In contrast to your remarks, in Cuba you can criticize the government which people do all the time and seems to be a national pastime. The internet, while still limited is free and uncensored. The noted dissident blogger Yoani Sánchez has traveled several times to the US and has received awards here. You most definitely can't organize against the government or form an independent political party. The death penalty has been indefinitely suspended and a national debate has opened on gay marriage.
Cuba has many problems, can feel stifling for its citizens and is far from perfect but is not the Heironymous Bosch painting of hell as it is often portrayed in the US. The sooner normal tourism from the US is re-established, the emerging middle class and independent business owners will profit and have their lives improved. We don't yet know what the effect of the new constitution will be, but hopefully further democratic change will come.
We are in no position to criticize its political situation when we are allied with the most repressive, violent regimes in the world such as Egypt and Saudi Arabia.
20
It is a true scandal that citizens of the United States, the richest country in world history, are forced to emigrate in order to be eligible for health care. I had to leave America 51 years ago because of a pre-existing condition that prevented me from having health insurance. I told myself that America was a very strange country because it had enough money to kill four million Vietnamese people but did not have enough money to give me health care. It has been getting stranger and stranger ever since.
31
California's legislature voted to have Medicare for All in the state. The legislature's accountants arrived at the cost.
The cost for Medicare for All residents, legal and illegal, of California was $400 billion dollars:
"A single-payer healthcare system in California — a galvanizing cause among the state's progressive flank — would cost $400 billion annually, according to a legislative analysis released on Monday.
"The analysis, released in advance of the proposal's hearing in a key fiscal committee, fills in what has so far been the biggest unanswered question concerning the plan to dramatically overhaul California's healthcare coverage.
"The analysis found that the proposal would require:
"A total cost of $400 billion per year to cover all healthcare and administrative costs.
"Of that, $200 billion of existing federal, state and local funds could be repurposed to go toward the single-payer system."
"The additional $200 billion would need to be raised from new taxes." https://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-first-fiscal-analysis-of-single-payer-1495475434-htmlstory.html
The planned Medicare for All cost was more than the state's annual budget. " On June 27, 2018, Governor Brown signed the 2018–19 Budget Act, which includes $201.4 billion in spending." https://www.ppic.org/publication/californias-state-budget/
Medicare for All but no money for schools, highways, salaries, pensions?
California dropped the plan.
3
Imagine a caravan of Americans heading north to Canada to escape the healthcare nightmare in the US and in search of a truly affordable medical care and a better life. Thousands and thousands of Americans!
9
The Cuban numbers may be correct or not, the American infant mortality rate is bad in any case; see: https://en.wikipedia.org/wiki/List_of_countries_by_infant_and_under-five_mortality_rates#Infant_mortality_from_the_CIA_World_Factbook
6
Many Latin American physicians are trained in Cuba. The Cuban medical education system is excellent and very affordable.
10
We would have plenty of money for every family in America to have their own doctor if we attacked the gross maldistribution fo wealth in America. Enact a truely progrssive income tax with no loopholes for the rich. Enact a progressive inheritance tax so the super rich could not create dynasties.
10
Another gullible progressive heard from. The statistics Kristof cites were discredited years ago. Cuba is a third-world socialist disaster, and to imply otherwise is absurd. Welcome to the dictatorship, where the health care is free, but you aren't.
9
“What happens if an ultrasound shows some fetal abnormalities?” I asked. “The mother would have an abortion,” the doctor replied casually. “Why?” I queried.
“Otherwise it might raise the infant mortality rate.”
-Katherine Hirschfeld, as quoted by Powerline's response to this piece today.
4
So Cuba, despite being a communist dictatorship with a perennially wrecked economy manages to achieve better healthcare outcomes than the US? Is there any more damning indictment of our profit driven healthcare insurance system? Today the Times carried an article highlighting how three big pharma companies and health insurers are conspiring to gouge diabetics on the price of insulin, a cheap-to-produce drug that's been around for decades. The drug companies tweak the formula for insulin a bit to preserve patent protections, but the tweaks are mainly cosmetic. Eventually the states or the federal government may act to reign in this latest example of extreme greed that effectively holds needed health care benefits to ransom based on pricing that bears no relation to development or delivery costs, but we need a better system. Eventually, after enough people get fed up with the shameless predatory behavior of the drug and insurance industries, Americans may finally shake off the brain washing and support a socialized system like Canada's.
6
Unless you possess dollars or Euros in Cuba, your health care is primitive or non-existent. If you have cancer, you die. if you have heart problems, you die. If you have kidney failure, you die, diabetes, you probably die because insulin is expensive and sometimes you cannot get it all. There are no MRI's in Cuba, two or three dialysis machines for the elites in Havana, no chemo therapy equipment or drugs. It's a primitive impoverished country with excellent propaganda, which is eaten up by certain very naive journalists.
7
While Medicare for All would be an improvement over our current situation, it is not free health care. People have had to sell their homes to pay the twenty percent Medicare copay for a spouse’s lengthy and expensive terminal illness.
2
Ugh.
As a US primary care physician who visited Cuba last year(albeit as a tourist), this article has so many inane comparisons and assertions I am sorry I wasted the time to read it (and by extension compounding that by sending these comments).
Cuba has a surfeit of physicians which it exports In servitude settings while holding the Physicians’s family member hostage in Cuba to help prevent defections.
While funds for medicine and basic health care infrastructure are sorely lacking, our guide in Havana said that the military museum was always well maintained and that the tank Castro commanded at the start of the revolution gets a new coat of paint almost monthly.
It’s nice the government of Cuba has its priorities in order.
11
When will Americans begin to realize that the main problem with the medical system in this country are the malign influences of capitalism? Simply put, less profit motive equals better health outcomes. A relationship that can be empirically observed studying health systems across the world.
7
This is universal health care, not “Medicare for all.” The former brings greater health equity to a society. The latter is an insufficient aspiration for Americans.
2
All Cubans have fair and more or less equal access to health care.
Modest though Cuba’s resources may be, they are mostly devoted to health care, education and other common goods — not to a bloated military industrial complex, ill fated military adventures around the globe, and economic subsidies that disproportionately benefit the wealthy.
It does not ‘deregulate’ banking, agriculture and other industries, and then bail out billionaire risk-takers when they fail catastrophically and bring the house down around their ears.
Cuba does not encourage the sort of toxic income and wealth inequality that has destroyed the social fabric of our country; and that leaves 99% of us living with the anxious realization that an illness, an accident or loss of a job might quickly leave us impoverished and even homeless.
Cuba does not have at least one privately owned gun for every man, woman, child and suckling baby in the country - and it does not have a powerful political contingent that refuses the most minimal regulation of ownership, use and type of high powered military weaponry that can be privately owned.
Just for starters.
12
In the end, we need to decide what kind of country we really want: one in which killing is a Constitution-guaranteed right, but staying healthy is a privilege (as we have now), or one in which everyone can get decent health care, and carrying a weapon is a privilege.
12
You do realize that any pregnancy that shows any high risk characteristics or any fetal abnormality is immediately aborted. Any pre term birth is recorded as a miscarriage and no interventions are made. Then of course, other than the Castro's close associates, the Cubans have no finances to destroy.
18
How disappointing that an article supposedly focused on the successes of the Cuban medical system couldn’t avoid numerous slights and insults about other aspects of Cuba and Cuban life. I don’t experience you doing that in other essays/opinion pieces. What is it so important To do so when writing about Cuba and its strengths?
4
A society with universal health care is one that clearly believes in and values making sure its women and children are safe and well, which in turn works to prevent so many of the ills that stem from the maligning and disregard and blaming of women and children. Sure America claims to value its women and children, as objects, as 2nd class citizens, as things to be controlled, but it does not care about them. Healthcare is just one example.
8
Perhaps we should examine the classist arrogance and selfishness of our medical doctors in the US. Clearly many of them believe that their acquisition of personal wealth is much more important than that pesky oath they took when given the privilege to do no harm and help others.
Humility is a virtue.
3
@Beanie
The oath doesn’t say doctors need to treat all that come to them for help.
Doctors have to agree to taking someone as a patient. Just as a patient can stop seeing a doctor, the doctor can refuse to see a patient. Being a doctor is a job.
5
@Driven
Yes, and as a job it is no more important that the job of teaching or other service professions. Why should doctors live in wealth and comfort while teachers and other servants of the society live in near-poverty?
Ah, the answer is in the identified self-importance of the medical industry and the resulting greed of many practitioners.
Medical schools should evaluate likely applicants for their measure of service to self versus service to others. As I said earlier, humility is a virtue.
11
@Beanie
Public servants are far from poverty—pensions and healthcare for life. Pensions far greater than the maximum SS payout. Why don’t you become a doctor and show us how it is done. Take out the loans, spend 7-10 years after college studying, buy your malpractice, etc.
4
There is also a philosophical trade off between treatment and cure. The former is more lucrative but the latter might be more cost effective in the longer run for society. Obamacare seemed to have given this some thought.
3
Cuba has a planned health care system accessible to all and designed to meet the needs of patients!
This is not the same thing as Medicare for all. American Medicare members pay deductibles and co-pays and many doctors do not accept Medicare and Medicare does not cover all conditions. In particular, Medicare does not cover maternity care.
Nevertheless, great article that everyone should read.
5
Mr. Kristof omits the primary reasons why so many Cubans are healthier than so many Americans.
Reason 1: Cuba is a very poor country. Their diet is vegetables, fruits, chicken and fish. There are no fast food stores and few restaurants. Cubans cook and eat healthful foods at home.
Reason 2: Cuba is a very poor country. Few Cubans own automobiles. They walk or ride bicycles. Thus Cubans get daily exercise.
Reason 3: Cubans don't consume legal or illegal drugs at anywhere near the high rates of Americans. "Despite its location between the largest exporters of illegal drugs in the hemisphere and the U.S. market, Cuba is not a major consumer, producer, or transit point of illicit narcotics. " U. S. State Department, 2015-2016 reports.
Many of the diseases of Americans are lifestyle diseases, diseases of prosperity. Hypertension, diabetes, and obesity cause heart and vascular diseases, many cancers, and the need for joint replacements. A diet high in fiber such as Cubans eat daily helps to prevent many diseases.
In the USA where many narcotic addicts give birth to addicted babies, it's expected that more infants would die. That's a sad fact.
Cuba's health care system would work in the USA:
- If all Americans cooked and ate the same foods as Cubans;
- If all Americans walked and/or rode bikes as much as Cubans;
-If all Americans took only those medications that were absolutely necessary - and only meds necessary for life for pregnant women.
15
@Azalea Lover
While the factors you cite perhaps explain some of the gap, you underestimate the power of the open and preventive approach utilized by the Cubans. I believe Cuba out performs similarly situated nations and the U.S. underperforms its first world cohorts.
That the richest and most powerful country in the world would have to be compared to such a small and poor nation is embarrassment enough and reason to re-evaluate the assumptions underlying former's delivery and access of health care to all its citizens.
8
I fear this will only feed into the negative stereotypes you seem to possess re: most doctors you see. But I must say it does sound as if you may be somewhat depressed which is understandable given your chronic illness, pain & poor experience of the medical system.
While it’s true that some doctors have poor communication skills, are less empathetic, personable, l burned out, rushed, etc. I suspect that you’re misreading at least some of the interactions.
Though you’re right, most aren’t likely to give you opioids for your pain in this era. As for “Your symptoms are vague, diffuse & poorly described,” that sounds like a textbook, robot or something you read from doctor’s notes in a copy of your medical record. If someone has actually spoken to you like that, I’d find someone else.
While sometimes patients are spot on , it’s common for individualswith depression, etc. to mistakenly attribute or exaggerate negativity to other’s responses.
Many Doctors are trained to ask “how can I help you today?” no matter what. The 1000 questions (? exaggeration) are often not too helpful for many problems. It’s common for doctors to have NO part in deciding what questions, if any, are asked in advance,
To possibly help, I need & want to HEAR & SEE you describe what’s going on. Records don’t provide as full a view of YOU & what you’re (potentially) experiencing, thinking, feeling as when we talk it over together. I can then hopefully “see” more deeply & maybe help,
I have relatives in Cuba and I can unequivocally assure you that Mr. Kristof's article is propaganda. Despite our medical shortcomings in the US, we have nothing to want from Cuba's failed medical system. I have an elderly aunt who recently died from lack of medical attention in Cuba. She had a series of strokes, started developing progressive dementia, then over a period of time slowly stopped talking, walking, eating and eventually died. The Cuban government provided no physical or speech therapy of any kind, despite the fact that she needed round-the-clock assistance, there were absolutely no homecare aids [unlike in the US were such aids are available via medicaid], we, her relatives in the US had to send money over to pay a regular neighbor $30.00 a month to clean her house, bathe her and cook for her. Visiting nurses? Hardly! Intravenous feeding, NO WAY! The doctors callously told my uncle who was caring for her, she's old, there's nothing we can do for her. She's going to die. Just let her die at home. Cuba's vaunted medical system basically killed her through neglect. By contrast, my mother [her sister] who lives in the US is elderly and has Parkinson's has access to physical and speech therapists, visiting nurses and specialists. I just took her to a gastroenterologist and neurologist. Despite her illness and age, she is relatively well and I know that if she has a crisis, they will not turn her away at the hospital and tell me to just let her die at home.
18
It's not really desirable for doctors to be paid like taxi drivers. Wont there be a shortage of doctors? Doctors have a heavy responsibility of saving lives. It would be hard to attract the best and the brightest to join the healthcare sector with such a low pay.
5
@Jane "Wont there be a shortage of doctors?"
The usual for-profit self-interest of US healthcare (in this case via restraints imposed by the AMA) means that the country already has fewer doctors per capita than the OECD average. It also has fewer doctors' appointments and fewer acute beds.
http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
5
@Jane
You are correct. The would be a massive doctor shortage as well as nurses, techs, hospitals, etc.
2
With family in Cuba (one of whom is a doctor) I can assure you that taxi drivers make way more money than doctors. He makes about $23/month and has to play guitar after 12-hour days to make ends meet.
9
I think this article downplays the U.S. embargo. Which has had a very big negative effect over the span of 70 years. Cuba used to get some help from Russia, but hardly any nowadays.
7
A bit of my bio may help to understand myvies. As Cuban veterinary pathologist since 1970 with a two year training in East Germany in catastrophic animal diseases, frequently used as bio-terrorism against Cuba, I wish to thank Mr. Kristof for his balanced and honest views.
As expected, critics of all colors and interest came out of the woodworks, mostly for opposing political interest and for their dishonesty. Notwithstanding the brutal financial crisis affecting the country, all healthcare facilities are open, even when medicines and equipment limited mostly by the embargo.
Cuba have trained tens of thousands of its students and thousands for over 30 countries free of charge and demanding nothing in exchange.
I live in the US since 1980, and the Cuban Medical System then that no one mentioned was a model for the world. Any patience without a diagnosis was sent with his approval with a relative to provincial healthcare and if there no answer they would be forwarded to Havana with all expenses covered. Many exceptional cases were sent to the Soviet Union, Checoeslovaquia, Germany and England absolutely free.
I hope Cuba can once afford to do the same for its patience.
Likewise, with millions of people in the US without Healthcare Insurance, PTSD, Addictions, Limited Reproductive Rights, Massive Suicides, why not develop a mutually beneficial agreement with Cuba just miles away and save tens of thousands of lives even if it may not be Politically Correct!!
8
As is often the case, context is important. Here, the author is either willfully misleading his readers, or is seriously misinformed about Infant mortality rates. Studies have consistently found that differences in reporting methods and terminology between the US and other countries accounts for the majority of the discrepancy in infant mortality rates. Importantly, “low birth weight infants” are not counted in the live birth statistics in most of the countries reporting lower Infant mortality rates. For example, Canada, Russia, and Austria do not count any child weighing under 500 grams at birth as a living child, whereas the US does. That is an important point when considering that mortality rates for these infants are substantially higher than normal weight infants. So, no, American infants are not 50% more likely to die than their Cuban counterparts, and this misleading statistic certainly cannot be used as the basis to compare the US and Cuban healthcare systems.
10
@WR As I pointed out below, the US government itself says there is no difference in reporting criteria between the US and most developed countries, either in gestational age or (contrary to your claim) in birthweight:
“In the United States and in 14 of 19 European countries [Austria, Denmark, England and Wales, Finland, Germany, Hungary, Italy, Northern Ireland, Portugal, Scotland, Slovak Republic, Spain, Sweden], all live births at any birthweight or gestational age are required to be reported. Also, since no live births occur before 12 weeks of gestation, the requirement for Norway that all live births at 12 weeks of gestation or more be reported is substantially the same as for countries where all live births are required to be reported.”
https://www.cdc.gov/nchs/products/databriefs/db23.htm
All those 15 nations with the same reporting criteria have better infant mortality numbers than the US, and there is no reasonable doubt that developed countries with different criteria (which include superb systems such as that of France) also do far better than the US.
And I'll repeat that the US also has the worst numbers in the developed world for maternal mortality, and is the only developed country to be getting worse: women in America are now twice as likely to die from childbirth as they were 25 years ago.
http://www.reuters.com/article/2015/11/12/us-health-pregnancy-idUSKCN0T10LO20151112#fE4cLCCbtrgVEwhu.97
6
You’re talking DEVELOPED COUNTRIES & your list specifically references European Nations & the US.
Cuba isn’t included there. Are you sure it’s considered a DEVELOPED COUNTRY with identical reporting criteria as those you seem to be discussing.
You seem to be making an argument about elevated newborn/infant morality rates in the USA compared to other DEVELOPED nations.
That is laudable. Unfortunately, from the data you provide, I’m not sure that we can make any comparisons between newborn mortality rates between the USA, these developed European nations & Cuba.
2
@Jethro
The article presents 5.9 as the US IMR. This number is a skewed for the reasons stated earlier and confirmed in the cdc article that you cite. Thus, this distorts the overall US ranking that the author presents.
The author claims that IMR is better in Cuba than in the US, when in fact he does not present any reliable evidence that reporting in the two countries are similar enough to allow for a comparison.
Furthermore, my broader assertion about IMR remains accurate, much of the discrepancy is due to data collection methods. To present international data and their US’s ranking therein without this context is misleading. While European countries may have lower IMR on average, the gap is not nearly as severe as you may suggest. The cdc states that the discrepancy amongst developed nations is primarily driven by a greater number of preterm births in the US. Preterm birth risk is primarily driven by maternal factors (smoking, obesity, hypertension, stress, drug use, etc.) rather than those caused by the shortcomings of the US healthcare system. Regardless, I did not claim that the US had a lower IMR than European countries, just as I did not discuss maternal mortality.
Context is important, and the author’s lack of it not only leads him to compare apples and oranges, but also to draw sensational conclusions.
4
Yes, universal healthcare would be very beneficial but it's not that simple. Major changes would need to be made in the US. How many doctors in the US want to work for $45 a month? They will not even work for $45 a day, not with $300,00 or so in school loans to pay off.
3
I have visited Cuba several times, including an "off the record" trip many years ago during a time when I was living in Guatemala and traveled to and from there. I speak Spanish my companions and I have been approached on the street by friendly Cubans just wishing to invite us to their homes for conversation. Except for one angry young man, all the rest of them simply wanted to welcome us to their country and/or invite us into their homes for a visit. Some expressed a wish for a "higher level" of health care, but almost all of them brought up the subject by saying that they were grateful for having access to all the health care they might need. They all had heard of people in the U.S. who could not get the care they needed, and they expressed concern for our people. I know this is not a scientific survey, but it was certainly fairly random and I felt the statements and opinions we heard were from the true hearts and minds of the speakers.
8
Good for Cuba, Kristof. But what poor judgment--- using it as any example will get strong pushback from many Americans to anything a Communist nation does.
Our media ignore the dozens of other countries for positive examples on h/c financing---capitalist democracie or social democracies with parties responsive to citizens basic needs more than the US.
Kristof as an international reporter could use these countries, with stories of real people, the counterparts of Americans in income. In other democracies, citizens' taxes aren't forced to subsidize insurance profits, as ours are. ACA is a big improvement but is set up as the world's most expensive and profitable h/c
Rewrite, Kristof. Give us some positive role models to use. The US voter is constantly propagandized by the GOP against h/c for all, that has been achieve abroad for generations in dozens of free countries. You're feeding them amunition to use.
Are you trying to strengthen support for universal health care or weaken it? Or what?
1
As it is, we’re so often afflicted by the “Tragedy of the Commons,” especially with respect to health care in the USA.
It’s so bad that even conservative male Congressmen that are part of the “family values,” anti-feminist, “pro-life,” generally “anti-contraceptive” crowd don’t even want to bother to help pay for healthy newborns, let alone entertain the possibility of universal health care!
They whine “I can’t get pregnant, so why should I have to pay more?” They think that women should exclusively shoulder higher insurance premiums to cover pre/peri/post natal care for newborn & mother!
Never mind that in most cases, men are eager participants in the act that leads to pregnancy, whether “naturally” or via IVF, etc. Logically, their insurance premiums should always include coverage for pregnancy care.
That’s how insurance works. Shared risks & shared costs over the population at large even if a particular individual, male or female, isn’t having sex at all, etc.
Certainly, some men want the act but not the pregnancy. In that case, they should always wear condoms & also only engage in sexual relations with women they are quite sure are also simultaneously reliably using another relatively reliable method of birth control.
Despite everyone’s best efforts, unexpected pregnancies occur. For the sake of mothers & babies, men should share in the costs of the potential outcomes of their actions. No free “lunch” for the guys without helping to pay for dinner!
Reading through both the article and most comments, I can’t believe my eyes. If you want to argue that the US health system should be more like that of Canada or Germany, that’s perfectly legitimate. But to shamelessly go back to communist propaganda boilerplate, that’s just too much. I come from a country where a few thousand people had to die so that we can get rid of communism and it’s health care system, which still worked better than Cuba’s, both in 1989 or now.
I consider as nothing less than an insult to the memory of the young people who died 29 years ago, when I see communist propaganda recycled into a regular NYT column, and people who have no idea they’re talking about musing about the “values” of Cuba’s health care. And by the way, trust their statistics, communists never lie.
60
@Gimme A. Break:
agree:
Seems like Kristof should have picked a nation whose statistics would be a bit more trustworthy.
For instance Sweden, which has (drum roll) "socialized medicine" and also the lowest infant mortality in the world.
Sweden's rate is 2.71 per 1000 births.
from: http://www.geoba.se/country.php?cc=SE&year=2018
11
@Gimme A. Break
"I consider as nothing less than an insult to the memory of the young people who died 29 years ago, when I see co-"
Shrug. Kristof is as entitled to articulate his opinions as you are entitled to spout yours. Welcome to America.
14
And where the people of Sweden go when they have cancer? Or where are the most seek out medical centers in the world (drum roll???) not really necessary we all know the answer. What is the name of that famous cancer center in Sweden? Or in Denmark? Or anywhere ? Cleveland clinic? Mayo Clinic? Anderson institute ? Sloan Kettering? I can’t think of any.
Mr Kristof probably has never “been” in the real Cuba, maybe he went and stayed in a fancy hotel conference and took a tour managed by the government (no private tour operators). Talk to real people, visited a hospital? He would have not written a article had he been exposed to the reality in Cuba health system. Just go ask and compare and then write an article. The obvious evidence is overwhelming, no need for anecdotal stories or government statistics, just ask real Cubans and you will find out what we all know and is obvious. There is a reason why Cuba does not have an immigration problem, but more an emigration problem. Or why there are no central or south Americans seeking medical care in Cuba. Ask the Mexicans, Hondurans, Costa Rican’s etc etc evidence, clear observational and verifiable FACTS.
7
"The secret of patient care is in caring for the patient." - Francis Peabody, MD
One might ask "How can those doctors and nurses do that for such low pay?" My answer is "Because they care about the people they serve."
"Why are drug company and health insurance company profits so high?" "Because they care - about short term stock prices. "
Our national health care problem is that the metrics of health of the US population are found nowhere on the balance sheet. They are externalities easily ignored.
A single payer system may in fact be best, but getting there will be difficult and contentious, from cutting off huge profits to trying to increase the number of providers for a sudden increase in demand.
Let's get on with it.
8
I suspect doctors work for about $45/day in Cuba “not because they care” so much more for their patients than US doctors do, but because at a minimum:
- their costs of living are presumably much lower than average for the US
- they potentially have no college debt & I believe the article may have stated that medical school is free.
4
Infant mortality also is a measure of a society's well being. While there are many problems in Cuba (as in all countries), the country starts by working to guarantee a standard of living, including housing and food, along with health care. Having visited several times, and just thinking about Latin culture, Cubans also tend to take care of each other, and such social supports also have an impact on infant mortality.
3
I often see misinformed statements about universal healthcare in Europe repeated in the comments to just about every article about health care. As an ex-pat American who has been living in Germany for many years I can state the following:
1) The system here is not perfect, and does have its problems. However, as a member of the middle class, my health care here has so far been superior than anything I received or my family receives in the U.S. Unlike them, I can choose my doctor and insurance, and don't have to worry about losing either if I change or lose my job.
2) There is no "lack of diversity" in Europe unless you are only talking about the color of someone's skin. Within the EU there are no restrictions to immigration for fellow EU citizens, including several former Communist Bloc countries which are economically behind most of Western Europe. EU Citizens enjoy full benefits including health care no matter which EU country they come from.
3) Statements such as "Germany is just now seeing problems with immigration" are ridiculous. The biggest impact on the German economy in recent history has been the reintegration of Eastern Germany, which was quite costly, indeed, much more so than the recent wave of refugees. I have seen NO impact on my quality of life from said refugees other than having to listen to a certain type of person (ironically, often people from Eastern Germany) complaining about women in hijabs and brown people on the subway.
12
Fair comment about Cuba and its health plan. What is your impression about Canada's universal health system? Canada is a country more similar to America. Canada's system has some faults, but that is so worldwide.
3
Having traveled the entire island of Cuba a few years ago, I was so very impressed by what I saw and experienced, particularly after listening to years of lies and propaganda condemning Cuba as a communist State.
The people throughout Cuba are friendly and although not rich, it is clear that they live decent lives. More than 90% own their homes. The streets are clean, the cities are pleasant and beautiful Cuban music can be heard everywhere.
The vast majority of the population has benefited enormously from the Castro-led revolution and the termination of mafioso and Batista rule who catered only to the wealthiest minority. Universal healthcare in Cuba is serves the people. The US healthcare system serves primarily the insurance companies and the drug industry.
10
You left out an important aspect of this. I would like to hear how these stats compare when you start with pregnancies, not just live deliveries. Cuba has one of the highest abortion rates in the world with 40 to over 50% of pregnancies ending in abortion. And, from what I've read, if it appears the pregnancy might end with a less than healthy child, there is strong pressure to abort.
Re immunizations, it's a lot easier to get good compliance when there's no choice in the matter. While there are many laws here to push compliance, there aren't any that will forcefully vaccinate you or jail you if you refuse.
6
You have to look at it by zip codes. There are two Americas. Some neighborhoods have terrific health care and every baby and mother get superb care. Then there are pockets of populations where the health care is terrible for a whole variety of reasons - racism, poor education, drug abuse, you name it. We do a terrible job of taking care of those at the bottom. But for those of us who have the wherewithal to access health care, the care in the USA is second to none.
6
As a 60 year old American citizen who has a disabling back condition and autoimmune disorder, but who is fortunate enough to have health insurance coverage through my husband's job, here's my summary of a typical doctors appointment, and what doctors really mean when they talk to me:
"What is it that I can do for you today?”
Meaning: I'm too busy and didn’t bother to look at your chart or any of the paperwork with 1000 questions that we made you fill out prior to your appointment.
"I see a lot of patients like you."
Meaning: I’m bored and don’t want to deal with another aging white female.
“You don’t seem very happy."
Meaning: Your attitude sucks and is probably responsible for all of your ailments.
“Well, you look pretty healthy.”
Meaning: You’re a hypochondriac.
“You have fybromyalgia.”
Meaning: I can’t bother to do proper diagnostic work on you.
“Your symptoms are vague, diffuse, and poorly described.”
Meaning: You have a lot of problems but I don’t have time to listen to you.
“Your depressed and should seek therapy.”
Meaning: Your chronic pain and fatigue is all a result of your mental problems.
“This is fairly normal for people your age.”
Meaning: Face the facts: You're an old goat.
“Maybe you should try acupuncture or something.”
Meaning: I can’t do anything for you and I’m not going to prescribe opioids.
“You deserve to feel better.”
Meaning: You’re really a mess.
“So how is it that I can help you?”
Meaning: I’m getting impatient with you and you're time is up.
10
Two points about prenatal care and infant mortality:
How many of those patients in Texas do not receive care in the first trimester because they either don’t know they are pregnant or because of other social/culture issues, not because they don’t have access to care?
How often is a baby born at 24-26 weeks even treated in Cuba vs how often are those babies treated here and what is the mortality rate of those pre-term infants that we aggressively try and save?
In Illinois, pregnant women and all children have access to care if they so chose—covered by the state if they do not have private insurance.
4
@Peter McDonnell
Many pregnant women present in Texas and California about mid-term in their pregnancy. They are migrants from Mexico and other Central American countries. My state - Georgia - has a high number of these pregnant migrants.
They are pregnant but have no documents - and they are given the same treatment that any other pregnant girl/woman is.
Regarding babies born at 24-26 weeks of gestation, many of them die but doctors and nurses will follow the directions of the parent(s) as to treating. Often the parent(s) will say "Do everything" and the baby will be treated.......and the parent(s) may have a baby that will never walk, speak, be able to learn, to read.
I know one couple who requested no treatment for a seriously-damaged baby. They wanted a rocking chair and privacy to rock and sing to their baby until he died.
Another couple requested everything be done for a baby born with no higher brain, no eyes, etc. The baby's skull was shaped like that of a frog: face normal, but from forehead to neck the head was slanted. The baby girl had balloons inserted into the skin of the back of the skull to create a normal shaped head numerous times as she grew. Artificial eyes put in. I've wondered at the cost-it must be several million dollars by now. I've also wondered if the parents really knew that a functioning brain would never grow.
Called anencephaly, there is no treatment and no cure.
https://www.cdc.gov/ncbddd/birthdefects/anencephaly.html
1
Whatever the truth of Cuba's infant mortality rate there's no reasonable doubt that the US has the worst numbers for infant mortality in the developed world, as the NYT itself reports.
http://www.nytimes.com/2016/06/07/upshot/the-us-is-failing-in-infant-mortality-starting-at-one-month-old.html
It also, of course, has the worst numbers for maternal mortality, an American woman being around five times as likely to die in pregnancy or childbirth as a British woman.
https://www.nytimes.com/2017/07/29/opinion/sunday/texas-childbirth-maternal-mortality.html
5
Here's a lead for you, Nick: the homicide rate in North Korea is almost zero, which means that a person is a million times more likely to get shot in America than in North Korea. How can you argue against that?
8
The NY Times has a section labeled Health, so it covers on a regular basis different aspects of healthcare. It would be to the benefit of it readers to go into detail the difference between the US healthcare system and that of the rest of the industrial civilized world and try to leave the propaganda of the pros and cons out of the discussion. The Cuban system is operating under the weight of 60 year US economic embargo, but still manages to outperform the American system in important ways. No one in the world distorts data like the US healthcare industrial complex.
1
If Americans had to deal with the Cuban healthcare system for even one day, there would be a revolution.
10
I see that many commenters are repeating the canard that other countries don't classify infant mortality in the same manner as the US.
The US government disagrees:
“In the United States and in 14 of 19 European countries [Austria, Denmark, England and Wales, Finland, Germany, Hungary, Italy, Northern Ireland, Portugal, Scotland, Slovak Republic, Spain, Sweden], all live births at any birthweight or gestational age are required to be reported. Also, since no live births occur before 12 weeks of gestation, the requirement for Norway that all live births at 12 weeks of gestation or more be reported is substantially the same as for countries where all live births are required to be reported.”
https://www.cdc.gov/nchs/products/databriefs/db23.htm
There is no reasonable doubt that the US has the worst numbers in the developed world for both infant mortality and maternal mortality.
5
Cuba has an excellent health care system for its standard of living. It is a model for many countries but not all.
Mr. Kristof is irresponsible in using it as a model for the USA. He is trying to score some pseudo-leftist debate points at the expense of the most basic health care of the American people.
According to the CIA Factbook, the US has an infant mortality rate of 5.8. Canada: 4.5. and Cuba: 4.4.
By comparison to Cuba, Canada is America with universal health insurance at two thirds the price of substandard American health care.
Canada also provides virtually all the bells and whistles of American health care. It guarantees the same level of personal freedoms as the USA, it has very well paid doctors, access to the best of technology with RATIONAL limitations, its hospitals and clinics are not shabby, and Canadian Medicare provides more COMPLETE freedom of choice of physician, care, etc than in the USA. It also has accurate statistics of its strengths and weaknesses. Canadians live longer.
Canadian Medicare did not come about because of a socialist revolution or Marxist ideology. It was passed and put into effect by the Progressive Conservative Government.
Thus the PCs in Canada have no inclination to kill Medicare as do our rightwing anarchist Republicans. The Liberals or the NDP are more likely to strengthen it.
Mr. Kristof appears to want to destroy the prospects of Medicare for All in the USA by providing faint praise for Cuba.
4
Medicare was brought in in Saskatchewan under Tommy Douglas's CCF Party..which later became the NDP. National Medicare was brought in by the Federal Liberal Party as the CANADA HEALTH ACT because of the threat of extra billing in Ontario. No where did the Conservative Party play a role. They are more like the Republican Party. Witness Brian Mulroney and Steven Harper
Well, achieving cheap and accessible healthcare by paying doctors very little and making it really hard to leave the country doesn't seem like a good sustainable approach to me. Once they are allowed leave, then even the accessible yet low-tech system crumbles. That happened to many Eastern European countries that also educate doctors and nurses for free, and keep healthcare universal but a lot of healthcare workers flock to the west immediately after school to get wages many times higher. And hospitals are facing severe staff shortage.
4
@Mirka S
In my opinion, it's unethical for prosperous countries to rob Eastern European, African, and Asian countries of doctors and nurses.
Facts are what they are.
In 1965, Canada adopted universal coverage for (most)) medical care. At the time, life expectancy in the USA was slightly higher than Canada.
In 2017, life expectancy in Canada is at least 2, and possibly as much as 3.5, years higher in Canada (depending on source). Check Wikipedia -- even the CIA list shows that.
And no, it's not diversity (Canada has a higher proportion of foreign born), it's not because of size (Canada has a smaller population spread over a larger land mass, nor is it because of culture, which shows no respect for the US-Canada border.
4
@Ed
Canada's foreign-born population came to the country with a considerable amount of wealth, education, good health, and good character.
Uneducated and thus unable to work in jobs available in Canada that ARE NOT and CANNOT be filled by Canadians? Don't apply to Canada.
Don't want a job but you aren't wealthy thus can't be self-supporting? Don't apply to Canada.
Unhealthy and want to use their system? Don't apply to Canada.
And BTW: no chain migration to Canada: your relatives must apply on their own and meet the requirements.
Here are the requirements to make application to migrate to Canada:
- Language proficiency: proficiency in English and/or French.
- Education: provide your foreign Credentials and assessment.
- Health and Character: provide medical and police certifications.
The above records are required, not suggested.
And BTW: yes, life expectancy in the USA is now lower than the USA enjoys - but the USA has a minimum of 11 million illegal/undocumented immigrants, mostly from countries without good education / health care - even vaccinations / who arrived in relatively poor health. And the USA factors in those residents as well.
You are comparing apples and oranges. As noted above, Canada's foreign-born are healthy, wealthy, and wise........and speak Canada's languages fluently.
1
Dear Mr. Kristof,
Thank you for an insightful article. I was afraid you would bash Cuba's economy without mentioning the impact of the US embargo; but you did not.
Cuba's health care system lacks an essential attribute of the US system: the involvement of insurance companies whose approval physicians must seek before intervening. The health professionals in Cuba and Canada are able to exercise their profession based on the medical facts and availability of treatments rather than the insurance company's profit line.
Some years ago, an MD in Philadelphia told me that some physicians in the USA had realized how much more money they could make by owning the insurance industry. I was shocked by the idea. I do not know how widespread this is, but it certainly suggests how little medical ethics may matter among some physicians in the USA with its for-profit model of medicine. I feel very fortunate to live in Canada.
One aspect your column does not mention is the availability of free education in Cuba. Yes, the medical professionals are abysmally paid, but no, they do not have any student loans hanging over their heads. They choose their profession for reasons other than economics. And the country has no shortage of doctors - the doctor-patient ratio is really rather good. NationMaster.com lists Cuba as having 5.91 physicians per 1000 people, and the USA and Canada as having only 2.3 and 2.1 respectively.
2
I grew up with the UK's National Health System. It was and is flawed, underfunded and far from perfect but everyone in the country had access to healthcare.
Living in the mighty USA I, like many others, am constantly making healthcare decisions based on cost. I'm fortunate to have health insurance and still face huge financial barriers. Then there is the Damoclean sword of a serious health crisis. If the illness or accident doesn't destroy us, the financial burden surely will. Many people do not have access to healthcare at all. This is inexcusable. Is the USA really a rich country when millions of its citizens are impoverished and underserved?
In Cuba, a country I have been to many times, whose healthcare system I have studied and been a patient in, healthcare is enshrined in the constitution as a human right. Therefore, everybody must have access to it. How this plays out is, of course, far from ideal. For a plethora of reasons, not least of which is the ongoing embargo (which also impacts trade with countries other than the USA and Cuba's ability to get credit), resources are limited and, in many cases, non-existent.
In all 3 countries I can find anecdotal tales of how the medical system failed people. In all 3 countries I can equally find anecdotal tales of how the medical system has been amazing. But, Cuba is the only country where there is a radical approach to prophylactic care and a disproportionately high level of good outcomes compared to the cost of providing it.
8
I like this column and the ideas for reform it expresses, but the math is wrong. A death rate of 5.9 per 100,000 is 1.9% higher than a death rate of 4 per 100,000, not almost 50% higher.
But these numbers take in the whole US population, including wealthy areas where the death rate among newborns is probably infinitesimal. A better comparison would be the death rate of babies in areas of the US that are as poor as Cuba -- I bet that would be far more than 50% higher.
1
@Chris NYC
The math is not faulty: A death rate of 8 per 100,000 would be 100% higher than 4 per 100,000; a rate of 6 would be 50% (half-again) higher than 4.
2
Saying that the death rate is "50% higher" is using statistics in a way that misleads people rather than informs. There was a famous book from the 1950s called "How to Lie with Statistics" that deals with this very issue. What you say is technically correct, but the proper comparison of the two figures is with the whole population of newborns, not with one another, since the death rates in both countries are already extremely low.
Your analysis is a bit like a statistical joke made a while back by Star Trek lovers that the fastest growing language in the world was Klingon. (A language spoken by aliens on that show). This was also technically correct for the same reason, since if there were 5 people in the world studying Klingon and one more starts, that gives you an annual growth rate of 20%. But is that a realistic appraisal of the desirability of studying Klingon or the changes that should be made to language-learning in the United States?
To give any useful information about our medical system, we should be comparing the infant mortality rate of people in the United States who are similarly situated to the ones in Cuba. Kristof does that later in the column, but the initial statistic is misleading, even if technically correct.
2
Not "may" be more likely to die"..but "are" more likely to die. U.S. infant mortality stats are an embarrassment for a country as rich as we are.
I know Cuban-Americans in NYC who fly to Havana for care they cannot get at home in the U.S.
Cuba has the best healthcare system in the Americas, bar none. And it is free for all Cuban citizens.
Cuba also sends thousand of medical doctors to disaster areas around the world. Why can't the U.S. do this?
3
Yes, some Cuban-Americans do go to Cuba for surgery, and they also take with them all the post-op supplies they will need( meds, wound care, antiseptics...). I have family in Cuba, and we routinely send them vitamins, medications, supplies ( including catheters), because it is unavailable.
4
We let people go without preventive care, and when they get sick we sometimes treat them. The treatment makes money for those portions of our health industry that focus on such usually expensive treatments. Lack of preventive care thus provides an occasion for the health care industry to expand its share of our national product.
Medical leaders who think like, say, the founders of Purdue Pharma would be very aware of this way to drum up more business and would be active in doing so. How they see what they are doing in the light of any ethical standards and beliefs they might have, is really a separate question. The way business works, if money can be made in certain ways then it will be made, and the people making it will see or not see what they are doing in various ways that are basically irrelevant to what is going on, since their purpose is to enable what is going on rather than discover ethical truths.
2
"Other peoples' money," one of the mantras of the right wing. They do not want to spend their and "other peoples' money" for your healthcare (or post office or education) even if it would be cheaper for everyone but the rich. They have nothing against government spending for private prisons, B-2 bombers whose mission was to fly into the USSR after a total nuclear exchange and take out the few remaining targets, and, of course, a wall. We could all have the healthcare that Congress and federal employees have for about 7% income tax. It would require government negotiation of drug costs. There would be phenomenal savings in billing and administration costs.
5
Agreed. But all the MFA plans I see want to take away my employer provided health insurance. Sorry, I didn't work thirty years for the same employer for nothing.
3
@Mike Carpenter
Correct—I do not want to support you.
I will support my own family.
2
What does it mean for a person to have "meaningful political rights"? Political activism has not helped our health care system. It has made it worse.
Cuba has a strong tradition of good quality medical care that preceded the revolution. Their expertise and competence is not an accident or byproduct of revolutionary socialist thought. It is one of the strengths of Cuban society that Fidel recognized and encouraged. Sound medical practices just happen to coincide with socialist ideology. The mistake of the American system is that they think capitalism is perfect for everything. In America it is profitable for the industry to be sick. American clinics are set up to see the maximum number of patients in the shortest period of time. If people are sick, so much the better, because that means more money for tests and money to be made from prescriptions.
Those who criticize the Cuban medical system are motivated by political animus, or are afraid such a system would deprive them of massive profits. But those who say Cuba does have problems with the delivery of health care to the masses are quite reluctant to criticize the great American system of medicine that is responsible for the third leading cause of death in the USA. Google: medical error 400,000.
3
It's pretty sad that the richest country in the world says it can't afford to take care of its citizens as well as a poor communist country like Cuba.
If the far right fringe would stop pretending that the community can do everything for its members without government "interference," we'd be far closer to a decent medical system like our neighbor Canada has, or even Cuba.
7
@Barbara
The richest country in the world has one of the highest rates of obesity and opiate use in the world.
You can't compare Cuba and the US - few Cubans drive because they don't have cars thus there are no drive-thru fast food stores. Cubans also have far lower rates of addiction than the US.
Why not mention Infant mortality rates in other countries with universal health care? There are 31 countries wit infant mortality under 4%. Most if not all have universal health care.
5
Mr. Kristof I can't believe you are this naive. Dr. Alvarez denied to you that "Cuba fiddles with its numbers"? Because if he had said anything else he would lose the meager existence he has to protect under that horrible system. Cuba has a negative population growth which is an aberration even in the poorest Latin American countries. Because most people don't want to have children in a country where there is no hope for a better future for them. They also don't want to have children because there is such a housing shortage that they just don't have the physical space for another family member. Anyone who wants a better future is trying to leave that prison island.
Our system is far from perfect and it is my sincere hope that we will within my lifetime be able to fix our severe problems. But please let's be realistic, Cuba is not an example to follow. My Venezuelan friends living in the U.S. always comment on how many poor Venezuelans have been killed at the hands of the so called Cuban doctors that were sent there to "help".Because they have only a basic training and no experience with medicines available in the outside world. At the beginning of the Cuban Exile, Cuban exiled doctors would master the english language and pass the Board Exams. Any Cuban doctor who arrives today becomes a lab tech or a practical nurse. Their training is so basic that they would have to start their training again from the beginning. There are lots of these "doctors" living in Miami FL.
14
Me Kristoff got it out if the way early,
the comparative statistics need to be taken with skepticism. American infants are 50% more likely to die than a Cuban infant? I doubt it. Cuba’s population of 11.5 million vs ours of 325 plus, isn’t even mentioned. And let’s please keep in mind this journals penchant for tilting ideologically left as is evident in selective portions of this article.
However, it’s a given that Cuba’s outcomes are better than ours and obviously all parents want the best healthcare for their babies.
That being said Cuba does doctor it’s numbers (late fetal deaths categorized as stillborn) while Cuban physicians choose to dismiss it.
Bottom line is, it’s still preferable to be
free to travel, speak freely, with almost limitless opportunities rather than have free healthcare and education while being held captive and fearful in your own country.
The last line of this article is truly sad.
5
On a recent trip to Cuba, I was informed that its infant mortality rate was also lower than Canada's and some other nations with universal healthcare.
1
I'm not sure we can get there from here. Maybe we can, but it might not be as easy as people think.
1. Who is going to see all these folks? As a family doc, I work 11 hours per day, which includes about 3 of fooling on the computer to satisfy bureaucrats. I'm pretty much tapped out by the end of the week.
Living upstairs and being on call all the time. Not going to do it.
2. Primary care gives the most bang for the buck in terms of aggregate health outcomes, no doubt. But any med student who does it will regret it the rest of his professional life. See number 1 above.
3. You're not gonna get docs in the USA to do all you want them to do for the money you want to pay them. Sorry.
4. Nurses don't like doing it much more than we do. Sorry.
5. The USA might be on the verge of inventing a very important job that virtually no one is willing to do.
5
@vbering
The CEO of the health insurance company my employer uses made $49 million in 2016 (the latest year I could find records for). So -- the first $49 million that came through the door (from people's premiums) went to him. As 2016 was a leap year I divided that by 366 and found that he made just shy of $135,000 A DAY. And how much health care does HE provide? None.
The last figure I saw for the Medicare Administrator is that he makes $250,000 PER YEAR.
THAT'S how we provide Medicare for all. We outlaw private health insurance and pay the premiums to Medicare. Everyone would have access to health care, and we would save money.
6
@vbering. "As a family doc, I work 11 hours per day, which includes about 3 of fooling on the computer to satisfy bureaucrats. "
Well all that time on the computer stinks! But did you know that healthcare for all advocates argue that it would reduce administrative [aka "bureaucratic"] time, paperwork, and costs? See, e.g.:
"A national health insurance program could save approximately $150 billion on paperwork alone. Because of the administrative complexities in our current system, over 25% of every health care dollar goes to marketing, billing, utilization review, and other forms of waste. A single-payer system could reduce administrative costs greatly."
http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php
5
Don’t believe it. Government bureaucrats demand more and more documents to complete. Not fewer.
3
An innovation of Cuba that's worked well for 50+ years is allowing the face value of losing lottery tickets to be used to to purchase savings bonds maturing in ten years. Its become a a savings program for the poor that works.
Here in NYC, plenty of people spend over $25 a month on lottery tickets. Ten years later, a year's worth of losing lottery tickets would would be a matured $300 bond.
1
Good to read something factual and positive about Cuba. Cuba's life expectancy is among the highest in the world and this also means an increase in cases of Alzheimer's and dementia, as Cuba's population has aged and many young people have emigrated. What Cuba lacks are resources, in large measure caused by the embargo. I'm afraid those who are now advising Trump on his foreign policy have targeted Cuba for more undeserved suffering by tightening the embargo. Sen. Marco Rubio, John Bolton et al.
3
Amazing! I recently went to the ¡Cuba! exhibit from the American Museum of Natural History in NY and Cuban cultural entity. There was exhilaration but also deep sadness surrounding the exhibit because it was so obviously undertaken after Obama began opening up relations -- whereas now Trump has reverted to the decades-old failed policy that has produced no result. One amazing revelation is the NATURAL environmental health of Cuba. Its coral reefs are among the healthiest and it has set aside a huge portion of the island as preserves. I plan to visit some day.
3
There is no reason why a capitalistic nation cannot provide medical care for all
assuming that its capitalism is
well regulated and made to work for the nation as a whole. As it is we have not
enforced the anti-trust laws for years and we now have the result. I would also point that Medicare for those over 65 and over works well. There is no reason why it wouldn't work
well for the whole nation.
4
Comparing health care systems in Cuba and in the US is obviously deeply problematic due to the enormous differences between the economic, social and political structures in the two countries. Consequently, this sort of column garners all sorts of comments pro and con, and all of them are to one degree or another legitimate. Of course it's great that every single Cuban citizen has access to some form of local health care. And of course it's true that due to a number of political and economic factors, that system pales in quality when compared to a typical US doctor's office.
For most Americans (except those on Medicare), access and quality of care is good to excellent while the cost is high. For the handful of rich among us, cost isn't an issue and quality of care is close to the best in the world. For the 20% at the bottom of the economic ladder, health care is virtually non existent.
So the obvious question to me is, how can we create a Cuban-style neighborhood health care system that addresses the needs of these 20%, without raising costs or degrading quality for the rest of us? Is that even possible?
Given the grotesque dysfunction in D.C. these days, I doubt we'll be able to find any solutions in the near future, so perhaps the best we can hope for is to keep plodding along with what we have until we can usher in politicians who are willing to solve problems instead of using them for political gain.
2
@TM "For most Americans (except those on Medicare), access and quality of care is good to excellent while the cost is high."
For "most" Americans access and quality is good?
I don't think you can support that claim, TM - though it depends on whether you say that "access" is good no matter the financial hardship it causes.
It's not just the 20% at the bottom that face challenges accessing decent healthcare - or any healthcare - because of economic hardship. Look at this NYT article about how deductibles and co-pays make Obamacare simply unaffordable for many insured:
https://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html
2
This column feels like a gift to Republicans and Fox News. Kristof knows 2/3 of Americans can't find Syria on a map, but he's coming out in favor of Cuba? If Venezuela had the hemisphere's best retirement system, it would still be better to look at the countries Americans have some knowledge of and build on that foundation. Because people are going to rightly reject a good health care system if it to comes at the cost of an authoritarian government, and that's what using Cuba as a model suggests. This help no one.
What I find interesting is how the title of this op-ed has changed from the early this morning. Early this morning it was called "Learning From Cuba's Medicare for All." Now its called, "Why Infants May Be More Likely to Die in America Than Cuba." Why was it changed? The new title is a better reflection of it is actually about, infant mortality in Cuba versus the United States. But to say America has something to learn from Cuba is a joke. Thank you.
2
@Southern Boy - infant mortality in Cuba is better if you can rely on stats. Easy to have great stats if you invent and fully control them.
2
the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9."
And what about the mortality rate for American fetuses?
It is pretty high, is it not?
But "we are progressives" and we count THAT rate as zero.
1
I was very glad to see this article, because I have read quite a bit on the Cuban healthcare system, and it is very clear that the impression you are trying to create is patently wrong.
It is hard to believe that you can be so gullible--it is hard to believe you are not duplicitous.
You state that Cuba obviously lies about its statistics, but then you can't believe they would lie so much so as to make their results look better than the US system.
As for the death rate, I have read elsewhere that they simply terminate many potentially difficult pregnancies in Cuba. In the US many babies are born and live who wouldn't make it in Cuba. Yes, some die after being born. In Cuba they avoid doubt and kill those who might be troublesome births well before full term. Simple and cost effective!
You extoll the virtue of paying doctors $80 a month. What is your point? That wages are too high in the US? That the government should impose price controls and require doctors to work for less money? While we're on the topic, how much do you make? I think you should work for less.
There are so many problems with your thesis and its support that you simply have no credibility.
6
We need universal free health care in the U.S., instead of our tax monies going to overthrowing governments (Iraq) and causing world wide chaos and refugees we should be funding health care for all Americans. We don't need walls we need a good government with an honest president.
7
There is a silver lining in every cloud. Maybe more people in the USA will adopt.
Surprise! America is only as excellent as it may excel.
“U.S. infant mortality rates (deaths under one year of age per 1,000 live births) are about 71 percent higher than the comparable country average.”
https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/#item-infant-mortality-declined-u-s-comparable-countries
Two considerations:
1) The definition of live birth is important. In USA definition is birth. In many countries, as is alluded to in this article, a baby born with problems never happened and therefor is not part of fetal mortality.
2) “A lower percentage of children are vaccinated in the United States than in Cuba.” This may be considered a disease of affluence. Cuba probably mandates vaccinations. As is widely reported in New York Times and other papers, many upper scale folk in USA harbor doubts re vaccination and get away with it. Exemplary of this phenomenon are G Paltrow's jade eggs and related nonsense. In this case it is to their good fortune that Cubans can't afford this sort of disease inducing nonsense.
6
Flightiness ,lack of depth of Mr. Kristof cannot be overestimated. In his last column he was bemoaning the fate of the marchers for democracy in Khartoum, Sudan, and I and others challenged him to be there with them in the realistic hope that his presence as a journalist would pressure the forces of order, army and police, to refrain from firing on the demonstrators. A NY congressman, Elliot Engel I believe was equally committed and his presence also would have helped bring calm to the tense standoff as well, but SURPRISE,, now NK is back to criticizing the tit for tat between Pelosi and the c-in-c.Kristof shows daring in going to places where others would fear to tread, but for him apparently it is all for the sake of a good story, and once his piece is FILED, he's onto another crisis, this time the medical crisis, comparing Cuba to the US in terms of care. and going after u know who?Where is the sincerity, sense of commitment in all this? Sounds to ABH to be a trifle superficial. Re Trump's refusal of govt. transport for Pelosi and Adam Schiff, neither of whom has any expertise in military affairs, it was wholly justified when her presence is needed in WASHINGTON to resolve the crisis over the much needed border wall or fence with sensors!Cited the words of late, great Times correspondent, Colin Legum, and his great remark: "1 twist of the knife deserved another!" For all the greenhorns out there Legum wrote wisely and well about the crisis in the Congo, c. 1960.
A more useful discussion is whether the US can get as good health-care as other developed countries or better (I think it can). No need to invoke Cuba as an example.
There are many things wrong with Cuba, including their health care, behind the propaganda aimed at non-Cuban visitors.
Perhaps US should become China as no other country has lifted more people from poverty.
2
Another important distinction about Cuba's approach is equity and inclusion. The family doctor deals with not only disease, but with wider health-related issues of the community. For example, in one community I observed, the family doctor noticed a rise in hypertension, and was able to address the problem early with classes on diet and meditation. In another, the doctor supported a community project to fix street lights to decrease crime, and to prevent accidents-especially in the elder population. Such personal attention at a local level in each community has contributed to comparable health indicators (infant mortality, life expectancy, etc) throughout the country. Compare this with US statistics, where huge disparities (15%-30%) in life expectancy exist depending on zip code. In the US, there is an overarching narrative about who matter. 80% of what shapes your health is about your opportunities (access to decent housing, healthy food, clean water, parks to exercise, access to good schools, employment opportunities, etc). These are the things that have been determined by longstanding policies and racism which have produced the high level of inequities in the US.
I agree with some of the comments about Cuba's imperfections. But if we are to consider health as a human right (which it should be), then Cuba's model of inclusion and attention to its population's basic needs - regardless of where people live or what their income is - is worth checking out.
6
Back in 2002 I was on a tour of Cuba and with the tour group was an OB/GYN from NYC. He wandered off from the group one day, I think we were in Santiago, and stumbled upon a home with a dozen pregnant women sitting outside. He started speaking with them and was introduced to the resident doctors.
The home was for pregnant women who lived too far out in the country to get the medical care their doctors felt they needed. The home was of course free of charge. The NYC doctor was stunned when he was telling us this story at dinner that night.
Could you imagine these homes here in the US? Women actually getting good prenatal care free of charge so their children would grow up healthy?
7
You mention that there is corruption in the Cuban health system. There is rampant corruption in the U.S. Medicare system also. Health care should be a basic human right, along with education, and a living wage. But, we smart Americans are against these things.
3
It is refreshing to see an acknowledgement in the Times of the fact that socialist Cuba is able to achieve superior healthcare results than the capitalist United States with considerably fewer resources. Of course no such acknowledgement would ever appear here without an obligatory denunciation of the supposedly repressive nature of the Cuban state and Mr Kristof dutifully included one.
It is tempting but mistaken to compartmentalize these features of Cuban society.
Cuba has the medical system it does because it had a revolution. Before the revolution, the Cuban government was a compliant pawn of the United States and its people suffered to the profit of US-owned sugar companies, hotels and organized crime. The revolution won Cuba its sovereignty. As a poor island nation 90 miles from the most powerful country in the world, that sovereignty is always in jeopardy. The US has sponsored every imaginable sort of intervention to bring Cuba back under its effective control from sponsoring an invasion to assassination attempts to training and offering sanctuary to terrorists like Luis Posadas Carrilles.
We have seen how terrorist attacks in the United States have been used to roll back civil liberties and to criminalize dissent. We should therefore understand how far more serious threats to Cuba's sovereignty coming from the United States were critical in creating the conditions under which the Cuban Revolution became more repressive.
3
In his travels, Mr. Kristof may have run into Cuban medics working outside Cuba, as I did in remote parts of developing nations in the Asia-Pacific region where their Afro-Latino heritage made them stand out. So, not only is Cuba doing its best with limited resources at home, but it also is exporting its medical expertise internationally. Maybe U.S. red states that deny citizens adequate health care due to their politicians views on the Affordable Care Act should do likewise.
6
There is the "Cuban" Hospital in Qatar. Almost all staff are Cuban.
The nurses and physicians are excellent and out comes are superb.
4
@ron - and doctors and nurses making almost nothing and can't leave - under threat to their families back in Cuba. It's profit center for the government.
1
@Maria That's not true. If a doctor leaves, their family doesn't suffer for it.
Adequate health care needs to be a right that is accessible to all. It's distressing to me that ALL Americans do not insist on accessibility to Health Care for every American Citizen. Due to a health condition, I am required to take a special medication twice a day. This medication is produced and marketed by an American Pharmaceutical Company. My Medical Clinic in the United States buys this medication from a Canadian supplier because it's 70 - 100 % cheaper in Canada than in the United States. This is because the Canadian Government negotiates the price they are willing to pay for this medication. Access to adequate health care should not be determined by one's income status. I am connected to many doctors and nurses in the United States who believe that a system more aligned or designed like the Canadian System would provide more effective health care for the American people.
2
@Leslie374
The USA subsidizes drug costs for the rest of the world. We pay more so the rest of the world can pay less. Good system, right?
2
@Healthsense America pays more because it has the only government in the developed world that fails to defend its citizens against medical extortion.
2
The article referenced the fact that one third of pregnant Texas women do not receive prenatal care in the first trimester. I suspect that almost all of these women are on or eligible for Medicaid and other tax supported health care programs. The health care is readily available but for whatever reason, the women are not making appointments for care. First trimester entry into prenatal care is an issue in many places, not just Texas. Perhaps the women don’t understand the need for early prenatal care. Perhaps they don’t understand that prenatal care, labor and delivery is free for low income people.
Also, there is evidence that even with excellent prenatal care here in the USA, some women don’t have good pregnancy outcomes. Research is being done to see what social determinants such as stress, living conditions, etc. has on pregnancy outcome.
Finally, the overweight and obesity issue we have here means more of our young women of child bearing age have high blood pressure, diabetes and other problems related to poor pregnancy outcomes.
How would Medicare for All improve pregnancy outcomes when the prenatal care through Medicaid and local health departments is already readily available in most places.
The one thing I see in Cuba that is done well is the constant social and emotional support for the pregnant woman.
3
What isn't mentioned in the article is how many preemies make it to term (and classified as Infant) in Cuba vs the US. In the US, many more preemies and ultra preemies survive to infant hood but have higher rates of morbidity and mortality leading to a higher death rate.
6
This article represents what I call the "Ed Asner School of Public Policy."
Even if the stats are to believed, Cuba is a dictatorship that employs coercive means to promote public health, such as the infamous quarantine of AIDS patient in the 1980's.
Why not compare the US with the United Kingdom, a nation with similar cultural norms and legitimacy of healthcare statistics. UK spends about half of what the US does on healthcare, per capita, yet they has 4.3 infant deaths per 1,000 live births, vs. 5.8 in the US.
The UK outperforms the US in life expectancy and many other healthcare outcomes.
5
@Peter Blau The "quarantine" of people with HIV early in the epidemic was not in camps, but in centers that, as outside visitors attested to, were group homes. It didn't last long, but that along with widespread testing, a mandatory two-week education in HIV, and other aggressive policies, made the HIV rate in Cuba one of the lowest in the world — this, despite a sexualized culture and sex tourism (almost all Cuban prostitutes used condoms). It should also be pointed out that, under Castro's daughter, Cuba has made tremendous strides in gay and trans acceptance by most people. Being gay there is no big deal.
2
I get what you’re trying to say but for one, I remain skeptical of figures coming out of a dictatorial regime. Two, Cuba’s healthcare system is not completely free, often people barter for services (like gifting chickens to doctors)
i have visited Cuba. Someone I was with actually got sick, took antibiotics, and remained mysteriously sick once back in the states. I know of someone else who contracted hepatitis.
Many of our health problems are due to lifestyle. Much of Cuba’s good health can be attributed to a small and simple diet as well as being exposed to less industrial pollution.
That doesn’t mean I am against universal healthcare, but it’s borderline creepy to glorify Cuba as if the loss of their freedom was worth it for the above average healthcare. But ok, I guess you need a sensational headline. Comparing the US to Canada wouldn’t have made the situation look as “dire.”
4
Interesting comments, as usual. It's hard to understand why the Cuba regime preferred to spend time, efforts, and their scarce money fighting its neighbor, instead of using their healthcare to attract the millions of persons that had to wait many years, until the Affordable Care Act was launched by President Obama.
They didn't need to embrace capitalism, they could use the same approach of countries like Denmark or Norway were you can find affordable or free doctors, and Freedom of Speech at the same time.
Sooner or later we will have something like universal healthcare. I hope sooner, because the republicans are going to try to bankrupt the country with tax-cats for the rich and then argue that we can't afford it. It certainly won't be a perfect system, but it will cover most or all Americans and the rich can still purchase the best health care money can buy. Just look at Rand Paul, the junior senator form KY. After railing against government run healthcare, calling it 'slavery', he went to a Canadian hospital that is excellent with hernia repairs that gets most of it's funding from the government.
Funny how that works isn't it.
3
Our health care is good but the cost is
very high. Child birth in US costs an
average of $11,500 and $2,000 in
Spain. Some end- of- life treatment costs
$80,000 a year in drugs. The defenders of US health care points out the profit incentive for innovations.Yet
those innovations don't seem to improve
the outcome. Americans are not
healthier than British or Canadians.
However, a great thing about our
healthcare cost is it rolls into GDP at
market value. Because it is so high we
become the richest country in the
world-mostly doctors, hospital executives and pharma executives
get all those riches, ordinary families
foots the bill with difficulty. It is this
costly healthcare system that drives
American companies to China and
elsewhre. Not only the wages but the
healthcare cost make it cost effective
in China, Vietnam,etc. No wonder
GM makes more cars in China than US.
3
I visited Cuba about ten years ago with a group studying Religion and Culture in Cuba. We visited one of the neighborhood clinics described in this column. We were asked in advance to bring soap and certain over the counter medications to donate to the clinic because the clinics frequently lack the basics. The young doctor, a recent graduate, was in charge of the clinic and the only doctor there. I was impressed by the Cuban system because everyone has access. I do not know what the outcomes are and it never occurred to me at the time that numbers might be doctored. But I do wonder about patient care when doctors examine patient after stormy without washing hands because they have no soap. The clinic that we visited had no soap. While in a resort area, I noticed a discreet sign on the door of a clinic. The sign said that no Cubans were seen at that clinic, only foreigners. That gave me pause. Nevertheless, I do admire what Cuba managed to accomplish with limited resources.
1
Boy, did Nick bring out a lot of passion from the commenters with this article. The same old scary arguments about "the communists" taking over if we have Medicare-for-all, as if adopting a system based on the idea of healthcare as a basic human right will turn us into a totalitarian dictatorship. Whew, I'm glad I'm over that. Come on folks, we can agree that healthcare is a right and still have a mixed economy like we do now. Yes, taxes would go up for the wealthy and the middle class (as in progressive taxation model.) But would we really lose our innovative edge? Wouldn't there still be money to be made by designing new drugs and innovating new medical procedures? None of this would end. We have a mixed economy now, medicare-for-all would be one more part of that mix.
7
Just for the record, Cuba does not have a system similar to Medicare-for-all. Rather it has a socialized system similar to Great Britain's.
8
Kristof's observations are repeatedly offered with words of caution that he couldn't verify many claims made by his Cuban hosts.
But to me the biggest point of this column is that we absolutely MUST be open to new ideas and practices, because clearly the American Model hasn't worked for years.
We must throw partisan and ideological beliefs out the window and examine all ideas. Just because Cuba's (and Canada's, and Great Britain's, etc) system isn't 100% effective doesn't mean we can't take bits and pieces from each of them to create a new system. We must be practical. Because blind faith in capitalism ("Let The Market Work") has clearly wrecked the U.S. economy.
6
Despite the shortcomings and criticisms, the United States can learn something from Cuba's health care system. Perfect? No, but for a poor country, they place a value on healthcare for its citizens, and does not put profit before people, unlike here in the U.S.
Yes, we have the technology, but healthcare here can drive you to the poorhouse with the astronomical costs, what with private insurance companies determining what they will cover, pharmaceutical companies arbitrarily setting prices for their drugs (they say the prices reflect research and development, but how do we really know?), hospitals that swallow smaller hospitals to form conglomerates, with their chargemasters (their price list for every little item they use), specialist services, etc.etc.
Just about all other developed nations offer some form of universal health care, and I cannot see why we as a nation cannot take the best of all universal heath systems around the world, and synthesize them into a workable system here that will benefit people here, and one not tied to employment.
But I know why we will have to fight for such a system: too many players in our current overpriced setup are making too much money for themselves to put the health of our citizens first.
3
You know the US is sinking to the bottom when we have to compare our health care system to Cuba, a poor and impoverished country that manages to care for the health of all of its citizens with less money. All the disparagement of Cuba's metrics on infant mortality just underpins the bottom feeder aspect of US healthcare. Compare the US medical system to our allies...we will be lacking but it will be something to strive for...a better metric for future improvements to health care in the US.
3
Cuba's successes have come from decades of an intense focus on primary disease prevention, an area that our current non-system fails as witness WHO statistics on infant and maternal mortality, vaccination rates, lifespan and healthful lifespan. This focus results in per capita health care expenses less than half of ours, with better end-results in many important areas. Cuba remains a very poor nation, in part due to our continued economic embargoes, with poor technology access for many, and poorly paid health care workers, so it is not a paradise. But if the goal is to maximize public health at minimal expense, they have made prudent decisions. I wish we would have serious discussions about goals, rather than partisan rancor over means and perceived infringement upon "liberty" and corporate profits.
7
@Bruce Becker, MD One of the side benefits of its poverty is that people have exceptionally good diets. As in the rest of the Caribbean, there isn't good pasture for grazing, so there are few cows. There are a lot more pigs, but even pork products are relatively scarce. The result is a plant-based diet (plenty of sugar, however, which is why rum is ubiquitous). The sentence for killing a cow there matches that for some violent crimes.
@HKGuy Actually, Cuba did have good pasture land before castro. The province of Camaguay was famous for its cattle which was its principle industry. Castro decimated the herds of cattle giving them away to other countries in order to earn browning points for his "revolution."
That said, I'm not sure how good the Cuban diet is when there is so much scarcity do to mismanagement. As the great Cuban author Reinaldo Arenas wrote in his posthumously published autobiography, "Before Night Falls," castro broke the backbone of the Cuban economy, [argriculture], with the infamous 10,000,000 ton sugar cane harvest. In order to achieve this technically impossible harvest he fell thousands of ancient fruit bearing trees, and razed farmland dedicted to produce. Another harebained idea was to have Cuba produce more dairy and dairy by-products than Switzerland. In order to achieve this, he brought hundreds of dairy cows from Switzerland. The Swiss cows used to the cold climate were never able to produce the amount or quality of milk that they did in Switzerland, so castro built them air conditioned stalls. The overhead was enormous. Fifty hears of this type of lunacy have meant that the quantity and quality of the Cuban diet has plummeted. Perhaps from a purely medical point of view, the Cuban diet is not bad, since we don't need to eat as much as we do, but tell that to a man or woman who eats the same food over and over again, has no variety and at times goes to bed hungry.
An enduring chauvinistic characteristic of America is resisting learning anything from another country--believing America isn't the best, smartest, most advanced. We even act this way between states--ignoring lessons and learning from one another! With health care, unfortunately, we have reduced the issue down to a matter of access--health care for all--as we ignore the inner workings and profit motive of the major players in our so-called health care "system." So the ideas of how health care in America should be, could be, delivered, modified, never gets examined.
3
@JP
Democrats advance health insurance for all. Republicans prefer universal access. Democrats want to make sure that big medicine gets funded, but stripped supplemental funding to hospitals that serve a large proportion of Medicaid patients. So inner city and rural hospitals and clinics closed, reducing access, in both states that expanded Medicaid and those that didn't.
Democrats completely defunded SCHIP, intentionally ignoring the large number of handicapped children who received supplemental services that allowed them to remain at home rather than be institutionalize while allowing their middle class families from being impoverished.
Prosperous hospitals that serve the wealthy and well insured have become more luxurious. They managed to get Medicaid and the Obamacare policies out-of-network for them and moved to the underfunded hospitals for the poor [some of which had closed, so it was a longer journey.]
Meanwhile, having shed their unreimbursed and under-reimbursed poor clients and so eliminated the need for cost shifting, the wealthy hospitals increased rather than decreased the rates they charged to insurers.
Obama wanted health insurance for all. It was the wrong path and led to increasing bifurcation between what is available to the rich and what is available to the poor. It has nothing to do with capitalism, it is the result of socialism, where the government directs money to cronies.
2
My friend is a doctor in Cuba. After he finishes a 12-hour shift at the hospital, he goes to his second job as a cab driver, since he can't feed his family with the meager wages of a physician. At one point, the government sent him to work in Kenya, where he received only a tiny portion of the paycheck given him by the Kenyan government (the rest went to the Cuban authorities). So yes, just like sweatshops can churn out plentiful products for a low price, Cuba can provide medical care to its people. But it comes at a high cost to the medical professionals, and I'm not sure it is anything we should be emulating.
12
@Nikki And yet he stays there. The doctors there have a real, honest dedication to their oath to do good.
"Repressive", "no vote" etc. I believe nothing about Cuba that appears in the US "press." It's not a coincidence that the Times' published opinions exactly match the consensus of the US security state. They will NEVER get over losing their sugar and gambling fiefdoms.
2
Yes, but..... where do people from all over the world come to when they need complex high level care?
1
@Jake Sen. Rand Paul is headed to Canada. True, the US has some of the best high-level care; my local hospital's new stroke care center is likely to be a good thing (I'm susceptible), but at the same time, my county has a lot of people with no health insurance, or poor insurance, and not much access to routine health care.
3
@Jake You are right! Millionaires get the best health care in the world here. You and I have earned our superior care. The other 99%... that's another story for another day.
People also travel to Cuba for health care. Medical tourism is a reality in Cuba.
1
But our "free market" healthcare, which guarantees massive profits to all the companies involved, is the BEST! Right? At least that is the propaganda foisted on us by those making the profits. Oh...right...they meant the BEST FOR PROFITS. Sorry, I thought they meant the best health care. Not even close. My bad.
3
@Joe Rockbottom
There is nothing free market about American healthcare. It's all about the government selecting big medicine cronies, and directing funds to make them richer.
Drug companies, health insurers, big medical systems all got much richer since the Democrats imposed their health insurance scheme on the American peoples.
The big boys are resisting the dismantling of Obamacare because their profits will decline. Gruberized Democrats blame the Republicans.
Had the Heritage Foundation proposal been implemented instead of Obamacare, healthcare costs in the US would be lower, but the big medicine cronies would be poorer.
2
Mr Kristof. Cuba is in America. In fact Columbus was in Cuba but never in the United States.
1
Cuba exported its great health care to Venezuela. Not a success story here.
Coming from Latin America It is hard to understand why US progressists love so much to use Cuba as an example to follow on anything. Hope they would be more balanced in the propaganda they chose to believe.
4
@Bruce Venezuela is its own special case of disastrous incompetence. Puerto Rico and Costa Rica have been on a par with Cuba for life expectancy.
2
The United States should be ashamed of itself that Cuba can maintain a lower infant mortality rate and a basic level of primary care (where many medical problems like cancer can be caught or prevented early on). This ties in to what I hope is the focus of the 2020 election: American-style capitalism's utter failure to serve anyone but the rich. We need only look north to Canada to see how we could be living as a society, instead of how we are.
Canada is a stable, wealthy, and free democracy and somehow manages to provide healthcare for all of its citizens, pay its doctors very well, keep drug costs low, and achieve amazing health results. Republicans, who represent their rich corporate donors in the healthcare industry, are wickedly adept at crafting talking points about the perils of universal healthcare, all of which are simply false. It's time we had a version of capitalism that actually serves all US citizens. Yes--the rich can pay more taxes and still be fabulously rich. Yes, we can all pay more in taxes if it means no more arguing with insurance companies, no deductibles, no copays, and no premiums. We can do it, but only if our politicians can muster the courage to fight for what is morally right.
3
@John
America's healthcare has nothing in common with capitalism. It is crony socialism run amuck.
Cuba has a higher rate of infant and maternal mortality than the US. Only someone extremely naïve would believe statistics published by a totalitarian communist government.
In 2010, healthcare consumed 18% of GDP. In 2017, it was up to 20% of a larger GDP. None of the excess profits went to expanding access to care. All of it went to increasing profits to big medicine donors to Democrats and RINOs like McCain.
No legislative or executive action by Republicans had any effect on medical costs for Americans until 2019.
As long as Gruberized Democrats believe the false narrative that Democrats and Obama intended to increase access to healthcare when what they actually legislated was increasing health insurance to make sure big medicine got paid, it is unlikely that Republicans will be able to improve the situation.
Democrats managed to win 40 House seats by campaigning on healthcare. Just goes to show that many people believe what they are told rather than the evidence of their own lying eyes.
2
I just returned from a visit to Cuba and don't pretend to know all there is to know about the country or its healthcare. That said, I judged the overall health of the country by the good condition of the Cuban population's teeth. Other than the very old (80+), people had their teeth. This is not true of many American cities and rural areas. We drove over 1400 miles from one end of the island to the other, visiting cities, rural country sides, and the poor areas of greater Havana. Despite being a very poor country, hamstrung by the American embargo, the people looked healthy even in the most rural of villages. I've seen much worse in America. But most importantly, there was a sense of community. The universalness of their healthcare system ensures people care about the welfare of others. This is what is entirely missing from our system of healthcare. Ours is based on those that get a lot resenting those who have none, making sure profits are maximized. If taking the most profit out of the system means someone is left out, then so be it, they deserve nothing because they are by default undeserving. Our ingrained national cruelty towards the poor is one of our greatest national sins amplified by blatant racism. One shouldn't have to trade "freedom" for healthcare. Why does America, alone of the rich nations, act like it's a sin to care for ALL of its people?
8
I am an expat living in Germany in the US when I read about the problems people have affording meds, insurance carriers denying treatments, outrageous coverage costs with insane co-pays, lifetime limits and pre-existing I become very angry. I could have the attitude I've got mine but to experience the German healthcare delivery system I simply wish for my fellow citizens to enjoy the same.
If the US didn't spend 700+Billion on on the military-industrial complex annually and give huge tax breaks to trillionaires think about how much we could really Make America Great!
5
@Robert Keller
If Germany were living up to their NATO commitment to spend 2% of GDP, the US could back off on its spending, but the Germans prefer the free ride.
If the Germans were willing to pick up their fair share of international drug costs, Americans wouldn't have to carry the whole burden. Germans prefer the free ride.
They've got theirs, and have no concern about anyone else.
3
@ebmem Germany's healthcare system is half the price of America's. Whatever the reason for Germany's under-spending on defense it obviously has nothing to do with healthcare.
Indeed, if America's system were as efficient and non-rip-off as those in the rest of the developed world it could save half its $3.3 trillion annual healthcare spend.
Just think how many new places America could bomb with that kind of money!
3
“The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.”
Why do you even write a story which is so obviously based on an outright fraud?
To cases: all we need to do is live under an oppressive dictatorship, in grinding poverty, without freedom, and we, too, can enjoy “Medicare for All”? Oh, and universal literacy; don’t forget that.
OF COURSE “Cuban families aren’t ruined financially by catastrophic illness or injury”; what can to take from a family with nothing?
Oh, and how many illegal immigrants – or unskilled legal immigrants – does Cuba have, if you’re comparing it to TX?
No, MD visits are NOT “free”; in Cuba, they come at a hideous cost. Perhaps, instead of “Medicare for All”, you should lobby American MD’s to accept Cuban-style incomes. Let us know how that works out.
In short, if you can enslave an entire country, prevent your MD’s from vamoosing – an ocean is even better than a wall – and fiddle with statistics, you, too, can have “Medicare for All.”
No, thanks.
5
@Brenda
All of the countries that have better infant mortality rates than the US fudge on the statistics. Sweden, the UK, France, Canada all use the same practice. They have limited neonatal care facilities and do not even attempt to care for premature babies born with low birth weights. In the US, if a baby takes a single breath, it is counted as a live birth even if it survives only minutes because it is too small to survive or has profound birth defects.
The rest of the industrialized world treats them as if they were never alive.
It would be a valid public policy discussion to evaluate whether it is a reasonable expenditure of scarce resources to try to save five infants at a cost of $500,000 to $1 million each when you know that only two of them are going to survive, but don't know which of the five it will be.
Europeans have made the public policy choice that they will let all five die. The Cubans and Chinese just lie.
American medical costs twice per capita what it costs in European nations. We could knock it down 45% if we replaced cronyism that inflates drug and hospital costs. We could knock it down another 5% if we paid doctors and other skilled professionals what they get paid in countries with socialized medicine. We could knock it down another 5% if we stopped trying to save premature infants, 5% if we rationed care to the elderly.
IMO, we live with the reduction from $10,000 per capita we pay to $5,500 by eliminating cronyism.
1
I have been to Cuba. I find it extraordinary that a doctor can make more money driving an old Chevy cab than he does practicing medicine! The locals tell me, that primary care is excellent, but don't get really sick as you can die waiting for an operation....On the other hand, I have a friend in AZ. that went to an ER 9 times before a simple problem was taking care of. One time, the nurse had to leave to buy supplies for the ER room... It's time for the US to have more affordable health care for all!! Fix ACA!!
2
@Spunkie
Eliminate Obamacare, which did nothing for access but increased costs. Replace it with the free market Heritage Foundation plan, which will reduce costs by 35% while increasing access.
ACA is so defective it is unfixable.
1
Why not look at health care in Canada?
Why muddy the waters by showing how good it is in Cuba, when that will simply stir up the communist nonsense?
2
There are many factors that don't make a comparison between the Cuban and US infant mortality rates reliable. The US mortality rate may stem from a higher number of high-risk pregnancies related to drug and alcohol abuse, access to birth control and family planning, fertility treatments in older women, number of premature births, mother's age and stress. Access to good quality medical is surely a contributing factor, but but not the only one.
@Anne
Every pregnant woman in the US is entitled to Medicaid coverage. Access to care is not denied anyone.
1
There's a creative way for the US can catch up (or more correctly, down) to Cuban infant mortality rates. Simply stop counting people who can't afford good medical care, thanks to having poor, or no, health insurance. With a constitutional provision for three-fifths of a person in its past, and attempts to fiddle with the census in its future, it should be a piece of cake for the US - perhaps brought to you by the same people who produce our immigrant crime statistics.
@mancuroc I think it turns out that affluent Americans don't do well in terms of life expectancy or other measures of health compared to ordinary people in Canada or western Europe. Low-class Brits are healthier than elite Americans.
1
Michael Moore made a documentary in which Americans were brought to Cuba for treatment, successfully. The point is that allocation of resources for the greater good,has a beneficial effect on society as a whole. The over-65 population of the US benefits from Medicare and it would be reasonable to expect that successful would be one to extend to all ages.
let's be honest, if we took the infant mortality rates of states like iowa or minnesota, they would be better than cuba's. these statistics are misleading when taken without context or understanding. how many immigrants does cuba take in annually? what is the average age of the mothers who have infants who die (i suspect that the US tends to have older mothers and thus more complicated pregnancies and higher mortality rates)? could it be that better medical care in the US allows for more fetuses to come to term, which otherwise which would have been a miscarriage in Cuba and thus not counted towards their infant mortality rate? Are cuba's mortality rates reliable? garbage in, garbage out. the reality is that the US population subsidizes for the majority of the world's medication and innovation in some form or another. our health care system certainly has it's problems and we can do better. but this piece of writing is lazy and superficial.
5
I briefly took a Journalism class at Los Angeles City College and was given a plum first assignment of covering a high-ranking Cuban Communist party member, a guest speaker. I enumerated many of Cuba's health care accomplishments: number of doctors per capita amoungst the highest in the world, infant mortality rate amoungst the lowest, all medical care free for everyone, world-class medical schools free for everyone, when a woman reaches 7 1/2 months of a pregnancy she may take a 6 month leave of absence from her job with full pay, etc.
The teacher/editor of the school paper wouldn't publish my article, "These aren't subjects of interest for college students." There went my promising career - out the window.
3
Sure, it's easy to attack the Cuban (or Canadian) health care approaches/systems and then conclude, self-righteously, that in America, "We're Number One!"
We have problems. A friend of mine had a heart attack last summer. The ambulance ride, about 10 miles, was billed to him at $2,000. No insurance to speak of. So he's paying back $2,000. He works for a non-profit; the payback will take years and take a bite out of his income.
My fantastic primary care physician left the local hospital system to return to her orthopedic specialty. There are no MDs available to take her place. Our only option was a nurse. A young nurse. What's next? The receptionist?
The recent articles about the requirement for hospitals to post pricing were almost funny. The codes are unreadable, the prices all over the place. That was because the law didn't require otherwise, and consumers are no better off. Of course, then there's the issue of whether a particular hospital is in network or not.
I recently binge-watched a British show, Helicopter ER. About the North Yorkshire Air Ambulance Service. The medics were from the National Health Service. The operating expenses were paid by donations and corporate grants (not ideal, but it seems to work). What struck me watching all those call-outs was that not one of those needing service was going to go broke paying the bills - there are no bills.
In short, we have very serious problems that are not being seriously addressed.
4
There was a recent article here about the cost of insulin and how many are making life and death decisions because of the dramatically rising costs. You can Google the difference in price of drugs in the US and in other developed countries. It is, on average, at least 3 times more for Americans. That means the same drug from the same company is inflated dramatically for Americans and the manufacturers make way more profit in the US. If price is a problem, your option is to just roll over and die. Is this a great country or what!
1
If Cuba is so great, rafts can go in two directions. People are not floating from super-depressed Haiti to Cuba, or Jamaica to Cuba., either. Meanwhile, there is so much any parent can do to block infant mortality that has nothing to do with doctors or consultarios. Be married, finish high school, don't use drugs/alcohol during pregnancy, and waiting to 21 to have a child.
5
Comparing health care delivery systems across different cultures is foolish. Our culture is very different than the more socialistic European countries, and certainly very different than Cuba.
We cannot 'fix' our system without a major change in culture. Start with more individual responsibility for your own choices. Eliminate the blame game with suing people for slip and fall and bad medical outcomes that were unavoidable. Eliminate the 'off the books' economy, or at least work towards it. Stop having children you cannot afford.
Maybe start with changing our culture, and then the money will be available for more universal coverage.
3
Cuba is "dysfunctional" compared to what, exactly? There are lots of people right here in rich San Francisco who live in cramped apartments on potholed streets, can't afford a car, and get by without a meaningful vote! AND: They also can't afford to get pregnant, much less become parents ...
3
If these so-called pubic servants,specifically the republicans, stopped spending our middle class tax dollars on obsolete weapons systems (i.e. Stars Wars & newer versions of the same)
Every man, woman and child could enjoy quality health care.
As taxpayers, we are footing the bill for Congressional benefit packages so why aren't we included?
Going broke to paid for basic health care is now an American right of passage. This too must change. Call it socialism, call it whatever Universal Health Care is coming like it , insist on it or continue to pay $398 for medicine that is available in Canada for $27
Many generic medications don't agree with certain individual's body chemistry. No-one should be penalized because a brandname is required.
Most health insurance companies must be run by republican leaning types, who value pricing over people's health.
2
Putting aside the very real possibility that Cuba is lying ("doctoring" the stats), Mr. Kristoff should look at more closely at how infant mortality is determined. Exceptional prenatal care in the US results in many more live births of at risk children. Unfortunately many of these newborns do not make it to their first birthday - and thus inflate infant mortality rates compared to countries where similar pregnancies result in miscarriages or stillbirths. Paradoxically, a high infant mortality rate can be a sign of superior healthcare.
2
Let’s not call it free. I am 100% for universal healthcare for all. However, there is cost to each of us. What always confuses me is that Americans are extraordinarily generous in times of crisis, whether there is a natural disaster or something horrible happens to a neighbor or friend.
Why not take care of each other with better planning?
1
Please, let’s ditch the idea of “Medicare for All”. It’s not what many, including young folks, think it is (it’s not “socialized medicine”).
People on Medicare can still go broke and lose everything.
I recently joined at 65, and wow: in my “market area” I’m now paying an extra $300 per month. So: a job required for the rest of my life to handle that ...and of course it will increase over time.
My friends mom at 90 years old recently fell, was hospitalized, and released after a week to enter a nursing home — and surprise surprise: $400 per day costs not covered by Medicare due to some technicality of whether or not it was “essential” or “prescribed.”
She has the famous “Plan F”, which we’re led to believe completely covers that “Medigap” — the place between what the government funds (from our lifelong payroll taxes) and what Part B (deducted from your monthly Social Security!) pays.
Confusing? Absolutely. That’s the point. Nobody has any idea what you’ve got—what you’re paying for, until a crises occurs. The bills will tell you...
Again: not what you think it is, my progressive friends.
And for the elderly, it’s supposed to be a safety net...but Medicare doesn’t cover vision, dental, hearing. You know, typical old age issues.
Why not invent something else, drawing from the best ideas and systems found in the world?...like Cuba’s neighborhood doctors for starters.
But please: not “Medicare for All.”
That’s still only about profits from the sick and the dying.
2
@Just Sayin’: In my experience, Medicare doesn't even want to know about false claims by doctors.
1
Doctors and nurses in every neighborhood. And neighborhood spies as well. That's a fine trade-off.
Honestly, Mr. Kristof, this is the most specious and preposterous exercise in romantic wishful thinking and cherry-picking I've ever read.
What the US needs is a hybrid healthcare system which preserves its towering leadership--which directly benefits the entire world, especially those socialized systems in Europe who receive our drugs and protocols at greatly subsidized rates-- as a medical and pharmaceutical innovator wholly fueled by the capitalist model, while delivering care more effectively and somehow not bankrupting both the citizenry and recipients. This is a tall order and Cuba is the last place to start.
2
I have visited Cuba twice in recent years and I can attest that Mr. Kristof was shown exactly what the Cuban government wanted him to see. Their healthcare system seems to deal well with vaccinating everyone & offering good basic prenatal care. Otherwise what I saw suggests primitive healthcare once one leaves the Havana area. We visited a what might be called a rural urgent care/ER. There was a doctor physically there, but diagnostic equipment was nonexistent - not even a basic x-ray machine. In the towns I saw occasional elderly people practically blind because of unattended to cataracts & those hobbling along because of hip & knee arthritis. During one of my stays a companion was bit by a stray dog. I urged our guides to confine the animal only to realize there was no functioning way to check it for rabies. At the ER in a larger city, we found that my injured companion could only have the wound disinfected & bandaged. No gamma globulin, no effective pain medication, no antibiotics. The ER physician who spoke English urged me to get her back to the States as soon as possible for a series of rabies shots which I had already decided to do. On my other visit we had a gastrointestinal virus, probably a norovirus, infect our tour group. We strongly felt it was contracted at a prominent tourist hotel in Havana. Since we were on a motorcoach touring the island at the time we had no resources other than to disinfect the bus with hand sanitizers,
This is medical care in Cuba
106
@Art Wilson,M.D.
Dr Wilson, your criticism of health care in Cuba is not an attack on universal health care, but a reflection of the limits of such a program in a poor and economically isolated country. As a Canadian physician, I deeply value the reality that I choose what treatment my patients need based only on medical facts, not economics.
You live in a country that by any objective comparison has the most expensive, selectively inaccessible health care with infant mortality worse than Lituania. Your country is comparatively unhealthy. Health care can be cutting edge, but only for those that can afford and access it. It demeans social support programs as entitlements. Health care is a business in the US, that fails to serve up to 20% of your population. The profit motive drives the system, leaving massive wealth for many physicians and insurance companies.
For the wealthiest country in the world to impoverish or exclude millions of poorer citizens from basic health care is a moral disgrace. As a physician to be blind to these flaws and argue that your system is good, is self serving and offends basic medical ethics. Americans deserve better.
494
@Ian Reid, MD FRCSC
A close friend of mine died because they were abroad and had medical insurance but when diagnosed with cancer the Cuban government refused to admit they had no treatment for it. They demanded the individual come back to Cuba for treatment. But the doctor's admitted to the family that cuba had only one dose of the treatment every 6 months for the entire island. My friend died untreated in a festering Cuban hospital.
Another friend was hit by a truck and the hospital told him to go home and treat himself. He had multiple embolisms and went septic twice.
Another friend was iron deficient and a friend told them that under no condition could they leave their home or else he may lose his licence as a doctor because he was recommended bed rest instead of terminating the pregnancy. Iron deficiency requires that the pregnancy be terminated or the pregnant individual will have the pregnancy involuntarily terminated and see prison time for stealing food and purchasing it on the black market. The baby was born healthy.
There's a joke in Cuba, under the universal healthcare system, everyone is universally sick.
18
@Art Wilson,M.D.: The US embargoes all these thing to Cuba.
32
USA should learn from European democracies about healthcare financed by the taxpayers!
Wanting to learn from the fascist/"communist" Cuba will only make it more difficult to convince Republicans/"Evangelicals" that healthcare financed by taxpayers is something every civilized country must have! Having greedy insurance companies decide whether someone will be allowed healthcare/surgery... is unnecessary expensive, and both stupid and evil!
3
secure border, controlled immigration, then we can talk about welfare for all
It's interesting to me that whenever it comes to health care, access to health care, and cost, we conflate big P politics -- in other words ideology -- with economics. The fact that we in the US deny consistent access to decent healthcare that would result in better medical and economic outcomes is lamentable. the fixes required to address the problem are well known and researched. They range from changes needed in our post-secondary education system that makes it uneconomical for medical professionals to become community health workers to mandating health insurance, either public or private. The fervor that opposes these measures has almost religious qualities. In short, universal access to health care available to anyone living in the US is frequently viewed as un-American. Should that be a surprise? I think not. The same is true for the legal system, education, law enforcement, housing, and the list goes on. The soloution is not socialism, but it also isn't more capitalism. It's an acknowledgement that every system produces the outcomes it was designed for. if we want a different outcome as a society, we have to change the system. If we're happy with the system, we're happy with the outcomes we currently get.
The problem in American healthcare is profits over care. Unless and until healthcare becomes a non-profitable public service, it will not benefit "we the people" but the people who want to make profits more than often at the public expense.
2
As a citizen who is more than happy with his health care for both physical ailments as well as psychiatric (being bi-polar) of Canada I must correct everybody who thinks our universal health care is free. It is not. Our higher taxation than yours pays for this health care but then we Canadians I think, like citizens of other countries with similar care to our own, live in societies where the emphasis on individual rights is secondary to the ethos that we are our brothers' keepers.
Although I loved living and working in NYC from 1995 to 2007 I was constantly astonished by Americans who would tell me why he or she should not have to pay for the health care of a fellow American. These same people of course had no problem with auto insurance where premiums paid by all help reduce costs for individuals involved in traffic accidents.
During my time in the "greatest" country in the world my recurring depression necessitated three hospitalizations - all of which ended not because i was better but because my health insurance would not pay for continued treatment.
I am of course now back living in Canada where my recurring depressive states have finally been treated better with ECT therapy - which I might add was never offered in the USA solely due to the fact that my Gold Standard health care insurance would not pay for it.
5
Just in from the Vietnam Veterans of America:
"CBO Suggests Raising Tricare Fees —health insurance for active and retired military personnel and their families— and Cutting Veteran Benefits to Slash Deficit"
If you think the Trump/republican coalition, that is making every effort to sabotage Obama Care, gives a hoot about the healthcare for 90% of the country then you are sure to believe there was no collusion.
4
Our medical system is simply a legalized system of price gouging. That it is tolerated, is proof of ignorance and apathy.
3
A model that pays physicians less than taxi drivers? No thanks. A college professor of mine, who was quite left-wing politically, recounted a story of going to Cuba with other anthropologists for field work when they were approached by sex workers. Turned out the people were physicians moonlighting as sex workers to pay the bills. This story always comes to mind when people praise Cuba's healthcare.
We should absolutely learn from the successes and failures of other countries' healthcare models to improve our own, but a system where physicians are paid so little they need second jobs is, to me, a complete failure.
2
Because republicans don't want anyone but the wealthy to have health care.
2
The American Capitalist complex, those guys who literally get away with murder and wear American flags in their lapels, but never served their country in any war, long ago made communism the bogeyman, it was good for business to have a bogeyman, and they counted on the stupidity of low information voters to equate socialism with communism. These are also the people who vote themselves gold plated health Insurance plans for life. The fact is everyone defends their style of government because nobody ever wants to admit they are wrong and have been played for saps all along.
Communism is a failed political system, everywhere it has been tried it has led to misery, but Capitalism is not perfect either, meeting in the middle of the two: socialism, seems to work the best, but people in America have been lied to so much by crony capitalists that it will be hard to convince them of that fact. Even though Social Security and Medicare are by their definition socialism in the flesh. It's good that Bernie Sanders has started the train rolling in the right direction, a fight lies ahead but at least thanks to Bernie we have a fighter chance.
4
I you were to take a look at UN pre-Castro medical care in Cuba you would see that the Revolution is simply taking credit for medical tradition dates way back. You failed to note that pre-Castro statistics show that Cuba's infant mortality in 1959-60 was right behind the US and Canada. Furthermore, Cuba has at its disposal what amounts to human slavery as doctors; they earn little, cannot leave the country when they want and may be sent abroad to bring in foreign money.
2
"She also gets by without a meaningful vote" For Kristoff participating in a democratic system from the bottom up where you elect people who even represent you at your appartment building all the way up to Congress has "no meaning". What do you compare that with? Maybe the US where you need to have millions of dollars to be a candidate, winner takes all makes almost impossible a 3rd party different from the existing center-right and extreme right options, and even if you get more votes than your opponent doesn't mean you actually won. Should I mention we are the only country that votes in a weekday that is not a national holiday and people feel their vote is so useless that over 90 million eligible citizens decide not to vote, or that the lines to vote here do not exist in any developed country in the world (maybe I should add ID racists laws to the mix) and all of them have higher participation than us? And of course using the racist principles not only to keep the electoral college but also to have a senate where Montana's vote means the same as NY, CA, FL or TX? 1 person 1 vote?
You really think you have ANY authority to pass judgment on another country that you know almost nothing about?
2
We can also learn from Canada, France, Germany, England, Japan, Israel, the Netherlands and many other countries, all of which have some form of universal healthcare, pay half or less per capita of what we pay and achieve better results.
5
Unsure right now about those "meaningful political rights" that you say we enjoy...
1
In your "email teaser" for the main article, you write, "A Cuban family doesn’t enjoy free speech or a meaningful vote, and the economy is dysfunctional". Other than the free speech part, Cuba sounds a lot like our country except they have a much better functioning government.
3
And then there is the childcare issue which is more easily accessible in Cuba. And the insulin issue here, I saw a person walk away without their insulin when they heard the price. Outrageous!
The callous American attitude toward healthcare is in our DNA - part of our founding history and every American marinates in it from the day they are born.
The template for our attitude was forged in 1630 by John Winthrop (Puritan leader and future governor of Massachusetts) in his famous “Model of Christian Charity” (“City on a Hill”) speech. The speech opens with these words:
“GOD ALMIGHTY in his most holy and wise providence, hath so disposed of the condition of’ mankind, as in all times some must be rich, some poor, some high and eminent in power and dignity; others mean and in submission.”
This Puritan ethos leeched into the wider Protestant ethic declaring an ordered chain of being, a natural hierarchy within humanity that was sanctioned by Providence.
That divinely-created natural order allowed for a lot Christian wiggle-room, and justification for a lot of Christian hypocrisy. But there it is; nothing we can do about it; that’s the way of the world – or of America at least. Because as Winthrop went on to say: “we shall be as a city upon a hill. The eyes of all people are upon us.” It went to our head. We believed it. And the profits of such an arrogant attitude went into the pockets of those who exploited such a social system.
So our healthcare is there for those who are ”high and eminent in power and dignity,” who can afford it. Otherwise: it’s likely you haven’t been chosen for salvation – earthly or heavenly. You’re disposable.
It’s the American way.
9
Great article. But this information has already been available to anyone who cared enough to look and who wasn’t blinded by the cries of conservative demagoguery – “Socialism!”
There is no greater mirror of who we are as a people than our health system. “The greatest country in the world!” Check the stats for a reality check. What America is great at is fooling itself.
In a self-proclaimed Christian country, we seem to have very little Christian charity and compassion. We perceive healthcare as a privilege while other countries (lousy Communists!) see it as a right. What they know (and what we don’t want to know) is that a healthy society is more productive, happier and less stressed.
In a former job I worked with a Canadian sales team that represented our products. In a wine-fueled moment of candor I once asked them why they seemed so carefree. They looked at each other, sighed and said: “You Americans are afraid of your own shadows; we have a safety net.”
America views society as a gladiator arena. Some win, some loose – it’s the American way. Underpinning this attitude is capitalism; healthcare is a business. Business is about profit. Never mind that the profit comes at the expense of human pain, suffering and death. It’s just the price of doing business in America.
6
This reminds me of what is happening in Brasil. Bolsenaro thought that he should send home these awful Cuban doctors. Long rows before medical centers. People with serious injuries have to wait and wait.. This is what rightist, conservative rulers do, they only think about what they themselves need. Even in my peaceful country the right thought it a very good idea to privatise the care. Luckily we have a more-party system so the social democrats can try to keep the lid on the pan. You can guess what would happen if not: more money to the rich and the very rich. In that respect my country is already doing bad, I'm afraid. 2020, I would like to cite Socrates, vote left and do not think the conservatives will help you better. They never never do.....
3
I like the ingenuity of the author. Don't you wonder where that number came from. I had a baby born in cuba and 2 babies born in the usa. There is no way that number is real.
1
@rac You should be at the top of the list. If Cuba is a poor country, look at how it started. Castro hoped that the country of freedom, next door, was going to help the poor Cubans after their grab for freedom. But the freedom of the US is only for the rich.....
2
Do you really believe that Americans can accept that other countries might (and actually do) have better solutions?
The knee-jerk "It is socialism (or worse communism)" does not allow for any improvements.
Regards
2
If a poor country like Cuba can train enough doctors to put a clinic in every community, why can't the richest country on earth?
3
Oh my. Yet another "Cuba is awful but..." column. I've been hearing this since Fidel and his gang took over the place. People who should know better twist and turn to somehow put a gloss on a regime that has beggared its own people and kept them in servitude for +50 years.
Maybe you asked: if given the choice, where would Claudia like to raise her new baby??
3
OK..so they have doctors that walk the street and answer questions and we have WebMd.
The only suspicious thing about this article is that Cuban government officials don't let western media types just walk into their country and begin interviewing doctors and nurses.
This is all carefully orchestrated so that Nick is seeing the good side of their system..not the nasty ugly parts which is most of it.
The other reason Cuban's have better healthcare is because in Cuba their truly is moral hazard.
If you're 400 pounds in Cuba, you're dead.
If you're 400 pounds in Miami, you have Medicaid pay for your fat reduction counseling, your high blood pressure meds, your diabetes meds, your amputation of your right foot when you get gangreen, etc...
If we had moral hazard here, our health care outcomes would be 10x better because shows like Ridiculousness wouldn't exist because people wouldn't be sticking bottle rockets up their rear ends or jumping bicycles off of rooftops into pool(decks).
Take away 90% of the cars in America and make everyone walk..limit their diet to 1500 calories a day or less...and America would have the best healthcare outcomes in the world...and our health care expenses would be 1/3 of what they are today.
1
@Erica Smythe
Erica, I don't think there are too many 400 pound Cubans walking around, because of poverty and tight diet.
Whew. Move over Michael Moore. As a cartoon propagandist you've lost a step or two on Nicholas Kristof.
Unlike most who'll read this nonsense, I've been to Cuba, several times, know Cubans and know former Cubans who are lucky enough to now be Americans.
Anyone stupid enough to believe that Cuba has better health care at any level than America needs to do a little real research -- the DMV -like lines for the most simple procedure, the numbing bureaucracy, the interminable wait for medications.
Or just ponder why two million people who used to live there -- nearly 20 percent of the population -- risked their lives and abandoned everything to get out.
3
After reading the first two paragraphs I was wondering why Kristof was writing this, since, at the outset, he puts doubt on the statistics he's writing about. With no explanation he claims that the Cuban people can't speak freely about politics. Then he describes the closeness between the people and their doctors—frequent home visits, advice on home safety for infants, etc., and free dental! Free Dental!!! Nobody in the U.S gets free dental! He makes no mention of how, in the U.S., Child Protective Services routinely involves the police, court fees and punishments such as jail and ending parental rights altogether for people addicted to drugs or who commit petty crimes—crimes of poverty. He also fails to mention that education in Cuba is free to everyone from cradle to grave; that there is free food and housing subsidies; that Cuban's vote locally on issues affecting their communities and for their representatives in those communities, or that the U.S. Embargo economically oppresses the Cuban people by prohibiting other countries from trading with Cuba. The U.S. is the richest nation in the world yet we still have communities with no running water or flush toilets. And, as for “democracy?” Well, we get to vote for one wealthy liar or another.
2
Left unaddressed in ALL these discussions of health care transformation is the cost of educating physicians. Let’s get a. Few facts only he table- the vast majority of cuban “physicians” are woefully trained by American standards...their training and expertise is equivalent to Nurse practitioners in this country. Now I hear a lot of nonsense from organized nursing about the equivalency between NPs and physicians with 5-10 years more training, but of course this is risible. And ask ANY NP who their doctors are, and invariably they are PHYSICIANS except for basic OB-GYN and uncomplicated deliveries. Who among NYT readers (and I dare say reporters -Times staffers - would choose NP and PA care if they have US trained physicians options ? But most importantly, there will be, and should not be, indeed cannot be, any movement in this regard until we step up and pay for doctors medical education and give them a decent stipend. When I see posters decry the “mercenary” attitudes fo doctors, try dealing with $250,000 or more in educational Loans , not to mentioned the even greater deferred income of not working for 4 years , and then being paid minimum wage for 3-7 years of residency and fellowship- even with the will and political commitment, such a transition will hav to phased in. Students can be persuaded to work for less if we pay for their education, but what about teh extant doctors with large loans already ? They will appropriately and reasonably object to changing payment.
2
The city of Idaho Falls population is right at 61,000 with a metro area population of 133,000, with the medical community being the most comprehensive health care delivery for eastern Idaho.
It is amazing to see the buildings housing this delivery system. A large hospital, with at least two other competing specialty hospitals, numerous clinics and doctors offices (including dental).
The largest and most expensive buildings in the entire county are the medical buildings, including doctors offices here in this town.
The health care delivery system in the U.S. has become a big money maker, a far cry from what it was even as recently as the 1970's when I was employed in hospital administration.
Something has to give! I know of a retired couple who are a bit too young for Medicare, who pay over $1500/month for health insurance. I'm thankful for Medicare and still have out of pocket expenses and I'm healthy!
Medicare For All with some reform of the cost of the delivery system.
3
Breast lump suddenly appeared within 24 hrs of landing in Paris. Same day I went to a walk in clinic and had an MRI, then an ultrasound then 2 consults within 8 hrs. $125 later it was determined it was a benign cyst. Wow, even as a Canadian where I'm generally a huge fan of the system here, I was impressed. It's not rocket science, folks.
6
Dig deeper into the statistics. I suspect Cuban mothers are healthier and younger, therefore delivering healthier newborns into this world. Many materialistic Americans delay having children until their biological clocks are running on empty.
3
Another provocative article, with several good points made by Nick. As I recall, Cuba has also provided free medical training to underprivileged American students, aiming to improve primary care in the US! May be it was part propaganda, but nevertheless a great example on how to move our dysfunctional health care forward.
4
Need to base medical services on the need basis, not the profit basis.
5
From an insider's perspective on the Cuban healthcare industry here are some questions worth asking, question's no one is allowed to answer. How many abortions are carried out in the Cuban healthcare system? How many of these are voluntary? How many women have more than 2 children? Are pre-natal visits to assess how the revolution can help a fetus or how much risk a fetus exposes the revolution to? The hospitals in most Cuban towns have no windows, no cameras, and no one leaves with notes. They are dark and filthy, the bathrooms have no toilets but are holes in the ground. The doctor's lack support and resources. One syringe a month, maybe a bottle of aspirin, and a pair of gloves. They are followed and their paths and activities heavily documented. Their children are followed and schools have special instruction to watch the child's behavior. The UN recognizes cuba's healthcare system as the largest government sponsored human trafficking system in the globe. I have many family members and friends who are currently under slaves as Cuban doctor's, their kids are held hostage by the system and they live in foreign countries being threatened by the locals, and daily watched by the Cuban government.
4
I have visited Cuba twice and have seen their healthcare. A psychiatric facility was clean and the residents had crafts, ballet, sports, and music. I saw their medical school where anyone can get a completely free medical education, including students from the US. I did not see any homeless people. All this in spite of being a very poor country burdened by our trade blockade.
7
The comparison with Cuba is unhelpful: yes, it has a great healthcare system. But no, we do not need to emulate an authoritarian communist country to get 'Medicare for all'.
Medicare for all will look more like a single payer system in countries like Canada. Nobody is suggesting that we nationalize the medical system. The idea is simply to expand Medicare so that younger people can use it as their primary insurance provider (i.e. to use Medicare exactly as it's used now).
3
It isn't just America's obsession with money and greed that keeps us from having healthcare or Medicare for all. It's also abortion, contraception, pregnancy, birth, and women's care in general. The white male Christian culture opposes paying for women's healthcare via universal care. It's not just about the expense of it - it's also about ensuring that women DON'T GET care. If women can get care without being dependent on their husbands or their employers, and won't go bankrupt to stay healthy, many more will be able to start businesses, run for office, get divorced, invest in stocks, etc. The current system helps to keep women impoverished and disenfranchised. For at least 40 percent of the US population, and corporations everywhere, that's a goal unto itself.
3
When healthcare reform was passed, as a Type 1 diabetic I finally was able to obtain an insulin pump without having my claim denied.
Since then, the GOP has incrementally been destroying healthcare reform.
Winston Churchill referred to universal healthcare as a necessity to "ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
Lincoln referred to Know-Nothings as detestable - and Trump foots the bill as a Know-Nothing as does his GOP.
They claim we have the "best healthcare in the world" - but only if you can afford it.
Why does having a life-threatening illness in our country have to be such a battle for the right to live.
The pump has helped to stabilize my blood sugars. Although a sensor device was recommended by an endocrinologist, the insurance provider denied the claim for one.
I know who I have to thank for that since I've followed what the GOP has done to destroy the benefits and functionalisty of healthcare reform.
It really is a shame we the people can't obtain the health insurance Mitch McConnell is getting on our dime.
6
If you visit the article below, you will find that for all the money, technology, doctors, hospitals, and knowledge, the USA is way up the list of infant and under-five mortality rates.
https://en.wikipedia.org/wiki/List_of_countries_by_infant_and_under-five_mortality_rates
Money,money,money is all what the USA is about when it comes to healthcare. Shame on you USA!!!!!
1
Don't worry. The invisible hand of our free market economy will sweep in and fix everything. Just keep giving the billionaire class everything they want. Privatize it all. Our healthcare system will be perfect. Any day now. Any day...
4
For all the claims that the US is the world leader in medical innovation: it spends more than twice the per capita rate on health care of the average of 30 countries with better health statistics.
4
Mr Kristof, Is it true that Cuba has much lower rates of childhood autism than we do? Or could it be a measurement issue. I'm among those that see an epidemic of autism in the U.S. and think we should seek information about its cause.
We should do the exact opposite of Cuba.
Cuba has basic medical care, but contributes nothing to medical research. Their doctors are basically mechanics.
What we need is a radical deregulation of medicine. A full conservative approach.
The cost of medical services will decrease and the quality improve as they are subject to free market forces. There is no reason why the average cost of an MRI is $2,611, aside from the heavy hand of regulation.
Eliminate the tax incentives for health insurance and medicaid. If people are paying the bills themselves, they will seek the cheapest and best service.
The market will meet consumer demand, including the poor. The safety net can be expanded to provide cash to those who at a given point in time need it, and they can make their own health decisions
2
Unfortunately, too many people in the US want to be "under the radar" and purposely avoid institution or Government agencies.
2
We can create a Medicare system that's equally accessible to everyone, portable no matter where you work or if you work, that never requires people remain poor like Medicaid for medical care, and where Americans will never wonder whether to purchase groceries or medicine, despite politicians who mock a shiny new Medicare card. States like California can create CA Medicare and show the beauty of becoming self-insured through a public, nonprofit insurance pool to the nation. California can pay claims directly as a single payer or contract with third party administrators to pay claims, a business model found in every self insurance fund. Like a Canadian client jokes, "You still have time to get it right."
When I went to Havana last year I was appalled by the living conditions; it looks like a war zone. I was told to bring aspirin and other medicines because there was little to be had. The pharmacy's don't have medicine. Our guide told me he could get a hip operation, but no treatment for a cold. He told me everything is "plan B."
I also live in France where there is Universal healthcare and it works beautifully. I often get my heath care taken care of there, without using my insurance, because it is so good and so affordable.
I think France is a far better example of a well functioning universal healthcare program, as well as existing in a democratic, capitalistic society much like our own in the US.
6
US drug pricing has only one input that matters: whatever the market will bear.
2
yes all citizens have access to medical care, and primary care is accessible. Although a patient in a hospital might be required to provide its own bed sheet, pillow, fan (most rooms don't have AC or is could be turned off), cleaning products and a bucket to clean the room and the bathroom, food, etc. on top of all of this if you want good service from doctors and nurses some kind of individual payment is necessary (cash or goods). Not to mention all the medicines that are in short supply. This is based on my experience in the Cuban healthcare system.
4
Cuba is just one of many nations who manipulate their neonatal and maternal mortality rates in order to compare favorably with other countries. They do so by deliberately categorizing neonatal deaths as stillbirths. That’s why it is much more accurate to look at PERINATAL mortality, the combination of late stillbirths and neonatal deaths.
According to the World Health Organization (2006) Cuba’s perinatal mortality rate was 14/1000 compared to the US at 7/1000. In other words a Cuban newborn is 100% MORE likely to die or be born death than an American newborn. That’s not something we want to emulate!
7
U.S. infant death rates are higher than n comparable countries due to differences in reporting procedures. Aa recent paper from the American Economic Journal found that data difference may explain up to 34 percent of the difference in infant mortality rates between the U.S. and comparable countries. A primary factor is the dearth of premature babies. The United States counts the death of premature babies as infant deaths while other countries count many of then them as stillbirths.
5
yes. I looked at data collection in different countries and found that US counts live births differently. this has some relevance to infant mortality rate being so much higher in US than other "developed" countries.
2
I lived in France and went to school there. As a student when I got sick, I had to pay nothing when I ended up in the hospital. Similarly, I paid next to nothing to replace my glasses. So all in all, I prefer a system that takes care of such basics as health care, higher education, child care, elder care, etc. We pay a lot of taxes in the US including Federal, State taxes, sales taxes, etc. and see very little in return. More than 25% of our Federal taxes go for defense. Defense contractors enrich themselves while babies die. That doesn't make sense. Paying for weapons should not be before people.
16
Yes and that large defense budget helped protect the EU from Russian aggression and conquest for half a century and counties to proved a large measure of security. If we spent 50% less on the defense of the world and its sea lanes from Russia and China, we could offer Medicare two all for sure- I’d love to see Britain rule the waves again but it ain’t happening.....ist petty top think we spend too much on defense but what really are our options ? Yes I agree we can avoid the Afghanistan’s of the future, but to stay out of the Middle East and Korea/South CHina sea will INCREASE the risk risk of large scale war and even nuclear weapons use, and thats not right wing fear mongering from the pentagon and neocons...
2
Having just returned from Cuba, I can say that even with free medical care, there are few medicines available. This appears to be partly true due to the embargo, but I feel certain it is also due to economic mismanagement. Cubans, for the most part, appear (and say in low voices they are) discontent with the system.
That being said, I am in favor of socialized medicine as it not only makes for healthier citizens (and saves lives), it makes for people that are more content and less stressed. If the system is well run, it can actually save the government money in terms of allowing for more efficient production (healthier and happier workers are better workers).
It is true that some doctors would flee to other countries if their salaries were not as inflated as they currently are, but with enough incentives, and with taxes high enough to cover adequate salaries, these problems can be ameliorated. Look at Sweden and Denmark as models.
4
I'd like to know how many hip replacements are prescribed for pain caused by pinched nerves. Every expensive procedure undermines the incentive to obsolete it here in the US.
1
@Steve Bolger
I had a hip replacement and it wasn't for a pinched nerve. It was after a year and a half of barely being able to walk thanks to destruction of the bone by a relatively rare condition.
Your progressive dismissal of a procedure that keeps large numbers of people mobile and productive shows just how compassionate progressives really are.
BTW the relatively rare condition I had is not uncommon in those with Sickle Cell Disease. Who's the racist?
I've seen many of your posts and you sicken me.
As always, Mr. Kristof delivers an unflinching and inspiring argument--always challenging us to make the world better.
As a suggestion, for journalists who might find this subject up their alley, I wonder what attitudes outside the US, in countries with perhaps simpler but universal healthcare, are toward home births... whether the wariness and outright demonization of medical intervention can be found so commonly in countries where healthcare is egalitarian.
It is worthwhile scanning the World Health Organization data for Cuba versus the US. You will see some surprising stats for not just neonatal mortality but also maternal mortality and overall life expectancy.
The difference is that Cuba takes a primary healthcare approach - focusing on prevention.
Canada does better than the US in healthcare overall, but we also could learn from this community-based approach that works on prevention and not so much on "end-of-the-pipe" medicine.
Finally, in both Canada and Cuba, citizens are virtually free of any mental anguish about the cost of insurance or the probability of catastrophically costly health events.
3
As a retired health plan CEO who ran both non-profit and for-profit health plans, I became acutely aware of typical motivations for practicing medicine in American society which contribute to the reality that health care is more expensive in America than in other countries and that the volume of care provided in America is greater. Medicine is a path to wealth in America and many people who become physicians are financially driven. (It’s also correct that people enter the field because they love science, because they enjoy problem solving, and/or because they desire to help people). As for corporate participants, it’s all about making money for the vast majority. There are refreshing nonprofit exceptions, but providing (or in some circumstances, the avoidance of providing) health services is simply the tactic employed to produce wealth in the dominant for-profit sector.
Details of how healthcare in Cuba is provided aside, the essential differentiating fact is that wealth generation is not the primary driver in Cuba. Our challenge in America, in my view, is to organize healthcare systems which provide high quality care with the most efficient and appropriate use of resources possible, where such systems and the people who work in them are reasonably rewarded for helping people stay well and for providing the right care in the right place at the right time when they are ill. Innovation should be publicly funded.
9
For far too long, Cuba has been treated politically as a bogeyman, with no room to see the nuances. But the healthcare Cuba offers its citizens has nothing to do with oppression. It is akin to that offered by Democratic countries like Canada, England and France. Let's separate an admirable medical system from Cuba's stifling governmental system.
2
Cuban doctors provided the only medical care available in much of rural Brazil, in a deal with its socialist leaders. The US objected constantly.
Now that a US friendly President has been elected, one of the first things he did was expel all those Cuban doctors. There are no replacements.
The US backed system is, "You can't have a doctor" in Brazil. Then again, that is the US system in too much of our own country.
8
Medicarer as it stands is not free. We pay the monthly premium with a deduction from our Social Security benefit.We then pay 20% of every office visit or treatment once Medicare haggles down the fees to a reasonable cost. Contractors administer Medicare payments and decide when to refuse payment. If Medicare refuses to pay there are 5 levels of appeal, the final step is in court. Attorneys specializein appeals. Private insurers specialize in profiting off the 20% coinsurance by overcharging high premiums to cover the 20%. Root out the profiteers, make the entry premium affordable on original Medicare and reduce medical overcharging and we have universal health care.for that small
2
Wow, a lot of what seems to be willful misunderstanding of this column in the comments section. Cuba's system is not perfect, and its government is a wreck. But what, really, is there about our health system to defend - unless you're a member of the 0.1% and are okay with everyone else laboring under the nagging worry of a medical crisis?
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@Diego
US government is not looking very impressive right now.
6
Yes!!! Thank you!
4
@Diego = I think a lot more than 0.1% of US people had health insurance even before Obamacare. Moreover, hospitals have long provided free care to those in need.
The health problem in the US in not health care, per se, it is public health, which is more than medical care and insurance. Eat right. We don't need to hire doctors to tell people to eat right. That comes more from sound families with concerned parents. Sounds a lot like the 1950s, doesn't it? Go back and look at pictures from that time--not many fat people then.
Evaluate health care in the US apart from obesity, it looks a lot better than it is . Tough to blame doctors and health insurance companies for people being fat. You can talk to people until you're purple and they'll still eat poorly and drink too much alcohol. Go back and teach morals in grade school and high school. Give teachers and police authority to enforce the rules. Encourage marriage and the nuclear two-parent heterosexual family.
3
I'm not a health care professional but I found this to be fascinating and maybe a key to how our health system can improve. Maybe we need to bifurcate our health system - a community based system with less specialized caregivers who live and work amongst their patients, and a referral system to treat conditions outside the capacity of that system. There is a movement across the country that supports local economies by encouraging citizens to shop local and support local producers. Why can't this also apply to health care?
1
Where are you going to find these providers? Medical grads are buried under catastrophic amounts of student loan debt. We have families to take care of, too.
In order to balance the outcomes of the health system properly it is necessary to examine where its funding comes from.
Cuba might be focusing many of its public funds to health not paying attention to other areas such as infrastructure, quality of education, the rule of law and human rights. From the article we can´t tell this.
You could be physically healthy in a country where you don't have freedom and access to other basic goods and services like clothing, transport, food, internet and education of high quality. This could be like living in a cage with good health.
1
"With its doctors, Cuba creates a global public good"
That is a Peace Corp, but with doctors.
The US send sometimes sends one of its two military hospital ships to the scene of a disaster, which can be a big help depending on how events develop (sometimes it has proven not needed, but better to be safe than sorry).
France did its "civilizing mission" in Algeria in the late 19th Century in part by setting up medical clinics to win over the population. The idea isn't new, the French Foreign Legion commander did it first 150 years ago.
The US has volunteer medical missions that do wonders, like eye doctor teams. There is a French medical organization which does this on a much smaller scale than Cuba.
Australia since WW2 has its "flying doctor" system to serve its huge Outback, doing at home (as does Cuba) what others do only abroad.
Is this the America we imagine, when we are proud of our country?
2
It seems to me that Cuba's biggest problem is that they do not want America to step in and buy them out, and America insists on the right to do so. So their economy remains in terrible shape because their huge neighbor has had them under embargo for 60 years.
But basic medical care, especially the training of doctors, is not subject to embargo, and the Cubans are doing a good job of it.
I had really hoped that this situation would resolve itself under Obama, but now we appear to be slipping back to the way it was before.
Cuba could be a model for how a small nation can protect itself economically from an acquisitive larger nation. If we'd drop the embargo, the world might get to see how this works. But the embargo could be a model for how the larger nation can push back and bully the smaller nation into economic submission.
2
"How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism."
I would say a HUGE dose of skepticism.
Would that it were true. A good idea gone sour.
3
I help to run a physician group whose mission is better health care for less cost. Copying Cuba’s health care system here in the US, in other words “Medicare for all”, would be a disaster for both the US and the whole world. Why? Capitalism and innovation. As the author notes, physicians in Cuba are paid so little that a taxi driver makes more. What the author doesn’t realize is that those physicians in Cuba would have no methods to treat their patients if not for the innovations that come from the US. Estimates in the medical literature note that approximately 75% of all medical advances come from the US. This is no accident, it’s because there is a profit incentive.
Also, the article mistakenly suggests that there is a binary choice between Medicare for all and our current system. In fact, every country’s health system a blend of government- run and free-market services; even England’s renowned National Health Service has many holes that are plugged with a secondary private insurance system. Having studied these systems for years it’s clear to me that the best chance to improve the US health system is Obamacare; a US-tailored blend of government and private incentives for better preventive care (which we sorely lack) and competition for better prices and lower-cost facilities. There are many physician groups leading the charge for these improvements now in the US, including ours. And we’re making real progress.
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@No labels
Cuba is innovative too.
11
@No labels In reality, being cut off from American medical suppliers by the embargo, has meant more innovation by Cuban doctors and scientists. The government has invested heavily in biotech research and has developed its own pharmaceutical industry. One result is an innovative lung cancer vaccine called Cimavax that as Mr. Kristof points out, is undergoing clinical trials in the U.S.
32
@Nb would love to see how. Show me.
2
Mr. Kristof, you answered your own question. Cuba trains three times as many doctors per capita! and I am sure, at completely free universities and then pays them...$45 a month.
A US doctor makes roughly $150 an HOUR. DO THE MATH, sir!!! even adjusting for the lower cost of living in Cuba, this is a factor of like 10,000%.
Also, in the US...the AMA has worked diligently for over 75 years to keep the number of doctors low so that there is little competition and no price controls. As a result, US doctors earn far more than any in the world. In Germany, which is a very affluent thriving first world nation....a family practice doctor earns about $80,000 a year. In the US, they earn about $250,000 a year or 3 times as much! and taxes here are much, much lower.
Mr. Kristof, I live in a neighborhood adjacent to TWO world-famous teaching hospitals and as a result, many young interns and residents live here. I've had many as neighbors and talked to them over the years.
I've asked, straight up, if they would trade the long hours (which they complain bitterly about) and high cost of med schools (ditto) for reasonable hours & free or subsidized schooling for a more moderate salary. To a man (and woman), they reacted in angry outrage! they did not go into MEDICINE, the toughest & most competitive major, to live like ordinary shlubs! They did to be RICH! to get out of my "lousy working class suburb", own a McMansion and a Mercedes. They are blunt about this.
9
@Concerned Citizen
Nothing wrong with getting rich. I am sure they are fine physicians.
2
Cuba is a communist dictatorship. One family, and those that family choose to be part of the government, control every aspect of the country.
I'm sure Cubans enjoy their healthcare, but I'm also sure they would enjoy more not having the government control everything about their lives.
If the price of obtaining "medicare for all" is to subject a country's citizens to a communist dictatorship, then I say the price is too high.
If this is your best argument for that policy (which I know it is not), you aren't helping yourself here. Dictatorships are neither necessary nor sufficient to obtain the goal of medicare for all in the United States.
You can do better.
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@Ben
Ben, your response is really quite naïve. The cost of adopting a Medicare-for-all style healthcare system does not include becoming a 'Communist Dictatorship'. Multiple countries provide universal healthcare with superior cost benefit outcomes to that of the United States. Dismissing the evidence fails to remove the shame that our healthcare system produces higher infant mortality rates than our impoverished neighbor. We can do better and we should be discussing it.
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@Jim O'leary
I support medicare for all. The point I was trying to make is saying "look how good this medicare for all system works inside a communist dictatorship" is not a good argument.
Did you see the part where I said that being a communist dictatorship is neither necessary nor sufficient for achieving that goal? Maybe you should re-read my comment :)
8
@Ben
The US is a billionnaire dictatorship which does not provide basic services to regular people but only to rich ones, whether in Helth, Education, Lodging, etc.
"They ( billionaires) are the one that control everything about our lives" through advetisement and lobying, not to mention the billions spent at election time.
In fact poor people are not really free but subject to GAFA and other bilionaire agenda which is to make more money.
So it would seem that a "dictatorship" which provides for all is preferable to a "dictaorship" which provides only for a few...
61
Thanks for the look at a healthcare system long admired by many outside Cuba.
The issue of valuing MDs and nurses is so important, as is their role in a society.
One issue: please consider stopping references to nurses as ‘the doctor’s nurse’. This diminishes the distinct professional role of nurses, and their complementary relationship with the work of MDs. No nurse is the doctor’s nurse. She or he is the patients nurse. You can state instead that the physician/doctor works with a nurse, not that it is his or her nurse.
Interesting also to note that many Nurse Practitioners in the US work similarly to the Locally based MDs in Cuba.
6
It would be HELPFUL if opinion writers would STOP!!! calling Medicare for All....FREE... or any other healthcare for all system in the world FREE. Everyone pays for Health Care through taxes. This includes poor people, as well as, the rich. It makes healthcare available for all at affordable costs. People can get care and focus on getting well without worrying about financial ruin. People have more freedom in taking jobs or starting businesses. Businesses are freed from trying to provide healthcare for employees.
2
@Mikki
Absolutely right!
Cuba does it while the US embargoes its access to drugs. I will never forget the delight of an asthmatic Cuban when my wife gave her an asthma inhaler, evidently unavailable in Cuba, when we visited it in 2002.
3
@Steve Bolger Yep, I took a large bottle of aspirin and a can opener for friends. Left everything I could behind.
1
Not smart on Kristof's account to tout the health care system of a communist country. Certain sensitivities have to be recognized. Now watch the political right call him a communist.
Better would have been to visit the health care centers in the Anglosphere: Australia, New Zealand, Canada and Great Britain.
1
Shareholders in our repressive insurance, pharmaceutical & 'administrative" system of bloodsuckers should be required by law to visit the homes of those financially ruined by sickness & disease.
Some are the same people upset that Cuba is no longer the former paradise of casinos, heirloom hotels & prostitution. Idle minds with excess spending capacity; the definition of freedom?
1
Universal Healthcare is not a system of simple addition, if we want “everyone” to have access to a level of care according to individual needs then it will cost lots.
The costs will be immediate, short and long term. In order to support UHS (Universal Healthcare System) we have to invest in public education so that we can grow the skills needed to support “everyone” having the level of care they need.
I think town-hall meetings should happen throughout the nation were discourse happens over a course of maybe 18 months. Each city that engages is awarded for participation by voting on UHS; a sort of modified democratic approach.
Let’s keep engaging here NYTs
Americans, except the wealthy, are grossly uninformed in too many aspects of living, especially in healthcare costs.
Perception management by corporate America, the true government of the U.S., is the reason; the only real unity is in the corporate boardrooms, united in keeping Americans deaf, dumb, blind, and stupid, to the truth of the widespread increasing rape and pillage they are being subjected to each and every day.
Americans are seen by corporate America as a commodity, an evergreen economic reality, one that is self-sustaining, eternally renewable, dependably generating wealth for the .01 and 1%ters until the end of time.
Numerous studies have been carefully done, examining our current rapacious system of healthcare, comparing it to a taxpayer funded system, the same as exists in the EU, in Russia, in Canada, in nearly every developed nation, and others we consider 3rd world, proving beyond doubt that if we were to emulate any of them, especially the EU and Canada, the annual savings would be in the hundreds of millions, see following Washington Post report -
"The U.S. is projected to spend $7.65 trillion annually on health care by 2031, according to the Mercatus study. That number would drop to $7.35 trillion if Sanders’s plan were implemented, the study found."
https://www.washingtonpost.com/business/economy/does-bernie-sanderss-health-plan-cost-33-trillion--or-save-2-trillion/2018/07/31/d178b14e-9432-11e8-a679-b09212fb69c2_story.html?utm_term=.9494470fe673
2
I live in Miami and speak fluent Spanish. For years I have asked arriving Cubans about Cuba's health care system. The reports I get vary wildly. One problem that people consistently complain about is that Cuba lends too many of its doctors to foreign countries. One day you go to your GP and you discover that he's gone to Venezuela.
Second, there is a shortage of medicines and of medical equipment, such as machines to do CT scans or MRI's. Also the waiting list for advanced procedures like heart surgery can be very long, and you may have to journey to Havana for anything of the kind.
You will hear it said in this country that Cuba can't get medicines or devices because of the embargo. Don't you believe a word of that. I'm a financial planner. I had a Cuban client that got very rich by forwarding medicines and other merchandise to a partner in Colombia, who then reshipped them to Cuba. Cuba can get anything it wants from this country. The trouble is with the country's economy: it keeps the country including the government in a state of poverty.
Finally dental care is horrendous. My dentist and his wife, who is also a dentist, both Cubans, tell me that people over 70 rarely have their teeth. He also was an oral surgeon in Cuba. I told him of a cousin who diagnosed with cancer of the tongue and cured of it. He replied that in Cuba oral cancer is "un sello de muerte," the seal of death.
Remember that the regime uses claims about its health care system to prop up its legitimacy.
2
So these issues do not stem from the US embargo? Think again!
Not that mysterious because like most of the world, Cuba's healthcare system has been optimized for health/safety - not revenue/profits.
NB: There's no standard definition for "universal health care" so it's really best to use universal coverage because how universal coverage is paid for can be either single or multi-payer. The payment part is largely irrelevant because it's not a big economic lever. The big economic lever is single pricing and (spoiler alert) universal coverage is really just the delivery mechanism for single pricing.
http://hc4.us/PriceNotPayer
1
Does Cuba extend universal healthcare to their tortured and abused political prisoners as well? Because, you know, that would be very admirable. Convenient for the prisoners too.
3
As if Mr Kristof would subject himself to the Cubanhealthcare system. Jeez...
The reality is that Cubans have to bring their own medicine to hospitals, bribe nurses and doctors for treatment, etc.
And when it was Fidel’s life that was on the line a few years before he died, he brought in Euro doctors to treat him. The best Castro’s Cuba had to offer weren’t good enough.
1
The mental gymnastics needed to hold that America should be more like Cuba is truly ridiculous. Cuba is dirt poor. The people are in poverty. They drive 50 year old cars. They are jailed for dissent. Their medical facilities are crumbling. Doctors are paid next to nothing. And the government can release whatever statistics it wants. There are no independent audits of a murderous, repressive regime. Try again.
2
@Jake ...and lacking access to medical equipment and supplies they STILL manage better health care outcomes.
No one ever said that "...America should be more like Cuba". What the article points out is essentially that one of the richest countries on the planet claims that universal care is unaffordable when a country in as dire straits as Cuba is can manage to do it.
Says something about American values that a lot of people don't want to hear.
As a Canadian, now living in the United States and a lifelong beneficiary of universal healthcare, I believe Cuba's stats on infant mortality. I say this because my experience living here is that Americans instinctively and reflexively reject the idea of free health care as inferior because they're told that is so. They're told that countries like Canada and Cuba aren't treated for their illnesses or wait so long that they die in the streets. The misinformation is alarming.
I can tell you that the one thing that will see me moving back to Canada with my American husband one day is the peace of mind that no matter how much money we or our fellow citizens make, we will all be taken care of when we need it most.
346
@Cara Having recently visited Quebec and Nova Scotia, the total lack of diversity and therefore, the lack of drain of resources (schools, health care, social services, etc) we in the U.S. provide immigrants makes the Canadian model not applicable to the U.S.
8
@Anne Austalia, New Zealand, Germany and Canada all accept more migrants than the United States and all have universal health care.
https://www.economist.com/asia/2017/10/05/australia-admits-more-migrants-than-any-other-big-western-country
Canada is also very racially and ethnically diverse.
38
@Anne With all due respect, this comment is totally wrong. Here's an article from a very reputable source on diversity in countries throughout the world -- Canada is ahead of the US. https://www.washingtonpost.com/news/worldviews/wp/2013/05/16/a-revealing-map-of-the-worlds-most-and-least-ethnically-diverse-countries/?utm_term=.10f13cefb8a4 Re: immigration, see this article https://www.theatlantic.com/ideas/archive/2018/07/canada-immigration-success/564944/, very critical of Canada, which nonetheless notes that since the 1980s, its immigration rates have been much higher than the US. Nova Scotia may not be particularly diverse (I don't know), but Quebec most certainly is.
34
Wouldn't it be remarkable if we embraced this wonderful country instead of punishing it? Learned from it instead of dismissing it for its shortcomings? My guess is that much of their repressive practices that we focus on would quickly evaporate and the Cuban economy would prosper. i believe the Cubans have another institution we could learn from, lifetime free education.
1
The US does not have healthcare. It has a system of for-profit medical services whose goal is maximizing shareholder value. End of. There is no "care." And we, as a nation, do not experience or prioritize "health." People with wealth avail themselves of excellence medical services using cash or insurance. Others are left to die. It is all about profit.
362
@Moderate
So, you think health care workers should work for free? For what you think is "fair?" With a "people's president" who has a $75,000,000 contract with Netflix?
You need to think more carefully, Mod. A lot more.
As for Nick's thesis -- Cuba isn't as diverse as the USA. It is subsidized by others. It is a violent dictatorship that would throw Nick in jail, in a NYC minute. Drug dealers who don't pay their "taxes" can be executed without trial, STAT.
No reason to waste, one more second on this malarkey.
@Urko:
Do you believe doctors and RN's who work in practices that accept Medicare work for free?
Medicare for ALL, which I support, which would extend a system that is in existence and works well, is the only solution.
By the way, Sweden which has the dread "socialized medicine" has the lowest infant mortality in the world, at 2.71 per 1000.
9
@Moderate
You aptly describe the triple oxymoron that is our "health" "care" "system."
No health (No profit in keeping us healthy)
No care (only treatment, as much as you can afford)
And it sure can't be called a system.
It's an unplanned, ill-managed patchwork of reimbursement models.
10
Even though they're mentioned, this piece still tiptoes around the statistics issues, which aren't trivial. (Nick, reversing the habit of progressives, should try to make sure that what he's saying has resemblance to reality.) The infant mortality contrast is not only skewed vis-à-vis Cuba, but also vis-à-vis most of western Europe: "WHO noted in a 2008 report, it is 'common practice in several western European countries to register as live births only those infants who survived for a specified period.' Infants who don’t survive are 'completely ignored for registration purposes.'"
America has higher rates of preterm births than western Europe, which pushes up infant mortality rates. This is caused by harmful behaviors during pregnancy and socioeconomic factors, often involving underprivileged minorities, not healthcare. Life-expectancy rates are also misleading, in that violence and accidents are included. Gun deaths are higher in the U.S., a country with an outré gun culture. And an obese population won't live as long, either; but this isn't "healthcare"'s fault.
"The U.S. has superior results ... for cancer, heart disease, high blood pressure, diabetes, and high cholesterol; the quickest access to life-changing surgeries ... superior screening rates for cancer; the earliest access to new drugs." And this excludes standard wait times and shortages. https://www.wsj.com/articles/single-payers-misleading-statistics-11545090658
1
The lack of access to modern treatments in Cuba is largely a result of the American embargo. Of course, we understand that we wouldn't want to do business with a country that is a repressive dictatorship and that doesn't allow free election unless its name is China, Russia, Saudi Arabia and a host more.
All of our treatment of Cuba is based on the widely propagated myth that before Castro, Cuba was a democracy when it actually was a Mafia controlled dictatorship. Yeah, that was a free Cuba: free for the wealthy who fled to the U.S. and made up the myth.
2
In a capitalist country it is capital, not humans which are the priority and focus for both government and business. Humans are secondary to the accumulation of wealth by way of capital. It's all around us, all we have to do is look. I don't understand why human citizens still can't seem to grasp this basic concept of capitalism.
213
@June. You are partially correct, but some capitalist based states do better than others: Germany, France, England, the Nordic countries, Japan. The major difference here and there is that in the US the capitalist lobbyists spend a fortune to access our legislators while average citizens don’t. The money buys a lot, mostly for the businesses.
16
@June
Well, then where are the economic successes of the global Communist party? Other than China and its "market Leninist" dictatorship?
As for Norway -- it is nearly all-white, rich with oil, and deep culture of thrift. The USA is not Norway. Really. Take a look.
1
@June Except that many European countries with a capitalist economic systems (UK, France, Spain, Germany Finland, etc) have universal health care systems and rank among the best in the world. These countries, so called "social democracies" elicit visions of gulags and totalitarian dictatorships a la USSR style whenever one mentions "socialized medecine" in the minds of most ignorant Americans, but also prove that you can combine a competitive economic system with beneficial social policies to benefit all. The two are not mutually exclusive as the European models, and similar ones in many Asian countries, prove. When will the U.S.A. join the rest of the industrialized world in that endeavor? Perhaps we must , and to paraphrase Shakespeare, "... first kill all the lobbyists"
5
"All this is possible because Cuba overflows with doctors — it has three times as many per capita as the United States — and pays them very little." Can you imagine an orthopedic surgeon or radiologist in the US willing to give up their $400K salaries to go to work for the government?
2
The U.S. system is not designed to provide health care, it's designed to create an income stream from those who live off medical consumers. It's enormously successful generating income.
This is silly. We're supposed to "learn from Cuba's Medicare for all?" Seriously? This is our model?
Why don't we just look to a model that is just as close, even more successful, without looking to a country that is "poor and repressive with a dysfunctional economy." Why not look to Canada?
It's Canada that more than half a century ago created Medicare for all, and called it "Medicare." It's economy is not dysfunctional, it's not repressive, doctors are paid well, and infant mortality is a fraction what it is in America.
If Nicholas Kristof really wanted America to adopt Medicare for all, he would have pointed to Canada, rather than tied it to a medical system in a poor, repressive, communist country.
78
@Sean
You missed the point. The point was that even a poorly-run dictatorship do better healthcare than the USA.
Basically, nearly every state around the USA, and the near totally of it's trading partners have better heath care. Everybody is a model for the USA, because it ranks so poorly.
20
@Sean
"We're supposed to "learn from Cuba's Medicare for all?" Seriously? This is our model?"
Actually, it's quite instructive to be reminded that even a dysfunctional, impoverished dictatorship provides better care to its citizens in this area - pointing up the idea that, surely, a country as rich as the U.S. can do better by its citizens.
And the long-gone 'doctor house visit' system might well be a model for a socialized, elderly healthcare delivery system in the U.S, particularly in rural areas.
10
@Sean
One of the glaring examples of why our nation is in decline is our refusal to learn anything new or useful, from any source.
Fear is now our stock in trade.
You contribute to this decline.
8
The problem with American healthcare is and always has been Greed. For profit medical care will always place profit above all else. Lest we forget Greed is listed as one of the 7 deadly sins, of which we are guilty.
Is the Cuban system the best example Kristoff could have used? Any of the European examples would have provided ample benefits to be shown without the negative criticism backlash towards the “socialism” of Cuba.
My son is doing a Transitional Year residency. His Annual salary is about $51,000. In Places like NYC it's higher maybe 65K for PGY 1.
His current 4 week rotation, 6 days per week, is Internal Medicine. My wife sent him an email last night. He responded.
"How is everything going ?" My wife.
"Crazy house this month.. up at 5am. Just got done tonight 10pm. Hardly time to even eat! I'm off on Saturday." My son's response.
Since he already passed USMLE 3, he can work independently, if need be. The decisions he routinely makes can determine if someone lives or dies.
If you don't have big bucks and great coverage you're in a system that is broken!
2
The proof is in the pudding.
Lower infant mortality rates, longer life-span, higher childhood vaccination rates, greater efficiency.
What exactly do we do better for billions more?
The Cubans have a healthcare system. We have a heath insurance system.
426
@Kat You are correct, and a very profitable health insurance industry at that. Regrettable the health insurance lobby has their talons dug deep into many in the congress. If only we the people had this much power influence maybe things would improve.
31
@Kat
We have a welfare system for the entire medical-industrial complex.
28
@Kat Incorrect. Cubans have a healthcare system. We have a healthcare industry.
18
Why look at Cuba? It’s not an apple to apple comparison.
Why not look at Spain? Spain’s economy is still suffering but it is a developed nation that has universal health care coverage.
If you have a half million dollars, you can buy a house or condo in Spain apply for residency and you will have health insurance for the rest of your life, come what may, while you are there.
2
The key takeaway is not the debate over which health care system is better, rather the obvious point that the U.S. needs to get beyond it's arrogance and realize our current healthcare system has serious flaws. The debate in Congress continues to center around the cost of insurance while it ignores the fact that the hospitals, administrators, lobbyists, big pharma, insurers, and doctors are in bed together making billions at the U.S. consumers expense.
Of course the USA has a more advance and better medicine care than Cuba. But what the use of it, if you can not afford it or you and your family has to go bankrupt by using it?
182
For those of us who have had the opportunity to visit and actually operate in a Cuban children hospital, I would say that reading about the paradise and living in it are very different things.
While I can see why their system is very good at primary and preventive care, I can't imagine the specific numbers for complex, tertiary care come even close not to America's health system but any other modern Latin America country. Lots of poetry in Cuba, little prose.
2
I left Cuba as a teenager in 1961 . Later I became an American Citizen and a physician . I am no expert on the Cuban Health Care System as you can easily see . I know the many shortcomings of our system , first as a practicing pediatrician , and now as a patient after I retired some years ago . But there are certain anecdotes that tell me everything that shines in the Cuban Health Care System is not true . Years ago I found out about a cholera epidemic in Manzanillo , the town of my birth in Cuba . Cholera is a disease typical of the Middle Ages or very backwards countries . A Cuban American I know went to Cuba to have a colonoscopy because it was cheaper . When he was waiting his turn for the procedure he saw a gentleman coming out after the procedure screaming in disgust . They did the procedure without anesthesia or sedation . They explained to the Cuban American patient that they used sedation on people that were not residents of Cuba but not on local people . Years ago , when the situation was worse than today`s , I remember an aunt visiting us from Cuba showing clear signs of malnourishment . In 60 years communism have brought to Cuba a lot of pain . Do not believes their lies .
3
"the doctors earn a premium while abroad, but much of the surplus goes to the government"
Which government paid for their entire education, from K through Med School, making them doctors for free, all because they were promising kids.
The US military used to have a program like that, which required either time as a military doctor or serving under-served remote communities. When we did it, we felt there was fairness to it.
4
Cuba has the world's highest doctor-patient ratio. Various European countries (e.g. France and Italy) have very good health outcomes and much lower costs than North America in part because they have higher doctor-to-patient ratios. House calls are not uncommon. They graduate more doctors, and the graduates stay in the countries (language, culture, politics, etc.), which creates ample supply for the demand. Most doctors are paid less, but they don't need a staff of clerks to fill out insurance paperwork.
If Canada overproduced doctors, it wouldn't get the same benefit because the surplus would just move to
the US. This is a problem for all the English-speaking countries. The US could solve some problems for itself and the world by greatly increasing the availability and affordability of medical education. Along with single payer insurance, that would go a long way towards improving outcomes and reducing costs.
2
Costa Rica has better health care results than Cuba, and is a stable democracy with the civil liberties we have. Look to Costa Rica for a Latin American model of how a country less wealthy than ours can provide excellent health care for all.
3
Back in 2010, I interviewed gubernatorial candidate Jill Stein (G) regarding her candidacy and her policies. At one point, she mentioned that we had a lot to learn from Cuba regarding not just their medicine but their agriculture, and how they fit together.
She had a point. Our healthcare system isn't fully aligned with our agriculture. Consider how our nutritional guidelines suggest more fruits and vegetables, but our farm bill still gives major subsidies for various meat sources and our public leases to ranchers are for grazing instead of farming.
I still have that interview. I do wish she'd been taken more seriously as a candidate.
1
@Jacob Sommer: When we get proportional representation (fat chance), she, and other non Dem/Repub cancidates will be taken more seriously.
1
Of course the anti Cuba embargo could be lifted to help the Cuban people improve the quality of life and yet in spite of the embargo the Cuban medical system appears to work very well, and it's free. But the current political thinking in the great USA is that Communism is evil and therefore must be punished no matter the cost to the people.
2
@Jordan Davies: There's another way to state America's objection to Cuba: if they won't let us move in and buy the place, we won't accept the legitimacy of their government.
1
People who want "medicare for all" as opposed to single payer aren't, I suspect, all that familiar with medicare. Does your doctor want to do some lab work to screen something that could be preventive? Nope. No medical justification. Oh, and that lab test? $250 cash (absurd...) Want to see the doctor you always did? Well, if you are lucky. Thinking of not signing up at the first opportunity because you are in good health and/or don't use much western medicine? Well, there will be a 10% penalty every year going forward per 12 months that you didn't sign up. And should you need medical care suddenly, forget that. Because they won't let you sign up except during a few months. And this after you have paid in your whole working life.
Now, should you be low income and break your leg, you can sign up for medi-cal and get it immediately. And it will be retroactive for 3 months! Not medicare. And that lab work that medicare didn't cover, well guess what? Medi-cal will cover it.
What a crazy system. Better than nothing, but please, no Medicare for All, and please, cover preventive tests, acupuncture and the like.
2
@Miriam Warner - My husband was on Medicare for 18 years before he died, and I've been on it for 8 years. It's far superior to the supposedly "cadillac" insurance I had through my employer, and neither my husband nor I experienced any of the things you mention. The 10% penalty shouldn't be a problem as long as people know that's the rule. I can guarantee that you'd be hard-pressed to find private or employer insurance that is superior to Medicare, so I question why anyone would prefer to remain on it (if their employer would even allow it).
@MegWright the penalty is quite obscure to find, and it isn't particularly clear that you are not allowed to sign up later in the year. Glad medicare worked for you.
Almost everytime I go for lab work I have to sign a paper saying medicare won't cover this or that part of the labs. But I guess it is my misfortune that my doctors want to check on things which may be brewing, and reversible if headed off early, or an troublesome indicator, rather than waiting till something is full blown.
Are there worse things? For sure.
1
Headlines like this always appear attractive because readers only see the word, Free. But they rarely get into how expensive the free programs are.
If my business were based in Italy, where I live, I would pay about 25% in income tax, the same in social security taxes, and just a little less in VAT. Plus a smattering of regional taxes, health care tax, etc. and it comes to about 80%. In Georgia, in the US, where my business is based, I pay about 20-22% total.
Next, the health care system in Italy is so backlogged, waits so long, people pay out of pocket for many services.
Sorry. Free is not free.
3
@Bret Thoman - The average cost of family insurance in the US is $28,000 in premiums and deductibles (not counting co-pays). For LESS than that in taxes we can cover everyone. Or we could offer a public option where people could pay premiums to buy into Medicare, which is superior to most private or employer plans.
"These clinics, staffed by a single doctor and nurse, are often run down and poorly equipped, but they make health care readily available"
For awhile, we had a nursing clinic in our local supermarket. I did half a dozen walk-ins with my kids. There was always one or two patients, but never a real line. Once they diagnosed an appendix on my youngest, that I hadn't imagined, and sent me straight to the ER for surgery within hours. It was very simple and very low overhead, but that whole chain of nursing clinics is gone now because our health system won't pay for that.
In Cuba, they get that plus a doctor. From experience I'm sure, if I have to wait until I myself already know it is a crisis requiring the ER, I wait too long. I think most people do. The ER is a long slow process that feels like panic, not the first choice I'll make.
My mother might have lived longer if I had that place to quickly and early check on what turned out to be her last heart attack.
This has been life for my son and I suspect death for my mother. It is not a minor thing just because it could be and should be cheap and easily available.
2
We could learn many things from Cuba, as well as universal healthcare systems in the rest of the world, if we wanted to. But do we?
For one thing, there are powerful vested interests, like the AMA, that don't want us to learn from other systems. Primarily, they don't want us believing that the medical profession can attract gifted and motivated people for less money than they currently get paid. They want to believe that they are irreplaceable, and that if their generous salaries (specifically in certain fields) are cut, healthcare will suffer.
The stringent license requirements for practicing medicine gives them leverage that other professions, facing competition from around the globe - don't have.
The primary objection to a single payer system, or even a public option is the leverage that would give payers in negotiating salaries.
In other words, they object to single payer not because it would be more efficient and effective in lowering costs, but because it would.
2
@DebbieR
You should apply to medical school (take out loans if you need to), successfully complete the training, and lead by example.
1
@Ron Dong
Someone on a med school admitting board told me that there's 9 very qualified applicants for every 1 accepted to medical school. And way more than that who apply.
I am a little surprised that Mr. Kristof would be comparing health care systems of Cuba, instead of the more apt choice of Canada. (which is more highly rated on world standings and is associated with a free Democratic society)
The United States is a decidedly Progressive and Socialist country in a multitude of ways, but the powers that be refuse to allow any system that might mitigate that Socialism of profits at the top and Capitalism of costs at the bottom.
All other western industrialized countries have shown that their myriad of systems (quasi privatized some of them) are far superior in costs and outcomes than the United States. IF however, costs are not a factor, then of course the United States doctors can perform ''miracles'' for the right price. (exorbitant)
It is time for the U.S. to join the rest of the world.
7
I've been traveling to Cuba since 1998 and their health care system has really amazed me.
When a friend mentioned that his father was having brain surgery, I asked about the cost, and he told me it would cost them sheets and towels which he was required to bring with him for the operation. I did not understand and asked how much money it would cost, since that surgery (and hospitalization )is around $70,000 in the United States. He replied that it would cost them nothing for the surgeon and hospital stay. The sheets and towels were required because the U.S.Embargo against the Cuba people makes them in short supply, but compare that with $5 for linens, and you can see who is really taking care of the health of their citizens. Oh and note the number of prenatal visits by this doctor who lives in the neighborhood with her patients.Are we Americans missing something?
9
@Jim Cuba cannot manufacture sheets and towels, or buy them from one of the 190+ countries that don't embargo it?
3
@Jonathan Katz
The economic embargo against the Cuban people which the United States instituted, forces the country to make tough decisions on how it uses its wealth. Not having enough sheets is an inconvenience. Not having affordable health care can be a death sentence.. Viva Cuba.
@Jonathan Katz
The point is , they would rather keep health care costs in line, instead of bankrupting itheir citizens with credulous ridiculous medical costs..
I visited Cuba two years ago. This is a country that by all accounts should be a basket case. But its not. The buildings are crumbling, the autos are worn out but the people are immensely proud of their education and health care systems as they should be. Their system is inclusive. Ours is exclusive. They may not have the latest medical equipment or shiny new schools but they get the job done. Meanwhile we are fighting about a concrete wall....
13
Many Americans would also welcome a guaranteed basic income, free tuition and a free birthday party every year. The US is already deeply in debt. How do we balance our budget while also paying for Kristof's freebies? Answer - we can't even balance our budget now.
8
@Robert
But, it seems, there are always ways to pay for massive tax cuts for the obscenely wealthy.
Government-run health care is not an expense, but an investment.
43
@Robert A good beginning could be to stop giving tax break to the 1%, corporations and the rich people. Another step could be to cut the gargantuan budget of the Pentagone which is main goal is to feed the industrial-military complex. And if my country Canada can afford a universal health system, I can not see why the richest country in the world and the economy number one could not afford it? About free tuition and free birthday party, well, forget about it.
25
@Robert
1. Cut military spending, by a lot.
2. Repeal the GOP tax cut
3. Eliminate the "wall" funding in favor of better border security and resources.
4. Eliminate subsidies to fossil fuel companies
35
Universal health coverage is good, particularly for the poor who are below 65 years of age. It is by no means even close to what Medicare or current private insurance provides. For example in Australia, most people not below the poverty level buy private insurance or "gap insurance" as an add on to Medicare to reduce waiting times to see specialists or avoid waiting months for "elective" surgery such as knee or even hip replacement. That said, the main problem in the US which neither the Democrats nor Republicans want to face is exorbitant costs. Supply of overseas educated Doctors is crimped, hospitals are now owned by large corporations that milk insurance companies, there is a ban on drug "reimportation" which makes US medicines 10x as expensive. Example a vial of Albuterol inhaler costs $300 in the US and $1.50 in India. Both made by Glaxo Smith Kline - Ventolin HFA. This monopoly is what funds both political parties and they would rather increase US debt or tax the "rich" to fund universal coverage but will NOT attack the cost components. FTC whose job is to ensure a free market and prevent monopolies has sat idly by as hospitals consolidated. Expect even higher insurance premiums going ahead.
7
@Ben Capitalism/greed can not solve every problem, and especially patients, and children/students, are not suitable to be used as profitable products by greedy Capitalists!
Two years ago I was biking in Cuba with a friend who lost all the drugs he needs to treat his high blood pressure, diabetes and high cholesterol. We visited a few small clinics, and later a larger one that did have the drugs available to help him and had the authority to help foreigners. We were impressed by the closeness of the small clinics to the population. In one instance at the village clinic, a four-year-old little girl came in with blisters on her feet caused by new shoes she was wearing at Carnival. She was promptly treated by a nurse. I’m not saying this is good or bad public health management but the whole experience of dealing with the Cuban health system showed us the services are complete, accessible and friendly and that people in general look healthy and in shape.
16
When visiting Cuba several years ago I learned Cuba sends many doctors to far flung countries in order to profit from payments to their doctors. The doctors, however, make very little money and are not allowed to accept any payments from their Cuban patients. So, patients bring gifts such as food or actual items. Yes, it is wonderful that Cuba has universal health care, but there is a lot wrong with the distribution of fees, not to mention the lack of adequate technology.
The Cuban-American speaking at a dinner I attended told us it is not the embargo, but the government's mismanagement which makes Cuba economically struggling. I loved what I saw that is vibrant and passionate on the part of the Cuban people, but the government needs to modernize its approach.
5
If all patients like Claudia Fernandez had gone 14 times to the OB in addition to home visits in the US, our system as it currently stands, would be immediately drained.
It's well known that US healthcare related financial catastrophe still exists, even among the insured. Not being able to afford care is a worry of every middle class patient I see. This is unconscionable in the richest nation in the world. HOWEVER, we cannot transition into single payer without serious changes to our dysfunctional, fragmented, profit driven system.
One of the biggest problems is we have no conduit for those with innovative ideas on how to improve the system to be able to present them. How about for starters we create a crowd-sourced nationwide think tank to allow people to present ideas rather than constantly comparing us to other countries and doing nothing.
6
One needn't go all the way to Cuba to see a better health care system in operation. But since you are there note that the primary difference is in how Cuba organizes its political economy.
The world of human rights is divided into two categories. We recognize political and civic rights, but not economic and social rights. Cuba emphasizes both. So under this approach Cubans have a right to medical care and education.
In our system health care is a commodity, not a right and as with any commodity you get what you can pay for. Our health system is very good at the very top, but costly and inadequate for the rest of us.
If you believe that health care is a right, not a product we can easily devise a system to insure that we can all exercise that right. This is what Cuba does, even with its extremely limited resources.
And your figure on US infant mortality is a national average, which is deceptive. Wealthy women have a low rate. But for African Americans and those who are poor the rate is 6.78 per 1,000, not 5.9.
3
Did you actually say that Cuba emphasizes political rights?
1
Cuba and Canada both have universal health care systems. Both provide for health care without the need to mortgage the house or sell the truck. Neither system is perfect but a heck of a lot better than the for-profit health care for only the rich and privileged that exists in the US.
23
@Lew
And to pay for its universal healthcare, Canada has dramatically higher taxes on income, value-added taxes at the federal and provincial levels, and smugly sponges off the defense capabilities of its NATO allies.
Ten years ago I visited Cuba with my partner. She came down with a cold and we visited a Cuban doctor. 30 minutes after she entered the clinic she emerged with some medications and good advice. I think she paid a small amount for the care, like $25. In every way it seemed superior to the American system.
4
Facts such as those highlighted in this excellent article have been available for a long time. Unfortunately, Republicans have, and continue to have, success in taking advantage of many Americans' fears of "government-run health care", latent resentments about "why should I pay for someone else's health care?", and a lack of understanding how insurance works. Add to that systematic misinformation from the right about the "failures" of "socialist medicine", the "endless waits", etc. It's all bogeymen and canards, and it will continue to work until Americans become better educated and informed through effective counter-messaging about how much of the rest of the world does health insurance/care so much better, with better outcomes and lower costs.
4
@Buck Thorn of course you followed with the a query as to getting a referral, right?
I think a lot of people are of the opinion that Medicare is "free" care. Socialized medicine has been a bugbear for decades largely because the AMA and other physician societies went out of their ways to spread tales of healthcare disaster if the US ever went down that path. The kernel of their argument was the canard that some nameless, faceless bureaucrat in a cramped cubicle in a windowless concrete building would make all your health decisions while you and your doctor were left completely out of the loop.
Medicare is most assuredly NOT free. But the Medicare taxes you pay during your working years are a pittance when stacked up against the value received at age 65 and beyond. If the money you and your employer pay for employer provided healthcare were funneled instead into a universal plan, one that does not have to pay dividends to shareholders, 7-figure salaries to corner office occupants and bonuses on top of that, or the magnificent buildings where those offices are located, it soon becomes apparent that Medicare for All is not an industry-destroying nightmare.
With Medicare for All, doctors will not find themselves living in dilapidated apartments above their clinics. Their income may not buy a new BMW 7 Series every other year, but paupers they will not be.
As it is today, traditional Medicare (Advantage plans are NOT a bargain) allows for more physician and hospital choice than nearly every private plan out there.
Let's do it for the babies.
25
So, we can have a space based missile defense system but we can't have Medicare for All? Why aren't we OUTRAGED?
46
You can’t even “keep your doctor” in the US if you have good insurance. I found a primary care physician I really like but due to travel, work, and being perfectly healthy, I didn’t see her for over 3 years. When I finally called to schedule a checkup, the medical corporation she works for told me it had dropped me from her patient list and she’s no longer taking new patients. Use it or lose it!
4
One reads of the high quality of Cuban medicines. The US pharma industry profits from the embargo that prevents competition.
As far as I am concerned, I want to see Cuban cigars imported to the US at the prices on the island.
2
Medicare coverage for those who want it, that is what we need. The option to buy Medicare coverage at any age. Let Medicare compete with the commercial insurers and offer health insurance to all ages, not just those over age 65. This will lower costs and balance the healthcare insurance marketplace.
I do not want "free" healthcare, I want reasonably priced healthcare insurance.
6
I don't understand the idea of medicare for all, and I don't understand this opinion piece which asserts that the Cuban medical network and customs have something to do with Medicare in the Untied States? Does medicare have consultarios? Do Medicare doctors live on the 2nd Floor? Supposedly this is one of the center pieces of the Democratic party platform, or at least some candidates are trying to make it part of the platform. I wish this article were more clear in how the two national systems, US medicare and the Cuban national system, are similar. My main question for democratic politicians who support Medicare for all is: why not support a Medicaid for All? That's simply an expansion of ACA, rather than the disruption of an entitlement that is already tried and true, and by its definition meant for the elderly and is already established as part of our payroll tax. Why change that? Where is the sense? I'm very wary of the left flank of the democratic party because they don't make sense, speak unclearly and work off of attention-gettng blather rather than substance They will ruin our chances in 2020.
1
It baffles me that so many fields (art, medicine, literature, science, etc.) are intensely globalized, but we do public policy with blinders on -- as if all the other free-market democracies in the world have nothing to teach us about how to set up and run modern systems of healthcare and health insurance. Why aren't Americans more curious about the 39 nations whose healthcare systems are ranked by the World Health Organization as superior to that in the US?
14
The rest of the first world demands access to basic health care uncoupled from income and ability to pay. Americans ask, 'What's wrong with reserving the best care for those who can afford it? The freedom to choose insurance and the ability to pay are personal choices.' But if that impulse was applied to auto insurance, nobody would be required to have a minimum level of public liability insurance. Why is the idea of everyone having a minimum level of health insurance (either through a publicly-funded or an ACA-type system) so controversial? Americans have a weird idea of freedom... and self-interest.
26
@Dortmund the United States has the worst Rube Goldberg medical system in the world. Republicans proudly proclaim that they have eliminated the health insurance mandate and that this is a good thing. It isn't. What the Republicans don't tell their voters and supporters is that people will get medical care, of the worst sort. It will come through emergency room visits or regular hospital visits which turn into bills they cannot pay. When they cannot pay those bills, they take out bankruptcy. There is no such thing as medical bankruptcy, and when these individuals fall into bankruptcy, credit card companies, car loans, etc are all included. This means that higher interest rates on these debts which are discharged in bankruptcy are passed on to the rest of us. Also, state governments also cover many of these indigent health care expenses which are pushed on to us as taxpayers. The last time I checked, my rural county spent approximately half a million dollars each year covering individuals healthcare costs. I don't know whether anyone is looking at this from this vantage point, but it would appears that I am being forced to pay for medical care whether I want to or not. It would seem that a medicare-for-all system would be much more efficient.
3
@Dortmund
The GOP & Libertarians (Plutocrats) have done their best to smear the ACA because it's a gov't program that's primary purpose does not benefit them.
The photos for this story by Lisette Poole are wonderful. Particularly the "Nurses chat at the Policlinico" photo. That one is really breathtaking!
3
How do you cover more people in the US without putting insurance companies out of business? You compete with them. The government needs to start selling Medicare policies at profit to compete with the insurance companies but subsidizing Medicare for those with low incomes(as in Obamacare). Veterans should get free Medicare thereby making the dreaded VA hospitals obsolete. The millions that work for insurance companies should not be casualties. Direct to single payer means overturning 1/5 of the economy all at once. Not going to happen. End Obamacare. Sell Medicare but it must have subsidies for those in need.
So you’re OK with doctors earning $45 a month? With doctors being paid directly by the government, being owned by the government? Poor pregnant women have access to medical care today in the US it’s called Medicare. Every state has Medicare for pregnant women and children’s health insurance for poor children.
5
@Laxmom Sorry I meant Medicaid.
1
Medicare is for those over 65 years old. I'm pretty sure no pregnant woman ever got it.
A Medicare for All, Single-Buyer system is the answer. Per Buffett, Diamond, Bevos and me, that would save us about $1.2T per year, without material changes in quality or delievery.
That's the marginal extra amount that is paid in the US for our current health care "ststem".
First big change under Single-Buyer: Free education for Doctors w/future service committment.
18
Most Americans do not want to pay more in taxes to improve our wealth care system. Either they don't want to or can't comprehend what would be better about having a true universal access single payor health care system where one can receive the care one needs wherever and whenever the need arises. In addition, they fail to realize that those premiums we pay and that our employers pay which reduce our salaries by a substantial amount could be used instead and we could have a system with no deductibles and small copays.
Medicine now is not what medicine was when our country was created. At this point our government's refusal (which is ours because we vote for these people) to work on creating a medical care system that serves all of us verges on criminally irresponsible behavior. Of course they don't live through what we do when we need medical care.
However, instead of comparing us to Cuba you might have written about France, Japan, or Canada. I understand that Rand Paul is going to Canada for some surgery. Yes, he's paying for it but if our system is so wonderful why is he going there?
9
@hen3ry Surely the point is that even Cuba, poor, embargoed and struggling, manages to provide decent health care for ALL its citizens?
1
@hen3ry Because his hernia surgery isn't offered in the U.S.
@hen3ry
Because it is a specialty hospital—that is why he is going
To observe the rules of full disclosure I am a fiscal conservative and a retired MD.On my recent visit with Cubans I found them open about their lives problems and were willing to share their thoughts.They liked their health care.Physicians are paid poorly.One of my taxi drivers was married to a surgeon and he made 5x as much as she did.Single payer care in the US would be better than what Cubans have,we are a richer country.
I think a US single payer system would be not much more expensive than what we have now.To have open borders with free universal health system is troubling.A South-American man upon arrival in the US called up a NY City hospital to request treatment and transplant for renal failure.He received treatment 3x a week and was placed on kidney transplant list.
4
It's actually pretty easy (and inexpensive) when the focus is on health and well being, rather than diagnosis and pharmacology. As a doctor here in the US, I am driven to order far more tests and medications. As a doctor in Cuba, I suspect that there is far less pressure to diagnose everything to the nth degree (no MRI for knee pain in a 65 year old there) or prescribe multiple (expensive) meds.. to treat abnormal labs that didn't really need to be drawn in the first place
13
Health care in the U.S. Is profit oriented; in Cuba the focus is low cost preventive care. Also, it's remarkable that in spite of the crazy economy, the U.S. embargo and the lack of resources Cubans are able to cooperate together as a society helping each other. This is reflected in such things as the enthusiasm of the exercise instructor who walks through the neighborhood coaxing the old people outdoors to join him in morning exercise; or the health worker who takes everyone's blood pressure before a community run. And, of course there's no money made in drugs - all delivered free at the lowest possible government cost.
14
In the 1990's in Myrtle Beach, SC obstetric care was provided by private obstetricians working closely with the county health department. Often young women without insurance would have high risk pregnancies and would need diagnostic technology such as ultrasound and expert management that could not be provided at the health department. Each week, these patients and the staff of the health department would come to a private obstetrical office and would receive the same medical care that insured patients would receive. The local privately owned (for profit) hospital working in concert with the community obstetricians agreed to charge uninsured pregnant women a total of $750 for the delivery of their infants. What has happened to the values our country?
5
Two points that ensure that our healthcare “system” will not improve:
1) to provide Medicare for all, we will have to pay higher taxes. The T word is so abhorrent to Americans that they would rather pay more in deductibles and copays than be taxed for better care.
2) the insurance and pharmaceutical industries would collapse in a more equitable system. The result would be the kind of massive white-collar unemployment experienced by blue-collar workers whose jobs are shipped overseas or obsolete.
Every great social change comes with social upheaval in which there are winners and losers. The United States will have to offer significant economic safety nets for those high earners who fall through the cracks. Nothing will appease these losers, and there will be too many stately homes—as the British say—to convert into museums and boarding schools.
As individuals, most well-off Americans are just too spoiled to give up their toys—until they’re socked with a $200k bill from that out-of-network surgeon who assisted their in-network surgeon during their liver transplant.
14
I fully support a "Medicare for all" solution, otherwsie known as single-payer system, but I think to compare it to the Cuban system is a mistake and creates a lot of confusion in this important debate. While I agree that Cuba provides good health care compare to many other Caribbean nations, the overall standard of care falls short of what many other "more developed" countries provide. Most american will expect more. In addition, Cuba's system not only pays for the care but also provides care. All care providers are empoyees of the Government. This is a critical difference from how the US Medicare system works. In the US, Medicare is funded by the state, but the medical service itself is provided by the private sector, allowing for choice of doctors and competition.
1
Not only Cuba. There are examples all over the world where universal health care works just fine without breaking the budgets of those countries.
16
Cuba does a very good job at marketing its healthcare system. It rigs its statistics and selectively shows 'accomplishments' for foreign journalists like Mr. Kristof. I don't fault Kristof for this. In general, I like his reporting and tend to agree with many of his views. However, I don't trust anything that comes from one of the most repressive regimes in the world. Period.
As for us here in America: we certainly need a well organized healthcare system. It doesn't have to be a copycat version of Cuba. It doesn't even have to be a European model. We can have a Hybrid model. You pay according to your income level. Healthcare for all is a must. But we cannot ruin the country for this. For instance, if Mr Bezos happens to need medical care (God forbid) and uses the public system (God forbid), he pays full price. But if Joe Blow who makes minimal wage (we could have several levels of income segmentation) happens to need care, whatever he needs is free or close to it. Say 2% of his income. Something nominal. This type of Hybrid system can work here, we just need POLITICAL WILL to do so. Not so much with the occupant of the White House these days I'm afraid...
5
You know that there’s a name for such a system right?
It’s “Obamacare.”
This story reinforced the conclusion of the story I read in NY Times about one year ago. Comparing different healthcare systems among eight developed countries (US, UK, Canada, France, Switzerland, Germany, and Denmark), US was ranked the worst and France the best. Our healthcare problems were known a long time ago including drugs too expensive, doctors too few, and system too bureaucratic and clumsy. They can be corrected. But for one reason or another, our elected officials are reluctant to fix them. Our healthcare system is testing us to see how long can we bear this inhuman and unjust treatment.
9
Lack of medical care is killing people in the US for sure.
Well, the cost of medical insurance is the cause for tens of millions to live in poverty in the US.
The cost of higher education financed by student loans is causing the impoverishment not the enrichment of millions of lives in the US.
So where is this American Dream everybody used to talk about. America may exist but it's surely not here.
4
Cuba's successes, and there are many in medical care, education and combating racial discrimination, and their failures, in material development, must be seen in the context of the American assault on their revolution, starting with Eisenhower and continuing for 70 years until President Obama sought a change. The impact of the embargo, which is still in place, has had its desired effect, to slow Cuba's development, but has not deterred its determination to remain independent and pursue a more equitable society in terms of health care, education and opportunity for all. The rest of the world has recognized their successes, it is time Americans do the same.
7
What a poorly written headline. It is certainly not free. The citizens are extraordinarily poor and the doctors make nothing. The gvt owns the means of production in Cuba. Are you suggesting that? You are even saying they’re exporting their doctors to make money. Holy face palm. That economic model is not working for them and you if you have a breast lump you can in fact get it checked in the US. It’s called Medicaid you just must enroll for it or walk into a hospital they must accommodate someone that they believe may have cancer. Yes we need to fix our system but Cuba’s economic model certainly should not be considered.
9
@Location01 I was in Cuba for 10 days recently, and health care is a major interest of mine. Health care is in fact free, in that the client/patient pays nothing--I don't know how else to define "free." The cost is paid thru general government revenues, and I cannot see anything wrong with a government investing in the health of its citizens. Yes, they "export" doctors and are proud of it, and the receiving countries are very grateful. They also train lots of doctors from poor countries. Anyone who is qualified, based on high school grades and exam results, can go to med school or nursing school without cost, while receiving a modest stipend. And while the doctor's pay seems ridiculous by our standards, $80/mo goes a long way in Cuba -- it is 4 times the average worker's salary. Lots of things need improving in Cuba, the political system perhaps foremost. But, for conservatives who support the embargo to complain about the Cuban economy is like the guy who put sugar in a car's gas tank and then complains it is running well.
4
@Peter Aitken I meant, of course, "is NOT running well."
1. “Some traits of.”
2. Article carefully pointed out what Cuban docs get paid.
3. You cannot simply walk in and “get Medicaid,” even if you are eligible. Their funds run short, and many Red States refused to expand their programs.
4. Article also pointed out that with the basics, Cuba does seem to do a better job.
5. Maybe try read article.
1
This could be the singular most disappointing column I have ever read from you, Mr Kristof.
There are just too many incomplete theories and not even remotely accurate statements / suppositions to make it worthwhile to waste any more of my time writing.
Really ?
3
Been to Cuba 2x, and inspired, wrote 2 books called The UnNamed Traveler, and pointed out in one that a Dr’s ‘Cinderella’ dream in Cuba—is to become a tour guide, cause, as u pointed out, people in contact with tourists there make a lot more $$$
2
The difference in infant deaths is based on the Americanslips counting every baby who takes 1 breath as a live birth, while the Cubans count only those close to full term without any fatal birth defects. I'm suspicious of any editorial that starts with lying through statistics.
4
Those critical of the Cuban system may have some valid points, but that doesn't erase the inequities of our system. Ours like mirrors our economic inequality because we have a political party who for decades that has wanted it this way. What did the Republicans do when they first took power in January 2017? Following the inducements of rich donors they went after healthcare established by the Black president. So that they could save on taxes. Gets old.
8
Presently, the United States has overwhelmingly preferred the private property principle — that wealth belongs to those who produce it. The reasons are pragmatic. Before an economy can have a distribution problem, there must be a product to be distributed. No other incentive keeps people continually interested in doing those things that encourage production as sought after wealth, or money, that their labor or property has brought into being. The private property rule is embraced by socialists (AOC) & capitalists all the same. Private property is also the ethical heart of the labor movement, & argues that every worker owns his or her own labor power and is thus entitled to receive, as a right, all of the wealth his or her labor produces in the marketplace. The private property principle makes it possible to objectively determine economic value & competitive markets. Without competitive markets, how can we in the US, determine the price of the items we buy and sell? If not, distribution of goods would be settled by brute force or arbitrary opinion which is what The Castros do to keep the current status quo. The 2nd alternative principle of distribution disregards productive input; its solely based on human need. All people would have to agree to be selfless in order to focus on the greater good. “To each according to his need” is of necessity a totalitarian principle. Creating the perception to some of an altruistic Cuba & egoistic USA.
1
The way to reform American heath care is to expand Medicare. Medicare is already functioning very well and the IT systems and core staff are already in place. Expanding Medicare to more Americans would also attack the root cause of your health care crisis which is the fact that it is so expensive it's becoming unaffordable.
Medicare has set prices that it pays thereby capping what a hospital or physician can charge. The other advantage of Medicare expansion is an ethical one. The health insurance industry is a gigantic bureaucracy that makes billions off of our illnesses. People don't choose to get sick and it is not right that highly compensated insurance and for-profit hospital executives make hundreds of thousands of dollars because you become ill. Healthcare spending is not discretionary and some of that money should stay in your pocket and you should not have to pay a slice to finance a vacation home for an insurance CEO. Congress could fix this if they wanted to. But until we get a new president and congressional leadership the status quo will remain.
8
Warring — members of the Trump/republican coalition may find these comments offensive.
Most people when they hear the word cartel they think of illegal drugs delivered by criminal organizations. What seems to escape many people I talk to about our healthcare system is that healthcare in the US is delivered by legally sanctioned criminal enterprises that employ a system of legally sanctioned bribes to ensure their enterprises can wring every last nickel from people and government run healthcare programs.
Also, if by chance you get caught defrauding a government healthcare program you get to keep the money and run for office if you are rich and employ the "I never intended to steal the money, my heart is pure" defense arranged for by Congress.
One more point, anyone who is paying attention can watch the slow motion veterans healthcare takeover being planned by VA shadow managers who meet at the Trump Mar-A-Lago Club. It appears that the Mar-A-Lago Club may offer one of the country's best returns on membership fees. Sad!
In closing, might I suggest that Mike Pence and his army of Evangelicals focus on protecting veterans healthcare rather than Trump.
Enough said, I think I hear helicopters overhead.
16
@old soldier
Another soldier here, and I get all of my care at the VA. There is already a system at the VA which allows patients to go to private doctors when services are not available at the VA. The VA healthcare system does not need fixing (i.e., privatization). It already works. There just needs to be more of it--more doctors.
Indicentally, the HR system needs to be tweeked; it shouldn't take 6 months or more to make one personnel hire.
5
@GiGi
Thank you for sharing your thoughts.
I am in fact retire from the military and very
fortunate to be served by TirCare for Life, which is paid for by DOD. Unfortunately, I am denied VA health services by a law passed in 2003 by Bush and the boys.
With regard to the veterans being allowed to be served by private providers it is the first step in privatizing VA healthcare. There is little interest in fixing VA healthcare because there are big profits to be made if the system is privatized. And of course taxpayer money to be kicked backed to the politicians who believe privatizing public services is always best.
If, like Cuba, the US had a totalitarian government and could force doctors to work for less than $100/month, we could afford Cuban style healthcare. But that's not going to happen. Democracy and Cuban style medical care are mutually incompatible.
And, as Mr. Kristof notes, health care statistics from Cuba are suspect. In addition to counting some infant deaths as stillborn (as France does also) there are allegations that the government promotes abortions of potentially infirm fetuses.
It has also been reported that cases of diabetes and heart disease in Cuba plummeted in the 1990's. The reason - after the collapse of the Soviet Union and the aid it provided to Cuba, there was widespread famine and being overweight contributes to higher incidence of both diabetes and heart disease. Somehow I don't think forced starvation would be considered acceptable medical treatment in the US.
5
Hmmm. I don’t see Danish physicians immigrating to the US in droves for the pay. In short, there’s a middle ground that would achieve health care for all.
4
There are certainly things we can learn from Cuba. However, we must not forget that they have both a smaller population and space, making it easier overall to have a better ratio of doctors to patients. To replicate that here would be quite costly and I rather doubt doctors here are willing to take a salary proportional to their Cuban counterparts.
5
@Patrick And many U.S. doctors don't really want to live in rural (and often, poor) America or raise their families there.
3
Cuba's universal health care is not what we should welcome. It works in Cuba because the dictators can put a lid on the protests and grievances and force the people to suck it up. You cannot sue for negligence or malpractice and any self inflicted healthcare issues like smoking related illnesses or drug addiction will receive paltry treatment. Long living persons will be neglected. The only positive thing of the Cuban health care system is investment and emphasis on preventive medicine, same as in Canada. Reducing the incidence of disease however it is enforced can make healthcare more sustainable.
The reason Canada's health care system seems to work, talking from living in Canada for 5 years is because Canadians take responsibility for their health seriously than anyone and take good care of their own health and wellness. Having said that those who have affordable private health insurance in the USA have the most advanced and best health care in the world. In Louisville,KY , I can say that the health care is world class and state of the art and there is no way I would welcome Medicare for all. Especially not having contributed to medicare all the times I have worked in the USA. On the other hand, I think to cover Americans who cannot afford private health insurance we should have government managed and government run health care like the VA system (without its flaws) where anyone who is sick gets treated. To those who think getting medicare coverage is simple, think again.
4
Thanks for the morning chuckle, Mr. Kristof. I think its the other the way around, Cuba, as well as the rest of the Caribbean, has much to learn from the United States. I have not witnessed the Cuban system, but I have witnessed Trinidad's. There if you go to the hospital, you go to die. If people can afford it they go to private clinics. In fact, in most nations that have socialized medicine, if people can afford to do so, they go to private clinics/hospitals. I am not just making this up, but I know people in Britain, Germany, Austria, and Switzerland who have told me that. I might be Southern Boy, but I have spent a lot of time out of the country. I have been there, I have seen the facilities. The radical left's cries for "Healthcare for All," "Medicare for All" will never happen; the healthcare lobby and private insurance companies will never let it happen. It would take a real revolution, like that Cuba experienced in the late 1950s, for the radical left to overthrow the American system and replace it with a Marxist-Socialist-Leninist Utopia as in Cuba. I don't ANTIFA yet has the firepower to pull that off. There are too many real Americans in America to allow that to happen! Again, thanks for the chuckle, it was a nice way to start the day! Cheers!
I loved reading this; the logic of going off, “I dunno anything about Cuba, so lemme rant on a totally different country, then seal the deal by claiming that people told me stuff and I been around.”
Here’s the deal, okay? If you’re really wealthy, or have a great job with excellent health care, or just get lucky, and something fancy and bad happens, you are likely to get the best care on the planet.
But for very many, and for the simple, vital stuff, we’re about 35th on the planet. Rebel yell as much as you like; it’s just true.
Ok gang let's go over it again, the number one crisis in this country, our de facto criminal health care system, (pre ACA) ie don't get sick, be rich and/or don't have a bad life event.
Just about every major peer country and many third world countries have a better system than we do.
6
I believe you were mislead and purposely taken to see what they want you to see.
The healthcare system is nothing like you write it up to be. While they may be seen countless times for free and have basic diagnostics done for free there is basically the minimal for treatment if any. There are very limited medications, and thats if you can find them.
For pregnant women there are no prenatal vitamins or special nutrition if needed. The system stops giving cow milk when the baby is around 2 years old. There is rarely any product sources available to provide adequate protein for good health.
Their Doctors get paid $10 per month and depend on a poor transportation. Many survive through bartering for food for their services.
Yet you glorify their system as one the US should learn from? Ive personally helped my wifes family and many friends family there by diagnosing diseases processes and sending them medication they were told they needed.
As many have said. Nothing is free. A government healthcare single payor system is not good for anyone except the governmnet. Thats because they CONTROL whats available and who gets it.
Our Medicare system is expected to go bankrupt in 7 years. How do you propose it will survive if its available to all? Taxes, and more taxes along with rationed healthcare.
Next time make an effort on telling the truth on how bad their system really is. Stop misleading hour readers like theyge dkne to you in Cuba and every other socialist led country.
7
The truth is, most Americans think they have terrific health care, even when they don't. They think that because that's what they are told. They hear about our great drug discoveries and advanced instrumentation, and hear about all the great things happening at the Clevelad Clinic or Johns Hopkins, but the truth is that most of them cannot afford to go there. Nor can they afford expensive drugs or advanced imaging, but the delusion exists because of endless commercials and politicians who tell the lie that we have the greatest healthcare system. We don't. We have the greatest healthcare system for rich people. Mostly, we are suckers who overpay for mediocre service, and if you are poor, you get squat. It will never change here because Americans are too stupid to understand what's happening to them. It's actually pretty pathetic.
8
@Jim Dennis - It's interesting how you assume all of us less educated and knowledgeable then you are. I'd say snobbish of you.
My family emigrated from one of the countries with supposedly "Free and universal" healthcare. Yes, it is free and universal if you are generally healthy. you have to pay outside the system to access good specialists or travel abroad. It is very expensive and inaccessible as soon as you got sick.
We are very lucky to live in US. I have a front row sit to health struggles of my parents, my kids injuries, and our own health care. Being sick is never fun, but I am happy about quality of care we all get.
And please don't dismiss my experience as not valid because it doesn't fit your preconceived notions. None of us had any inherited wealth, I paid for college with loans while cleaning ppl houses for living expenses.
Cuba is a small, highly government controlled society top to bottom. Not a large, diverse, individualistic, decentralized nation with millions migrating in every year legally and illegally with little accountability.
That the U.S could take any lessons from how little Communist Cuba is run is farcical.
4
Are MDs in Cuba really the same as MDs in the US? It’s doubtful. The notion you can compare these two healthcare systems is ridiculous.
5
Yeah, crazy to look at the stats, ain’t it?
@Robert - if you can rely on stats. Easy to have great stats if you invent and fully control them.
The ACA, ("ObamaCare"), stinks.
The non-existent Republican plan stinks.
Here is MikeCare. It almost doesn't stink:
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is covered. Just like with the other services medical services should be paid for using the taxes which we pay.
You go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere. In any event you get the best possible care which is what we all deserve. What is the argument in favor of letting people get sick and die just because they are financially distressed?
And that's the end of it. Welcome to the 21st Century!
If it makes the prez feel any better call it "TrumpCare".
Representatives, get this through your heads, THIS is what We the People want. Anything less than this is no good, antiquated and criminal.
If a backward place like Cuba can do this so can we.
4
Under Cuba’s dictatorship, are patients forced to use their local doctor even if he is corrupt, incompetent, or abusive?
Living under the thumb of the Castros is unhealthy. Treating the lack of basic human rights in Cuba as an “oh by the way” is dangerously naive.
Every Western industrialized democracy but ours has a national health system without the political repression. Let’s look there for models, not to the enslaved Cubans.
4
What about the morality of the embargo? In 60 years we have succeeded in punishing a sovereign country for daring to govern themselves in a manner we despise. If the rationale for the embargo was regime change, it has failed spectacularly. It is the height of hubris, of entitled stupidity. The surest way to unite a people and instill patriotism is to present an external threat. Perhaps those responsible for continuing this useless punitive debacle are afraid that without sanctions the Cuban government would thrive. I don't know if the communist model would survive without the embargo, on an equal basis in the world community, but neither does anyone else.
2
I just got back from a 4 day trip from Havana. Loved the people, felt very safe walking the streets of every type of neighborhood.
People seemed for the most part happy but by by no means "middle class american."
Unfortunately while in Havana, I contracted Giardia, a common water/food born parasite found in many 3rd world countries. After 2 rounds/20 days of antibiotics I now I have IBS. This could take months,years or even never go away.
I am sad about this. Why cant cuba's government make the water safe for all when their health care in other areas rises above so many other countries?
If I had to do over again, I would still take the trip- just would have been more careful like my girlfriend did. The cuban people are some of the nicest that you will meet anywhere
1
Circa 2085, United States. One teenager commenting to another: "can you believe we once had a capitalized, for profit medical system where health care was ranked out of the top ten in the world and people could go personally bankrupt from medical bills?" the other replies "thank god we didn't live back then!"
2
Free healthcare? There is always a cost.
1
Until recently, Cuba exported doctors to Brazil under the "Mais Médicos" ("More Medics") program. At one point there were over 10,000 Cuban doctors working in the poorest parts of Brazil--its hinterlands, especially in the North and Northeast, and in the poorest suburbs of São Paulo and other metropolitan areas.
Brazil's newly elected President, before taking office, said he objected to money being sent to a Communist dictatorship, and would stop the program. Cuba pulled the plug immediately and over 8,000 doctors left their local communities bereft.
Why do so many Cuban doctors volunteer to spend 3 years abroad? If Brazil is any guide, it's because they will earn multiples of what they earn in Cuba, and will be able to save much of it as they typically receive housing in addition to their salary.
1
The doctors flee when they can. It’s why you will never see the AMA support the idea.
1
Besides being free to talk about Trump, what do we get in the US from our elected leaders? An antagonistic healthcare system which makes it difficult to get treatment? A workplace where people have to choose between work, bills or a visit to a doctor. Does anyone seriously think we need the US corporate incompetent “chumocracy” where “Doctors”’with MBA make the rules for profits while paying lip service to “quality care”.
3
@NSf Difficult to get treatment?? I have so many clinics near my house that I can get care whenever I might desire it. Be healthy and stay away from the doctors.
@vulcanalex it is not the clinic. It is the pre authorization you will need when you are sick. But you would not know unless you need to access the system. Wish you will never have to do.
1
@vulcanalex Consider reading this article in NYT and it is not just insulin.
“The Insulin Wars
How insurance companies farm out their dirty work to doctors and patients.”
What timing by Kristof! Paul Krugman has a similar article today on health care experiments in California, Washington and New York, i.e. “laboratories of democracy.” The common thread is that America’s belief that laissez-faire capitalism serves it’s people best maybe ain’t so.
One of Ronald Reagan’s economic architects tried to tell us this ten years ago. In his book, The Failure of Laissez-faire Economics, Paul Craig Roberts lays bare the damage done by the pernicious notion I call “Little Bo Peep” in which we are assured that if we just leave capitalism alone, it will come home. Not in my lifetime it hasn’t.
3
What? Cuba is better than the United States? Next thing you will be saying is that Canada, the U.K., Germany, France, New Zealand, Japan, Spain, and maybe even Uruguay are better than us! I thought we were the best.
2
If you want the government to control your health care and not your doctor, adopt the Cuban system. In the Eighties the Castro treatment for AIDS sufferers was internment. We should now follow their model?
3
Medicare for ALL: 2020. It’s Time. Please, let’s not allow the
“ perfect “ to be the enemy of the good. Ask yourself, would YOU rather have Medicare, or the outrageous hodgepodge of Insurance Companies and “ managed care “ ?
Yeah, thought so. And, good on you, Cuba. Credit given when due. Seriously.
2
@Phyliss Dalmatian I would be happy with Medicare for all as an option as long as those who want in pay 100% of the costs without any government money. Try that and see how many take that deal.
1
The greatest thing about Cuban healthcare is the attitude Cubans have about it. They are proud and comforted. It would not be the same in the US. One of the biggest spends of Medicare is for artificial joint replacement. A procedure that is not available to ordinary Cubans. “We know that people get old and we adapt” said one Cuban to me about this issue. The same for cancer treatments. Not many people die in a hospital, let alone an ICU. Lots of economy to be gained there. Would we in the US love it just the same?
3
I sometimes call for a Cuban health care plan. This means that almost everyone is poor and therefore not obese. They walk a lot because they are poor, but they get exercise. Little to no unhealthy food, and little freedom. If we had such a population we would need way less care and it would be more affordable. Anybody up for this???
1
Dr. Rodriguez is available 24/7 for less than $1000 a year. I don't see that happening here.
1
I spend hours and hours on medical claims, understanding my health insurance, keeping my own records, examining bills and calling billers and the insurance company, resubmitting rejected claims, making sure the EIBs match the bills, correcting wrong codes, changing doctors to be in changing networks, etc. I won’t be able to even handle all this when I’m old. It’s clear we need Medicare for all.
5
@Irene You must be very sick, I do none of that and never will. And when you are old you will have Medicare.
@vulcanalex
I think the topic of this article is what people do when they're sick or pregnant, not what they do when they're not "very sick."
1
As a second generation Cuban-American that visited Cuba for the first time this year, it's heartbreaking to read an article like this. When I came back from my trip, the main refrain I heard about Cuba was "well, at least they have a good healthcare system, right?" After speaking with many people "off the record," I learned that this couldn't be further from the truth. Technically, yes, you can see a doctor for free. However, it requires waiting for hours in line and dealing with medicine and supplies shortages as the article mentions. Sometimes they don't even have simple supplies like bandages or sheets for hospital beds. When I asked a cousin about scheduling an eye appointment for preventative care, he laughed and said a doctor would turn him away if he went to a hospital for that reason. Our driver's wife nearly died in a maternity ward after giving birth due to substandard care and lack of supplies. People with advanced or complicated illnesses have no chance of staying alive as the island lacks medical technology and medicine is practiced as if it's the 1950s. I could on and on. The article recognizes some of these shortcomings, but in my opinion, they should be the headline, not buried at the end.
Very disappointed to see the NY Times perpetuating the myth of how great the Cuban health care system is. There are other countries one could turn to in order to make the point that universal healthcare is a right (which I firmly agree with).
12
Most of the problems you mentioned are caused by the United States. our embargo of this country makes no sense. We trade with China and Russia, why has this continued for so long? The only reason is the power of the Cuban community in Florida. But those who fled Castro in the 1950s and 60s are dying out so maybe some day we can have a real relationship with this neighbor. Obama tried but Republicans fought him all the way.
Sure, lets take advice on revamping our entire healthcare system from a reporter. Not doctors, hospital execs, or insurance execs. A reporter, whos more than likely never put on a pair of scrubs in his life, and hasn't had one conversation with a chief surgeon who understands healthcare and its delivery. Oh yeah, I hear Bernie has a "plan". Another tried and true student of healthcare delivery. When will people ever learn?
I'm in the business. Medicare for all will turn our hospitals into something that resembles your local DMV. Our great healthcare relies on innovation and research and development. That gets accomplished by our drug and device companies. Every drug and device in existence has this minute, R&D being INVESTED by these companies to make them better. That R&D is only paid for by private insurance and cash. No silly, the government research doesn't develop a better knee replacement so Stryker and J&J could make more money. And no, govt run community plan insurance does not reimburse anywhere near what is necessary to help finance R&D. A universal single payer takeover of our healthcare system would bring innovation to a halt. There wouldn't be enough money to do the R&D, and surely not enough to profit on it if it is successful. So those investments aren't made - innovation stops. Smart people wont become doctors anymore if their income is capped. We have tons of medical residents from Canada here at our hospitals. That's the real world folks, welcome to it.
3
@Sports Medicine
I don't know what part of the business you are in but I have been a Pulmonary and Critical Care physician for 30 years and I disagree. Do you know of any, new antibiotics being developed? Those profits have vanished and so has R&D. Pharma companies spend most research dollars on clinical trials and more than that on marketing, watch TV. A very large percentage of primary research is done at NIH and Universities with NIH grants. I spent 15 years in city hospitals, DC General and Cook County Hospital and trained at VA hospitals. I felt that the care given was in many ways superior to private because there was no profit motive, more Hippocratic oath motive. This meant less profitable excess invasive procedures that I have seen in the private sector and Yes the lines are a bit longer, but try to get an appt with a doc in DC and you will wait 3mo. We spend twice per capita than Europe with no better outcomes.
Our health care system depends on performance more than innovation (read literature). Our innovation is now working on important but rare conditions and is being studied at or by NIH.
Profit motive is a part not the essence of good medicine and can survive with less of it.
5
I’ve been to Cuba several times. Pharmacies have empty shelves and local hospitals are falling apart with broken windows with lines around the block. Hardly sounds like a successful medical system. I’m always confounded by articles extolling the virtues of the Cuban medical system when the truth is something completely different.
12
i went to cuba in 2017 with Witness for Peace. There is even more to learn from Cuba than their health care system. One thing is very clear: our government's policies of animosity have not worked for over one hundred years. We have lost a lot by not embracing the Cubans as friends. We have rejected opportunities to help them in their difficulties and in fact solidified our determination to make them suffer. Read the history. Participating in mission trips will not do the trick. We need to turn our government's policies upside down.
8
@enid flaherty
We need to run our government, all of it, out of town, out of our lives, especially both mainstream parties, and replace with true representatives of the people, wholly independent individuals with no ties or allegiance to corporate money or government entities of any kind.
3
@enid flaherty Why would we want to help them, traditionally they oppose things we want and either help or are helped by our opponents. We don't need them at all, they could use our help a lot.
It's funny how those opposed to national healthcare because of supposed self interest and capitalism really don't understand how they can benefit.
With so many people not insured in our country and so many who are still not able to afford co pays and prescriptions, there must be billions of dollars left on the table.
Put all Americans into the same health care pool and give them insurance and what will happen? More doctor visits, more money for drugs and doctors.
A real issue in a transition is that there are not enough doctors because the number is restricted as both a monopoly and because they only need to serve a portion of the population.
Commensurate with any national healthcare we need to greatly increase the number of doctors and that needs to start now.
So many of the doctors we get go into medicine not because they love it but for money. Which, don't get me wrong, is ok. But this distorts the number of primary caregivers and the locations where doctors practice and thus underserve many areas in the USA.
Insure everyone and bring in and train more doctors who will want to be primary caregivers. This ramp up of doctors needs to really take place before insurance expands or the system will be overloaded.
3
@TStreetBob When all professionals in health care make less due to Medicare for all, they will either retire, move, or just take cash. Organizations will close as well.
1
I was in Cuba about 12 years ago and went to pharmacies and saw empty shelves. Yes there are neighborhood doctors but the lack of supplies was appalling. People on our airplane who had family in Cuba were bringing in band aids and other common medical items. I had heard about the incredible medical system in Cuba but somehow didn't see it. Maybe things have changed since my visit.
3
I am not crazy about the idea of Medicare for all, but I agree 100% with Nicholas Kristof, that there is a lot to learn from the Cuban system. One thing that pops out is that they have 3 times as many doctors per capita as the US. The US has many smart college students who want to become doctors and cannot get into med school. Yet go into any large city medical center and you find that many of the doctors are foreign born. The US has a shortage of family practice doctors and doctors willing to practice in rural settings. The answer is we need more Medical Schools. Lets double the number of medical school slots over the next five years. We couple this with an increase in STEM education, and we will begin to have doctors willing to take some of the less glamorous positions. Doctors will still have opportunities to learn in the top 5% of the income levels in the US, but the country might see additional competitiveness with doctors fees and greater access to care.
8
@John Domino I somewhat agree but just because you are smart does not mean you are doctor material.
@John Domino
Cuba has many more doctors per capita because they have chosen to make medical education virtually free, and to train enough physicians to provide the kind of universal care now available there. When they complete medical school, they are not burdened by debts of up $500,000. Their focus, very appropriately, is on primary care, not expensive specialties. Cost is kept way down. This situation exists because the government there has deliberately created it, generally by mandate and law. There are plenty of deficiencies in their system, but the average American would receive better care in Cuba than here. Only the truly wealthy here could obtain a generally higher level of care.
2
@John Domino
The medical school system in the United States is a very complex monster. Competition for entry is fierce and even at that level requires large amounts of funding in order to randomly fly all over the country for interviews.The entire process is repeated when applying for residency and fellowship positions. Successful applicants go into the high-end specialties to pay off their astounding school debt loads.
The number of residency slots available determines the number of medical school students admitted. The
residency slots are restricted by Medicaid funding rules.
I visited Cuba a few years ago and became ill. My Havana hotel concierge made an appointment for me within walking distance of the hotel.I went to see a Cuban doctor and got in right away. I was diagnosed and she prescribed medication for my condition at no cost.
I visited Egypt and became ill. The concierge at my Cairo hotel called a doctor and arranged for the doctor to visit me in my hotel room where he diagnosed my condition and prescribed various medications that I had filled at a pharmacy near the hotel.
I had purchased comprehensive health and medical care insurance as part of my international trip itinerary at a nominal costs.
3
Cuba is a very poor country. It is difficult to compare its health care system to ours. Indeed, it may even be hard to learn much from them. Canada, on the other hand, is right next to us and has a comparable standard of living. In addition, their system is very much like the proposed improved Medicare for all which, given our dysfunctional politics, is much more like to be approved here than the system of socialized medicine used by Cuba and the UK even if the data shows socialized medicine to be more efficient.
Canada's bottom line health care statistics are better than ours in spite of a worse climate. We paid $9506.20 per person for health care in 2016. In Canada, they paid $4643.70. If our system we as efficient as Canada's, we would save over $1.5 TRILLION each and every year. This is money that can be used for better purposes.
If one uses bottom line statistics, we see that both Canada and the UK (real socialized medicine) do better than we do:
Life expectancy at birth (OECD): Canada- 81.9, UK - 81.1, US - 78.8
Infant Mortality (OECD)(Deaths per 1,000): Canada - 4.7, UK - 3.8, US - 6.0
Maternal Mortality (WHO): Canada - 7, UK - 9, US - 14
Canadians mostly live near the border and have some familiarity with our system. Ina a Globe-Mail & Canadian Broadcasting poll 91% preferred their health care system.
0.5% of Canadians receive health care in the United States a year, but only 0.11% come here for the purpose of obtaining health care.
61
@Len Charlap
It’s also worth noting that The US spends more PUBLIC (i.e government) funds per capita on health care than Canada. So, a smaller amount of tax dollars are spent on health care in Canada even with universal coverage.
6
@Len Charlap Sure compare Canada's population diversity and health to ours as well as the outcomes. We have doctors from Canada who hate their system and love ours. They also live part time in Florida, I doubt many US citizens do that in Canada.
@Len Charlap
"Contrary to popular belief among Americans, health care is not entirely free for Canadians. Dental, ambulance and many other services as well as prescription medications must be paid for out of pocket or they're covered through a combination of public programs and private health insurance. About two-thirds of Canadians have such insurance."
https://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care
1
Here is the fallacy in your argument. The poor health outcomes in the United States occur among the population that is already eligible for free (meaning I pay for it) health care through Medicaid. Don't tell me the health care system has to changed until you fix the bad habits that lead to bad health outcomes. Medicare for All will not solve the problem of babies being born with alcohol in their blood.
5
@SHerman The issue of individual bad habits is addressed in the article.
1
I know plenty of well off drunks. Perhaps you don’t.
1
@SHerman Wow, that is quite an assumption! My sister in law lost her baby at a prestigious NYC hospital during labor. She never had a drink and she had paid employer-based health care. Since you are focused on maternal health, learn something: https://everymothercounts.org/giving-birth-in-america/
1
Welcome to the great American healthcare rip-off, the greatest rip-off in the world.
Brought to you by rapacious, unconscionable Greed Over People and a nation of anti-Christs hellbent on radical, right-wing for-profit healthcare.
"If you're not feeling well, take two tax cuts and call me from the morgue..."
The Republican Doctor is in !
Country and % of GDP spent on healthcare
United States 17.2 %
Switzerland 12.3 %
France 11.5
Germany 11.3
Sweden 10.9
Japan 10.7
Canada 10.4
Norway 10.4
Austria 10.3
Denmark 10.2
Netherlands 10.1
Belgium 10.0
United Kingdom 9.6
Finland 9.2
Australia 9.1
New Zealand 9.0
Portugal 9.0
Italy 8.9
Spain 8.8
Iceland 8.5
Greece 8.4
Chile 8.1
Slovenia 8.0
Korea 7.6
Israel 7.4
Hungary 7.2
Ireland 7.1
Czech Republic 7.1
Slovak Republic 7.1
Estonia 6.7
Poland 6.7
Lithuania 6.3
Latvia 6.3
Luxembourg 6.1
Mexico 5.4
Turkey 4.2 %
https://stats.oecd.org/index.aspx?DataSetCode=SHA
"Twice the price...and half the healthcare...drop dead, America !
"Free-DUMB !"
GOP 2019
97
@Socrates you have no idea what youre talking about. Thats why many (those who can afford the trip) come here and pay CASH for routine work ups instead of waiting more than 6 months to a year for routine work ups that can save their lives for diseases like cancer if not caught early, as well up to date and life saving healthcare.
Why do many of their Physicians/Specialist/Surgeons come here to US for training?
What good is free healthcare if its rationed healthcare? I know the system because I practice healthcare. How about you?
4
@Socrates So just get our GDP to grow about 10 times while eliminating imports and problem solved. Percent of GDP means nothing here or almost anywhere.
1
@vulcanalex
"So just get our GDP to grow about 10 times while eliminating imports and problem solved. Percent of GDP means nothing here or almost anywhere"
Wow !
Talk about someone who needs a mental health check-up as soon as possible.
Everything you said is perfectly detached from reality.
Alarming.
24
Sorry to burst your bubble about the magnificence of health care in a repressive island dictatorship, but the truth is Cubans are impoverished, lack basic medicines like Tylenol and antacids, subsist on low protein diets, live in crowded, dilapidated housing, and beg tourists for money to buy milk for their kids. Having more medical attention from doctors who make less than taxi drivers doesn’t make up for all the rest.
13
Your Money or Your Life.
I am a health care industry and insurance company investor, and unlike doctors and health care workers who care for people, I do not. I care for profit and the CEOs of all of the companies in which I invest, work for me the stock holder.
Our goal is to make as much money as we can off human illness and suffering, while providing service in a manner that keeps us in business and within the law as our attorneys interpret it.
Profit drives our policies and practice, not what is best for patients and the nation.
The old time highway robbers used to say "Your money or your life" and many of them were caught and hung. But isn't it great........ we can take all of your money, and sometimes even your life, and yet remain respected pillars of the community.
Our nation has socialized military, socialized police, socialized legislatures and socialized court systems, because if those institutions were turned over to capitalists it would subject America to great harm and expense perpetrated by people like me. For profit health care is no different.
It is illogical for huge profit to be part of any system we must use to avoid suffering and death, because like the Mafia, business will use the inherent leverage to extort a price most cannot afford, but all must still pay.
65
@rich
I'm in the business too. Tell me, what happens to all our R&D if profit is taken out of the picture? That R&D is actually an investment. Those hundreds of millions of dollars invested into making better devices and drugs are made with the expectation of a windfall return. Without that expectation, the investment wont be made. No silly, the govt doesn't do the research for better knee replacements so Stryker, and J&J, and smith and Nephew, and all the rest could make more money. those companies do their own R&D, financed though the money they make off their existing products paid for by private insurance. Govt run community plans do not reimburse enough to provide the capital for that R&D. Whatever part of the healthcare business you are in, you still have a lot to learn.
1
@Sports Medicine
Advertising expenditures are greater than R&D.
12
@Sports Medicine-
It is not up to US citizens to subsidize all of the R&D for better sexual performance drugs.
What good are all the advances if fewer and fewer people can afford to use them?
It is long past time for your side to offer solutions to this problem, not simply trotting out worn out PR points from big pharma and insurance. They system cannot continue this way.
Except, of course. for those who run Sports Medicine practices.
7
There is NOTHING in this article that makes me think government run healthcare is good. I have too much experience with National Health ( UK) which is high in capability but the service is awful simply because it is rationed like all government funded programs. Waiting months to get an MRI read, getting the next appointment , or getting a specialist are not only frustrating but deadly. Why do people think that the private insurance market developed in the UK?
10
@James lol
A letter in my local paper described an elderly American's experience in Britain when he suffered stroke symptoms then received expert care that required a three day hospital stay and was charged only $2000 dollars. (It would have been free if he were British).
This is part of what he wrote:
“There I remained for three days and two nights undergoing many tests, including an MRI. When I rang the help bell, an attendant was there within five minutes. The printouts of my tests, a dossier about one inch thick, were presented to a team of doctors headed by a world-renowned authority on strokes. The whole team came to my bedside and explained the results. It was atrial fibrillation, not a stroke. I was not discharged until I had been examined by three therapists speech, occupational and cognitive”.
As an American healthcare investor I find this incident very disturbing. To maintain the profit margins,that make me rich, my investments in hospital, insurance and drug company stocks, require that $2000 dollars cover the in hospital cost of about 4 Tylenol tablets and that the care he received, cost him or the taxpayer, about $160,000 dollars.
If America were to provide health care without obscene profit how could we pay hundred million dollar health care company CEOs salaries, and how could those health care companies and CEOs pump millions into our elections and political system?
All that expert health care at such a low cost seems very un-American.
22
@rich
I'm in the business too. Tell me, what happens to all our R&D if profit is taken out of the picture? That R&D is actually an investment. Those hundreds of millions of dollars invested into making better devices and drugs are made with the expectation of a windfall return. Without that expectation, the investment wont be made. No silly, the govt doesn't do the research for better knee replacements so Stryker, and J&J, and smith and Nephew, and all the rest could make more money. Those companies do their own R&D, financed though the money they make off their existing products paid for by private insurance. Govt run community plans do not reimburse enough to provide the capital for that R&D. Not to mention, smart folks wont become doctors. Whatever part of the healthcare business you are in, you still have a lot to learn.
@James
Forty years ago this month I suffered a miscarriage while in London. Not only was my hotel able to arrange a visit to a local National Health service hospital I was seen very quickly and given an ultrasound. I had never heard of ultra- sounds before although I had two children and regular medical care in the US. In fact it was several years before ultra sounds became in regular use in the US. That afternoon I was operated on in a very modern surgery as the ultrasound had shown the pregnancy was non-viable. The cost: nominal.
In the winter of 1992 my husband became very ill while we were skiing in Italy. The ambulance service took him to the local medical center where he was stabilized because he had a temperature of 105 degrees. Because they were only a clinic for ski injuries he was taken fifty kilometers down the road to an Ospedale Civile. It proved to be an E. coli infection and after one week in a private room and intravenous antibiotics, he was released and we flew to London before returning home to the US. The hospital apologized for the billing of about $4000 for the care and pointed out that had we been British or European or even Canadian, there would have been no charge. Even so, far cheaper that the US and excellent care.
When I visited Cuba in 2015 one of the people in our group arranged medical care in Havana and the doctor came to her hotel room. No charge.
4
In wonkish terms, the ratio of outputs to inputs measures efficiency. Similarly, the ratio of outcomes to outputs measures effectiveness. Because of the way American for-profit insurance and health care industries are compensated (basically they receive a fixed percentage of inputs), there has been far too little emphasis on efficiency or effectiveness. This is a primary reason that the U.S. spends more on health care relative to GDP and achieves poorer results given that amount of spending than do other developed countries. If you want the for-profit insurance and health care industries to change their behaviors, change their incentives by rewarding them for achieving efficiency and effectiveness.
Another reason we spend too much on health care is patient behavior. Having paid our insurance premiums and facing minimal co-payments, we as consumers erroneously believe that health care is "free". We go to the doctor for things that could be handled better at home, e.g., the common cold. More importantly, we rely on medicine to deliver wellness rather than taking personal responsibility, e.g., get some exercise, don't smoke, don't drink excessively, eat healthier, etc. Again, change the incentives. Reward people with healthier lifestyles with vanishing deductibles. And those who have created chronic medical conditions for themselves through un-wise choices should face increasing deductibles.
5
@Earl W.
Many people unfortunately have chronic medical conditions through no fault of their own. I have a daughter with MS and one with rheumatoid arthritis. Both were raised with healthy diets and lots of exercise and despite their illnesses still exercise to the extent possible and hold down jobs. Our insurance system punishes them for something out of their control.
2
@Earl W.
The problem with health care in the US, and the only real problem, is that we do not pay for health care, but rather health "insurance".
1
@Julie Carter Our health care system is smart enough to sort out the relatively small number of patients who have chronic medical conditions through no fault of their own. In what ways are your daughters punished and how would you make the current system fairer in this regard?
1
US public and private sector leaders are not interested in eliminating 10% of the GNP to achieve a healthcare spending rate similar to Canada's. It's all about the "health" of the broader economy.
2
Recognizing that the Cuban system has pitfalls, "Welfare for all" is a model worth pursuing. Lobbyists from big medical corporations and big-pharma keep Congress from implementing universal healthcare in the U.S. By now, there are sufficient global models that prove its benefits to the citizens; however, Congress is not invested in what's best for constituents, but what is best for campaign financers/lobbyists.
5
Health care should be recognized as a human right.
Universal coverage is not inconsistent with a strong economy either. Look at Germany.
4
@Julio Wong
You do not have a right to another’s time or education.
Healthcare is a service not a right.
1
@Julio Wong So get it in the constitution, only legal rights have any impact on government, not some "human" ones. Yes look at the population of Germany it is way different than ours.
You brought up one of numerous challenges to universal healthcare. Doctors, hospitals, provers of all sorts are paid huge amount and the licensing/professional associations act like guilds restricting the number of doctors, nurses, etc. When you pay the average experienced dermatologist $400K per year, restrict ability to negotiate for lower drug prices, and allow hospitals to buy out all the physician groups in a geography to lower competition, you will have a system that has costs 2x that of any other industrialized country
9
It may be true, on some level, that Cuba provides "care for all", but given what we know about how other totalitarian governments have operated, it's almost certain that "some are more equal than others"--i.e. that high-ranking folks receive care that is better in many respects than the folks on the bottom.
6
@Howard Kay While that may be true, don't think that in the US that some people are more equal than others. Replace high ranking folks with working age population for large and mid size companies that have insurance. There is a sizable amount of our population that not only gets less than equal care than no care. Which is preferable?
1
@Howard Kay And paying tourists as well.
@TStreetBob Many get Medicaid, and they being poor should stay healthy.
Your point about the number of doctors per capita in the US versus Cuba is a good one. When Johnson created Medicare and Medicaid virtually nothing was done to increase supply to meet the obvious surge then and later demographily driven demand growth for health care services. Health care inflation has been higher than general inflation ever since.
1
@William Eakins - @Realist - What you say sounds reasonable. Unfortunately it is not correct. New Zealand, Canada, the UK, Japan, etc. all have fewer physicians per 1,000 people than the US and get better care at much lower cost. http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-...
We spent $9,507 per person on health care in 2016 while the UK spent $4,193. Here are some bottom line statistics:
Life expectancy at birth: UK - 81.1 US - 78.8
Infant Mortality (Deaths per 1,000): UK - 3.8 US - 6.0
Maternal Mortality (WHO): UK - 9 US - 14
https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics_health-data-en
Another point is that in the US many studies such as the Dartmouth Atlas show that the higher the density of doctors, the higher the cost of health care.
The two factors that have been shown over and over to provide efficient health care are universality and government operation. The "free market" has always proved to be a disaster in health care.
4
@Len Charlap Correlation is not causality, and none of those countries have our very unhealthy population, drug problems, crime, or poverty in the amounts that we do. We have a somewhat free market and it works well for a vast majority of reasonable people.
@vulcanalex - While "correlation does not mean causation" is logically true, it is useless in the real world because one can NEVER prove causation. Just ask the physicists who thought they had proved Newtonian mechanics. All we have is correlation. What's that definition of insanity?
And if you would ever take the time to check your assertions, you would find many of them are false.
For example, check smoking and obesity in Australia or drinking in France. You could also compare the health care in poor countries with a lot MORE poverty than we have. e.g Costa Rico.
If the free market in health care works so well why do so many people put it near the top of problems we have to solve?
2
Could the government shutdown close hospitals that depend on Medicare payments to stay open? How long would that take?
2
I support Universal Health Care and find Singapore's model to probably be the one most in line with what our country might adopt.
I do wish, however, that the term "free" would just go away and be replaced with "taxpayer financed".
21
"A country like the US cannot provide "free" healthcare to everyone. It is simply not possible financially."
That is basically a FALSE statement perpetuated by insurance companies. The insurance companies are the single biggest impediment (and their lobbyists sand the corrupt politicians) to universal healthcare in the US.
If we took all the money flowing into Medicare, Medicaid, and the Insurance companies, we would provide top of the line healthcare to everyone in the US AND save a few billion dollars.
UnitedHealth Group CEO Stephen J. Hemsley received $66.13 million in compensation. That was money that did not go provide Healthcare. Think about it for a moment.
8
@A A We could??? When it is free the volume will go up a lot. I agree that CEO's are way over paid, but that is only a very small amount of money.
I don't know Cuba but I know NHS here in UK. The admin is awful but once in front of the doctors it is top class and free!
Everyone I know in Europe are fascinated that America despite investing g more than twice as much as over here seems unable to provide healthcare for everyone and produces so poor population health stats. Why does a day in hospital cost £5000 over there and only £500 here? I have many friends working in American hospitals and it os certainly not their wages that makes the difference.
6
Capitalism has its place, but that place is not in health care. It's amazing, this far into our history and we still don't understand that, powerful forces are fighting against Universal health care, big businesses, that ironically are staffed by people who need health care, the classic case of the working man/women cutting his own throat and his neighbors throat for a paycheck, while at the top of the power structure the greedy rake in the bucks.
9
An anecdote:
I was living in London when a friend of my girlfriend showed up one Sunday night with a high fever. We rushed him to the local hospital. The ER was dark and dinghy and empty. There was a widow with a woman behind it. We were sent to an examining room and in a minute a doctor showed up. He treated my friend and handed us two prescriptions. He said the pharmacy was around the corner.
I handed the pharmacist the scripts and in five minutes had the drugs, I then asked, "Where do we pay?"
"Pay?" she said, "There's no money in this hospital."
"You don't understand, " I said. "We are not British citizens. We are just guests."
"No, YOU do not understand, This is England. This is a hospital.. We treat sick people. We treat all sick people, Brits, Frenchmen, Chinese, even Americans. And that's all we do. We just treat sick people."
3
Cuban healthcare is a joke. Take if from someone who lived there. There are NO resources. If you want a procedure done, a lot of times you have to procure the materials and then take them to the doctor. In my time there I had to have an invasive surgery because the hospital didn’t have the means to find out that what I actually had was an infection.
Cuban mothers are substantially younger than American mothers on average. Cubans typically give birth in their early 20s. Of course that lowers the birth complications substantially. Also, Cubans are not shy about abortion, especially if something is “wrong.” It’s a cultural trait, the island just simply overwhelmingly ascribes to the idea that the mother takes precedent and a child isn’t a child until it’s actually born. That helps a lot.
12
As our tour guide in Cuba noted, a free health care system does not guarantee access to health care, let alone access to quality care. He shared anecdotes of going to get an X-ray, but none of the machines worked. When he needed a certain ongoing medication, it was unavailable to Cubans. His only recourse was to go to a pharmacy that caters to tourists and pay an astronomical fee (relatively speaking), which he could at least choose to do because he works as a tour guide and makes a better salary than most. Surely there are many ‘universal’ systems around the world from which the U.S. could learn, but those who hail the Cuban system as a model to embrace do not have the full picture (and I am not putting Mr. Kristof into this camp, as he points out several drawbacks in his article).
7
A few years ago when Universal Health Care was a hot topic various reporters went to many countries that had such care systems. They found a variety of models that work very well and our congress could have picked and choose parts from here and there to come up with a model special to the USA. But, as usual, the congress seemed intent on remaining ignorant because this information never seemed to make it into congressional discussions. If there were hearing, expert testimony, or congressmen relating such models to their fellow congressmen, there was not a peep from the press. I believe the valuable information never made it past congressional bias. Sad!
3
Yes, you can have universal health care if you pay doctors $25 a month. I don't think that would go over very well in the US.
Let's look at annual GP salaries in more reasonable comparisons:
Spain: $40K
Germany: $85K
France $92K
Switzerland: $116K
Canada: $107K
Australia: $91K
Here in the US, the average GP salary is $180K. Not only that, but every else in the medical system says that if that's what doctors make, then I deserve high pay too. At the bottom, about 90% of the costs are salaries.
1
@Jonathan yup paying for that $500,000 in student debt from private schools and not starting to make a real income until their 30s.
4
@Jonathan
I know a couple of GPs, and their salary is nowhere near $180k.
2
Let’s add to that the incredible number of “administrators” in the US healthcare system. Most have been added in the past 20 years to manage government rules and regulation. Letting doctors just do what they do without interference would solve much of the problem.
5
I just returned from my first visit to Cuba. Based on conversations with people I met, I think the health care picture may not be as rosy as Mr. Kristof paints it. It takes more than doctors to provide good care. It takes medicine, and drugs as basic as aspirin and asthma pills are rationed in Cuba. I met one man whose monthly quota of asthma pills was insufficient to treat his illness, and after the government refused to give hime more pills, he developed pneumonia. Apparently, Cuba is not even able to furnish inhalers to asthma patients. Another heart patient needed more aspirin than the government was willing to provide.
I don't believe you can blame basic drug shortages on the US embargo, as Cuba could purchase them from many suppliers around the world. The real problem is the dysfunctional, centrally planned economy that leaves Cubans with little incentive to work and create value. An economy that cannot create value cannot provide decent health care, no matter how many doctors it has.
7
So.. you survive as a baby, only to die young from diseases that are easily treated in the United States.
You make it sound so simple!
Who wants to live in the inner city to deliver heath care, for any salary.
Or in rural poor areas.
I am in favor of Medicare for all, but I would like my doctor to be more educated than a taxi driver!
6
@Shp Cuban doctors are actually very well-trained. Amazing that they work for less than $1000/year.
2
@Louise Banks
What choice do they have?
While there is much to emulate about Cuba's healthcare system it is worth noting that how Cuba as a nation survives day-to-day is pretty much a mystery. The wage of $80 paid to an experienced doctor is still not even close to a living wage. A cab driver makes more than a doctor because of the 2 currencies used in Cuba: the Cuban peso and the CUC. Foreigners use CUCs, which are tied to the value of the US dollar. Cubans use pesos. A Cuban who has interactions with foreigners in the tourist business receives tips in CUCs, which were valued at 25 times the value of the peso when I visited Cuba in '13. It is easy to see how this two-tiered monetary system introduces distortions in the economy.
One evening at a paladar our waiter was the top OB-GYN at the Cienfuegoes hospital. He, like most Cubans, had to hustle a living outside the official salary. So, drawing parallels between Cuba and the US healthcare system are tenuous at best, since no one can call the present Cuban economy sustainable.
I also had a chance to tour the hospital and talk with doctors in Cienfuegoes. The hospital was decidedly Third World. No screens on the windows, broken down and cobbled-together medical equipment, waiting rooms packed to capacity with Cubans waiting for medical attention. I asked what effect the embargo has on quality of care. One dedicated doctor said it is incalculable. The level of care would be so much better with free access to modern equipment and drugs.
6
We just returned from Cuba and spoke to a number of residents about health care. They were shocked to learn that my husband's recent emergency appendectomy was billed for more than $100,000 - with less than 20 hours in the hospital. While the model in Cuba is good - and I believe the US needs universal health care - the embargo HAS dramatically impacted the quality of care in Cuba. One woman we met had three root canals, all without anesthesia because none was available.The embargo hurts real people.
6
@Brenda Considine
They could get those basic medical supplies from anywhere else. It’s not the embargo darling, it’s the system.
Our NHS here in UK isn’t perfect, for patients or as myself as a clinician. It is however difficult to see why in US you value the health and well-being of your young, your priority groups and low to middle income patients so little.
7
Why not choose Germany and/or France to do a close-up report of how well these systems work, with extremely well-equipped facilities and well remunerated doctors and support staff? Maybe that would finally stem the fear mongering about "socialized medicine."
3
@Ellen I dont think either of those countries have Military. No Navy, Marines, Army, Coastguard...So to compare them without total removal of our military funding would be futile. They have funds they are not using on military for health care. We are their military, so getting rid of ours is not an option.
1
@Daphne Sanitz
If you do any kind of research, you will find that both France and Germany do have armed forces: Armies, Navies, Air Forces, Marines, Coastguards, etc. Both countries are members of NATO and so help contribute to US defence. Where required, they form part of UN forces, they just don't interfere in other countries as much as the US does.
2
Daphne: Protection rackets only work one way. Nobody forces the Mafia to protect them.No country can twist our arm and make us spend money on their defense.
So we get better options for late stage treatment......most expensive, worse survival rates and harder recoveries.....because we refuse to provide the basics.
7
Kristof, you're just feeding the Republicans' views about universal healthcare with this column. This is not helpful and even comes across as concern trolling for universal healthcare.
As a millennial who supports universal healthcare, I prefer to use Canada and Scandinavia as my examples. Let's not use a communist country where many doctors stopped working as doctors because they make more money as taxi drivers, eg Cuba.
6
yes, the system may have it positive points, but let us remember if anyone in the U.S. walks into any hospital they will be seen. Ask any of those Doctors who make less than the cab drivers if they would like to practice in the U.S. and I'm sure 98 percent would say yes. If this America is so terrible, why are there thousands of people flocking here?
5
@Joe P Enough of the specious reasoning to justify a complacency that only serves the profits of the few. By your logic, we need do nothing for the betterment of Americans' lives and health until people start fleeing the country in droves.
Which, by the way, they do if they can and must. I had a Canadian-born friend, who had no choice but to repatriate to Canada, after 35 years in the U.S., when he developed cancer and could not afford treatment here. They rushed him into an advanced, experimental protocol treatment that gave him two more years of life where here he had been given months to live on nothing but opiates. It is commonplace among Russian-born American citizens I know to return to Russia for expensive surgery that would bankrupt them here. And that's not to mention the countless Americans living along the border who go to Mexico for dental treatment and prescription drugs. Our national shame of a healthcare system is not counterbalanced in some cruel calculus by the other benefits of living in America.
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@Joe P So your argument is that because people are flocking here we have nothing to learn from others?
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Cuban doctors do not graduate with a large debt to pay for their education.
As the United States moves toward universal healthcare, it is also important to educate more doctors and other healthcare professionals without them graduating with debt.
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This type of comparison could be made with many other countries in particular every other developed one, where you find lower costs, universal access and as good or better outcomes than the US.
Cuba’s system is very different from, say, Australia’s however they have commonalities.
They both require all citizens to be covered and and have access to money and life saving primary care, AND pay in in some way - no free riders - so costs are spread across more people and tied income making it affordable, and secondly prices are tightly controlled.
Our failure to do these has caused huge costs and worse the misery of many deciding to avoid care because of lack of insurance leading to worse disease, higher costs, and millions of bankruptcies.
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The American healthcare system is... well for one it’s a business. The doctors, insurance companies, drug companies, medical equipment manufacturers , hospital chains and drug stores all have positioned themselves to rely on the sick. The sick are pitied and as a society we can’t allow them to ever be forsaken. The sick are our loved ones which we will do everything for to save . Therefore this health system will always have costumers to exploit. Prey on the needy.
The problems are so intertwined and complex that whomever has the strongest pull, meaning political power wins their stake and piece of the pie. The stakes are global and help run our economy. The problem is self evident but no government has the ability to defend themselves to do the right thing. Lobbyists from each stakeholder enforce this present path . Blame is easy on the surface but see where you spend your health care dollar. It’s so complex that is nearly impossible.
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Cuba’s doctors are delivering medical care in many countries of the world who do not have adequate numbers of professionals. Its medical school in Havana is admired for teaching hands on care. When the US Government was struggling to deploy medical support teams to help Hurricane Katrina’s victims Cuba offered to send some doctors and other medical professionals to New Orleans. President Bush declined that offer. I visited Cuba two weeks ago I and every Cuban I met mentioned how great their medical system works.
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"Cuba regularly screens all women for breast and cervical cancer, so it is excellent at finding cancers — but then it lacks enough machines for radiation treatment. In the United States, on the other hand, many women don’t get regular screenings so cancers may be discovered late — but then there are advanced treatment options."
Cuba in general stresses prevention. This can work in socialist (or communist) medical systems as ultimately the government budgets this. Insurance though probably is less amenable to paying for prevention, after all nothing is wrong. Insurance is usually more comfortable with actual illness.
If one is seriously ill, or suffers from a chronic illness or an unusual disease, it is hard to compete with the US, taking into account all of the problems. E.g., I might be wrong, but a Crohns patient, for instance, is probably better off in the US.
A system that is right for one country is not always correct for others, although there are things to learn from different systems.
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@Joshua Schwartz: " Insurance though probably is less amenable to paying for prevention, after all nothing is wrong. Insurance is usually more comfortable with actual illness."
Only true if insurance is for profit and is first and foremost responsible to its shareholders. Make insurance not for profit and mandatory for all full-time employed workers, and the game is totally changed. For the better.
Caveat: Ain't gonna happen in the US. Money and greed reign supreme. As does apathy and ignorance on part of the electorate.
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@Joshua Schwartz. We ultimately pay way more for poorer outcomes....and run the risk of bankrupting our families for serious health conditions. I for one would prefer better universal preventative care.
A mole removed early rather than disfiguring surgery and chemotherapy....and less risk of survival?
Not a great deal.
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There’s a price to be paid for everything, even if the payment is not made in cash. Healthcare in Cuba is available to all and that’s great, but it is not free.
The price has been paid for decades in political prisoners, summary executions, shortages of food and lack of many conveniences we take for granted.
US healthcare has been evolving and I do believe that everybody is entitled to care. Some balance should be reached where those that can pay contribute into a system that provides everyone with care and brings dot per person. Legislators are unlikely to agree on how to accomplish the feat, especially when the likes of Purdue Pharma is out there as reported in an article the other day. It seems that money changes legislators ideas and commitments to constituents. I’m retired, but between my Medicare part B payment, IRMAA assessment, and the cost of supplemental and prescription drug coverage, I’m still paying close to $20,000 in premiums. I’m fortunate to be capable of handling that, but it does make a dent in the other ways I might prefer to use the money.
Nonetheless, I would prefer the tradeoff for freedom and take some healthcare risks to be here rather than Cuba or other countries ruled by autocrats. Then again, are we on the road to autocratic rule?
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“.....Cuba or other countries ruled by autocrats”. So I understand your point, Canada and all other countries that have universal health care are ruled by autocrats? It’s this kind of misinformation and fear mongering that prevents progress on fixing this problem in the US. Basically your point is “I have money, so I’m okay, too bad about anyone else”.
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You’ve obviously taken that out of context. Cuba is ruled by autocrats and so are other countries but that does not include Canada or the Netherlands or Sweden, etc. This is an article about Cuba and “free” healthcare. But even in Canada, there is surely some cost, which may be in taxes. There ain’t no such thing as a free lunch.
@Steve We almost alone among nations do not provide universal health care.......we pay double for poorer outcomes and financial ruin......its not the political system, it’s the lack of understanding and the money pharma and medical lobbies pay to keep us from this.
We all appreciate our national system of highways w/o bemoaning national government.
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This is an excellent point. But we should pay our doctors even more than Cuba... maybe $100 per month. Then we can afford more healthcare (assuming people would bother to adhere to basic principles of preventative medicine). We may have to conscript people into 12yrs of training or limit other opportunities for their lives to get them to make such a sacrifice but if we make things miserable enough here, they’ll also travel to Ebola outbreaks to establish goodwill with America. Seems like a good plan.
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@Eric Yoss Ah yes Cuba pays their doctors a pittance. And what do they get for that pittance? Good, universal healthcare. I worked at a hospital where anesthesiologists made in the high six figures AND received 16 (not a typo) 16 weeks of paid vacation per year. So they get six figures AND get almost 1/3rd of the year off. In a country that believes two weeks for everyone else is , well frankly, asking too much. Doctor's work hard and are on call. True. But nurses?
Techs? They haven't sacrificed enough to derserve the pay and benefits doctors receive.That is the system that Americans get for their healthcare dollar. And these doctors will cite all kinds of reasons why a system like Cuba's is a disaster compared to the U.S. And they will rationalize our lower scores by blaming it on the patient. Asking for free health care and expecting wealthier people to pay for it. I mean, c'mon get real. We have doctors and healthcare executives to pay. And provide adequate time off to.
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I am in favor of universal healthcare and enjoyed reading about Cuba's system, but using a small, poor, repressive island nation as a model for US healthcare seems remarkably impolitic, exactly what the other side would use to argue against reforming our system ("Look, they want to make us like Cuba").
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mortality is an awful indicator of health care. obesity, crime, drug use etc all play major roles, whereas cancer survival in usa is the highest in the world. there is so much data on this issue- that kristof doesn't bother to bring it up is shameful, shoddy journalism.
the bottom line remains the same- if you like the post office compared to fedex, then yea- universal govt-run healthcare is great.
there is no free lunch--there are costs and benefits to govt-run care, like waiting in line for a hip replacement or cataract surgery. if people are ok with that, just say so. but to pretend you will get timely non-urgent care if the govt is running the show is preposterous.
our system is the worst of both worlds- not quite private, not quite public. so we have all the waste and inefficiency of a system where there are no price signals or true competition. but it beats govt-run.
ask yourself--why do you think the rich buy private insurance in those countries??
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I honestly believe that those who oppose Medicare for all, think that even a modest sort of plan means that all property will be confiscated and people will be sent to thought prison and elections will be bigger shams than they are now.
We have a poorly informed country. European countries have thriving free market economies and universal health care and childcare. It's not an all or nothing proposal.
But many like what they have through employers. They are unwilling to give that up. And many doctors have staggering education loans to pay off and need high incomes to cover the loans. And then there is Pharma which charges Americans more than they charge people from other countries because they can. Pharma is a powerful lobby infested business. Insulin is now higher than ever and it is not a new drug.
When I practiced law every bankruptcy I handled involved not having enough insurance to cover health care or accidents. Liz Warren knows first hand how hard a cancer diagnosis is for an uninsured family. And even those who work for a company that provides health insurance can lose it if the health care gets too expensive.
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@Nb
" .. Liz Warren knows first hand how hard a cancer diagnosis is for an uninsured family .."
Ms. Warren has been proven to know, zero about medical care costs, she is just a lawyer and not an economist --
https://www.theatlantic.com/business/archive/2010/07/considering-elizabeth-warren-the-scholar/60211/
Problems cannot be solved by know-nothings, such as Ms. Warren and BoyNee. They only provide confusion, waste valuable and limited time, and are comedy.
In America we are all "equal." We all know that, don't we? The truth is that some are just "more equal" than others. That is not a paradox. It is the plan. We left it to religious institutions to care for the poor and the disabled. Why would we naively think that less than 100 years from the 'New Deal" that we would embrace universal health care? Forget Cuba. There are a score of other advanced countries that deliver better outcomes for less ( much) costs than the U.S. Very wealthy ( Republicans) people only worry about themselves, in the form of low taxes. The arc of a "New Deal" to the 'Great Society" changed with the arrival of Ronald Reagan. This ushered in the era of "you are on your own." If you move manufacturing overseas, you won't even need a healthy labor force. Just remember the real "golden rule". He who has the gold rules.
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This week the national news had a story about a child saved from blindness with a one-time gene therapy for his retinitis pigmentosa (RP), a condition always ending in blindness. His one treatment cost $800,000. Cuba could use the same amount of money to fund five doctors entire careers in primary care.
What you value is shown by what you are willing to pay for. For the United States, it is profit. For Cuba, people.
A country is not an advanced country if it is only judged by the greatest advances for any single individual with it. It should be judged by the greatness of the advances available to the greatest number of its people.
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Well, if doctors, hospital administrators and all healthcare professionals were willing to take 75% pay cuts so their salaries were in line with Cuban salaries, we could have Medicare for all.
But would we want it. Do any foreigners travel to Cuba to obtain their "first class" healthcare? I don't think so.
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@Erik, they might be incentivized to do that if their debt from medical school wasn’t $300,000 at a 6.5% interest rate that will take them 20 years to pay back.
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@Brad more like $500,000 for private university
@Brad Here in NY you could get a great education at one of the SUNY schools, and go to a state medical school (Upstate, Downstate or Stony Brook).
Problem solved.
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It never ceases to amaze me how an opinion-former read by thousands of people fails to perceive how superficial and lacking of reliable information is one of their pieces. It is true that expectant mothers get the kind of medical attention Mr. Kristof describes. What about adults and seniors? Diabetics and asthmatics? Cancer and heart patients? Pharmacies devoid of even the most essential medications, such as aspirin? How many hospitals did Mr.Kristof visit in how many provinces? It is truly amazing
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When I lost my eyeglasses in Cuba, I was told I could have a free pair — but no eyeglass frames were available. Ever see a Cuban wearing glasses?
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I, too, am admiring of Cuban health care. While short on cutting edge technology, the Cuban system is a triumph of public health policy, and especially impressive when set against the poverty of the Cuban economy. They have achieved a healthy nation with virtually no money.
However, I must correct a blatant factual error on Mr. Kristof's part. Cuba does not have a "Medicare for All" system. This term is used to translate "single payer" for Americans, using the Medicare system as a reference with which Americans are familiar. Cuba's health care system is not a single payer system, and does not involve the national insurance referenced as the "payer" in "single payer". (Single payer systems could more accurately be described as "single insurer".)
Cuba has socialized medicine, more akin the Britain's NHS than Canada's single payer health care system. Doctors and nurses work for the government, hospitals and clinics are owned by the government. This structure is fundementally different than single payer. Whether one supports socialized medicine or not, there has been no suggestion on the part of national politicians in the US that such a system be implemented here.
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There should never be an embargo on health care essentials. Nor should there be any government restrictions on open sharing of medical knowledge. Leave self-serving politics to the likes of Putin and Trump. Keep it out of efforts to improve the heath of humans.
There is so much to learn from Cuba's remarkable adaptation to poverty. Take agriculture: Permaculture has deep roots there. GMO poisons are non-existent. We should be embracing each other's culture and honoring our common humanity.
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I went to Italy last summer and my wife fell and shattered her ankle. She spent 5 days in the hospital and had major surgery to repair fractured ankle. Not once did anyone ask us for money or insurance information. The care was very good and we didn’t see any Italians dying on the streets from lack of good quality health care as most Americans believe. Since my wife hold a Italian passport (she was born here) all health care is free. No copays. No worries. No stress. You would think the greatest country in the world could give its citizens universal health care.
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One would think that the greatest country in the world would have a better medical care system. Maybe the right conclusion is that the United States is no longer the greatest country in the world...and is getting worse by virtue of our infantile president’s campaign to destroy the ACA.
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@SA: WITH the ACA...if I broke my ankle...I'd owe $9000 PLUS my premiums of about $4500 a year....if I break it in December and still need care in January....TWO deductibles, or $18,000!!! and this on a take home pay of roughly $27,000 or 80% of my total income.
THANKS OBAMA!
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@Concerned Citizen
Thank the greed of the US for profit health system.
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Ok, but the large unanswered question, which goes with the neat campaign slogan, "Medicare for All" (and is not addressed here either re Cuba's system) is "How is it paid for?" There is NO such thing as "free healthcare." Someone has to pay. In the United States with our advanced treatment, expensive machines, and increasingly expensive designer, gene based treatments for things like cancer, those costs are very, very high. It is not simply that consumers do not "shop around" nor is it simply "waste" in healthcare provision. Modern, state-of-the-art healthcare is very pricey.
So, who pays and how? Currently, Medicare is paid for through pay roll taxes. It works because everyone pays, but only seniors and the disabled receive care. If everyone receives care, that system no longer works. Who pays? The so-called 1% cannot pay for everything, even if we raise their taxes a lot.
Then, too, current Medicare has both a public-private partnership (Advantage plans) and Traditional Medicare run by the government. Would 'Medicare for all' offer both or just one?
I definitely support the idea of universal healthcare, even a single-payer government run system. That said, we must get straight that there is no "free" healthcare. We must move beyond the neat slogan and talk about the reality of what universal coverage would look like for us.
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@Anne-Marie Hislop Medicare for all would end the Advantage plans that many seniors depend on. It would/will end seniors' access to health care, but I'm pretty sure Democrats and liberals see that as a feature, not a bug.
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@me
Doesn't have to end it. All options could be on the table.
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We spent trillions of dollars fighting wars of dubious necessity without ever questioning the cost. It says something about the distorted values of our country that we obsess over cost when it comes to health care.
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I have been to two Cuban doctors and there were both very professional , educated, and more noteworthy, they took their time in asking a lot of questions. By contrast, my brother-in-law and I both had appointments in the U.S and we had a contest to see who would have the shortest visit. I proudly announced that my knee appointment lasted six minutes to which he responded that his dermatology appt. lasted 58 seconds
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@Buoy Duncan hilarious... and sad. We can and MUST do better. I've had doctor visits (Private insurance, mind you) where the doctor won't even make eye contact with me because of his rush to get to the next client (sorry, 'patient'). It's like McDonald's... only that the burgers are better.
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Not "free, universal health care system" - it's taxpayer (or, in the case of the dictatorship called Communist Cuba, state) financed.
I'm all for universal health care. Not free but available to everyone regardless of job status or income. But the facts have to be laid out to everyone.
Universal health care means that everyone (EVERYONE) will get pretty good health care. This also means that some people will get worse health care.
Some people might have to wait months for a non-acute operation (e.g. hip replacement, benign cancer treatment, corrective surgery).
In addition, doctors will no longer make six and seven figure salaries. They'll be government employees and make maybe $75k per year.
All of this is fine to me but many people don't know what UHC entails-
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@Equality Means Equal - The rich can always fly to another country and get their hip replaced immediately.
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@Equality Means Equal
You would have no doctors or nurses.
PA’s make far more than 75,000 -so no PA’s either
See Sicko
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@Gary Cohen Yes, because we should all trust millionaire leftists.
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Understand the Cuban approach is working really well for the Venezuelans, too! Clearly the answer to fixing our health care system has two parts: (1) open up medical school to all applicants and put all doctors and nurses on the public payroll with pay of about 20% of what they make today; (2) lie about the results. Voila! US healthcare makes great strides! On second thought, you don't even need step 1.
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You say a baby has a better chance of survival in Cuba than America but you also mention a high late fetal death rate. if you combined the infant mortality rate and the late fetal death rate in both countries would they be similar? Also I do not think we could attract many Doctors or Nurses with the low pay that Cuba can dictate. It might be more useful to discuss Canada than Cuba
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We spoke with a doctor in Cuba. He said he makes so little. Less than 100 dollars a week.
How can we equate that with the American system? One lawyer we met supplemented her income as our tour guide.
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What this shows me is that even rich hi talking America can learn something from a poor, isolated country like Cuba. We should stop all our hypocrisy and lift the embargo and travel restrictions. We are great pals with China, Saudi Arabia and Vietnam and really love Russia, is Cuba worse than them?
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The unreported difference between US and Cuban medical care:
capitalism vs socialism
Politics aside, years ago a Cuban friend of mine was in a horrific car accident on her way back from to Havana from Pinar del Rio in the west. The driver fell asleep, drove off the darkened highway and into a drainage ditch. Of the four in the car only she survived after being ejected into what we'd call a swamp next to the ditch. She was found the next morning when the wreck was discovered. She suffered severe head trauma and was barely alive. It took her more than two years to recover from her injuries. During that time she spent more than a month in a Cuban hyperbaric chamber, had numerous surgeries involving her skull and plastic surgeries to restore her left side of her face and scalp. Due to the extent of the injuries to her brain she also had to undergo month-long sessions of speech therapy. If you had ever seen her and engaged her in conversation you would never have know she had been near fatally injured and recovered so successfully. She came from Alamar, a cluster of Soviet-inspired apartment complexes east of Havana. She and her family had no money so to speak., like most Cubans they all worked for the state for about $20-$30 a month. Her years of medical intense no-cost medical care by Cuban physicians left me speechless. The night of the accident, if her doctors and emergency personnel didn't care she could have been left for dead in that swamp by the side of the highway.
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It is really insulting that in order to advocate a better health system Mr. Kristof would use as an example a repressive dictatorship. Surely there are very good health systems in democratic countries, for example in Europe, to talk about that are not based on suppressing free speech, incarcerating opponents and obligating its subjects to be a meek flock of sheep. How can people continue to sympathize with Communist regimes that time after time have behaved brutally with their own people: Stalin's Ukranian disaster, Mao's Great Leap forward, Cambodia and Pol Pot, and now Maduro and Venezuela.
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@hourcadette How can people continue to sympathize with a regime where the rich get the diamond mine, and the poor the shaft.
Cubans, on average, get better health coverage than US residents. But it is the poor Americans that drag the numbers down.
Universal medical care for everyone. That is the goal.
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It is fine to use Cuba as an example of what may work well in low wealth nations, but I hope Democrats don't start running on this kind of comparison- we will be routed if we do.
Let's stay focused on proven systems adopted by other wealthy, industrial nations who spend about half of what we do to keep their citizens healthier than Americans, and achieve significantly lower infant mortality.
We are functioning at an extremely low level of efficiency compared to other wealthy democracies in most of what our government does that can be measured- health care, criminal justice, defense spending- the list goes on.
Obviously, the American problem is more than a broken health care system- we have a government that has been run off the rails by excessive corporate influence in our politics and media.
Cuba is an example of the dangers of the other extreme. They may have a fine health care system, but they've crippled capitalism to the point that their people are doomed to general poverty.
The success of a modern democracy relies on the right balance between capitalism and socialism.
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After visiting Cuba here are a few observations, People walk, few can afford cars. Fast food almost, non existent, folks drink a lot of water, great coffee, very little processed food in stores and from what I witnessed a healthy diet of meats, fruits and veggies. Sure they have social issues, I just hope our great food and car culture does not change Cubans lifestyles.
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@Dave Martin That is really true and oddly enough, everything is organic as the nation cannot afford to import pesticides and synthetic fertilizers. The produce is really tasty as a result apparently
7
Mr. Kristof.
YES. Almost all developed and semi developed nations provide more humane health care than does our system dominated by insurance profiteers and profiteers in hospital systems and such.
WE can do better. It is a false analysis that we only get Medicare for all if we have a Communist Dictatorship as the first commentator seemed to suggest. Ideology clouds the issue, that it is "communism" or "socialism" to provide health care for all as a human right.
We can afford it! One less fighter jet, one less aircraft carrier, one less unnecessary military intervention, one less tax cut for the rich, one less giveaway to big pharma, and we have universal health care; it saves lives, ameliorates suffering, is a national security benefit, fulfills our beacon on the hill myth, and saves money. Saves money by ending the excessive cost of insurance companies gouging out a huge percentage of the health care dollar (30% and more), and lowering the profit incentives.
A health care system that rewards prevention and education over high tech heroics is called for.
We know that an improved diet with some exercise will do wonders to lower health costs and improve lives. But our leadership/government ignore the benefits of policies that stress education about diet, especially the excesses consumed of animal products and sugars, all subsidized by the taxpayer.
Truly, a massive government education campaign leading to healthier eating would do more to lower health costs.
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@John
Michelle Obama did have a program (Partnership for a Healthier America) to educate us, especially children, on the benefits of eating healthier and exercising.
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@John
Yes. The costs from smoking and heavy drinking are roughly equal to the PPACA. Which the (D) never mention. That's on them.
"In many ways, the Cuban and United States health care systems are mirror opposites." A textbook case of sibling rivalry. Why are they mirror images, because Cuba saw it's sibling failing in a high profile area and decided to 'show off' where the sibling had failed. As you say, the reported figures must be taken with a grain of salt, they are still putting on a good show of taking better medical care, if only medical care, of their citizens.
Nicholas, this article would really be improved by dropping comments like the one in your last paragraph: We should call on Cuba . . . . We have been doing way more destructive things to Cuba than "calling on" it, and our history of invading everywhere and maintaining a military presence in, what, 180 countries stands in stark contrast to Cuba sending doctors around the world. If there's one thing the Trump era should teach us, it's to quit prescribing what Cuba ought to do.
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