Cuba’s health-care system offers U.S. lesson in results

HAVANA — Claudia Fernández, 29, is an accountant whose stomach bulges with her first child, a girl, who is due in April.

Her baby appears more likely to survive than if she were born in the United States.

Cuba is poor and repressive with a dysfunctional economy, but in health care it does an impressive job that the United States could learn from. According to official statistics, the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9.

In other words, an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant. How is this possible? Well, remember that it may not be. The figures should be taken with a dose of skepticism. Still, there’s no doubt that a strength of the Cuban system is that it assures universal access. Cuba has the Medicare for All that many Americans dream about.

In Havana, I shadowed a grassroots doctor, Lisett Rodríguez, as she paid a house call on Fernández — and it was the 20th time Rodríguez had dropped in on Fernández’s apartment over the six months of her pregnancy. That’s on top of 14 visits that Fernández made to the doctor’s office, in addition to pregnancy consultations Fernández held with a dentist, a psychologist and a nutritionist.

Missing a prenatal checkup is much less likely in Cuba because of a system of front-line clinics called consultorios. These clinics, staffed by a single doctor and nurse, are often run-down and poorly equipped, but they make care readily available: Doctors live upstairs and are on hand after hours in emergencies.

This proximity and convenience, and not just the lack of fees, make Cuba’s medical system accessible.

Home visits are also a chance to reach elderly and disabled people and to coach dysfunctional families, such as those wracked by alcoholism (a common problem), and to work on prevention.

Each consultorio doctor is supposed to see every person in the area at least once a year, if not for a physical, then at least to take blood pressure.

All this is possible because Cuba overflows with doctors — it has three times as many per capita as the United States — and pays them very little. A new doctor earns $45 a month, and a very experienced one $80.

Critics inside and outside the country raise various objections to the Cuban system. Corruption and shortages of supplies and medicine are significant problems, and the health system could do more to address smoking and alcoholism.

The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.

In many ways, the Cuban and U.S. systems are opposites. Cuban health care is dilapidated, low-tech and free, and it is good at ensuring no one slips through the cracks. American medicine is high-tech and expensive, achieving some extraordinary results while stumbling at the basics: A lower percentage of children are vaccinated in the United States than in Cuba.

While we should call on Cuba to grant people like Fernández meaningful political rights, we should likewise push for American babies born in low-income families to have the same opportunity for attentive health care as her daughter will have.