallies and in official media. President Miguel Díaz-Canel on Thursday urged Cubans in a televised address to vote for the code, tying the balloting to support for the political system.

“Voting ‘yes’ is saying yes to unity, to the Revolution, to socialism,” he said.

That rankled government critics, who noted that Cubans were rarely given the opportunity to vote freely on other matters — such as choosing their leaders.

The vote comes at a time of widespread anger over food and electricity shortages. The economy is still hobbled by the effects of the coronavirus pandemic and extra U.S. sanctions imposed by the Trump administration and partially maintained by the Biden administration. The dissatisfaction raises the possibility that some Cubans could cast a protest vote.

“I understand that the rejection of the dictatorship will prompt many people to want to vote no, reflexively, so that the regime suffers a symbolic defeat,” independent journalist Mario Luis Reyes told the news site 14ymedio, run by the Cuban dissident Yoani Sánchez. “But if the ‘no’ wins, those who will really be defeated are us.”

The 100-page proposal reflects a sea change in official attitudes toward gay rights in Cuba.

In the 1960s, after the triumph of Fidel Castro’s revolution, the Communist government exalted the “new socialist man” and repressed dissidents of all kinds. Gay citizens were fired from jobs and even sent to labor camps.

A leading figure in transforming such homophobic attitudes was sexologist Mariela Castro, the daughter of Fidel’s brother and fellow revolutionary, Raúl. She runs a government sex education institute and is a prominent advocate of gay rights.

Today, workplace discrimination based on sexual orientation is outlawed, and the public health system provides gender-reassignment surgery free of charge.

The new family law would expand not just gay rights but also protections for women, children and the elderly. It urges couples to share housework equally, condemns family violence and insists that kids have a voice in family decisions.

“So this goes against the traditional paterfamilias [model], with the Latin father being in charge,” Kirk said.

Cuba’s Catholic bishops and other Christian religious leaders have spoken out strongly against the proposal. It could also get a thumbs-down from other social conservatives.

“The proposal is permeated by what is known as ‘gender ideology,’ which, as often happens with ideologies, is a construction of ideas that people want to impose by force onto reality, and wind up distorting it,” the Cuban Conference of Catholic Bishops said in a statement.

The new measure, which would replace a 1975 family code, was discussed in more than 79,000 community meetings between February and April, and amended based on citizens’ suggestions. Cuba’s National Assembly passed it in July. It needs more than 50 percent of the votes cast in Sunday’s referendum to take effect. Typically, measures put to a referendum in Cuba receive overwhelming support, but the outcome this time is not as clear.

While the government has billed the referendum as an exercise in democracy, some critics say the rights of gay people shouldn’t be subject to a vote.

“The fact they are asking people what they think about the rights of a minority shows they don’t really understand how democracies work,” said Juan Pappier, senior Americas researcher for Human Rights Watch.

 

"They'd just as soon kill you as look at you.”

My previous post on August 28 was prescient. Less than 24 hours after I posted it, I was in the emergency room of the hospital described in the article I had written about. I saw for myself exactly what had happened to medical care as a result of the sale of what had been a very good community hospital. 

I was lucky because I went to an urgent care facility, where my condition was quickly diagnosed and was then sent to the hospital, bypassing the emergency room intake. I felt a bit guilty being rolled passed hallway after hallway of patients on gurneys waiting to be seen by someone from the understaffed ER, although I did end up in a tiny room, not much larger than a closet, in the ER for 2 days before being sent to surgery. Fortunately the staff, although overworked and sometimes lacking basic supplies, were wonderful. Most were young and had worked in the hospital less than 3 months. One has to wonder how long they are going to last, given the conditions they are working under.

I was also lucky when I came home. I didn't have to worry about a bill in the mail that would "break the bank". I have a "cadillac" health insurance plan, between Medicare and the secondary insurance from my former job as a teacher in Maryland. The latter is the result of a strong union, which negotiated both good wages and excellent benefits.

So, when I read the article from Absolute Zero: A Newsletter by Richard (RJ) Eskow that I have reproduced below, it struck me as a very cogent analysis which describes our medical system. It makes reference to a city, Baltimore, where I lived and worked for 12 years and which is undoubtedly a "poster child" for the extreme racial inequities of our society, but even I was shocked by the evidence of those inequities presented by the author.

It all begins with a graph.

Richard (RJ) Eskow

When I was growing up in the Rust Belt, there was a phrase people would use to describe an unusually vicious or cold-blooded kid in the neighborhood (and there were a few). “He’d just as soon kill you as look at you,” they would say.

I thought of that phrase when a graph went around recently on left-leaning social media comparing life expectancy and health care costs in the United States with those in other industrialized countries. It went viral, even though the information it contained has been widely discussed for years. That’s the power of a well-crafted image.

Why are our costs so much higher and our health care outcomes so much worse? There are a number of reasons, but the most important one is: our health financing system is sociopathic. That’s not hyperbole. Ours is a system that would, quite literally, “just as soon kill you as look at you.”

The graph can be seen above. Some things to note about it:

• It doesn’t include the disabilities, loss of productivity, economic stagnation, and poor quality of life created our inferior health system.

• It doesn’t break out the vast disparities in American healthcare outcomes by race or class.

• It ends in 2018, so it doesn’t include the more than one million people who have died so far from Covid-19 in this country, much less those who died elsewhere.

• Nor does it include the billions of dollars the government directed to private pharmaceutical companies and other vendors during the pandemic, only to have them overcharge us for the products they then developed at public expense.

And remember: when we talk about longevity, we’re not just talking about people losing the last few years of life,. That’s tragic enough. But infant and child mortality bring down the curve, too, as does premature death at all ages.

Racial Disparities

During the decades covered by this graph, Black infant mortality rates were 2.5 times that of Whites. Race is a longtime predictor of health outcomes.  These statistics, which I prepared for Bernie Sanders before a Baltimore speech in 2016, are all too representative of Black America’s experience:

• If you're born in Baltimore's poorest neighborhood, your life expectancy is almost 20 years shorter than if you're born in its richest neighborhood.

• 15 Baltimore neighborhoods have lower life expectancies than North Korea. Two of them have higher infant mortality than Palestine’s West Bank.

• Baltimore teenagers between the ages of 15 and 19 face poorer health conditions and a worse economic outlook than those in economically distressed cities in Nigeria, India, China, and South Africa, according to a 2015 report from the Johns Hopkins Bloomberg School of Public Health.

Here's another statistic: Black children are seven to ten times more likely to die of asthma than white children. That’s one I take personally, since I nearly died of asthma myself as a child (despite being white) and it’s a terrible way to go.

I could muster more facts and figures, but you get the idea. The racialized nature of the American healthcare system – which is instrumentalized through economic discrimination – both disables and kills. That’s why, since the arrival of Covid-19, age-adjusted statistics show that Black Americans have been especially hard hit, with death rates that are approximately 67% higher than those of Whites and approximately 2.2 times higher than those of the group with the lowest adjusted death rates (Asian Americans).

Class Kills

White America is catching up, at least its poorer neighborhoods.  “Deaths of despair” – suicide, opioid addiction, and alcoholism – were ravaging lower-income White American men even before the pandemic, contributing to the USA’s declining life expectancy (as seen in the graph above).

A paper in the Journal of the American Medical Association (JAMA) showed that living in an area with high economic inequality was, like race, a strong predictor of Covid deaths.  In 2020, nearly 46,000 people in the United States killed themselves. White men, who make up 30 percent of the population, committed 70 percent of the suicides.

Class is a killer.

Indifferent to Suffering

Our healthcare system is the most direct killer of all. It is designed to be indifferent to human suffering, to life and death. To this system, it doesn’t matter whether a person lives or dies as long as it gets paid. That’s why our healthcare costs are so high, even though our life expectancy is so low.

Medical providers and institutions get paid for the services they provide, whether you live or die. The more services they provide, the more money they make. Health insurers operate under an even more perverse set of incentives. Their rates are based on the overall volume of services expected, which they then mark up. Their business practices are designed to shift as much cost as possible to the patient, while at the same time restricting the patient’s freedom to choose. They drive patients to providers who accept the insurance company’s low rates and agree to its restrictive rules about medical care.

That system is designed to be expensive. Let’s say you’re paying for a plan with a $5,000 deductible. As Sarah Kliff and Josh Katz documented for the New York Times, a colonoscopy at the University of Mississippi Medical Center will cost you $1,463 with a Cigna plan and $2,144 with an Aetna plan. If, on the other hand, you have no insurance at all, that colonoscopy will cost you “only” $782.

Kliff also reported on the case of a couple whose baby died while in the hospital. Although they had insurance through Cigna, the couple subsequently received a bill for $257,000 in what was described as “a dispute between a large hospital and a large insurer, with the patient stuck in the middle.”  This system is indifferent to the trauma it inflicts on patients or their survivors.

It's About the Incentives

Outcomes are also a matter of indifference. People are billed, no matter what happens. One study found that the average cost of treating accidents in the United States with fatal outcomes is $6,880 if the patient dies in the emergency room and $41,570 if they die in the hospital.

Some historians claim that ancient court physicians in Asia were paid for every month their patients remained healthy. That may or may not be a myth. What is definitely not a myth is that, in many publicly-funded health systems worldwide, health professionals are paid by salary and not by volume, while hospitals are given a fixed (or “global”) budget to provide care. That creates less of an incentive for “churning” patients and more of an incentive to focus on patient care.

That’s the kind of system we should have. Instead, we have a system where they charge $2,144 for a colonoscopy and $41,570 for an unsuccessful treatment. That’s a system where they’d just as soon kill you as look at you. It doesn’t matter. They make money either way.