Wednesday, July 29, 2009

Cuba: A look into the perils of communist health care

Whenever I hear people discussing the perils of socialized medicine, I think of three countries immediately. Japan, Sweden, and Cuba. Japan and Sweden I immediately think of because these are two of the indisputably healthiest countries.

Sweden has universal almost-free health coverage, where the state pays for about 98% of all costs; in Japan, health coverage is mandatory and either supplied through an employer, with the government providing coverage for students, elderly, farmers, and the self-employed. We could consider Japan the exemplar for the private model and Sweden the exemplar for the public model; in either case, the far less healthy United States is getting far less bang for its health care bucks than either.

However, I think of Cuba because Cuba is actually identified as communist. Nobody is going to dispute that Cuba is communist - nor will anybody mistake Cuba for a rich country. The CIA World Factbook estimates that Cuba's GDP per capita, by purchasing power parity, is only $9500, barely more in total than what we spend per capita on health care.

Cuba spends even less - the WHO estimates 7.6% of its GDP - and due to Cuba's particular economic and trade relations situations, Cuba is short on many modern medical supplies, and this is reflected in the number of Cubans dying from causes we consider easily preventable.

Here's where the Cuban system falls short. Maternal mortality - perhaps noncoincidentally, this ratio is matched by the rise in the number of c-sections performed. Tuberculosis - detection, treatment, and prevention. Child deaths due to diarhorreal disease or pneumonia - which would be especially easily solved with a little more money for drugs and sanitation infrastructure.

Cuba also has noticably - albeit not as dramatically - higher deaths due to cardiovascular problems, something that may be linked to Cuba's substantially higher tobacco use rather than a specific deficiency in care, but that pretty much covers all of it.

Life expectancy in Cuba is quite similar to the US. Infant, child, and adult mortality are overall lower. And what does it say about us that we spend twenty times as much on health care (ref) and yet get so little, as a population, out of our health care system? How much would it cost us to match Cuba's infant and child mortality rates?

I am sure there are many specific procedures that are simply not available in a poor country like Cuba - but how can a rich country like the United States fail so badly with basic care that all the advanced procedures in the world barely let us catch up to our poorer neighbor on the demographic level?

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