[By Ben Whitford, the GUARDIAN]
... in [Michael Moore's] movie's climactic set-piece, he gathers three ailing 9/11 rescue workers in Miami,
herds them onto a motorboat, and plots a course for Caribbean communism. Pausing briefly to demand free
health care at Gitmo ("The same kind that al-Qaeda is getting!") he heads into Havana, where he
marvels at the immediate, free, high-quality treatment doled out to his pals. "They didn't ask for money
or an insurance card - just their name and date of birth. That was the entire intake system," he says.
"Their only sin when it comes to healthcare seems to be that they don't do it for profit."
Um, how's that again? Foreigners - at least those unaccompanied by film crews -
haven't been entitled to free treatment in Cuba since the mid 1980s, when
Castro's government started trying to squeeze a profit out of the country's
burgeoning health-tourism sector. In 2002, the Cuban health system charged $45m
for medical services to foreign visitors, at an average cost of $3,600 per
treatment. Cubamedica, the group responsible for Cuba's health tourism sector,
urges hospitals to devote between 30 and 60 percent of their budget to treating
foreign visitors; many institutions now operate separate floors or wings for
their foreign guests, kitted out with newer equipment, brand-name drugs, and
dedicated health staff.
[do the problems with Cuba's healthcare system have anything to do
with the US blockade and efforts to sabotage the country??]
There have been some knock-on benefits for ordinary Cubans, of course - the few
resources they share with foreigners have been given a facelift, and in theory
the income from health tourism is channeled back into the domestic health
service. But the fact remains that while foreign cash-customers and Party
apparatchiks get top-notch treatment, most of Cuba's 11m citizens have to make
do with a creaking and increasingly overloaded system that viewers of Moore's
movie would struggle to recognize.
The Soviet-funded heyday of Cuban medicine is long since past; these days much
of the country's medical equipment has fallen into disrepair, and patients have
to turn to the black market to get their hands on basic supplies like
Pepto-Bismol, sutures and band-aids. The country may have recovered somewhat
from the dark days of the mid-90s, when hospitals stood dark for lack of light
bulbs and couldn't even give their patients safe drinking water, but many still
struggle to provide full courses of antibiotics, and have to ask patients to
bring their own food, soap and sheets. The doctor-to-patient ratio remains high
- but with some 20,000 health professionals, including a fifth of the country's
doctors, currently on loan to Venezuela in exchange for cheap oil, many Cubans
say their local clinics are now understaffed.
Fans of the Cuban health system like to point to the country's vital
statistics: infant mortality is lower than in the US; life expectancy is
slightly higher. These are, of course, impressive figures, especially when one
considers that while America's annual healthcare spend works out at over $6,000
per person, Cubans make do with a mere $230 per capita. But it's worth sounding
a couple of caveats: the country's high abortion rate suppresses infant
mortality and inflates life expectancy, while the ongoing exodus of refugees
probably skews life expectancy figures somewhat. And institutional healthcare
isn't the only factor at play: the pork-and-rice diet and car-free lifestyle of
Jose Cubano are undoubtedly healthier than those of an SUV-driving,
super-sizing, sedentary American.
[pork is good for one's health?]
All this isn't to knock the Cuban health service. Castro inherited a fairly
respectable healthcare system from Batista - Cuba's infant mortality rates were
the lowest in Latin America in 1957, too - and all things considered has done a
pretty good job of keeping it up and running. He's taken healthcare out of the
cities and into rural areas, and in the process trained a small army of
excellent doctors who do an admirable job in difficult circumstances. As Moore
rightly points out, the 45 million Americans who lack health insurance could be
forgiven for looking at Cuba's free, universal health service with envious eyes.
But away from the film cameras and visiting American heroes, Cuba's
doctors continue to struggle with a decaying system plagued by
mismanagement, under-investment and chronic shortages; the country is
a long way from being the healthcare utopia Moore describes. That
Americans could learn from their communist neighbor nonetheless is
perhaps itself a sign of how functionally bankrupt the US healthcare
industry has become.<
there are no real-world utopias. Did Moore say there were?
FWIW, a friend reported getting free -- and bureaucracy-free --
health-care in the old East Germany before the Fall.
--
Jim Devine / "The price one pays for pursuing any profession or
calling is an intimate knowledge of its ugly side." -- James Baldwin
