[xyahoo]

On the other hand:

- average life expectancy in Cuba is almost the same as the USA (and higher than Mexico, Belize, Bahamas, Brazil, etc.).

- literacy rate in Cuba is higher than that in the USA

- Physicians per 10,000 people: Cuba has 67, USA has 24

In the Ebola crisis, Cuba has been leading from the front.

[WildUtah]

Physicians per capita figures are misleading.

The US figure reflects very long careers; late retirements; investment in large teams of trauma specialists due to high war, car crash, and gunshot wound rates; a high percentage of women physicians working part time; and a high concentration of expensive specialists with no documentation that they improve outcomes and paid for by large federal government subsidies.

The actual amount of primary physician and general surgery time available to Americans is very low compared to other countries with similar numbers of doctors. Most countries also allow as many as half the cases administered by fully licensed doctors with 12-20 years of post-secondary schooling in the USA to be handled by nurses and pharmacists. Prescriptions for sniffles or heartburn, basic non-controlled medications, simple physical assessments, and vaccinations are handled by professionals the USA would consider nurses or pharmacists or unlicensed assistants in most first world countries. In the USA those jobs take the time of physicians.

And that is the top reason, among many other unrelated ones, that health care is so much more expensive in the USA. US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages or else some must go without care. It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.

Cuba, on the other hand, appears to be counting nurse practitioners as physicians. That's fine to do because they're highly qualified, but it makes the numbers not comparable across countries.

[chimeracoder]

> It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.

Sort of. There are a lot of very common misconceptions around this.

The AAMC (not AMA!) limited the number of medical school students until about ten years ago, at which point they announced an explicit goal of expanding the number of graduates from medical school.

However, this doesn't mean anything in practice[0], because the bottleneck isn't the medical school graduates - it's the residency programs. As a medical school graduate, you have an MD, but you are not actually qualified to practice medicine. That requires usually four years of training (minimum), plus several more for various specialties.

These programs are costly to run, and so hospitals that offer residency programs are funded by the federal government to do so (through Medicare). The only way to expand the number of practicing physicians in the US is to skimp on quality during training (which nobody wants to do), or to increase funding through Medicare (which nobody wants to do.

> US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages

They also have to be paid a hefty amount to pay off massive debt. If you see an attending physician in his 30s (or even 40s), even if he's making a respectable amount of money, there's a good chance he still has a negative net worth. The level of debt of course varies by location, specialty, and quality of education, but it's rather misleading to look at an e.g. $200K/year income for a physician and compare that to the equivalent amount in the tech industry.

[0] pun not intended, but very a propos!

[WildUtah]

Thank you for adding detail.

In this case, the bureaucracy eventually overcame institutional resistance of the wealthiest professional Americans to reform of a system that limited doctors and thus vastly expanded their incomes. I expect that same government and institutional bureaucracy to eventually increase significantly the residencies, but it will move in that typical slow motion of bureaucracy eventually doing good.

When it eventually adds to our production of new doctors, it will have a bigger impact than ten Obamacares or single payer plans or HIPAAs.

The debit of American medical students is as legendary as the vast incomes of doctors, both wildly out of proportion to the rest of the first world. Hazing practices during residency are also still crazy, though much reduced after glacial bureaucratic reforms.

I don't know if there's any better idea there than to hire and appoint good administrators to plan better. A violent revolution like the one in Cuba that built a better health care system seems too extreme.

[WalterBright]

The last vaccinations I received were from the pharmacist at the drugstore.

[WildUtah]

Licensing practice is mostly at the state level (aside from certain DEA pharmacy regulations). States that promote licensing, liability, and practice regulations that encourage more pharmacists and nurse practitioners to practice more independently have much lower overall health care costs (also dental hygienists, opticians, &c).

Your pharmacist is part of a system that got your health care right this time.

[mistermumble]

yes, good points. It seems that Cuba has become something of a health resource for other countries in Latin America, where there is much less access to doctors (and NPs) than in Cuba. Middle-class people in those countries travel to Cuba for health care. At least that is picture I get when I've spoken to a bunch of people in the region over the past few years. I hear about a number of people travel to Cuba, others got to Chile, and almost no one can afford to go to US to get treated.

[molmalo]

> others got to Chile

At the south of the continent, it is far more common to travel to Argentina, to get free health care. As Argentina has a large public health system, (that has been gradually loosing a lot of quality in the past 20 years) it's common that poor people from Bolivia, Chile and Paraguay travel and get attention for free in Argentina's public hospitals.

[baddox]

Not only that, but more physicians per capita isn't inherently a good thing.

[qwerta]

Perhaps good idea for startup, medical turism..

[scardine]

I highly recommend reading "Guide to the Perfect Latin American Idiot" which explain how dictatorships can pick a handful of indicators and elevate them to first-world levels while still making everybody's life miserable.

[1] http://www.amazon.com/Guide-Perfect-Latin-American-Idiot/pro...

[discardorama]

You're talking as if the dictators sit around, wondering about some sort of "SEO" to game their ranking on these lists.

The "life expectancy" figure can't be gamed, unless you out and out lie.

Here's a recent article for thought: http://www.wired.com/2010/04/cuban-health-lessons/

[scardine]

The indicators per se are not gamed. Instead, you select a few indicators like "Olympic medals", "life expectancy" (etc) and commit every resource of the country to them at all cost and without regard for everything else. The indicators you picked will show amazing and you can use them to justify your ideology. Pretty much like a SEO hack, they are hacking public opinion (looks like it worked on you).

[mistermumble]

I highly recommend travel to those countries so that you can observe it for your self. The picture is different than the book.

[wdr1]

Michael Moore needs to read this book.

[jff]

He's already mastered the essential strategy of selecting a handful of indicators to make your point seem right.

[Moru]

I'm sure he already did

[rgbrenner]

> - Physicians per 10,000 people: Cuba has 67

2nd highest in the world, behind Monaco (70): http://kff.org/global-indicator/physicians/

For comparison: Sweden (38), UK (27), Japan (21), Canada (20)

Makes you wonder if that number has any significance at all. Japan has 1/3rd the number of doctors, but the highest life expectancy in the world.

[mod]

Maybe there's a cause-effect going on in Japan.

They just aren't unhealthy enough to demand more doctors?

[Retric]

Japan has a lot of welfare fraud which inflates their life expectancy numbers. It also has a fairly low level of income inequality relative to their per capita GDP which helps things. (AKA few poor people.) And to top it off universal healthcare which significantly increases a population’s life expectancy.

Edit: Arguably the high food prices reduce obesity which is really important.

[veidr]

> Arguably the high food prices reduce obesity which is really important

I don't think it's the food prices, because the cheapest foods tend to be the ones that lead to obesity (among other health problems). Fast food burgers and white bread are not expensive here in Japan, but fresh fruits and vegetables are.

I think there are many factors, but the pretty great universal health care system has to be a big one. As a working adult in Tokyo, I receive tons of preventative care and thorough annual check ups. It's cheap, and virtually all health care for my kids is completely free until they turn 15.

The lack of equal access to health care in the USA is almost certainly a reason that poor people die 5 years earlier than affluent people[1]. I would guess good access to health care is a big reason that Cuba does so well on that front, despite its obvious economic obstacles.

[1]: http://news.rice.edu/2012/06/21/poorer-us-citizens-live-five...

[michaelbuddy]

my experience in Japan is they eat more vegetables more often. I think this helps in so many ways. They also eat too much salt, smoke too much and probably work too many hours, but apparently the vegetables and great tea are doing something right.

[rgbrenner]

You're focusing too much on Japan. Japan was just an example. This number that Cuba excels on has little relation to health. So what is the point that Cuba has this great number? It's just a number.

Canada, which has even fewer physicians, has a life expectancy only 2 years less than Japan.

[Retric]

Ehh, just pointing out that having more doctors is not that important from a public heath perspective. Plenty of people in the US for example only really see/need a doctor at birth for vaccinations and then suddenly die in there late 80's or early 90's. For much the same reasons that some people actually lived into there late 90's 2000+ years ago.

If nothing breaks there is little need to fix anything.

[pdeuchler]

Comparing statistics from small, homogeneous populations to statistics from larger, heterogeneous populations is fraught with peril. Doubly so for metrics on education and health. (I like to call this the Scandinavian Fallacy)

As engineers we would never compare uptime statistics from a small, niche startup serving a couple thousand people to uptime statistics from, say, Google. Why do we immediately ignore these principles outside of engineering?

Edit: wording

[tomp]

I'd expect the uptime of Google to be better than the uptime of a niche startup.

[Hello71]

small, niche startups usually have poor uptime on their services. we commend them if they have a year up (hell, if they still exist after a year), but criticize Google for being down once every few years.

therefore, if you want to bring in the analogy of startups and Google, it should be even more impressive that small countries (viz. people in small countries, viz. Cuba) live longer than Google (viz. people in large countries, viz. United States).

[EpicEng]

No, because the specific topics at hand are not comparable (service uptime and, say, physicians per capita). The analogy was meant only to illustrate the fact that you cannot (should not) directly compare statistics from such different entities without attempting to control for the variables.

[avar]

What does the heterogeneous populations of the US have to do with it? Maybe when it comes to life expectancy you're right, because genetics is a large factor in that. But when it comes to literacy rate and the proportion of physicians that's entirely down to government policy.

Do you really think the US couldn't beat Cuba on those metrics if they decided spending money on those topics was more important than spending money on the military?

[aaron-lebo]

I believe the point that is being made is that the US was designed from the outset with the idea that diverse factions compete against factions, and that was the only way such a large and varied democracy could work. See Federalist 10.

Citizens of the US have wildly varied views about what it means to be a good American, and we often have greater cohesion to groups such as race or state, etc. Just about the only thing we do agree upon is when there is an existential threat to the country, hence military growth over time.

Cuba or Norway have much less divided societies to govern, and Cuba's leadership is so small that it can focus on specific issues in a way US politics cannot.

[avar]

Sure, that's a factor in US politics. I'm just saying that has nothing to do with having a heterogeneous population as the parent was claiming.

The parent was comparing the proportion of physicians in Cuba v.s. the US and claiming that the US couldn't match Cuba because of its heterogeneous population.

Now if you look at the WHO report on density of physicians[1] you see first-wold countries like Japan and Canada ranking below the US on the number of physicians per-capita.

I think numbers like these have a lot more to do with how the health care system is structured than the sort of population you have. E.g. maybe nurses in Japan and Canad have a bigger role in health care than the US.

1. http://www.who.int/gho/health_workforce/physicians_density/e...

[baddox]

Government policy is heavily affected by cultural heterogeneity.

[finid]

> Comparing statistics from small, homogeneous populations

Cuba is small. Does it have an homogeneous population?

No, amigo!

[sdm]

Since when has Cuba had a homogeneous population?

[aaron-lebo]

I really like that term. Is that your own?

[wazoox]

Furthermore, as Cuba lacks any agrochemicals, almost of their food production is organic, proving that agrochemicals are completely unnecessary.

[organsnyder]

Huh? I'm a big proponent of eliminating agrochemicals, but you've set up a huge straw man here: No one is arguing that agrochemicals are "necessary" in the sense that agriculture is impossible without it (indeed, millennia of experience prove otherwise). Rather, the rationale is that they allow us to increase productivity for the same input of acreage and man-hours.

I'm not saying that agrochemical proponents are right (I've heard that crop rotation is as good or better than synthetic fertilizers, though it's hard to argue against the labor efficiencies of huge tractors and lots of pest/herbicides), but the simple fact that agriculture is possible without agrochemicals doesn't disprove the argument that it might be better with them.