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Eight Reasons US Healthcare Costs 96% More Than Cuba's--With the Same Results

Why does Cuba's healthcare system do so much with so little money--while we do so little with so much? The author visits Cuba, and revisits US health costs, to find out.

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The $3 billion Human Genome Project would supposedly revolutionize the treatment of most human diseases. But Stephen Hall writes in Scientific American that it is failing to produce medical miracles, largely because of its emphasis on genetic rather than environmental causes of disease. Many more people would be benefited by research on how to get already-known treatments to those who are not currently receiving them.

8. Costs not counted

Scrutinizing dollar figures leaves out the unnecessary irritation, pain, suffering and death from profit-oriented health care. In 2008, reduced access to care resulting from lack of health insurance caused the death of 2200 veterans over the age of 65.

A review of pooled data from studies of 26,000 hospitals with 38,000,000 patients found that private for-profit ownership of hospitals is associated with a higher risk of death for patients. The authors noted that for-profit hospitals have extra costs which leads them to skimp on patient care, often by hiring fewer highly skilled personnel.

One study of health care plans concluded that “if all 23.7 million American women between ages 50 and 69 years were enrolled in investor-owned, rather than not-for-profit plans, an estimated 5925 additional breast cancer deaths would be expected.”

Another source of human suffering is prescription drug overdoses, which are now the second-leading cause of accidental deaths in the US. According to the CDC, they cause more overdose deaths than heroin and codeine combined.

As for-profit health care causes needless suffering, its cost feedback loops flow into each other, creating yet more illness and sending costs spiraling. The growth of the sickness industry reflects little growth in human well-being.

Revolutionary medicine in Cuba

The Cuban approach to health care is so different that it cannot be described using the concepts that are so problematic in the US. It goes beyond taking profit out of medicine. Cuba's system is not a perfect one (and indeed, the issues of government repression and poverty remain stark there) and yet it stands alone in constructing an advanced health care system with extremely limited resources.

What it has accomplished is remarkable. Life expectancy climbed from 58.8 years at the time of the 1959 revolution to 73.5 years by 1983 and 78 years currently. Cuba has eradicated polio, controlled malaria and dengue and decreased infant, child and maternal mortality to be roughly equal to rates in the US. Cuban medicine is widely recognized by international health groups such as UNICEF as surpassing that of developing countries and being comparable to developed ones.

The foundation for the transformation is a commitment to health care as a human right. There is a strong connection between poverty and sickness. Better care is understood as interwoven with improvements in housing, education and employment.

One of the most revolutionary developments in Cuban medicine was the “idea that physicians are responsible for all those people living in a geographical area rather than just a number of patients.” What is now known as the primary health care (PHC) model in Cuba is based on targeting at-risk groups, including pregnant women, children and the elderly.

The 1989 fall of the Soviet Union and disappearance of most of its oil and markets for Cuban products dealt the economy a crushing blow. By 1998–2000, 13% of Cubans were undernourished. Nevertheless, the new medical approach was so effective and had become so much a part of Cuban life that infant mortality continued to decline throughout the “special period” of exceptional hardship.

Health care in Cuba—Consultorios

During a May, 2010 visit to Cuba, I spoke with Ivan Angulo Torres, who was then finishing his final sixth year of medical school. Though the PHC model has gone through several modifications, he outlined the form as it is practiced in Cuba today.