Cuba provides a comprehensive health service to a population three times greater than ours for one-fifth of the cost - £1 billion compared with £5 billion. Cuban life expectancy is nearly as good as ours, despite chronic malnourishment.
The World Health Organisation has described the Cuban health system as a model for the world, and its seeming success, despite US embargoes that leave its chemists' shelves empty, raises interesting questions. If a Third World economy can get its act together to look after its people from cradle to grave, then why can't a First World economy like ours get it right?
The health system of the Republic could learn a lot from the Cuban model, which focuses on primary healthcare and preventive medicine in the community, according to a documentary due to be screened on TG4 on Saturday.
Rich in people and idealism but poor in medicine and supplies, the Cuban health system is, by necessity and ethos, more humanitarian than our own, according to Aodh ╙ Coileβin, who directed the programme, C·ba: Slβinte Mhaith?
I put it to him that the documentary comes across as a combination of Cuban government press releases and travelogue. He responds that he checked all the facts with independent sources and that any country, including the Republic, will present its health services in the best light. "What you see is what you get," he says of the documentary, adding that many incisive comments were made off-camera.
One of those interviewed in the programme, Dr Seamus O'Beirn, a GP in an innovative practice in Spiddal, Co Galway, provided research on the Cuban primary-care system. He is disappointed by the documentary and has criticised its makers for failing to ask "hard questions" of the Cuban authorities - although he says Cuban doctors interviewed appeared evasive, making objective analysis difficult. "You can't make comparisons, because you're not comparing like with like," he says.
╙ Coileβin admits that Cuba and the Republic are like chalk and cheese, and that comparisons between Cuba and here are distorted by wide differences in salaries and costs. Put it this way: GPs in Cuba earn $20 a month - low even for Cuba - and cardiac surgeons earn no more than manual labourers, about $40 a month, which is less than your average Irish hospital consultant might spend on a tie. If Irish doctors were willing to work for peanuts - and why should they be? - we'd have a cheap healthcare system, too.
Health professionals' salaries account for the largest proportion of healthcare costs in this country. If Irish doctors and nurses were paid $20 a month and did their rounds on bicycles, our health service could cost a mere £1 billion a year as well. That said, Dr O'Beirn is convinced there are lessons to be learned from the idealistic Cuban model.
Keeping people out of hospital by preventing illness is fundamental to the Cuban system. Cuba has 12 times as many family doctors as the Republic: one for every 370 people, compared with one for every 1,500 here. Cuba spends 65 per cent of its health budget on hospital care, compared with 95 per cent in the Republic.
In Cuba, everything from 24-hour GP service and antenatal daycare to organ transplants and plastic surgery is free. That doesn't mean you'll get your new heart or boob job, as a shortage of drugs and equipment makes surgery unlikely. Heart transplants are down from 20 a year to three as a result of the blockade.
Even so, Cuba has taken its share of Chernobyl children, treating 1,900 since 1990. And its institute of nephrology, of which Ben Dunne, the former supermarket chief, is a benefactor, has reached such a high standard in the speciality of bone grafting that patients come from abroad for treatment - which helps to fund the hospital. Healthcare "tourism" is a big money-spinner, along with sandy beaches and clear blue waters.
Providing breakfast, lunch and dinner for everyone has become a greater problem for Fidel Castro since the blockade, and malnourishment is endemic. The maternal mortality rate is 10 times the Irish rate, and lack of nutrition is seen as a principal cause. Antenatal clinics in Cuba give women two good meals a day.
In 1959, when Castro came to power, the average life expectancy was 57 years. Today, it is nearly as good as ours, due in large part to the fact that all Cuban children are vaccinated against 13 diseases. This isn't possible in a democracy, where parents have the right to object.
Cuba's primary healthcare in the community is a vision of selfless idealism. Doctors say they do the work because they love people - but do they have any choice? Their work must be effective, as vaccination alone cannot explain increases in Cuban life expectancy, but is primary healthcare really responsible for keeping hospital costs down? There are two ways of looking at this: either primary care is successfully treating patients out of hospital or sufficient money cannot be spent on hospital care because the drugs and equipment are not available. Without objective measurements of GP referral rates and other factors, it is impossible to answer this question.
Dr O'Beirn quotes British research estimating that, if all the hospitals in the UK closed, life expectancy would fall by only a year. Life expectancy and quality of life are not the same thing, however. While GPs are revered in Cuba, they remain the unsung heroes of the Irish system. Ninety per cent of the Republic's health funding goes to hospitals, yet GPs deal with at least 95 per cent of illness in the community. Research in Dr O'Beirn's practice demonstrated a GP referral rate of just 1 per cent. Yet GP care is largely a private enterprise. The Department of Health and Children has paid little more than lip service to general practice, and although the new health strategy declares its importance, this may yet turn out to be a cynical exercise.
Investing in primary care is crucial to the health of the Irish population - if it's true that primary care is responsible for increasing Cuban life expectancy, then the argument would add ballast to Irish GPs' efforts to seek greater public investment.
In Cuba, GPs are like "close family friends" and have access to polyclinics, which offer an array of outpatient services, from gynaecology and cardiac care to psychological services and acupuncture. The polyclinic, with its decentralised service, is promised by the Government's latest health strategy, although whether it comes to fruition is another matter.
Alternative medicine has blossomed in Cuba as a direct result of a severe shortage of pharmaceuticals. Cardiologists are prescribing sugar cane to lower cholesterol, for example, and psychiatrists are using hypnosis, relaxation exercises, flower remedies and psychotherapy to treat mental illnesses - they have no other option.
The documentary doesn't ask for the medical-research evidence that proves this works, but perhaps there isn't any. You cannot conduct a double-blind controlled medical trial, comparing drug therapy with alternative therapy, if you haven't got the drugs.
C·ba: Slβinte Mhaith? is on TG4 on Saturday at 7.15 p.m.
Muiris Houston returns next week