After four days in Cuba, seeing much countryside and touring three cities – Cienfuegos, Havana, and Santiago de Cuba, I have some reflections regarding health care, there and here in the United States.
First, some history that I learned. Christopher Columbus landed on the east side of this very long island (770 miles – twice the length of Iowa) in 1492 and claimed it for Spain. By either 1515 or 1522 (I have been told both years), Spaniards brought the first African slaves to the island, first to work the mines (like copper) and then the sugarcane fields. In 1902, in negotiations following the Spanish-American War, Spain freed Cuba under the protection of the United States. This protection ended in 1959 with the Cuban Revolution and the deposing of Batista. The now-free Cuba entered into a major relationship with the Soviet Union, which ended with the fall of the Soviet Bloc on December 25, 1991.
Cuba suffered severe economic hardships through the 1990s in what Fidel Castro called the “Special Period.” It appears Cuba is rebounding, in part, due to an increase of tourism from 1 million visitors to 4 million visitors per year and now the allowance of individuals having private businesses. It now allows also for the presence of religions. Christmas celebrations were allowed starting in 1998.
Interestedly, I asked my guide where she drew the line between Cuba being a communistic vs. a socialistic country. She claimed communism is a theoretical ideal that can never be actually achieved; she claimed Cuba never was communistic and is now and has always been socialistic. I found that explanation to be the most strained of her otherwise seemingly very honest and forthright thoughts regarding Cuba.
Regarding health care, I have the following observations. In 1959, the new Cuban government instituted universal health care and free college education. I witnessed a country with an aging and often suffering infrastructure. In the countryside, I witnessed many unused fields and several fields being worked with the use of horses and ox-drawn equipment, such as carts and plows.
I saw less smoking compared with travels around the world or in the United States. In 2016, the American Cancer Society’s report called The Tobacco Atlas ranked 181 countries from high to low in terms of cigarettes per person per year. Cuba’s ranking was 146 of 181, with an average of 234 cigarettes per person per year, vs. the United States’ ranking of 68, with 1,017 cigarettes per person per year. Life expectancy in 2015, according to the World Health Organization: The United States was 31st in the world at 79.3 years, and Cuba was 32nd at 79.1 years. Cuba has a better record regarding infants’ deaths. WHO data on 2015 health-care costs showed the United States spends $9,536 per person per year, while Cuba spends $826 per person per year.
A guide told us that the hierarchy for Cuban health care was children, pregnant women, and then elderly. In Cuba, a pregnant woman quits work at the seventh month and returns to work when her child is 1 year old. The woman receives the same salary as when she worked and is guaranteed her previous job. Finally, I saw no homeless people in my tours of three cities.
Do I want to live in Cuba? No.
Do I want more Americans to have health-care coverage, and do I think lower health-care costs would help achieve greater health-care coverage? Yes and yes.
A few thoughts. I like the idea of universal health-care coverage for children and pregnant women. As I learned with the Iowa Children’s Health Insurance Program (CHIP), known as HAWK-I, hardly anyone argues against covering children for health care. By extension, the same should hold true with pregnant women. Iowa this legislative season is going to debate paying additional monies for our HAWK-I program. This is a no-brainer for me. It will be interesting to watch the political dynamics.
I think we have universal coverage for our elderly with Medicare.
For individuals not pregnant and between the age groups of children and the elderly, that is where the debate is hot and furious. I believe the 2020 presidential election may help the United States chart some kind of realistic, positive course.
Finally, we live in a world of code words. The president said during his State of the Union Address that “America will never be a socialist country.” This statement sets the stage for branding Democrats as socialists for many of their ideas. Wikipedia defines socialism as “a range of economic and social systems characterized by social ownership and workers’ self-management of the means of production, as well as the political theories and movements associated with them.”
Social Security, Medicare, and Medicaid were denounced as socialism when these policies were proposed and enacted. Americans now embrace these policies. The lesson for us as a nation is to debate ideas on their merits and not use code words to obscure and distract from the debate.
In summary, Cuba was a very interesting and enjoyable place to visit. Despite its flaws, my visit to Cuba continues to reinforce my ideas of universal health-care coverage and the need to control health-care costs.
I agree with Senator Michael Bennet from Colorado, who said on Meet the Press this Sunday that the individual who can devise for the United States universal health-care coverage, along with driving down the extremely high cost of health care, deserves the Nobel Prize.