Understandably, a growing number of Americans are dissatisfied with our expensive, dysfunctional health care system. We spend far more money on health care than any other country, yet rank far down the list of health outcomes. Our system is also dangerous—medical errors are the third cause of death in the U.S., following heart disease and cancer.

In looking for solutions, it’s important to look at successful health care systems in other countries. Today’s column is about health care in Cuba, based in part on an article that appeared in The Atlantic Monthly magazine a few years ago. The title is “How Cubans Live as Long as Americans at a Tenth of the Cost.” 

Cuba certainly has its problems. But it is known for its medical education—which is free, like all education there. Free health care for all citizens is a constitutional right. In order to make this system work in a poor country like Cuba, the emphasis is on prevention–keeping people healthy, as opposed to the expensive “disease management system” that we have in the U.S.

 The Cuban system is based on primary care, and Cuba has twice as many primary care doctors per capita as the U.S. does. Family doctors and nurses work in teams. They are assigned to live in a particular   neighborhood, and care for everyone in that neighborhood. At least once a year the doctor sees each patient for whom they are responsible, in the patient’s home. Doctors are trained to talk about healthy lifestyle, such as nutrition, exercise and tobacco cessation. These check-ups also involve questions about jobs, social lives and living environment (which is easy to assess given the home visits). Doctors then put patients into risk categories, which determine how often they need to be seen in the future. If necessary, primary care doctors refer patients for specialty care.

In 2016 Cuba spent $813 per person annually on health care—in American we spent $9,403 ($14,570 in 2024). In spite of Cuba being a poor country, their average life expectancy is slightly longer than ours. Their number of years lived in good health surpasses ours, and their infant mortality is lower. Vaccines are mandatory, so they have one of the lowest rates of vaccine-preventable diseases in the world.  

Of course, the Cuban system isn’t perfect. For example, people don’t have a choice of providers, and pay for doctors is low. Due to lack of money and the U.S. embargo, medical supplies and pharmaceuticals are sometimes hard to come by. Hospitals are often old and in disrepair. But maybe we in the U.S. can learn something from the good parts of the Cuban system.

The Atlantic article concludes by saying this: “While Cuba’s situation is far from ideal, it serves as an elegant counterpoint to the three-trillion-dollar U.S. health-care system[5 trillion in 2024]—which is controlled by corporations [privatized insurance, pharmaceutical, medical-device, and hospital systems] that drive people to pay exorbitant costs [either directly or through taxes]. Cuba offers a reminder that efficient healthcare can be provided at much less cost to the people—when the focus is on primary care and prevention.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.