By Mike Lado
December 15 2011
What's Cuba got that we don't? A good universal health care system.
Despite the valiant attempt of the Affordable Care Act passed in March 2009 and signed into law by President Obama to fix health care, about 50 million Americans remain uninsured, and another 25 million remain under-insured, trapped in limited-benefit and high-deductible health plans.
There are also 26.5 million Americans with heart disease. There's an autism epidemic that affects 1 in 100 children being born. For many parents the treatments they need for their children aren't even covered by insurance. The poor cannot afford health care so they end up waiting until they are so sick they wind up in the emergency room driving up waits and costs for everyone through no fault of their own.
Rates of lack of insurance amongst Latinos, African Americans, Native Americans and other minorities are appalling. Most progressive Democrats agree the Affordable Care Act does not go far enough in ending the nation's health care woes.
So how can we fix this mess while putting the bogus insurance industry out of business and curbing bloated pharmaceutical industries? The simple answer is a universal health care system that works. Many opponents of a universal system point to supposed government waste and abuse along with a massive health bureaucracy. There's a way to avoid that.
I look to Cuba as a model for us to follow.
A recent conversation with an American medical student studying at Cuba's renowned Latin American School of Medicine provided me with some key facts.
The basic health care system in Cuba, she said, starts at small neighborhood clinics staffed by a trained nurse and a doctor. The doctor or nurse in charge of the station typically lives above the clinic in a small apartment so they are available even when the clinic is closed. This doctor is a primary care family doctor who serves as the health care frontline. He or she handles all basic health care such as checkups, immunizations, and health questions.
For situations requiring a specialist or medical tests the next stop is the polyclinic. The polyclinic is basically a centralized medical office where specialists are located and diagnostic tests are carried out. Cuba has more than 400 polyclinics around the island. Things such as X-rays, ultrasounds, dentistry, and other health specialties are handled at the polyclinic.
At the polyclinic emergencies can be handled that do not require overnight stays. So fractures, sprains, and other urgent care situations can be treated there. This removes the need for everyone to show up at a hospital emergency room at the slightest sign of trouble.
Hospitals in Cuba are truly for treatment of life-threatening emergencies and conditions. They come in all shapes and sizes. Ambulances can transport patients who are too ill to move themselves to either a Polyclinic or hospital depending on the emergency.
The best part of Cuban medicine in my opinion is that alternative or complimentary medicine is part of the free universal health care the government provides. Alternative treatments like acupuncture have come to the island. It it's not limited to a select few patients. Alternative medicine is used at all three levels of care! Doctors and nurses along with alternative treatment providers such as acupuncturists work with their patients and each other to coordinate care successfully.
It's amazing. Even with the discriminatory U.S. economic embargo against them, Cubans have built a modern medical system in which every citizen is able to have quality care at no cost to themselves. Something Americans lack.
How could a Cuban-style health care system work here in the United States?
In part one of this series, I described how Cuba does a miraculous job of having a successful health care system despite the U.W. embargo she faces. In addition to hospitals Cuba has an island-wide network of neighborhood medical stations and specialty polyclinics that reduce reliance on emergency rooms for care. Now onto the million-dollar question: would such a system work here in the States, and how? I've tweaked the system a bit to adjust to our current structure of government.
The first level of care, based on the Cuban system, would be a municipal medical clinic. Each town or municipality of over 1,000 people would be served by a clinic staffed by nurses and physician assistants. So don't we have this like the Cubans do? As KaiserEDU.org notes, the United States is facing a critical shortage of primary care physicians in medicine. Most medical students saddled in debt go to high paying specialties instead of primary care. It would take some time to train all those new physicians to fill the gap.
In the interim we can use nurse practitioners and physicians assistants to fill the void. NPs and PAs can work alone or under the supervision of a doctor. They both have prescribing rights and are just as qualified as doctors to deliver basic care. In a Cuban-style system a doctor would be assigned to a set of clinics to oversee operations with the NP or PA supervising a nursing staff directly as needed. These medical stations would cover primary care such as physicals and immunizations.
The next level up is a polyclinic. I suggest one polyclinic per county or county equivalent. In Cuba polyclinics generally serve several tens of thousands of people. In our big cities and larger counties more than one polyclinic will be needed to cover people. At the polyclinic people should be able to see a doctor who's a specialist, receive diagnostic tests, dental and optical care, outpatient surgeries, and treatment for urgent care scenarios.
Finally, the hospitals. These would be used in case of life threatening emergencies. The more we reduce the need for a hospital emergency room through the polyclinic, the less people will show up at the hospital sick.
A successful health care system that covers all for free must be well financed and have some kind of democratic control.
So who's going to pay for all this? Well first we can start by jacking up taxes on the rich and big corporations. Strengthening the progressive income tax system is a must for a good health care system to be successful. A successful taxation system that places the burden of cost on the people who can afford to pay allows every citizen to receive free, quality health care without having to turn the entire nation upside down searching for a way to finance such a system.
Now the nitpicky part: who gets to control the system? In my plan the people do. On the local level I propose that every county elects a democratic assembly of health care workers, professionals and patients who oversee the day to day operation of the county polyclinic and local clinics. There should be regional assemblies as well for control over hospitals affiliated with a major university or medical school.
Abortion should be legal and on demand at a polyclinic for women who choose it. HIV/AIDS treatment and testing should be free and available for all who need it, including post-exposure prophylaxis treatment. Fertility treatments for women who are unable to conceive should be available. Local medical clinic staff should be trained to be sensitive to the needs of all patients and should set their personal beliefs aside when it comes to the needs of a patient.