“Many men can draft many laws. But few have the piercing and humane eye, which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of health to the old and to the poor. And fewer still have the courage to stake reputation and position, and the effort of a lifetime upon such a cause ….”
– President Lyndon B. Johnson on the signing of Medicaid Bill, 1964 –
President Obama culminated 6 months of intensive efforts to normalize relations with Cuba last week with the announcement of the reopening of Embassies in the respective countries. Among other things, I believe we will now begin to hear more about the intricacies of the Cuban Healthcare System.
Over the past 10 years, I have made dozens of trips (legally) to Cuba. In my visits there, I have lectured, done collaborative research, and in a variety of ways, studied their health and medical system. It is an understatement to say that I emerged from these experiences with deep fascination.
Put simply, my fascination with the Cuban Health System stems from the similarities of their system, and our system of Medicaid and Medicare, and how Cuba has succeeded at making sure that Health care is a human right rather than a product for economic profit. Therefore, all Cubans have equal access to health services, and all services are free.
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As we know, Medicaid was introduced for two reasons: 1) providing medical insurance to people with incomes low enough to qualify for cash assistance, and 2) to complement Medicare by paying for long-term care for people with the means to do so for themselves.
I have always envied how Cuba is able to provide high quality care to a poor population, with limited financial resources. Yet, the Cuban people enjoy better health outcomes in every category of measure: low infant mortality; low rate of depression and sickness in the elderly; and almost everything in between.
Cuba has the lowest infant mortality and the lowest HIV/AIDS rates in the western hemisphere; they have a life-expectancy equal to that of the United States; and in addition to notable advances in vision and diabetes treatments, have numerous approved vaccines developed and approved for global use.
Medicaid is at the foundation of our nation’s commitment to insure equal opportunity for all people, regardless of income, disability, age, or race.
Medicaid is a critically important source of health coverage for a significant share of blacks and Latinos, in this country, who would otherwise have no access to the health care they need.
One particular visit was devoted to looking at how the elderly receive healthcare in Cuba.
Like the rest of the world, the US is an aging society. This will place substantial additional pressure on publicly funded health, long-term and income support programs for older people. The older U.S. population (persons 65 years or older) numbered 39.6 million in 2009 (the latest year for which data is available). They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030.
In the last 25 years, aging on the island increased by 6.5 percent, and in 2010 the elderly population was greater that the number of Cubans between 0 and 14 years of age, representing 17.8 percent of the total 11.2 million inhabitants. An estimated 54 percent of Cubans over 60 are retired.
As I visited many different parts of the healthcare system devoted to care of the elderly in their society, I paid close attention to the “take-aways”, that I felt were of particular interest to the challenges we face here in the US.
One of the biggest problems found in elderly Americans is depression.
Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not.
Many health professionals in this country seem to mistakenly think that persistent depression is an acceptable response to other serious illnesses, and the social and financial hardships that often accompany aging – an attitude, unfortunately, often shared by older people themselves. This contributes to low rates of diagnosis and treatment in older adults.
In Havana, I saw hundreds of elderly people full of life, and looking forward to a meaningful, productive years in their family, their neighborhoods, and their general communities. 
I visited clinics; “senior centers’; a Rehab Center; and a Family Medicine Office (primary care). I was even able to join a doctor for her regular visit to the home of one of her patients.
After my of interviews with professionals and elderly Cubans in the community, I found a vibrant, healthy, and active elderly population, with healthcare providers organized, and structured, in a way to allow healthcare to be delivered to met the needs of the elderly.
I also conducted interviews in Spanish (with the help of a translator) with officials and community leaders of the Cuban National School of Public Health.
The Cuban health care model is a public health/holistic one. In other words, health care includes the whole person; the physiological, psychological, emotional, social (including family relationships), and environmental aspects of the person. The services are distributed in a public health triage model. If ten people are waiting to be served, rather than be seen on a first-come-first-serve basis, they are taken in the order of need.
Cuba possesses specialized geriatrics services throughout the country, as part of the actions to prolong, with quality, the life of its inhabitants.
Cuban health authorities give large credit for the country’s impressive health indicators to the preventive, primary-care emphasis pursued for the last four decades. These indicators – which are close or equal to those in developed countries – speak for themselves.
Cuba’s physician per population ratio is 1 per 255, as compared to 1 to 430 in the United States. With a life expectancy of 76.9 years, Cuba ranks 28th in the world, just behind the US. However, its spending per person on health care is one of the lowest in the world, at $186, or about 1/25 the spending of the United States. Health care spending increased tenfold between 1980 and 2011, when it reached $2.6 trillion and accounted for 17.6 percent of the U.S. economy. All that spending isn’t bringing Americans the best care in the world, either.
Yes, it’s possible to take care of the poor and underprivileged with bankrupting America. I left Cuba with a new sense of optimism about what is possible…if only we have the “Political will”.
“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”
Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!
This column is for informational purposes only. If you have a medical condition or concern, please seek professional care from your doctor or other health professional.
