Graham Sowa

Michell Bachmann. Photo:

HAVANA TIMES, Feb. 20 — United States Congressional Representative (and former Presidential Candidate of the Republic Party) Michele Bachmann said that the Federal Government should decrease its involvement in healthcare.

When asked how poor people would get medical care she said those patients who don’t have money will be taken care of by sympathetic doctors who will accept payments in commodities, such as chickens.

Representative Bachmann might be surprised to know that this solution to doctors pay already exists, and it exists far away from her version of a world where the Federal Government has no responsibility to provide for healthcare.  It exists in Cuba.

As far as I can tell just about everyone who works for the government in Cuba gets a salary.  This includes doctors.  Monthly take home pay depends on education and job responsibilities.

Some workers might make a couple hundred pesos in pesos cubanos ($10 usd) and others make closer to 600 or 700 pesos ($30-35 usd).

Some people might assume that living in Communism means that everyone has to earn the same amount of money, but that is not the case.  But at the same time the income gap that does exist is still a smaller percentage than that of the United States.

Even though the official pay scale is more egalitarian than competitive there still exist “unofficial” market forces that make some jobs much more preferable than others.

Since doctors in Cuba don’t work directly with money, and rarely with tourists that bring in hard currency, they have scarce opportunities to make a little extra on the side that gets them by each month.

In place of money gifts from patients to doctors have becomes popular.  I suppose sometimes these are given as a genuine expression of thanks and sometimes with expectations of getting through the bureaucratic pipeline quicker than the other patients waiting in the same line.

I’ve mostly seen food items and homemade goods given as gifts.  But it is not difficult to imagine that as one climbs the healthcare ladder toward the in-demand specialists and complicated laboratory tests that gift giving becomes a bit more elaborate.

So there is the problem with Representative Bachmann’s healthcare solution for poor people: a chicken will only get you so far.

Havana's Reina St. Photo: Caridad

So maybe instead of abandoning the very significant Federal Government involvement in healthcare in the United States we should focus on how to make the money we spend work more efficiently.

One area we need to start at is the anomaly almost unique to medicine when compared to all other jobs in the United States.

That is that the doctors who do procedures usually get more money than those who diagnose problems or prevent those problems in the first place. In short: they cost a lot.

In most other professions the people that diagnose the problem get paid a premium over people who turn the wrenches to fix the problem.  I’m thinking of engineers called in to solve a problem on a production line, technicians reading problem reports from complicated software that monitor jet engines, and outside consultants that review business models.   But in medicine it is the other way around.  The people that diagnose the problem earn far less.

So a place to start making government involvement more efficient in healthcare in the United States would be to put more surgeons who are working for Government paid heath care plans or Medicare/Medicaid clients on a fixed income.  Maybe even throw in incentives for finding ways to get the same healthcare results with fewer procedures.

Some of the most successful non-profit healthcare groups in the United States already keep most of their doctors on a salary and rarely pay by procedure.  The Cleveland Clinic and Intermountain Healthcare have millions of patient visits a year and are routinely held up as some of the few relatively successful models of patient care coming out of the United States.

Some doctors are even becoming more accepting of the salary based payment system and are losing their fear to point out that their procedure paid collogues are making healthcare in the United States less efficient.

I have especially enjoyed Abraham Vergese’s literary commentary in his novels about the disparity surrounding diagnostician vs. procedural doctors pay and the vast amounts of resources consumed by the latter.

In the United States, where we are quickly realizing our medical industrial complex is unsustainable, we should reallocate resources from procedural pay and towards good diagnostics.

It might even meet some Republican demands, such as Representative Bachmann’s call to decrease the amount of money the Federal Government spends on healthcare.


Graham Sowa: I've been living in Cuba for three years now. I would like to blame my obvious hair loss seen in this updated photo on the rigors of life here and medical school, but it is probably just genetic. I've made some of the strongest friendships during my time in Cuba from other writers on this website. The strength of those friendships has almost restored my faith that the online world can lead to offline and real life change. On that same note I've adjusted to using internet one or two hours a month. In the meantime I have rediscovered things like flipping through the pages of books, writing stuff down by hand, and having to admit that I don't know something instead of rapidly looking up the answer on Google while the teacher isn't looking.

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