What’s
Wrong Today:

Like
many, the Wrongologist watched the SOTU last night. You can read the text of
Mr. Obama’s speech here.
There will be millions of words written today about the SOTU, so let’s focus a
bit on the GOP response and what it tells us about the loyal opposition. Cathy McMorris
Rogers (R-WA), gave the rebuttal. You can read the text of her speech here
and learn more about her votes in the House here.
She is now the 4th ranking person in the House Republican
leadership.

Let’s
unpack her talk:

“Republicans have plans, big
plans! But they are not gummint plans. Never any icky gummint plans.
They are Republican plans. Big Republican plans!

(Sadly she had no time to explain any detail of any Big Plans.)

She did have time to fill the air with adjectives about how you will feel, how warm and happy and yummy in your tummy you will feel.

About yourself, and about America.

And after the Republican’s Big Plans have succeeded in solving every
problem and wiping every tear from your eyes, there will be no more crying or
pain, when the old order has passed away.

Amen.”

OK,
that was snarky. Let’s look at a few actual quotes from her talk:

Republicans
want you to be empowered to make your own decisions. This is a Republican theme
that appears in every one of their proposed solutions to any problem, real or
perceived. It disregards the fact that
those below the poverty line, those who are long-term unemployed, the poor
elderly, and those with food insecurity or job insecurity HAVE FEW OR
NO OPTIONS.

Their
choice is between paying rent or buying medicine this month, between taking the
bus or walking to the store, between phone service and internet service.

Ms.
McMorris Rogers, like all Republicans, are in an idealized, out-of-touch place
where everyone is middle class, and that they have at least some savings that
gives them the choice between staying in the dead-end job they have, and going
to school to improve themselves.

Speaking
of choices, she continued:

Another
Republican idea that glosses over the real facts of health care. Before the ACA
most healthcare was tied to the employer’s group plan. So, if you lost your
job, you lost your healthcare, except for a small minority of insured’s who had
individual plans that were job-independent. So how much choice would Republicans
have offered to the unemployed or those who couldn’t afford health care, or
were denied insurance due to a pre-existing condition? She voted to end Medicare,
and supported and voted for the sequester, which slashed $86 million from
family planning and reproductive health care for poor women. 

Where
is your “choice” in that?  

It seems that
Republicans and Ms. McMorris Rogers in particular, are all about choice, except
for women’s issues. She is the mother of a special needs child who voted
against, and then voted to defund Obamacare 42 times. Apparently, she
believes Americans don’t deserve the coverage she has as a member of the US
House.

In
eight years, just one bill that she has authored has passed. And it was
the renaming of the airport control tower in Spokane, WA. 

That’s
her common sense record.

Fox News said Ms.
McMorris Rogers championed personal
responsibility in her response, another Republican meme that somehow
absolves them from helping the disadvantaged in America. More from the rebuttal:

Republicans
are not alone in using juxtaposition, laying out their good idea vs. the bad
idea of the opposition, but it is time
that Republicans gave us real plans that address the real problems of the
disadvantaged. We do not need more of the “then a miracle will happen”
posing by Republicans.

Their
strategy is to play to the fears of the average person in their home district, that
someone they see as undeserving could get something from the government, like health
care or food stamps or unemployment compensation. They play to the mindset of
these particular voters: That they prefer to be robbed by the rich, mocked by
their own candidates, and encouraged that their racism is secretly shared by
their leaders.

Showing
their own brand of personal responsibility, Republicans sat on their hands at
some interesting points of the SOTU speech. From Mr. Obama:

Democrats
cheered. Republicans sat in stony silence. House Speaker John Boehner grimaced
on the podium behind Mr. Obama. When the president spoke about voting rights:

No
Republican applause. What is it that Republicans don’t like? Voting, or citizenship?
Republicans rose from their seats to applaud preventing a terrorist attack on
the homeland; the military; and winning gold medals at the Olympics.

Now,
that’s backbone!

It
is a strange kamikaze mission they seem to be on, a party of discredited memes
that are unmoored from common sense, fairness, kindness and generosity.

They
came across exactly as they are.

In
the words of former Arizona Cardinals Coach Dennis Green’s rant: “They
are who we thought they were.”

 

What’s
Wrong Today:

On
Friday last week, the BBC broadcast a live TV debate about the US and
whether it has lost its way internationally. The debate was held in Davos,
Switzerland at the World Economic Forum, where hundreds of business and
political leaders spent the week discussing the world’s most pressing issues. And
networking.

The
BBC-organized debate asked the question: Has America lost touch with the world?

The
panelists included Sen. John McCain (R-AZ), Russian parliament member Alexey
Pushkov, Chairman of Russia’s State Duma Committee for International Affairs and
Saudi prince Turki Al-Faisal, former Ambassador to the US and former head of
Saudi Arabia’s Intelligence Agency, and former US Rep. Jane Harman (D-CA), who
is now President and CEO of the Woodrow Wilson
International Center for Scholars.

They
debated America’s role in the world in 2014 and whether the US is losing
credibility, influence and power on the international scene. The debate lasts 55 minutes. You can find it here.

Mr. McCain
says in a BBC
video clip (at 1:48): (emphasis by the Wrongologist)

“We”? It
was only “we” in McCain World.

McCain takes his CIA and Israeli Intelligence briefings
and believes all of it: Democracy loving young people were (are) being massacred
by the twisted dictator, and we were winning until the Hezbollah showed up!

Mr. McCain also took
Mr. Obama to task, for refusing to take stronger action against Mr. Assad for
using chemical weapons. His comments drew support from Prince Turki, who
has criticized the US for the same thing:

To Sen. McCain, the US’
main problem was that it is not active
enough on the world stage. He says that makes America’s allies feel
they can no longer depend on the US, and it leaves room for others to fill the
void. Fill the void?
Isn’t that what we tried to do in Iraq? How did that work out?

McCain droned on:

The use of
force by the US in the Middle East has not made anything better. It has created
more enemies for the US and has not led to any type of self determination.

McCain’s
BBC comments led Secretary of State John Kerry, also at Davos, to spend 37
minutes of his speaking time enumerating the many ways in which the US was
deeply engaged around the world, from trying to solve the crisis in Syria to
pushing for a settlement between Israelis and Palestinians, and negotiating
with Iran about its nuclear program.

So, we
have another in the long list of occasions where McCain undermines the efforts
of the US in its international negotiating position, this time in the Syrian
Peace negotiations. Back to the debate, Mr. McCain said his “friend” John
Kerry had a lot of work to do “as long as we have a president who does not
believe in American Exceptionalism”.

That comment brought
a retort from Mr. Pushkov, saying that the comment was “racist”. Even Ms. Harman
distanced herself from the concept of American Exceptionalism, saying that she
disagreed with Mr. McCain. Harman
said the US should be looked at differently in a post-Cold War world, as an
“indispensable partner” rather than the sole superpower.

But McCain also needs to
mend fences at home.

Arizona Republicans passed a resolution
to censure Mr. McCain for what they characterize as a liberal record that has
been “disastrous and harmful” to
the state and nation. Apparently, they are angry that McCain supports
immigration reform and failed to support the government shutdown. They fail to give
him a free pass just because he advocates
war in every
situation in most countries on
Earth.

It used to be that if
you believed in American Exceptionalism and thought that the use of America’s military
force was always a good thing, then Republicans would willingly stamp your
candidate dance card.

But now, you have to
bring much more (or less), in order to stay in the club. You have to be a
defender of the “Christian nation” philosophy. You have to believe
that women are inherently inferior and must be directed and controlled by the
hand of a man. You have to believe that dark skinned persons are a threat to
the nation’s health and security.
You have to believe
that anyone who does not succeed in life is a lazy moocher who wants everything
handed to them. You have to believe that the wealthy have attained their status
because they are better human beings. You have to believe that there is
absolutely no role for government beyond fighting wars and protecting the
elites. You have to believe that, above all else, an individual has the
pre-eminent right to own any firearm manufactured, and that they have the right to use their own personal discretion to
decide if an armed rebellion is necessary in the US.  

You see the pattern
here. The basic tenet of George Bush’s “you’re either with us or against
us” philosophy has morphed into a Frankenstein’s monster that is consuming
the GOP and our political debate.  

How ironic that this
is happening to Mr. McCain, who, as leader of the “undermine Obama’s international
position” team, along with his fellow-travelers
Lindsey Graham and Joe Lieberman get more mindshare and face time from the media than anyone
else.

That should be enough
for the Tea Party and the most conservative Republicans, but it is not.

John McCain is simply
the latest in their cross-hairs. In his case, it’s good to see it!

Its time he stood
down from politics.

The week
started with our return from Cuba. We learned a lot in a short 7 days. Read
those posts if you have time, starting
here.

Mr. Obama’s 5th State of the Union speech comes on
Tuesday. It will be accompanied by more Washington theater than usual with
three responses
by Republicans, Tea Partiers, and Rand Paul representing, well, Rand Paul.

Use this
quote by former Rep. Mo Udall (D-AZ), about the difference between the words “caucus”
and “cactus” to write your homily for this week:

Last
Monday, we celebrated the Martin Luther King, Jr. holiday. Here is what Clay
Bennett thinks about how we have managed the King legacy:

America’s voting
process is broken and neither party wants to address the true underlying issues.
A state desiring a picture ID must be willing to do whatever is necessary to
provide every voter with the required ID, including deploying mobile units to
provide them.

Reverend
King’s dream was equal opportunity. He never suggested redistribution from the
successful; he advocated for everyone to have the opportunity to be successful.
He encouraged people to prepare for and utilize opportunities.

Dr. King’s
dream was of an America providing a hand up and not a handout is far from a reality
and Congress is not helping. We still have fewer jobs today than we had at
the start of the Great Recession in 2008. Where have all the jobs gone?

Decide for
yourself whether any the following are part of the caucus coalition:

Governor
Christie lays low for now:

Mr. Obama reports that NSA is no different than Obamacare:

The Sochi Olympics are threaten by local terrorists:

Syrian negotiations won’t  produce peace:

What’s Wrong Today:

The Farm Bill expired on September 30, 2013. It happens to include the authorization for funding the Supplemental Nutrition Assistance Program (SNAP, or Food Stamps). Senate lawmakers are proposing a $4 billion cut over the course of 10 years, while the Republican-controlled House voted to slash $40 billion from the program last year. Most lawmakers think the Farm Bill will be voted on in the next few weeks.

Congress should consider the unintended consequences of cutting food stamps.

A new study from the University of California, San Francisco, (UCSF) published online in the journal Health Affairs indicates that poor people with diabetes are significantly more likely to go to the emergency room (ER) for dangerously low blood sugar at the end of the month when food budgets are tighter than they are at the beginning of the month.

The ER admissions occur because diabetics can suffer from low blood sugar (hypoglycemia), when they have not had enough to eat, but continue taking medications for the disease. The symptoms include dizziness, sweating or nausea. In rare cases, hypoglycemia can cause fainting, coma, or death.

In order to control diabetes, patients need to keep their blood sugar within a narrow band. Levels that are either too low or too high (known as hyperglycemia) can be dangerous to diabetics. About 25 million Americans, or 8% of the US population have diabetes, according to the Centers for Disease Control and Prevention. The US spends more than $100 billion a year treating people with the disease, the CDC estimates.

And the poor are disproportionately affected: In the study, UCSF researchers matched hospital discharge records from 2000 to 2008 covering more than two million people in California with the patients’ ZIP codes. People living in the poorest ZIP codes, where average annual household income was below $31,000, were counted as low income.

For each 100,000 admissions of poor people, about 270 of them were given a primary diagnosis of hypoglycemia, compared to only 200 per 100,000 among people of higher incomes. Dr. Hilary Seligman, assistant professor of medicine at UCSF, and the study’s lead author, said the difference was statistically significant.

The New York Times reported that Dr. Seligman said she and her colleagues were aware of the debate in Washington about food stamps, and sought to document whether running out of food stamps or money to buy food at the end of the month damaged people’s health. Previous research had already established that people often give a higher priority to paying monthly bills for rent or utilities, for example, than to buying food, which is managed from day to day. From Dr. Seligman:

Seligman and her coauthors posit a plausible story about the “pay cycle” that develops in households of low-income individuals. Toward the end of the month, a household’s resources—income, SNAP, Social Security, and/or other benefits—can become exhausted, ostensibly changing food consumption patterns.

From the Study’s Abstract:

The Incidental Economist blog posted this chart from the Seligman study:

The chart shows that low-income individuals are at higher risk of hypoglycemia—and the risk increases over the course of a month, consistent with a hypothesis about exhausted food budgets. Their high-income counterparts exhibit no significant trend. Appendicitis findings are offered as a comparison which shows no significant change in admissions over the course of a month.

According to the authors, “hypoglycemia is one of the most common adverse drug events leading to visits to the emergency department”, and it’s been estimated that episodes of care for hypoglycemia have an average cost of $1,186. 

For some perspective on food stamps, they are actually only about 2% of the overall federal budget. The program cost $78.4 billion in the 2012 fiscal year. The amount given to each household averages $272 per month. In the 2010 fiscal year, 40.3 million people were enrolled. Two years later, that number had jumped by 16% to nearly 47 million people. Just over 45% of those getting food stamps are children, according to the Agricultur
e Department.

In the Fox News version of America, food stamp spending is not higher than in the past because more people are poor and hungry. Rather, food stamp use is up because the Obama European Socialist Machine is deliberately trying to build a bigger, stronger, government-supporting coalition for future elections.

In reality, it’s a mirror of the social inequities that plague our nation and drive health disparities.

The poor are always first up for attacks by government. They do not make any campaign donations, and they don’t have lobbyists. Isn’t any Congressional agenda in the last 20 years simply a matter of following the money?

To Republicans, the poor are political poker chips. They are the poster children for an ever expanding government, as well as the preferred sacrifice when the time comes to “defend our principles”.

Anyone who suggests that we must care for the poor, is considered to have an ulterior motive. Give to defense contractors? That’s another story. You have to spend on defense, or the terrorists win.

(This
is the 2nd of 3 columns about the Wrongologist’s 7 day visit to
Cuba. The primary purpose of the trip was to learn about the Cuban health care
system.)

What happens when you
build a healthcare system on preventative medicine, family care, and free universal
access? This is what was established in Cuba after the 1959 revolution. 

We met with Dr. Rosa López Oceguera, a professor at the
University of Havana, who indicated that in 1959, Cuba had about 6000 doctors,
half of which fled the country during the revolution. There were only 16 Professors who remained at the University of
Havana’s Medical College. The exodus required Cuba to rebuild its health care
delivery and health education system from the ground up.

The result is that
over a 50 year period, Cuba has built a system where many health outcomes are
comparable to most industrialized nations. The system was built gradually,
starting with free vaccination services and a program to improve sanitation in
the 1960’s and community-based health services delivery in the 1970’s. In 1976, Cuba’s healthcare program
was enshrined in Article 50 of the Cuban
constitution that
states:

The Cuban
system is based on the concept that doctors must live in the neighborhoods they
serve.  A doctor-nurse team are part of the community and know their
patients well because they live at (or nearby) the consultorio (doctor’s office) where they work.  The
local consultorios are
backed up by policlínicos (polyclinics)
which bring together nursing, medical specialists and diagnostic and health
services. The polyclinics offer laboratory services, x-ray, and emergency care.
The polyclinic model exists in many
countries,
including Russia, Germany and France.

Some
national statistics on Cuba’s health care system:

• 1
  Nurse per 117 persons

• 1
  Doctor per 143 persons

• 1
  Dentist per 878 persons

• 36,478
  MD’s in primary care in Cuba

• 11,
  492 local doctor offices in Cuba, of which, 2,167 are located in Havana

• 452
  polyclinics in Cuba

• 152
  general hospitals

• 142
  maternity homes (for high-risk pregnancies)

• 126
  elder day care facilities

• 26
  blood banks

• 13
  medical research institutions

• 23
  medical schools

We visited
the Polyclinic of Revolution Square, a center-city polyclinic. Here is a photo
of some of the nurses who were working at this clinic on the day we visited:

The
Revolution Square polyclinic we visited had the following statistics:

• 173,000
  people are served by this polyclinic

• There
  are 6 pharmacies in the area

• There
  are 16 local doctor offices in the service area

• There
  are 235 staff in total assigned to the polyclinic, of which 86 are doctors and
  52 are nurses

• There
  are 58 medical technicians assigned to the clinic, along with 56 in general
  services and 41 other staff

We also
visited a local doctor’s office (consultorio) about a block from the polyclinic. It has two
permanent staff, a doctor and a nurse. We were told that the office serves 136 multigenerational
households and was open 8 hours/day, 6 days/week. They receive around
30 patient visits per day, or about 180/week. The doctor lives above the clinic
and is available off-hours to its families. The doctor said that she can make
appointments for specialists to visit her office to see patients as needed. Here is the
outside of the consultorio building:

These translate
into interesting numbers: If we assume a family has 6 individuals (possibly
low), the local office has a potential patient population of 816. We were told
that each patient sees the clinic staff 3.3 times per year, or 2,693
visits/year.

House
calls seem to be routine. Usually, the local office does not schedule
appointments in the afternoon, in part because it’s the responsibility of the
doctor and nurse team to understand the health issues in the neighborhood. By catching diseases and health hazards before they get
big, the Cuban medical system can spend a little on prevention rather than a
lot later on to cure diseases, stop outbreaks, or cope with long-term
disabilities.

One value
of the community-based model is that Cuba has standardized immunization
nationally. This has eliminated polio, diphtheria, tetanus, rubella, mumps,
syphilis, tuberculosis, rabies, Nile virus, and yellow fever. It has controlled
meningitis, pneumonia, Hepatitis B, and leptospirosis.

In
addition, most of Cuba’s health indicators are at or near those of the OECD
countries. The CIA Factbook indicates that:

• Cuba’s
  infant mortality (under 1 year) was 4.78/thousand in 2012 while the US was 5.90

• Life
  expectancy in Cuba was 78.05 years, while it was 78.6 years in the US

• Health
  care expense in Cuba was 10% of GDP, while it was 17.9% in the US

The major
cause of death in 2014 is expected to be cancer, possibly because about 50% of
the population smokes, which causes high incidence of lung, throat, and head
and neck cancers. Dr. Oceguera told us
that this is a change from 2012, when the #1 killer was heart disease followed
by cancers and cardiovascular disease.

On the other
hand, most technology was antiquated. We saw a suction apparatus that probably
was new in the 1950’s and an EKG monitor which would have been new in the
1970’s. Here is a photo taken inside the polyclinic:

The medical
records are simple and handwritten, similar to those we used in the US 20 years
ago.

When we
asked the nurses what resources they needed, they asked for syringes. It is hard to imagine what Type I Diabetics use if the polyclinic is short of syringes.

We visited a facility
for high-risk pregnancies. It had 50 beds for in-patient care, but most women
visit on an out-patient basis. The facility serves 5 municipalities in Old
Havana. The usual process is for women at high risk of losing their baby to be
referred to the Hogar Materno. High
risk is defined as pregnant women over 30 years old, or under age 16, or having
a history of low weight births. The day we visited, there were 49 inpatients. The
officials we spoke with attribute Cuba’s marked improvement in infant mortality
to the attention paid to high risk pregnancies. Here is the waiting room of the
Hogar Materno:

As is visible in the
photo above, many mothers are using the facility on an out-patient basis. Birth
control is encouraged, and is free. Abortions are permitted with the agreement
of the father and mother, but it is seen as a failure of pregnancy prevention. Adoption
is difficult, with the government very involved in the process.

We also visited an
elder care day care center in Old Havana. Retirement is at age 65 for men and
60 for women. This facility was most
similar to what we would see in the US:

This facility provided services for cultural/social
activities, PT and rehab from falls, and eye care. In addition, it cared for 88
patients in their homes. We saw a modern eye care and eye glass production lab
in the elder care home. They made progressive and bi-focal lenses in about an
hour.

Medical
services as an export commodity:

Cuba started in the
1960’s to build a health care education machine. This was developed primarily
because so many health care professionals left the country during the
Revolution and the domestic need was so great. Since then, it has graduated
nearly 78,000 doctors, of which roughly 38,000 work in Cuba, while the rest
work in foreign countries. In total, 135,000 Cuban health care professionals of
all types have worked in foreign locations.

The genesis of the
export of health care services was Cuba’s medical services provided for the Chilean
earthquake of 1960. Today, Cuba is providing health care services in 66
countries and it is the #1 hard
currency earner for Cuba, outstripping tourism and exports of nickel.
The most recent estimate of income derived from medical services is $9 Billion
per year, more than double the earnings from the successful tourist industry. Here
is a chart from the World
Affairs Journal
showing the growth in Cuba’s service exports, virtually all of which are health
care related:

According
to World Affairs Journal, the host
government provides each doctor in overseas service with housing and a monthly
stipend generally between $150 and $500 for food and personal expenses. Cuba pays
the family back home their regular peso salary (equivalent to $25 a month on
average for a doctor) and a hard-currency bonus of around $50 to $120 monthly.

We visited the
Escuela Latin America de Medicina, (ELAM). This is Cuba’s medical school for training foreign medical students.
ELAM was founded in 1978 and trains only in family medicine. Currently students
from 98 countries are represented, including about 90 Americans. Roughly 1400
students are currently enrolled. These students pay tuition and fees to attend,
and that is another source of foreign currency.

Conclusions:

No one
should romanticize Cuban health care. The system is not designed for consumer
choice or individual initiatives,
yet
the Cubans we met, from patients to health care providers, were very proud of
their health care system.
Although
Cuba has limited economic resources, its health care system has solved some
problems that ours has not yet managed to address completely.

The fundamental question for the Cuban
government is whether the health care system is sustainable as constructed. Salaries for
doctors are going to double at some point in the spring. Salaries of other
health care workers are likely to rise as well. Medical technologies and
pharmaceutical costs will continue to rise, and all health care services are
free.

Cuba has
developed its own pharmaceutical industry and not only manufactures most of the
medications in its basic pharmacopeia, but also fuels an export industry.
Resources have been invested in developing biotechnology expertise, including production
of a drug to treat diabetic foot ulcers called herberprot-b.

Cuba’s
health care system — with a physician for everyone, free health services
including surgeries, an early focus on prevention and patient education, and
clear attention to community health — may inform both rich and poorer countries
as well.

 

Tomorrow, we will conclude
this 3-part report with a look at Cuba’s future and how its relationship with
the US may play out.

 

This is
the first of three columns about the Wrongologist’s 7-day visit to Cuba. The
purpose of the trip was to look at Cuba’s health care system.

Today’s
postcard is an overview of the country, its people and daily life.

History and Demographics:

America’s view
of Cuba is based upon snapshots from history. Since the revolution in January
1959, and the subsequent embrace of the Soviet Union by Fidel Castro, the Cuban Missile
Crisis,
and the Elian Gonzalez
Affair
have dominated our thinking. Some of us vaguely remember Mafia-owned hotels in
Havana that America’s rich visited in the 1940’s, Cuban cigars and American
cars of the 1950’s, the cars kept in pristine original condition and still on the roads like the 1956 ford thunderbird.

Cuba today
has a population of 11.2 million, while Havana has 2.2 million inhabitants. About
18% of the population are 60 or older while
just 17.2% are 14 or younger, so its population is declining. 78.3% of
jobs are in the state sector.

Cuba’s
culture blends the Spanish culture, brought about by a 400+ year period of Spanish
colonial control, with African cultures that arrived with the more than 1
million slaves brought by the Spanish to work the sugar cane fields. Spanish Catholicism
melds with a variety of syncretic religions of African origin.

Christopher
Columbus landed
on Cuba’s northeastern coast on October 28, 1492 and claimed it for Spain. It
remained a Spanish colony, (except for an 11 month period when it was captured
by the British), until the Spanish-American
War
in 1898. It was then administered by the US until 1903.

How did
the US get Guantanamo? After America won the Spanish-American War, as part of
the establishment of a Cuban-managed Republic, the US insisted on including the
Platt Amendment, which dictated
the conditions for the withdrawal of US troops remaining in Cuba. After Theodore
Roosevelt withdrew US troops from the island in 1902, Cuba signed the Cuban-American
Treaty
(1903), which specified the terms of a lease of land to the United States for a
naval station at Guantanamo Bay. The Cuban government regards the US presence
in Guantanamo Bay as illegal and insists the Cuban-American Treaty was obtained
by threat of force in violation of international law.

Most of us
have heard of the Cuban Embargo. It is a
commercial, economic, and financial embargo originally imposed on Cuba in October,
1960. However, the US makes no effort to block Cuba’s trade with third
countries. The Cuban embargo has been the most enduring in modern history. In
February 1962, the night before John F. Kennedy extended the embargo to cover all Cuban imports, he sent his press
secretary Pierre Salinger to buy 1,200 of his favorite petit H. Upmann Cuban
cigars. Despite the embargo, the United States is the fifth largest exporter to
Cuba, mostly of food (6.6% of Cuba’s imports are from the US). However,
Cuba must pay cash for all US imports, as no credit is allowed.

The Obama
administration made some changes to the restrictions on US travel to Cuba,
easing the travel ban, by allowing Cuban-Americans to travel freely to Cuba. On
January 14, 2011 he further eased the ban, by allowing students and religious
missionaries to travel to Cuba if they meet certain requirements. This is the
kind of sanctioned trip taken by the Wrongologist.

The old cars:

This
Chevy was parked at the Jose Marti International Arrivals building when the
Wrongologist landed in Havana:

What is
not generally known is that these old cars are mostly privately owned and
operated taxis that ply routes from one side of Havana to the other. These are
highly prized cash businesses for those Cubans who can afford them. The cars
trade at the value of the license to operate them, rather than at the value of
an antique car. They earn the peso equivalent of $1 for a trip all the way
across town. Cubans have evolved a form of sign language that lets the taxi
driver know where the person on the side of the road is heading before the taxi
stops to pick them up. Today, the cost of the license to operate a taxi can be
paid off in about 2 years of driving in Havana. This is what most of the old
American cars operating as taxis in Havana look like:

Many cars
are kept on the road by using Russian parts. Many have been modified with different
tail lights so that it can take a careful look to determine the original car
model.  Very few of the old cars look as
nice as this one:

Cars this
nice make up less than 1% of the antique American cars seen in Havana. The
beautifully restored cars are used by Cuban entrepreneurs to drive sight-seeing
foreign tourists. And those trips cost way more than the equivalent of $1!

Daily
life:

The
average Cuban appears to be cash poor. Few people own cars. Fewer own motor
scooters, so most use some form of public transportation, including buses and
trains run by the government. So, rush hour does not create traffic jams. Transportation
to work and to stores takes a major portion of each Cuban’s day. The longest
lines seem to be for bus transportation, which costs around a peso. During rush
hour, buses often arrive at stops already packed:

While ATM’s exist, less than 20% of people have bank accounts. Yet, the government
pays workers by debit card. While the cards can be used at larger markets, most
people shop locally, so the cards are quickly exchanged for cash. People get
ration cards for a subsistence amount of rice, but it does not cover the needs
of most families. Most food shopping is done in open air food stalls:

Gasoline
is subsidized as well. Many people have mobile phones that require a pre-paid card,
so there are long lines at mobile phone stores as people wait to replenish
their phone cards.

Most
people live in an apartment or a detached house that has been passed down from
their parents. All children share equally in the inherited building, so homes
are sub-divided into private spaces by the next generation.

Most buildings in
Havana are made of concrete and their outer walls are deteriorating from the
salt air and much deferred maintenance. There does not seem to be a
well-established concept of “curb-appeal” for private homes:

Most homes have
reliable electricity, TVs and washing machines, while clothes are dried
outdoors on a line. Municipal water supply can be problematic, with most homes
also having pumps and cisterns.

Cubans
seem optimistic about their future. They see recent liberalizations that allow
the purchase and sale of homes to be a positive sign.

200
types of businesses have recently been opened to private ownership, and this
gives many the idea that they will be able to make more income by opening a
private business while keeping their government job. People expect that it will
be only a few years until the US and Cuba normalize trade relations, and they
expect to see a huge increase in American tourism as a result. The
privately-owned tour companies are now hiring additional guides in anticipation
of trade normalization.

Tomorrow,
a Postcard about Cuba’s health care system.

Today
as we remember Martin Luther King, let’s move beyond his “I have a dream”
speech and consider his stance on the other divisive issue of the day, the War
in Vietnam. Dr. King made two speeches in April, 1967 about the war in Vietnam.
For some context, we had 485,000 military in Vietnam in 1967, and 11,153 would
die in action in that year. Lester Maddox became Governor of Georgia, and the 1st
Super Bowl took place.

Here
are a few quotes from Martin Luther King, Jr. on the subject of the Vietnam War:

From Dr. King’s speech at Riverside
Church in New York City, April 4, 1967: (text and audio here).
(Emphasis by the Wrongologist)

“I am convinced that if we are to get on the right
side of the world revolution, we as a nation must undergo a radical revolution
of values. We must
rapidly begin the shift from a “thing-oriented” society to a
“person-oriented” society. When
machines and computers, profit motives and property rights are considered more
important than people, the giant triplets of racism, materialism, and
militarism are incapable of being conquered.”

“As I have
walked among the desperate, rejected and angry young men I have told them that
Molotov cocktails and rifles would not solve their problems… But they asked —
and rightly so — what about Vietnam?
They asked if our own nation wasn’t using massive doses of violence to solve
its problems, to bring about the changes it wanted. Their questions hit home,
and I knew that I could never again
raise my voice against the violence of the oppressed in the ghettos without
having first spoken clearly to the greatest purveyor of violence in the world
today — my own government.”

From
his April 30th speech
in Atlanta: (emphasis by the Wrongologist)

“There
is…a very obvious and almost facile connection between the war in Vietnam and
the struggle I and others have been waging in America. A few years ago there
was a shining moment in that struggle. It seemed that there was a real promise
of hope for the poor, both black and white, through the Poverty Program. There
were experiments, hopes, and new beginnings. Then came the build-up in Vietnam.
And I watched the program broken as if it was some idle political plaything of
a society gone mad on war. And I knew that America would never invest the
necessary funds or energies in rehabilitation of its poor so long as adventures
like Vietnam continued to draw men and skills and money, like some demonic,
destructive suction tube. And you may not know it, my friends, but it is
estimated that we spend $500,000 to kill each enemy soldier, while we spend
only $53 for each person classified as poor, and much of that $53 goes for
salaries to people that are not poor. So I was increasingly compelled to see
the war as an enemy of the poor, and attack it as such.”

“There
is something strangely inconsistent about a nation and a press that would
praise you when you say, ‘Be nonviolent toward Jim Clark, [sheriff of Dallas County, Alabama
who was one of the officials responsible for the violent arrests of civil
rights protestors during the Selma to Montgomery marches] but will curse and damn you
when you say: ‘Be nonviolent toward little brown Vietnamese children.’ There is
something wrong with that press.”

 “A true revolution of values will
soon look uneasily on the glaring contrast of poverty and wealth with righteous
indignation. It will look across the seas and see individual capitalists of the
West investing huge sums of money in Asia, Africa, and South America, only to
take the profits out with no concern for the social betterment of the
countries, and say, ‘This is not just’…This business of burning human beings
with napalm, of filling our nation’s homes with orphans and widows, of
injecting poisonous drugs of hate into the veins of peoples normally humane, of
sending men home from dark and bloody battlefields physically handicapped and
psychologically deranged, cannot be reconciled with wisdom, justice, and love. A
nation that continues year after year to spend more money on military defense
than on programs of social uplift is approaching spiritual death.”

Once again, our country needs another person with social
conscience to lead us away from what Dr. King suggests in our approaching spiritual
death.

So today, remember Dr. King not simply for his eloquence
on civil rights, but also for his social conscience.

 

There
will be limited or no blog posts in the coming week as the Wrongologist and Ms. Oh So
Right visit Cuba. This trip is part of a US Government-sanctioned visit. There
are way more Americans visiting Cuba than you might think. According to cubaabsolutely, some
500k Americans traveled to Cuba in 2011 on a sanctioned basis, and at least
another 100k visited without authorization, via a third country.

That’s
huge: 600k visitors who (let’s say) stay on average for 7 days. That’s 4.2
million US tourist days per year. Cuba limits tourist expenditures to
$179/person/day. If people spend their limit, that’s $752 million/year spent
by Americans in Cuba each year.

Not
chump change.

But alas,
Internet use is highly regulated. And based on our cold war status, US mobile phones
do not work there, the US dollar is not accepted and US credit cards cannot be
used. There are work-arounds for some of those issues, but no simple solution
works for the Internet, or for the lack of SMS-based communication, so limited
or no blog posts.

According
to The
Guardian, Cuban and US representatives
met today in Havana for a new round of restarted migration talks. From The
Guardian:

The most recent discussions in Havana occurred last September,
and focused on mail delivery. One issue that may come up this week is Cuba’s
recent banking woes at its diplomatic missions in Washington and at the UN.
M&T Bank, which had processed Cuba’s diplomatic banking in the US, moved to
sever the relationship in late 2013, prompting Havana to suspend nearly all
consular services in the country.

While in country, we will be meeting with staff from
the Ministry of Health, (MINSAP), visiting the Latin American School of Medicine (ELAM) and participating in discussions
to learn about the training and education of medical professionals in Cuba. We
are meeting with staff from the Cuban
Society of Nurses (SOCUENF). SOCUENF is a scientific society,
non-governmental organization under the National Council of Scientific
Societies of Public Health Ministry of Cuba, whose primary purpose is to raise
the scientific and technical level of its affiliates.

We are also meeting with the staff at Centro Nacional de Educación Sexual (CENESEX).
This is the National Center for Sexual Education and is best known for
advocating tolerance of lesbian, gay, bisexual and transgender issues on the
island.

We are also doing some
fun things, seeing a Cuban jazz show and meals at some of the private
restaurants in Havana.

Sadly, we will be unable to bring home a pristine ’56 Chevy
Bel-Air or any Cuban cigars.

Also, we will not be meeting with Raul or Fidel.

What’s
Wrong Today:

6 years
on, the budding economic recovery has not raised all boats. Back during the GW
Bush era and in Obama’s first campaign, we heard about the “New Economy” and the
promised new economy jobs. You haven’t seen many of them, but we know they are
here somewhere, because Apple, Google, Facebook say so.

Congress
must have seen those jobs heading our way before they went home for Christmas,
because they let extended unemployment benefits expire for 1.3 million
unemployed Americans, who have not yet met up with a new economy job, or even
with an old economy job. Here are 3 bad trends to consider:

I.  The
Long-Term Unemployed:

Since the
Department of Labor began keeping track in 1948, the US has rarely had more than two million workers go without a job for
more than six months. At the height of the Great Recession, nearly 7
million people who wanted jobs faced extended joblessness, and today that number
sits at a cool 4 million:

That’s
also historically large as a share of population or the workforce. Despite
many positive
signs in the economy, this is Congress’s and the White House’s largest
failure: The US just can’t put its people back to work.

As US
lawmakers return from their winter vacation, President Obama and the Democrats
want to reverse the expiration of unemployment insurance for some 2 million of
these people—1.3 million last week, and another 850,000 at the end of March.
Typically, unemployment insurance only lasts 26 weeks, but during recessions
the federal government offers extensions for as long as 99 weeks; the currently
expired extension was set at 73 weeks.

Republicans
favor the expiration, or want an equal reduction in spending elsewhere in the
government to extend benefits. With roughly three unemployed workers competing
for every job opening in the United States and the long-term unemployed among
the most-discriminated
against potential hires, it’s not clear that unemployment insurance is the
main obstacle to their hiring.

Still, Republicans
contend that ending payments to the long-term unemployed will force people back
to work at minimum wages. But we have an example that suggests that’s not
what’s going to happen: North Carolina cut its unemployment benefits
significantly last summer, and since then, there was no boom in employment.
Instead, more people have left
the workforce, putting stress on local charities and the local economy.

II.  Wage
erosion:

But
there’s another layer to this picture. According to the official wage
statistics for 2012, 40% of the US work force earned less than $20,000, 53%
earned less than $30,000, and 73% earned less than $50,000. The median wage or
salary was $27,519. These are current dollar amounts and they are the gross compensation
that is subject to state and federal income taxes and to Social Security and
Medicare payroll taxes.  

In other
words, take home pay is less. To
put these incomes into some perspective, the poverty threshold for a family of
four in 2013 was $23,550.

The only
incomes that have been growing in real terms are those at the top of the income
distribution. Everyone else has experienced a decline in real income and
wealth.

Slightly
more than one percent of Americans make more than $200,000 annually and less
than four-tenths of one percent make $1,000,000 or more annually. There are
simply not enough people with discretionary income to drive the economy with
consumer spending.

III.  Unequal
impact on the young:

We are
seeing catastrophically high unemployment levels among young people. As Wolf
Richter has written,
the civilian labor
force in the US represents the official number of people working or
looking for work. It’s what the official government unemployment rate
(U-3) is based on. If labor force participation drops – if for whatever reason,
millions of people are no longer counted as part of the labor force, as is the
case in the US – it’s a troublesome indicator for the economy and the real
employment picture. It makes our 7.3% unemployment rate look a lot less awful: if you’re not counted in the labor force,
and you don’t have a job, you’re not counted as unemployed.

There are
millions of people in that category. And their numbers are growing, not
diminishing. The irony of the U-3 unemployment statistic is the fact that while
unemployment has gone down 30% since its 2009 peak, we have the lowest labor force participation rate in over 3 decades.

Before the financial
crisis, the unemployment rate and the labor force participation rate weren’t
correlated. Unemployment could move up and down, based on the economy, but
labor force participation moved to its own drummer. From the BLS:

The chart (from Global Financial Data)
juxtaposes the unemployment rate and the labor force participation rate since
1980. After the financial crisis, suddenly,
for the first time in history, they both started moving in lockstep. Downward.
The unemployment is the red line and is tied to the left axis, while the
participation rate is the blue line and is tied to the right axis:

This chart shows the
true crisis of employment in this country. The diminishing labor force
participation rate − the officially available labor pool, has been driving down
the unemployment rate for the first time in history.

But beneath those
overall numbers, it’s even worse. This chart by the BLS
depicts labor force participation rates by age cohort in 1992, 2002, and 2012,
with an estimate for 2022:

The young are not making it into the
labor force.
The participation rate for those 16 to 19 has plunged from 51.3% in 1992 to
34.3% in 2012. OK, the BLS explains that there has been an increase in school
attendance, and that is a good thing. But the participation rates of 25 to 54 year olds also dropped from
83.3% in 2002 to 81.4% a decade later.

Among the 18 to 34
year old “Millennials,” those who are officially counted in the labor force,
unemployment has been a nightmare, with double digit unemployment rates, still,
nearly 6 years after the financial crisis, reports
the youth advocacy group, Young Invincibles, it’s even worse for the 16 to 24
year olds, whose official unemployment
rate is still 15%!

In prior downturns,
the employment rate for young adults nearly reached pre-recession levels within
5 years. Since the start of the Great Recession, young adult employment has not
even recovered halfway by the same point. In fact, a quarter of all job losses for young adults came after the Great
Recession was officially over. The lack of jobs had driven many
discouraged young people from the labor force altogether.

A recent report by
Opportunity Nation estimates that 5.8
million young adults are neither working nor in school.

The above chart shows
that the 30% improvement in the official unemployment rate came mostly from people
54 and younger being statistically purged from the labor force.   

At a time
when most unemployed Americans are running out of coping mechanisms, the US government
talks like our long economic nightmare is behind us. But many millions of us are
still being ground down because our economy cannot produce enough jobs.

It remains
to be seen if the chickens can be kept from coming home to roost for another year.

Sorry for the radio silence, but the Wrongologist’s hard drive has lost its mind. We are in the midst of a restore from the server, which looks like it will take the rest of today and this evening. Early signs are encouraging, but you never know in these matters.

In the meantime, here is a photo of wall art in Beirut taken on January 6, 2014 called “Evolution of a suicide bomber: