MSNBC's Andrea Mitchell devoted part of her show Tuesday to an analysis of the upside of health care in Castro's Cuban dictatorship.
Mitchell began her show with a panel discussion on the Affordable Care Act hearings before the Supreme Court, from a plaza in the police state.
This is not the first time Mitchell has praised the Cuban regime.
On Tuesday, Mitchell profiled a medical school she had previously toured with Fidel Castro himself, and called the country "highly regarded for its health care."
ANDREA MITCHELL: And joining me now is Gail Reed, international director of a nonprofit based in Atlanta, Medical Education Cooperation with Cuba, working to bridge Cuban and American medical treatments. Thanks so much, Gail. Great to have you here.
GAIL REED: Thank you.
MITCHELL: We're seeing this debate in our country about universal health care, the mandate, the Supreme Court arguments today. We have universal coverage here. Of course, it's a very different society and an economic model that would not work in the United States. What do you see as the advantages of the Cuban system, the low infant mortality rate, for instance, which is legendary around the world but also the gaps you're trying to fill?
REED: I was struck by one what one of the medical students said about having so little and building up to more, because obviously what they've done in health care here wasn't built in a day. It was built over the last 50 years. It was built with a public policy of emphasizing health care for all. So today you really do have universal health care, free. It is also a system that emphasizes very much prevention, built on primary care clinics, doctors and nurses, sort of dotting the country, and they have worked very hard in that area, which I think has economic implications when you're trying to do health on a shoestring, prevention's very important. You avoid big-ticket items in the first round. And the other thing is, it's back to basics. It really is. The doctor and nurse are in the community. They make house calls. There's no middle man.
MITCHELL: House calls?
REED: I remember in the 50s when I was a kid we used to get house calls from our pediatricians. They still make house calls in Cuba. And so it's something that is built over time and has given them outcomes very comparable to those in the States and in Canada, as you mentioned, low infant mortality. Women in Cuba are living over to 80 years old now, a bit more than men, at 76. Prevention is the name of the game, in terms of vaccines, health education and it's not without its problems.
MITCHELL: It's not without its problems. There are other problems here. We shouldn't underemphasize the infrastructure problems, the impact of the embargo. What do you do in terms of bringing in doctors who train here, do they teach? Do you also deal with vaccines and other supplies although Cuba has a very – Fidel Castro once showed me the laboratories, back when they were briefly controversial, there was an erroneous claim that they were biomedical weaponry and he showed they were basically making antibiotics.
REED: You got into the inner sanctum to see what was going on.
MITCHELL: It was quite amazing. But there are shortages.
REED: There are shortages and I would say there's a few different kinds of problems. One kind of problem is very similar to we face in the states, which is chronic diseases the kind of diseases– heart disease, hypertension, cancer, the obesity that causes it. And then there's infrastructure problems that come from years of economic problems in the 90s, some of the hospitals need repair. The salaries are not what they should be. And of course, you know, I would say you do have to take your own bed sheets in some of the hospitals, even though you can get a heart transplant for free. They weigh these things. Right now, the emphasis is trying to make this sustainable.
MITCHELL: And work the way it has been envisioned. Great insight.
The constraints Reed alludes to have been a major issue for the health care system in recent years.
Cuban authorities announced last year they had slashed medical employment in 2010; overall employment in the health care employment fell 14 percent in 2010, from 330,000 to 282,000. Health spending in the country also dropped by 7.7 percent in 2011.
Those cuts came a few years after a major reorganization of the family doctor program Reed describes. In 2008, the Cuban government closed more than half of family doctors offices, reorganizing those doctors to work in remaining offices:
Cuba's family doctor program began with much fanfare in the 1980s with a family doctor for every 500 to 700 residents, coordinated by larger community-based clinics.
The family doctors were given the task of preventing illness by getting to know every family under their care and identifying health problems early on for referral to medical specialists.
Now each family doctor office will cover up to three times as many residents, between 1,500 and 2,000, a doctor said.
This month, the Miami Herald reported that while health care is technically free, important medicines and supplies, like needles and tooth-filling materials, can only be secured through the black market.
In one Cuban hospital, patients had to bring their own light bulbs. In another, the staff used “a primitive manual vacuum” on a woman who had miscarried. In others, Cuban patients pay bribes to obtain better treatment.
The cable acknowledged that medical institutions reserved for Cuba’s ruling elites and foreigners who pay in hard currencies “are hygienically qualified, and have a wide array of diagnostic equipment with a full complement of laboratories, well-stocked pharmacies, and private patient suites with cable television and bathrooms.”
During a visit to the Calixto Garcia Hospital, which serves only Cubans, the U.S. nurse “was struck by the shabbiness of the facility…and the lack of everything (medical supplies, privacy, professional care staff)…reminiscent of a scene from some of the poorest countries in the world.”
Cuban authorities have also been blasted by groups such as Human Rights Watch for denying medical care to political prisoners.
No cure has yet been found for Cuban tyranny.