Monday, July 26, 2010

CastroCare in Crisis: Lessons of ‘Single-Payer’ Health Care

The single-payer crowd, which advocates for government monopoly over people’s right to access medical services, is ready for the next big push.  Obamacare was just the “appetizer,” according to activists at the Netroots conference this week.  Maybe it’s time to check in to see how “single payer” works in reality.  Destination: Havana.

Although Cuba’s government commits 16 percent of its budget to health care, the Communist dictatorship’s real health-care “system” is dedicated to serving cash-paying customers from Canada and other countries.

This comes from a fascinating article in the latest issue of Foreign Affairs, “CastroCare in Crisis,” by Laurie Garrett of the Council on Foreign Relations. It’s not news that the Castro brothers profit from medical tourism. Michael Moore infamously shilled for the enterprising Havana Hospital in his movie SiCKO, where he brought 9/11 Ground Zero rescue workers to be treated. The Havana Hospital appears to be a more competitive, patient-centered enterprise than any American general hospital I’ve seen: It posts prices for its services, reports testimonials, and can schedule surgeries on short notice (three days for open-heart surgery)!

Garrett explains that the hospitals that serve foreigners are owned by a government-owned tourism conglomerate, and serve patients from 70 different countries. Canadians are significant customers. Like Cuba, Canada controls access to medical services through a government monopoly, so citizens cannot get timely care. Unlike Cuba, Canada allows the rest of the economy to operate freely, so Canadians are rich enough to be able to pay just under $7,000 for knee replacements in Cuba (instead of waiting for months in Canada). But what will happen when the Castros are gone?

Two competing effects, according to Garrett: An influx of U.S. patients will be free to travel to Cuba for treatment, but an exodus of physicians will be free to emigrate to the U.S. Plus, Cuba has the second-oldest population in the Americas, with only one quarter of the population under 40 years of age. Once the Cuban people are free of Communism, their pent-up demand for medical care will also explode. Cuban patients (as opposed to Canadian patients in Cuba) already have to provide their own syringes, sheets, and towels. Soap, disinfectant, and sterile equipment are rare.

Unfortunately, Garrett does not consider the consequences of Obamacare, which will likely accelerate the international travel of U.S. patients, while minimizing the emigration of Cuban doctors. If Cuba becomes a free society that welcomes foreign capital, investors will soon decide that investing in Cuban hospitals that serve U.S. and other patients is a good bet. There will be plenty of opportunities for Cuban surgeons who stay at home.

By:  John R. Graham

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