DR. BERWICK’S STEP TOWARDS CASTROCARE: BRET STEPHENS
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Heaven forbid that anyone accuse Donald Berwick—lately of Harvard, newly of the Centers for Medicare and Medicaid Services, with $800 billion under management—of being an admirer of Cuba’s health-care system. In the matter of CastroCare, progressives of Dr. Berwick’s stripe are rarely at a loss for superlatives. But suggest that ObamaCare is a step in the Cuban direction, and these same people will accuse you of rank scare-mongering.
We don’t scare-monger in this paper. And for the record, nothing in Dr. Berwick’s published record indicates he has ever praised the Cuban system.
But note that when the health-care bill became law in March, Fidel Castro emerged from semiretirement to praise it as a “miracle.” Note also that Dr. Berwick has made himself notorious by warning of “the darkness of private enterprise,” admitting his “love” for Britain’s socialized National Health Service, and insisting that “excellent health care is by definition redistributional.”
Without imputing a mutuality of views, then, it’s worth noting a certain mutuality of respect. So it’s a good time to check in on the state of the Cuban health-care system. That’s just what Laurie Garrett, a senior fellow at the Council on Foreign Relations, does in the current issue of Foreign Affairs magazine.
Lest anyone mistake Ms. Garrett as a raving opponent of the Cuban system, she praises Cuba for offering “an inspiring, standard-setting vision of government responsibility for the health of its people.” Cuba’s (reported) success in reducing the incidence of child mortality and tropical diseases, she adds, is “laudable.”
Just one problem: The system is in an advanced state of collapse. It is bankrupting the state and driving doctors out of the medical field and the country. Its ostensibly egalitarian nature disguises a radically inegalitarian reality, with a tiny number of well-appointed clinics catering to paying medical tourists and senior Party apparatchiks while most Cubans take their chances in filthy, under-resourced hospitals.
Consider the facts as laid out by Ms. Garrett. There are 73,000 physicians licensed to practice in Cuba. This allows Cuba to boast of having the best doctor-patient ratio in the world, with one doctor for every 170 people, as opposed to one for every 390 in the United States.
Yet reality belies the statistics. Slightly more than half of all Cuban physicians work overseas; taxed by the Cuban state at a 66% rate, many of them wind up defecting. Doctors who remain in the country earn about $25 a month. As a result, Ms. Garrett writes, they often take “jobs as taxi drivers or in hotels,” where they can make better money. As for the quality of the doctors, she notes that very few of those who manage to reach the U.S. can gain accreditation here, partly because of the language barrier, partly because of the “stark differences” in medical training. Typically, they wind up working as nurses.
As for the quality of medical treatment in Cuba, Ms. Garrett reports that hospital patients must arrive with their own syringes, towels and bed sheets. Women avoid gynecological exams “because they fear infection from unhygienic equipment and practices.” Rates of cervical cancer have doubled in the past 25 years as the use of Pap tests has fallen by 30%.
And while Cuba’s admirers love to advertise the country’s low infant mortality rate (at least according to the Castro regime’s dubious self-reporting) the flip-side has been a high rate of maternal mortality. “Most deaths,” Ms. Garrett writes, “occur during delivery or within the next 48 hours and are caused by uterine hemorrhage or postpartum sepsis.”
Sound inviting? The number of ostensibly serious people—Michael Moore not being one of them—who think so is nothing short of astonishing. On a visit to Cuba last October, Margaret Chan, the director general of the World Health Organization, said that Cuba “has the right vision and the right direction. Health is a state policy and state is seen as a right of the people.” In 2005, one prominent New York Times editorialist headlined a column “Health Care? Ask Cuba.” Health care was probably also what former Secretary of State Colin Powell had in mind when he noted that “Castro has done some good things for his people.”
Now, to repeat, Dr. Berwick is nowhere on record endorsing Cuban-style health care. And ObamaCare, with its million flaws, is not CastroCare.
But it remains the case that for all those for whom “free” health care has been, as Teddy Kennedy once put it, the cause of their lives, the Cuban system has been a touchstone—proof, supposedly, that socialized medicine is, as Dr. Berwick has said, the only “just, equitable, civilized and humane” answer when it comes to addressing the dilemmas inherent in health-care delivery.
The truth is that socialism and related forms of command-and-control technocracy work as well in the health-care market as they do in every other. Which is to say, not at all. When better-heeled Americans start flying to offshore medical centers for their facelifts and bypasses (performed by expat American doctors) while poorer folk make do in ObamaCare’s second tier, then perhaps the real lessons of the Cuban system will begin to sink in. Even, perhaps, among Dr. Berwick’s progressive friends.
Write to bstephens@wsj.com
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