Freedom to Choose (II)
Dmitri Prieto
Free to Choose: A Personal Statement, 1980, is the title of a book by Milton and Rose Friedman, the prophets of the monetarism and neoliberalism (neo-conservatism).
To preach an ideology, it’s indispensable to trap people with catchy slogans and a patchwork of ideas – some true, others not.
I think that among the most irksome, abhorrent and absurd ideological occurrences of the 20th century is the fact that socialists were incapable of globally upholding the flags of freedom. Instead, they ignobly handed them to the defenders of private enterprise. The “they” were, of course, State socialists.
The (neo)liberals, under the slogan of “freedom to choose,” undermined and brought down the welfare states —built by State organizations— and delivered the world to the situation we live in today.
The age of buying so easy on credit has ended. It will be necessary to work harder and have less fun. Those who don’t fit in the system will be left outside the cosmos that the system has been slowing creating.
Cuba is not foreign to that problem.
We are so tired of the same thing over and over again; we want to be able to choose. It seems that we’re going to have micro-enterprises operating at full capacity and with their wage-labor work forces. We will soon be able to choose what sandwich we wish to eat while the owners create jobs for the proletarians from the ranks of a reserve army of the unemployed.
However not everything is question of sandwiches.
Choosing your doctor
A few days ago, I went to an informal seminar on how to cope with and handle pregnancy and female postpartum. The expecting mother is assigned to the hospital where she will give birth (except if “by chance” she arrives to another hospital if contractions have already begun).
Attending the seminar was a single-mother, a teacher of Latin American students, who recalled how she had to explain that situation to one of her pupils (“Teacher, have you already chosen the maternity hospital where your daughter will be born?”). The poor child had trouble understanding how things really work.
The same mechanics apply to any sick person.
Each of us is assigned to a specific “family doctor,” and not another. If this assignment cannot be changed via the official route, it may however be achieved through “personal relations.”
The “family doctor” is not a Cuban invention; in England it’s called “surgery,” and is administered under the National Health System – completely free. This was an achievement of the Labour Party (that of earlier times, not of New Labour).
Once, when studying at the London School of Economics and while I was in the library, some Cubans comrades and I got into a dispute by e-mail with an official from the Ministry of Culture. The exchange gave me a tachycardia (an excessively rapid heartbeat), right there in front of the computer. So, I left for “surgery” on the corner to see if they could take my blood pressure. “Are you registered with our doctors?” they asked. “No? Then you had better go to the surgery where you’re assigned, and there you’ll be attended.”
On another occasion, here in Havana, a young woman was in the middle of an asthma attack but was not accepted at CIMEQ, the Cuban hospital for ranking officials. The irony lies in the fact that the woman worked in one of the scientific research centers whose workers do in fact have the right to be treated at CIMEQ; the only problem was that she had still not been issued her related ID card.
I’ve heard that in Sweden you can choose what doctor will attend to you, and this treatment is free. However, these physicians are paid through the public health plan according to the number of patients they serve and the complexity of those cases. Obviously, the doctors most sought after do better.
The Canadian system is not without its faults, but I cannot imagine living under a system that is much different. The freedom to choose is universal. I can go see any doctor I like and the bill is always paid by the government. It is a private system in that the doctor does not work for the government, the government is simply the insurance carrier, and the insurance is paid through our taxes. In that respect, it’s not free, but the taxation levels are much lower than the health care premiums paid in many other countries. But it’s also a socialized system in that the delivery of many treatment and diagnostic services such as MRIs are only allowed to be delivered by government controlled facilities.
The problem in any socialized system is the access and allocation of resources. I’m allowed any doctor I want, but that doesn’t mean the doctor I want has room on his schedule to see me. I’m allowed any treatment I want, but that doesn’t mean that treatment is available when I ask for it. The problem with allowing anyone anything is the costs get out of control to the point of having the effect of making it impossible to make the supply available on demand.
The solution, I believe, is to open up private delivery a little more. Make everyone pay into the public system, but allow those who want to pay more to go elsewhere to do so. People complain that that gives those with money faster access and that’s unfair. They forget that it also takes that rich person off the schedule in the public system and makes MY wait shorter too. At bare minimum, I’d like to see things like MRIs be opened up to be allowed in private clinics.
In New Brunswick, Canada, where I live, we are under a free public health care system. I have a family doctor who I make an appointment with for routine non-urgent matters. This family doctor has also entered into an arrangement with a number of other family doctors whereby they operate a clinic for their combined clients in a central location that is staffed on a rotating basis and one is able to obtain an appointment for a consultation usually on the same day. The provincial government also maintains a network of after-hours clinics whereby one can call after 11 am for an appointment in the afternoon, or after 5 pm for an appointment in the evening. In this way all individuals that don’t have a family doctor have access to routine medical care. As a last resort, or for serious matters, hospitals maintain out patient departments that can be accessed on a drop in basis 24 hours a day, waiting times triaged of course based on the severity of the situation. All residents are issued a Medicare card which is presented to receive these services free of charge, funded through our taxation system. Numerous charges have been leveled against the Canadian system, mostly through proponents of U.S. style private health care, that is results in excessive levels of taxation, but polls consistently show that Canadians overwhelmingly choose to pay this taxation to have the safety and security that this system provides and that they are satisfied with the quality of healthcare provided.
We have the same lack of choice here in the States. If you are wealthy, and enjoy a gold-plated health insurance, such as Blue Cross/Blue Shield, you have much greater choice in physicians, hospitals and treatments. The rest of us, if they are fortunate enough to be employed and have insurance through their employer, have to take whoever we are assigned to by our HMO (Health Maintainance Organization). About ten years ago I had a wonderful doctor, but then my employer changed health plans and I was assigned to a revolving series of “physicians’ assistantes, whose average tenure is two or three years. I rarely–if ever–even get to see a real doctor. In any event, both doctors and physicians’ assistants are so harried, required to see 50+ patients a day, often two or three at a time, running back-and-forth between several examination rooms, that it is no wonder their care is second-rate, or that the one recourse for both patient and families is to hire a lawyer and sue for damages done–sometimes death–when there is a mis-diagnosis!
The truth is, Canada probably has the best all-around health system in the world. The government provides the service free to all Canadians and is supported totally by taxation. Look it up on the internet.