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Cuba vs. the USA on medicine
First things first: the Cuban economy is a wreck, and the political system is a monstrosity. Second, Cuba is not a good place in which to be a physician, at least from the standpoint of compensation (related to the state of the economy -- wrecked).

But longevity is about as high as in the USA, which suggests that something is right in a country in which about $813 per person is spent on medical care as opposed to $9403. I am guessing that a back pain that simulated a coronary cost Medicaid at least $4000, and maybe another grand in physical therapy. I should have gotten the physical therapy first and saved some medical costs. Maybe some good primary care might have saved some huge cost to the system. If you live in Michigan, you are paying for a bad system. But so it is in all states.

Quote:On public-access TV in 1985, Bernie Sanders defended an element of Fidel Castro’s regime: It was rarely mentioned that Castro provided health care to his country. Sanders grumbled that the same could not be said of then-President Reagan.
The comment came back to haunt Sanders in the wake of Castro’s death. On Sunday on ABC’s This Week, host Martha Raddatz played the old clip and then asked Sanders if he was aware that “this was a brutal dictatorship despite the romanticized version that some Americans have of Cuba.” She reminded Sanders that Castro rationed food and punished dissidents, then hit him with the big question: “So have you changed your view of Castro since 1985?”

Sanders said he didn’t exactly remember the context for his comment (being 31 years ago) but that Cubans “do have a decent health-care system.”

Many consider it more than decent. After a visit to Havana in 2014, the director-general of the World Health Organization Margaret Chan called for other countries to follow Cuba’s example in health care. Years before, the World Health Organization’s ranking of countries with “the fairest mechanism for health-system finance” put Cuba first among Latin American and Caribbean countries (and far ahead of the United States).

OK, so if you visit Cuba you might want to ride around in a 1950s vehicle in a country whose economic progress seems to have stalled in 1960. You do not want to visit its prisons for political offenders. But I would not want to visit Florence ADX, either.

If the physicians got honest pay, then the cost would be significantly higher, Remember: Cuba relies heavily upon general practicioners who are easier to train than the specialists who work largely in heroic struggles to undo the damage that years of bad habits impose on someone who eats too much fat, does not exercise, drinks too often and too much, and perhaps does street drugs. But -- Cuba does train lots of GPs, and that might keep the costs down.

Cuba has long had a nearly identical life expectancy to the United States, despite widespread poverty. The humanitarian-physician Paul Farmer notes in his book Pathologies of Power that there’s a saying in Cuba: “We live like poor people, but we die like rich people.” Farmer also notes that the rate of infant mortality in Cuba has been lower than in the Boston neighborhood of his own prestigious hospital, Harvard’s Brigham and Women’s.


Quote:In Cuba, health care is protected under the constitution as a fundamental human right. As a poor country, Cuba can’t afford to equivocate and waste money upholding that. This pressure seems to have created efficiency. Instead of pouring money into advanced medical technology, the system is forced to keep people healthy.

It’s largely done, as the BBC has reported, through an innovative approach to primary care. Family doctors work in clinics and care for everyone in the surrounding neighborhood. At least once a year, the doctor knocks on your front door (or elsewhere, if you prefer) for a check-up. More than the standard American ritual of listening to your heart and lungs and asking if you’ve noticed any blood coming out of you abnormally, these check-ups involve extensive questions about jobs and social lives and environment—information that’s aided by being right there in a person’s home.

Then the doctors put patients into risk categories and determine how often they need to be seen in the future. Unlike the often fragmented U.S. system where people bounce around between specialists and hospitals, Cuba fosters a holistic approach centered around on a relationship with a primary-care physician. Taxpayer investment in education about smoking, eating, and exercising comes directly from these family doctors—who people trust, and who can tailor recommendations.

Of course the United States constitution does not guarantee any right to medical care, food, or work. Such is up to the legislative process. The Cuban idea is to keep people from needing advanced, delicate technology. So exercise, don't smoke (except for those wonderful Cuban cigars that create no medical problems -- ha, ha!), don't overeat, drink in moderation if at all, stay active, and do not use street drugs. Or perhaps someone from a Comité de Defensa de la Revolución (the Cuban secret police) might pay an its own sort of house call.

Quote:The system requires around twice as many primary-care doctors per capita as we have in the U.S., made possible because the country also invested in medical education, creating in 1998 what U.N. Secretary General Ban Ki-moon called “the world’s most advanced medical school.” Cuba has become known for training not just domestic doctors, but those from around the world—and sending its doctors to help other, wealthier countries when needed. During the recent Ebola crisis in Sierra Leone, more than 100 Cuban doctors and nurses were at the front lines.

Castro justified sending so much support with a brutally holistic understanding of disease as a global phenomenon. He wrote at the time: “By completing this task with maximum planning and efficiency, our people and sister peoples of the Caribbean and Latin America will be protected, preventing expansion of the epidemic, which has unfortunately already been introduced, and could spread, in the United States, which maintains many personal ties and interactions with the rest of the world.”
That spirit also underlies Cuba’s vaccination program, implemented in 1962, which has left the country with some of the world’s lowest rates of vaccine-preventable infectious disease.

The much wealthier U.S. also has vaccines and primary-care check-ups, of course. The key difference is that in Cuba, these things are mandatory. They’re seen as akin to doing routine maintenance on a car to keep the warranty valid. If the system is going to take care of people in dire situations, people must also let the system take care of them before those dire situations occur.

(Note that the house call is a much-deprecated practice in America as inefficient).

Quote:This is the opposite of the U.S., where people demand the former but forego the latter. There are costly barriers to primary care and preventive medicine, but showing up at an emergency room is easy.

While Cuba’s situation is far from ideal, it serves as an elegant counterpoint to the three-trillion-dollar U.S. health-care system—which is controlled by corporations (privatized insurance, pharmaceutical, medical-device, and hospital systems) that drive people to pay exorbitant costs (either directly or through taxes). Cuba offers a dire reminder that efficient health care can be provided at much less cost to the people—when the focus is on primary care and prevention.

Much as I hate to say this, profit, or at least elite compensation, is the objective of American medicine.In our system, profits are an incentive to make things more expensive, including public services.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated Communist  but instead the people for whom the distinction between fact and fiction, true and false, no longer exists -- Hannah Arendt.

Interesting and provocative chart:

[Image: d93a53c68026e5452dba7d7b115d47583f45bd84...d07e81.png]

Comment at will. We are excellent at making medical care expensive.

Life expectancy in Michigan is just 0.1 years more than in Sri Lanka, a very poor country -- and worse than in Cuba. Cabo Verde, a sub-Saharan country fares better than seven US states. If you are thinking "race" -- it is "blacker" than Mississippi. Only six states do better than (very poor) Peru in life expectancy.

OK, habits matter greatly. States toward the bottom are some of the heaviest users of cancerweed products in America. Contemplate also sedentary habits, drug use (the opiate and meth epidemics), pollution, alcoholism, and obesity.

When something as severe as another Great Depression or a cataclysmic war breaks down our social arrangements, as usually happens in a 4T, we might have to rebuild without some of those arrangements better at enriching elites than at serving people.
The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated Communist  but instead the people for whom the distinction between fact and fiction, true and false, no longer exists -- Hannah Arendt.


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