HEALTHCARE
Wellness, longevity take varied paths in U.S., Cuba
U.S. healthcare costs more than Cuba's and may not have an edge in
helping people live longer, but Cubans often lack prescription drugs and
over-the-counter remedies.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
The average Cuban lives slightly longer than the average American, but
the American's healthcare costs $5,711 a year while the Cuban's costs $251.
Those are the figures of the World Health Organization. Some experts
question the accuracy of the Cuban numbers, but no one doubts the
underlying revelation: There is little relationship between the cost of
your healthcare and how long you'll live.
''Medical care is responsible for only a small portion of the variation
in life expectancy,'' says Gerard Anderson, a Johns Hopkins professor
specializing in health policy. ``Behavioral factors such as diet and
exercise are much more important. The U.S., which spends much more than
any other industrialized country on healthcare, is getting little value
for much of the spending.''
These factors have moved to the forefront of the American political
discussion as leaders in both major parties work toward solving what
almost everyone agrees is a ''healthcare crisis,'' with soaring costs
threatening to increase the numbers of the uninsured, which already
include 46 million Americans.
In such a discussion, Cuba serves as the starkest possible contrast, a
completely government-controlled system in which ailing leader Fidel
Castro benefits from the best possible care, including consultations
with a Madrid surgeon, while many Cubans struggle to get basic treatment.
Here are the numbers: The average American has a life expectancy of 77.8
years, as of 2006. The average Cuban lives 78.3 years. Even if the Cuban
figure is inflated, no one disputes the statistics from European
countries, where people tend to live a year or two longer than in the
United States -- at about half the healthcare costs per capita.
At its highest level, most people agree, the United States has
top-quality care. The country offers the latest magnetic resonance
imaging, robotic-arm surgeries and drugs to deal with cholesterol, acid
reflux and arthritis pain.
Americans want the biotech drug to target tumor cells, but many don't
get basic preventive screening tests. That's particularly true for the
uninsured, who often avoid treatment until their condition sends them to
the emergency room.
Cuba offers universal healthcare and has twice as many doctors per
capita as the United States. The Cuban government did not respond to The
Miami Herald's request for comment via telephone or e-mail, but its
publications have boasted that the country is one of the world's leaders
in healthcare. Ann C. Seror, a professor at Laval University in Quebec,
Canada, says Cuba has ``achieved a remarkable level of healthcare
quality of life for its citizenry.''
But six Cuban doctors The Miami Herald interviewed -- two dissidents
still on the island, four now in Miami -- say many prescription drugs
and even over-the-counter remedies are nearly impossible to get, and
patients sometimes have long waits in clinics unless they pay bribes.
One irony is that poverty has forced Cubans into a healthier lifestyle.
Juan A. Asensio, a University of Miami trauma surgeon and a Cuban
American who is certainly no friend of the Castro regime, put it this
way: ``No McDonald's, and Cubans walk everywhere or ride bikes because
they can't afford cars.''
About one in 10 Cubans are obese, according to the Pan American Health
Organization. In the United States, one in three are obese, ''increasing
risks of high blood pressure, type 2 diabetes, stroke, heart disease and
osteoarthritis,'' according to the Agency for Healthcare Research and
Quality.
Still, the aging American, no matter his weight, can lay claim to a more
comfortable life, with access to everything from Advil to Pepto-Bismol
and Viagra -- products virtually nonexistent in Cuba.
As Nestor Viamonte, a physician who left Cuba in 2003, puts it:
``There's a difference between a 75-year-old with quality of life and a
75-year-old without quality of life.''
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