The Affordable Care Act (ACA), or “Obamacare,” is the signature legislation passed this decade, and depending on one’s perspective, it has either been a savior for the uninsured or a socialist disaster. Of course, Obamacare has been a financial windfall for health insurance companies — the front from which Republicans, many of whom were for the ACA before they were against it, source much of their frothy rhetoric against President Obama.
Ironically, our current health care system’s market-driven approach dates back over 40 years. President Richard Nixon, embroiled in the Watergate scandal, wanted an even more liberal health insurance system based on the requirements that companies provide health care to their employees as well as an individual mandate. Democrats led by Ted Kennedy, however, wanted a system more aligned with Medicare and Social Security, so Nixon’s idea went nowhere.
A generation later, Republicans floated a bevy of market-based national health care insurance programs to counter Bill and Hillary Clinton’s idea for insurance reform. Compromise proved impossible, and that failure and resulting backlash almost made Bill Clinton a one-term president. And a decade ago, presidential hopeful Mitt Romney led the charge to reform health insurance in Massachusetts when he was that state’s governor; the Bay State’s plan later became the blueprint for the ACA.
What really has not changed, however, is the basic premise of the American health care system. Instead of focusing on prevention, doctors are ingrained to become more reactive and focus on treatment. And while opponents of health care reform have brought up the bogeyman that “you won’t be able to choose your own doctor,” the reality is that most Americans cannot have much of a relationship with their physician when appointments are made in increments of 10 or 15 minutes — and that is especially true if one belongs to a managed care system like that of Kaiser Permanente. If you are starting a family, or have to consider long-term health care options for the elderly, the options available are often expensive, and largely unaffordable, for many citizens.
The American health care system, in fact, is a vicious, pricey circle. Doctors run up huge loans as they go through medical school, so there is little incentive to settle into a career as a generalist since specializations pay much more. There is no desire to develop rapport with patients as the U.S. health care system is run like a business, not like a partnership between doctors and patients. Some health care organizations, such as the famous Mayo Clinic and Cleveland Clinic, stand out for their business models, which allow for a closer doctor-patient relationship that engenders more of a focus on preventative care. Many patients, however, feel getting into Fort Knox is easier than seeing their doctor, and the quest to see a specialist often sends one’s heart rate soaring.
Considering the timing of President Obama’s historic visit to Cuba this week, one question comes up: Could this country of 11 million people, and long the ideological arch enemy of the U.S. dating back to the Eisenhower administration, offer lessons on how to improve the American health care system?
Cuba’s health care system has long been recognized for its emphasis on real-life physician training, a focus on preventative care, and preparing its doctors and nurses to confront emergencies not only in Cuba, but worldwide. While both critics and supporters point to the effects the longtime U.S. embargo had on Cuba’s economy and access to technology, the flip side of that argument is that they often have to be imaginative and flexible about delivering treatment. While spending a sliver per capita on health care — almost one-twentieth the amount of what Americans spend on medical access — Cuba has a lower infant mortality rate than the U.S. and even boasts a slightly higher life expectancy, according to the World Bank.
Much of Cuban doctors’ success, despite the odds against them, is because of their unwavering attention to prevention. An analysis by Allison Shelley and Sam Loewenberg, two journalists who researched Cuba’s medical system on an International Reporting Project fellowship, showcases the results of the country’s doctors on a very hands-on, yet low-technology approach.
Cuba’s system rests on a national network of polyclinics, each of which support anywhere from 20 to 40 doctor’s offices. A recent reorganization of the system has seen these clinics benefit from medical equipment usually found at hospitals, but their biggest impact still is to serve as regional training centers for up-and-coming physicians. And despite the assumption that Cuba is a socialist monolith with a one-size-fits-all model of health care delivery, these clinics offer more than just treatment and consultations: They also provide counseling on a bevy of health challenges, including education programs related to smoking, infant care and, in areas with high pollen counts, allergy testing services. Women who need prenatal care go through an intensive risk assessment program, and the country maintains a network of homes for women with high-risk pregnancies. Almost all doctors are required to to specialize in family care; after a few years, they can apply for residency in a more focused specialization.
Cuba’s health care delivery strategy is evident in one of its leading medical schools, ELAM (Latin American Medical School), which graduated its first class of doctors in 2005. Over 23,000 doctors, mostly from poor countries and low-income communities in the Americas (including the U.S.), have completed ELAM’s six-year medical school program.
Another outcome of Cuba’s health care system is that doctors are well trained to deliver medical care in poor countries or during times of crisis. One article, in fact, has suggested that Cuba sends more physicians to work in developing countries than all the G8 nations combined. Cuban doctors have been lauded for their response to the Ebola outbreak in West Africa and their work on educating patients has led to the elimination of HIV and syphilis from mother-to-child throughout Cuba. When Hurricane Katrina hit the Gulf Coast in 2005, Cuba was ready to send hundreds of doctors to assist with recovery efforts, but the Bush administration scorned the offer.
Cuba’s health care model has its challenges, and some of its aspects would not go far in the U.S. Most American students, for whom many college is both a time of career development and personal freedom, would chafe at the spartan living situations and dated resources at Cuban medical schools — and two more years of medical training, at U.S. prices, would be a non-starter.
House calls, still the norm in Cuba, are largely relegated to black-and-white movies and TV shows here in the U.S. But medical care professionals and medical care networks could be more open to providing classes and support groups covering a range of health challenges, which could educate more citizens while promoting public health.
In an era where we are constantly told we have to do more with less, there is no finer model on the health care front than Cuba — it has been the country’s modus operandi for its doctors and nurses for almost 60 years.
Image credit: PBS NewsHour (Flickr)