Watching the U.S. Democratic debates, I was struck by the various proposals to give health care to all in the U.S. Not endorsing any one proposal, I want to explain Nicaragua’s health system and point out the pluses and the minuses of each…
As part of the Nicaraguan constitution, health care is a right… not a privilege but a basic human right.
The way the current system works was explained very well by my daughter-in-law, Cassie, who worked as a medical intern under the Nicaraguan system.
There are three levels of health care:
- Universal
- Single Payer
- And Private care.
Universal means that ANYONE can walk or be carried into a public hospital or clinic, be treated and leave with no bill.
When Pat had what the neurologist thought was a massive stroke, she fell and cut her jugular vein and her carotid artery on a broken butter plate that she was carrying.
She was rushed to the hospital with our Dr. Flores pushing on her neck (he happened to be there) to staunch the flow of blood. In less than 5 minutes after she fell, she arrived at the closest hospital and had no pulse. After 4+ liters of blood, ER care, surgery, and three days in the ICU, she died.
We had no hospital bill.
We felt that Pat received the best care possible.
That was our experience, but not all receive that level of care. Chico, our once-bus driver, went to the same hospital coughing up blood. He was told to go home to die with stage 4 lung cancer. After helping him get a second opinion, he actually had TB and is still smoking and coughing but alive and doing fine two years later.
Not all receive good care and for elective surgery the wait is long.
The second tier of Nicaraguan health care is the single payer plan. Those who work in the formal sector pay into the national insurance1 (INSS). With this plan, people tend to get a higher level of care, a more consistent level of care, and the waiting period is less, because they stay with the same doctor and have paid into the system.
Jessenia, our health promoter, is in and out of hospitals with diabetes. She has survived, thanks to the INSS, an infection of the heart and is now battling a failing kidney and an ulcerated toe.
In contrast, Diana’s son broke his arm for the second time… or so she was told. The doctor, scamming the INSS for more payment, x-rayed the arm and put a cast on the boy’s arm. When Diana wanted the cast off, she got the arm x-rayed again to learn there was no second break at all. Her son had worn the cast for 6 weeks for no reason.
The third level is private care. Our Nueva Vida Clinic falls into this category as well as the more expensive specialists and hospitals. Leaving clinics like ours out of the equation, most of the better trained doctors work in private care. They also tend to work either with the INSS or as public doctors. For example, my internist2 is also the government’s foremost specialist in infectious diseases, especially HIV.
There is no waiting in the private sector. There is an abundance of tests in the private sector for more accurate diagnosis. And the private sector gets the most income because the private sector is where the wealthy go.
Just like private vs public schools, when the wealthy have options then the public suffer… it is the same in health care. If the wealthy of the Pellas family who own about half of this country had to go to the public clinics, the clinics would have everything they need.
So, when candidates talk about people needing health care options, remember options mean the rich have options and the poor get the dregs… like always.
-Kathleen
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1This is what the first demonstrations in April 2018 were about… raising the percentage people have to pay to the national insurance and taking 5% of what retirees get to enroll them in the national insurance, so that they would get better and more consistent care.
2I go to him because I have a compromised immune system, because I lack a spleen.
*If you want to contribute online to help patients at the Nueva Vida Clinic, https://donatenow.networkforgood.org/jhc-cdca
