Part two of a two-article series. See part one here.
Despite the valiant attempts by progressive Democrats to pass a universal health care system, we got the less-than-ideal Affordable Care Act that still leaves several million uninsured people.
In part one of this series, I described how Cuba does a miraculous job of having a successful health care system despite the U.W. embargo she faces. In addition to hospitals Cuba has an island-wide network of neighborhood medical stations and specialty polyclinics that reduce reliance on emergency rooms for care. Now onto the million-dollar question: would such a system work here in the States, and how? I've tweaked the system a bit to adjust to our current structure of government.
The first level of care, based on the Cuban system, would be a municipal medical clinic. Each town or municipality of over 1,000 people would be served by a clinic staffed by nurses and physician assistants. So don't we have this like the Cubans do? As KaiserEDU.org notes, the United States is facing a critical shortage of primary care physicians in medicine. Most medical students saddled in debt go to high paying specialties instead of primary care. It would take some time to train all those new physicians to fill the gap.
In the interim we can use nurse practitioners and physicians assistants to fill the void. NPs and PAs can work alone or under the supervision of a doctor. They both have prescribing rights and are just as qualified as doctors to deliver basic care. In a Cuban-style system a doctor would be assigned to a set of clinics to oversee operations with the NP or PA supervising a nursing staff directly as needed. These medical stations would cover primary care such as physicals and immunizations.
The next level up is a polyclinic. I suggest one polyclinic per county or county equivalent. In Cuba polyclinics generally serve several tens of thousands of people. In our big cities and larger counties more than one polyclinic will be needed to cover people. At the polyclinic people should be able to see a doctor who's a specialist, receive diagnostic tests, dental and optical care, outpatient surgeries, and treatment for urgent care scenarios.
Finally, the hospitals. These would be used in case of life threatening emergencies. The more we reduce the need for a hospital emergency room through the polyclinic, the less people will show up at the hospital sick.
A successful health care system that covers all for free must be well financed and have some kind of democratic control.
So who's going to pay for all this? Well first we can start by jacking up taxes on the rich and big corporations. Strengthening the progressive income tax system is a must for a good health care system to be successful. A successful taxation system that places the burden of cost on the people who can afford to pay allows every citizen to receive free, quality health care without having to turn the entire nation upside down searching for a way to finance such a system.
Now the nitpicky part: who gets to control the system? In my plan the people do. On the local level I propose that every county elects a democratic assembly of health care workers, professionals and patients who oversee the day to day operation of the county polyclinic and local clinics. There should be regional assemblies as well for control over hospitals affiliated with a major university or medical school.
Abortion should be legal and on demand at a polyclinic for women who choose it. HIV/AIDS treatment and testing should be free and available for all who need it, including post-exposure prophylaxis treatment. Fertility treatments for women who are unable to conceive should be available. Local medical clinic staff should be trained to be sensitive to the needs of all patients and should set their personal beliefs aside when it comes to the needs of a patient.
This is a system that is for the needs of a patient, is run by the people themselves, and takes big insurance out of the equation.
Photo: Medical students in Cuba. Roberta Wood/PW