Instigator / Pro

Cuba has a better healthcare system than the US


The participant that receives the most points from the voters is declared a winner.

Voting will end in:

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Contender / Con

BoP is shared.

Better: more desirable, satisfactory, or effective.

Round 1
Interpreted resolution: Cuba has a more desirable, satisfactory, or effective healthcare system than the US.
Position: PRO 
BoP: Shared

The healthcare system is the way in which the available medical resources are organized and distributed to meet the needs of the population, and the laws regulating this system.

Healthcare outcomes = resources invested into the healthcare system * how good the healthcare system is. 

The above statements shouldn't come as a surprise as they are extremely obvious.

1. Cuban healthcare system is more desirable

Built on morally superior foundations 
America refused to sign on a convetion affirming "the right to everyone to the enjoyment of the highest attainable standard of physical and mental health" [aba]. But Cuba did sign on that, and their healthcare system is based on this human right. Despite the numerous pressing problems the Cuban government has to deal with, the healthcare system is a top priority for them.

Less complicated
The American system is way too complicated. "Many people are hopelessly confused by how their insurance works. About half of consumers say they do not understand some aspect of their coverage, including about one-third who do not understand what costs their plan covers or what costs they will owe.[tjamanetwork]. Each year, more than half who report a problem with using their health insurance. Government programs are also hopelessly complex, with millions falling out of Medicaid after covid-19, with very complicated proceedures for signing up, and great confusion as to the criteria for eligibility. Americans have to waste billions of work hours writing, comparing, signing and interpreting healthcare policies. Is that desirable?

Greater coverage
In 2022, 27 million americans lacked health insurance. That is 8% unable to access crucial care. Ethnic minorities and the poor are heavily overrepresented in that figure, excacerbating generational poverty and social inequality. In America, 1.7 million veterans who served loyaly, get rewarded by being robbed of health insurance. But in Cuba, everyone is covered free of charge.

Foreign relations
In Cuba, you do not need to go into debt in order to become a doctor, their robust medical education is completely free. Just in 2013 they trained 10.000 physicians and 30.000 clinitians [phc]. Cuba has more than twice as many doctors per capita than America, 7 per 100 000 people, more than any country in the world. The surplus of medical personell is a great advantage. Cuba is able and willing to send upwards of 30.000 doctors abroad to help other countries and areas harmed by natural disasters. Most would agree that having enough doctors to provide for your own population while also doing humanitarian work is inherently desirable. Especially since this policy of medical diplomacy substantially increases Cubas international standing. Cuba is able to trade its medical expertice which it has an abundance of, for highly valuable oil from Venezuela. 

Cuba treats doctors better
American doctors are consistently overworked and burnt out, and 50% would warn their children not to become doctors. The pursuit of profits drives private hospitals to accept way too many patients, and then guilt trip their staff into taking on excessive workloads. Staying at or above maximum capacity, around the clock for weeks on end, in a job that is inherently stressfull, is extremely detrimental for your own health. Exhaustion also increases the occurence and magnitude of human error when treating patients. They are not even fairly compensated. The accute shortage of medical personell is only going to get worse because of the way America limits the numbers of doctors trained. So the gross exploitation of medical staff is one of the cornerstones of the American Healthcare system. 

Better to have a healthcare system like Cuba that easily handles a medical crisis and then helps other countries, than the American system which is spectacularly unprepared for a crisis. 

2. Cuban healthcare system is more satisfactory.

Better outcomes
According to data from the Health System Tracker, Cuba’s healthcare system has consistently outperformed the U.S. in terms of health outcomes. Despite spending significantly less on healthcare, Cuba has a lower infant mortality rate and a higher life expectancy than the U.S. This is largely due to Cuba’s emphasis on preventative care and its robust primary care network. In fact, the US is way below average on every health metric when compared to the rest of the developed nations [healthsystemtracker]

Patients more satisfied
Patient satisfaction is another important measure of a healthcare system’s effectiveness. In Cuba, the healthcare system is designed to be patient-centered, with a strong emphasis on doctor-patient relationships. Most cuban doctors are stationed in communities, where they form close bonds with the people they serve. This increases trust and emotional connection between doctor and patient, which substantially improves patient outcomes. This has led to high levels of patient satisfaction, with many Cubans reporting that they feel listened to and cared for by their healthcare providers.

More coverage
Cuba’s healthcare system provides universal coverage, ensuring that all citizens have access to the care they need. This is in stark contrast to the U.S., where millions of people are uninsured or underinsured. Universal coverage not only improves health outcomes, but also reduces health disparities and ensures that everyone, regardless of their income or social status, can access care.

More desirable priorities
Cuba’s healthcare system prioritizes public health and preventative care, rather than profit. This means that resources are invested in keeping the population healthy, rather than treating illnesses after they occur. In contrast, the U.S. healthcare system often prioritizes expensive treatments and procedures that generate high profits, even if they are not the most effective or necessary.

American system has grave side-effects
Employers get undeserved power over employees because quiting the job means losing healthcare. Ambulances are sometimes hindered by arbitrary lines drawn to define which areas each ambulance company is allowed to "profit" from. Healthcare politics take up a huge chunk of the political bandwith. The American healthcare system has numerous other flaws [harvard].

Cuban Healthcare system is better for women
Unlike Cuba, America does not guarantee women the right to good sex education, contraceptives and abortion. Many states and regions, those basic human rights are outright denied.

Ridiculous pricing
I need not elaborate too much on this I hope. That insulin prices can even come close to a thousand dollars, and that giving birth costs more than 10K in most states, is horrifyingly ergregious. 

3. Cuban healthcare system is more efficient

Preventative care is more efficient
The American Medical Association agrees that Cuba has a better healthcare system [ama]. "The United States spends more on health care than any other country by far—$11 072 per capita in 2019.1 Yet the health status of the US population, when compared with that of like nations, remains at the bottom of the list." AMA also agrees that Cubas system is much more effective. "It has had remarkable success, changing its population health status (life expectancy, infant mortality, infectious disease mortality, older adult health) from that typical of a low- to middle-income country to a high-income country, all while suffering for 60 years under the impact of the strongest embargo enacted by the United States." Experts agree that Cuba is able to achieve health outcomes massively better than what its very limited resources would suggest possible. "Hospitals in Cuba are often shabby and badly-lit, and lack equipment and medicines. But the health system built by President Fidel Castro's government has produced results on a par with rich nations using the resources of a developing country. Experts say that is because Cuba focused on prevention and because its universal free health care allows Cubans to see a doctor quickly and treat illness before it needs costly procedures" [reuters].

The American system is driven by monetary concerns, to the detriment of everybody. The healthcare industry there is incentivices to focus on more expensive and profitable treatments options, rather than simple and effective preventative steps that cost less but generate low profits. Nearly a third of americans are forced to delay or avoid trips to the doctor because of the steep cost, which causes illnesses to develop far more easily and quickly. Actually, the number may be close to 40%, where 27% avoided going to the doctor for very serious illnesses. So despite America spending 26 times as much per capita on healthcare, they still fail to cover the entire populations medical needs.

Unecesary deaths
You may be thinking, okay, so the American system is very inefficient, and delaying medical care is wastefull of resources. But in America you can just throw money at the medical problems and solve them even after the illnesses have developed for way too long. But you would be wrong. Once they are forced to go to the doctor, treating the disease is far more cumbersome and costly, and in many cases, simply impossible. 45 000 deaths each year are caused by lack of insurance and seeking medical attention too late. That is to say, the American system of rellying on health insurance rather than universal coverage, is literally killing tens of thousands of Americans each year. And the other issues also come into play here.
“It’s the system more than the individuals that is to blame,” Makary said. The U.S. patient-care study, which was released in 2016, explored death-rate data for eight consecutive years. The researchers discovered that based on a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year — or about 9.5 percent of all deaths — that stemmed from medical error. Afterward Chris said he discovered that pharmacy technicians, rather than well-trained and educated pharmacists, are compounding nearly all of the IV medications for patients. And many states have no requirements, or proof of competency, for these pharmacy technicians. [cnbc]
So the third largest cause of death in America, taking 250.000 lives each year, is the systems unwillingess to respect the limitations of the human element. The problem of overworking medical staff and understaffing hospitals to maximize profits, leads to lots of human error. Plus, many states do not even have adequate requirements of competency for those working in the medical industry. Universal healthcare could save 330.000 lives each year. Plus, it would also save trillions of dollars [citizen]. So the single-payer system that Cuba has is leaps and bound cheaper than Americas, while simultaniously producing better health outcomes. 

America has every advantage:
  • Larger scale increases efficiency
  • 26 times more resources invested in healthcare per capita
  • No blockade, easier collaboration with other nations
  • Actually has access to all the important equipment
  • Has not sent its doctors abroad for free
And yet Cuba has better or at the very least equal health outcomes. But even if America had better health outcomes, it would be absurd to attribute this to the healthcare system. 
Americas system is a laughingstock, that is inadequate when it comes to serving America. Cubas healthcare system is so good that they can serve themself and other countries.

I am going to solely do a constructive, if any point counters Pro it's a coincidence and incidental to the case for Con. All direct rebuttals will begin in my Round 2.


Scale and thus complexity

While one would assume that the health conditions being relatively equally varied amongst Cubans and Americans means the healthcare systems have equal complexity this isn't the case (and I do know Pro hits on this). However, to suggest 'simpler' is better and that the American system's complexity is ignorant of not only the reasons why but the benefits that come with the complexity.

US includes 50 states, Washington DC, five major territories, and various minor islands. This entire system is being critiqued by Pro and defended by Con. It's easy to see any flaw in it given it's meant to be so complex and adaptable that it can fit the local healthcare cost variations, demand variations as well as fluctuations in availability of staff or any procedural differences across these federal states due to State Law differences. This system is so versatile and complex that it's catering to a population of 341 million and this ignores tourists using it.

It is worth noting why the complexity is beneficial and what a major reason for it is beyond just scale. Capitalism being embraced. The US doesn't limit you to one provider per state but lets them compete and trusts you as a consumer to choose both the best Insurance to meet your needs (unless very poor which it has begun since during Obama's term to provide plans for the masses). A 2022 official census of US tells that 92% were covered by health insurance. So, Pro may wish to fixate on the 8% or to say simpler is better but you need to grasp that the vast majority of over 300 million people across many states is being handled successfully.

What many who repreent a Cuba-esque system do is take a much tinier scaled systemt hat limits you to one provider across the equivalent of one US state and say this system is superior for its ability to achieve similar outcomes with far less. This is because it's easier, much easier to do so than to have one system with enough intricacy that it works across the entire United States of America.


The best of actual treatments is generally US or it's close to it, Cuba is nowhere near to it in that regard.

US is beaten by Cuba in the cost. There is more to a system than cost if you understand what benefits may come with a more expensive system.

When you analyse where you'd go in the world for cutting edge cancer treatment or anything along those lines and not have it be some shady con artist in a dingy corner of a country where legislation is easy to pay off corrupt officials to get, the US thwarts other highly developed nations. This may well have to do with how huge it is meaning that it has much higher selection of doctors to form specialist teams with (think about the most obsessed with a certain healthcare field tend to either move from one US state to another or even at times come to US from other countries).

So with all of that said, yes, America has among the best cancer survival statistics because of an incredible abundance of high technology equipment and drugs, more extensive screening, and more aggressive treatment.

America also in general has better survival statistics when cancers are compared stage for stage. Of course there are exceptions. Japan survival statistics for stomach cancer are much better than American numbers.

Very expensive cancer treatments such as the new immunotherapies for cancer are more widely available in America than in countries with national healthcare where there are restrictions based on cost/benefit and budget caps.

Often regarded as one of the gold standards of healthcare in the world, the American healthcare system boasts an impressive collection of accomplishments. Consisting of a vast network of specialized providers, cutting-edge research, and novel therapies, the American system features personalized treatment plans with an emphasis on patient choice [1]. In almost every scenario, individuals have the autonomy to choose their healthcare providers and the nuances of the care they receive. Moreover, this care is more accessible than ever with the continued expansion of healthcare coverage and the integration of mobile clinics and telehealth. 

The American healthcare system has invested significant resources in medical research and pharmaceutical development which has led to groundbreaking discoveries and improved treatments in a variety of fields [2]. This was well illustrated during the COVID-19 pandemic, where the United States outpaced all other countries in vaccine development and distribution. This $32 million investment has led to millions of lives saved and has created potential avenues for the treatment of other diseases. Additionally, the United States leads the world in new drug and medical device approvals, holds the distinction of having the highest number of Nobel laureates in chemistry and medicine, and produces the second-highest impact of scientific works in the world [3].

The degree of medical specialization in the United States is also among the most advanced in the world. Between the years of 2011 and 2015, nearly 90% of graduating internal medicine residents, the specialty responsible for providing the majority of the medical fellows in the country, were pursuing fellowship subspecialization [4]. This degree of individual academic achievement provides patients with physicians who are highly knowledgeable and well equipped to treat them. The downstream effects of this subspecialization can be demonstrated by improvements in a variety of contexts including in cancer detection and treatment. During their additional training, physicians are exposed to improved early oncologic detection strategies and surgical techniques which has contributed to a 32% reduction in the risk of cancer death compared to 1991. This translates to nearly 3.5 million lives saved [5]. 

Patient-centered care and freedom of choice are major strengths of the United States healthcare system. Patient-centered care focuses on placing patients at the center of healthcare decision-making and considering their values, preferences, and needs [1]. This technique has shown great success in multiple avenues. For instance, a Cochrane review of the patient-centered care model in patients with obstructive sleep apnea showed improved patient adherence as well as significant improvements in patient outcomes [6]. Americans are also awarded the freedom of choice in selecting healthcare providers, specialists, and treatment options. This empowers patients to seek care from providers they trust and have confidence in, and it promotes competition among healthcare providers -- potentially leading to higher quality and more accessible care. Overall, the emphasis on patient-centered care and freedom of choice highlights a commitment to individual patient autonomy and the recognition of patients as active participants in their own healthcare.

The United States is well positioned to be a global leader in the emerging field of personalized medicine. Personalized and precision medicine, utilizing a patient's own DNA to guide treatments and predict potential future diseases, is poised to revolutionize the field of medicine and shape its future [7-8]. By analyzing an individual's genetic makeup, healthcare providers can tailor treatments and interventions to their unique genetic profile, maximizing effectiveness and minimizing adverse effects. This approach holds great promise for improved patient outcomes and enhanced precision in healthcare delivery. America is home to a very large number of experts in this field including Vanderbilt University’s Dr. Dan Roden who is well-known worldwide for his pioneering work on personalized and precision medicine [9]. Through its combination of strong research infrastructure, significant investment in genomic research, and precision medicine initiatives, the United States will continue to innovate at the forefront of this transformative field.

The United States is also implementing new policies to increase accessibility to healthcare insurance and services. The Affordable Care Act (ACA), enacted in 2010, expanded Medicaid, created health insurance marketplaces, and limited insurance denials due to pre-existing conditions. Further supplemented by legislation such as the American Rescue Plan and Inflation Reduction Act, which provide additional subsidies for health insurance coverage, these policies have led to a near year-over-year reduction in the rate of uninsured. From 2013 to 2021 there has been a 38% drop in the number of uninsured patients, and more than four million people have gained coverage in the past year alone [10].

click sources in that.

The real question I ask you readers is do just those 2 contentions make it superior to the Cuban one? Yes.

You see, worldwide the healthcare systems would not be anywhere near to what they are if it wasn't for US cutting edge innovation. It could be cancer, AIDS, absolutely anything. The US invests a huge amount into it, yes, however it comes out with far superior results if you look at the heights of its system in any actual treatment or innovation sense, Cuba isn't anywhere near to it and is crippled by a still-present Socialist mindset.
Round 2
Thank you, RationalMadman.

Before we start, I must highlight the laziness of copy-pasting half your argument and making an unreasonable request of the voters to open nested sources you didn't even refence.

RM has more than 500 debates under his belt. He knows this is a 3 round debate, and that if wants to use a different framwork from the one I presented he has to lay it down in his opening argument. Presenting a different framework near the end would be an underhanded tactic tantamount to cheating and terrible conduct that voters should punish. RM knows this and still deliberately elected to forfeit his only opportunity to make objections  or propose changes to the framework. That means he has implicitly accepted the framework presented in my R1 as quoted below. 

Interpreted resolution: Cuba has a more desirable, satisfactory, or effective healthcare system than the US. BoP: Shared

The healthcare system is the way in which the available medical resources are organized and distributed to meet the needs of the population, and the laws regulating this system.

Healthcare outcomes = resources invested into the healthcare system * how good the healthcare system is.
Voters and debaters shall from now on regard these 3 statements as the definitive framework not longer open to contestation, and the measuring stick to compare validity of arguments.

Health insurance
RM has not even brought up a single benefit the system of health insurance has over Cuba's single-payer system. His claim that complexity and confusion are good is unsupported.
Literally a scam
An ideal insurance company would run with perfect efficiency, meaning every last penny from fees goes directly towards paying medical bills. 

Essentially you are gambling with your own health:
  • You "win" by getting sick enough that your medical bills ecclipse your insurance fees. 
  • You "lose" by staying healthy enough that paying medical bills out of pocket would have been cheaper. 
But in practice, insurance companies are way worse due to being terribly inefficient. Money from fees gets used to cover employee salaries, advertisement cost, rent, electricity and CEO pay. Of the money that remains, a lot is given to shareholders rather than paying for your medical bills. They frequently deny people what they are owed and waste money on legal battles. The fear of losing in court, as well as the deliberately confusing contracts, means many people don't even try to press their legitimate claims. And these companies also make shady deals with hospitals against the interests of the consumer. They even fail to negotiate prices effectively. Despite millions of people paying outrageous ammounts of money to these companies, they still don't cover all medical expenses. Many people still end up in deep medical debt. There is literally only downsides with it comes to the system of privaticed health insurance.

RM already conceedes that health insurance industry fails to cover 8% of the population. An admission that the American system causes at least 40.000 unnecesary deaths each year.

Insurance companies are all bloody parasites. The freedom to choose what specific parasite to have forcefully injected, is not a good argument in favor of parasite injection.

They almost get it
The system of health insurance was so bad that the US government had to step in and start doing what other countries like Cuba have been doing, which is covering poor people's medical expenses with federal programs. But instead of paying the health providers directly, they often give money to insurance companies, which wastes money for no reason.

Private healthcare providers

Collectivised development cost, privatized profits
"The National Institutes of Health has invested close to $900 billion in the basic and applied research that formed both the pharmaceutical and biotechnology sectors. Despite these taxpayer subsidies, prescription drug prices are nonetheless increasing at an alarming rate. At least 1 in 4 have said that they engaged in insulin rationing, which can lead to diabetic ketoacidosis, a fatal condition, because they have no other choice. That was the case for Antroinette, whose daughter was rationing insulin due to the high cost and died at the age of 22 as a result.[1]. Their profit margins are more than 15%, way higher than the 4-9% of the largest non-drug companies. At the same time, 11% of Americans are unable to take medications as prescribed.

Patents destroy competition
Drug companies also benefit from patents which ensure that prices remain high by reducing competition. 78 percent of new medical patents are just previous products changed slightly [1].

RM misinterprets his ncbi source
He presents the study as though it's dickring the US healthcare system, when the opposite is the case: "Despite all of the innovation and praise in the American healthcare system, there exists a massive flaw with significant implications -- its cost. The United States of America spent $4.3 trillion, more than $12,500 per person, on healthcare in 2021 This amount made up more than 18% of the country’s Gross Domestic Product (GDP). The investment disparity between the United States and every other developed nation in the world is quite profound. Unfortunately, instead of seeing a significant return on this investment, the nation lags significantly behind most of the developed world in a wide range of health outcomes. Among the 38 members of the intergovernmental agency Organization for Economic Co-operation and Development (OECD), the United States is ranked 34th in infant mortality, 32nd in total life expectancy, 32nd in suicide rates, and 38th in total obesity rates. Approximately 30% of all healthcare expenditures in the United States go toward an element that has zero effect on the health of its citizens -- administrative expenses" [ncbi].

Unfortunately, the costs of maintaining such a system are quite profound, and the higher investments do not pay dividends in health outcomes.
RationalMadman stays true to the latter half of his name by citing a study that clearly refuted his argument right in the motherfucking abstract. 

Health outcomes

RM misrepresents his source talking about cancer
He cherry picks lines from a forbes article, but it's author actually bashes the inefficiency of the US healthcare system: "American doctors overtest for cancer. American cancer patients are over-treated compared to those in other countries. Almost every patient has some kind of treatment in the general panic of learning of their diagnosis. Too many American cancer patients have surgery that may not lead to better survival. Sometimes the benefit in treating is an additional 1–2%. There is too much testing with PET and CT without regard to radiation risks over time. There was a rapid move to expensive robotic surgeries with subsequent studies showing marginal or no improvement in results, or in some cases even higher complication rates." [forbes].

  • A strong primary care system that allows physicians to see their patients regularly and detect health problems early.
  • Patients suspected of having cancer are referred to specialized centers for diagnosis and appropriate treatment.
  • Cuban scientists have made tremendous progress in finding new treatments for cancer and new tools to improve diagnosis and prevention.
This is seriously impressive for such a small country under a constricting blockade. Cuba also has excellent health outcomes rivaling or surpassing the US on almost all other metrics. 

His argument misses the point
RM conflates the healthcare system with medical resources. Him saying that drugs and treatments developed in the US are the healthcare system is like saying that glocks is the austrian police department. There is a fundamental distinction between a system of organizing people and resources to achieve a goal, and the resources and tools they develop and use. Even I could beat Magnus Carlsen in a chess match if I get 26 seconds per move and him only 1. That does not make me better than him at chess. The same applies here, even CON's source thinks that way. US healthcare is not necesarily a good system, they just have ungodly ammounts of time, money and equipment to throw at problems with no regards for the law of diminishing returns. 

Refuting the nonsense claim that "Cuba is crippled by a still present Socialist mindset":.
  • There is not a single country on earth that has achieved even remotely comparable health outcomes with an economy of comporable strenght to Cuba.
  • In documents sent between US government officials is a direct admission that the blockade aims to "deny supplies in order to bring about hunger and desperation"
    • The global community has voted each year for 30 years that this blockade is inhumane and illegal [2].
  • "The Cuban socialist healthcare system is internationally recognized as one of the best in the world. It is innovative, preventative, people-oriented, comprehensive, community-centered, internationalist, and, of course, de-commodified—treating healthcare as a human right, not a profitable commodity. However, in spite of its extraordinary successes, the United States’ sixty-year long blockade has tremendously detrimental effects on Cuban life in general, and their healthcare system in particular. As Amnesty International reported, the US blockade “limits Cuba’s capacity to import medicines, medical equipment, and the latest technologies, some of which are essential for treating life-threatening diseases.” [3].
    • It is denied the drug Nusinersen which could significantly help more than half of its children who struggle with infantile spinal atrophy
    • 158,800 Cuban patients are harmed by the impossibility of accessing technology for the implantation of percutaneous aortic valves
    • At the height of the pandemic the US company Vyaire Medical bought ventilator manufacturers and immediately banned all sale of ventilators to Cuba.
    • This is just a small selection. There are more examples than the character limits allows.
  • "A humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens. Cuba still has an infant mortality rate half that of the city of Washington, D.C.. Even so, the U.S. embargo of food and the de facto embargo on medical supplies has wreaked havoc with the island’s model primary health care system. The crisis has been compounded by the country’s generally weak economic resources and by the loss of trade with the Soviet bloc. Few other embargoes have so restricted medical commerce as to deny the availability of life-saving medicines to ordinary citizens[4].

  • His choice to not present a framework means my framework has been implicitly accepted. 
  • RM's sources have literally the opposite conclusions from what he wants them to say, and have only further strengthened my case. 
  • He made a nonsense claim that Cuba is crippled by some vague socialist boogeyman and not the US blockade.
  • He has not yet responded to my arguments from R1, so I extend all of them.
  • His points are not arguments but just examples of conflating medical resources and the healthcare system. 

The Cuban healthcare system performs exceedingly well despite all of Cuba's disadvantages, while the American system fails spectacularly despite America's advatanges.

The Cuban system is much more desireable, satisfactory and efficient.


Health insurance
RM has not even brought up a single benefit the system of health insurance has over Cuba's single-payer system. His claim that complexity and confusion are good is unsupported.
I have. In fact I rebuked the entire Round 1 incidentally due to explaining what's traded off for.

The US system has to:

  1. Work for 50 states and more territories all allowed different local laws and rates for healthcare and different standards and maximum payouts for civil lawsuits against doctors in malpractise cases.
  2. Keep up the apex healthcare cutting edge innovations globally.

In the United States, the Biomedical Advanced Research and Development Authority (BARDA), a federal agency funding disease-fighting technology, announced investments of nearly US$1 billion to support American COVID‑19 vaccine development and manufacture of the most promising candidates. On 16 April, BARDA made a US$483 million investment in vaccine developer Moderna and its partner, Johnson & Johnson.[44][53] BARDA has earmarked an additional US$4 billion for development. It will have a role in other programs for development of six to eight vaccine candidates destined for clinical study into 2021 by companies such as Sanofi Pasteur and Regeneron.[53][54] On 15 May, the government announced funding for a fast-track program called Operation Warp Speed to place multiple vaccine candidates into clinical trials by the fall of 2020 and manufacture 300 million doses of a licensed vaccine by January 2021. The project's chief advisor is Moncef Slaoui and its chief operating officer is General Gustave Perna.[55][56] In June, the Warp Speed team said it would work with seven companies developing vaccine candidates: ModernaJohnson & JohnsonMerckPfizer, the University of Oxford in collaboration with AstraZeneca, and two others,[57] although Pfizer later stated that "all the investment for R&D was made by Pfizer at risk."[58]

The system needs capitalism and not single-payer itself because it has to run for profitable scheme to encourage the end results it gets. Let me put this in a different way; if it had single-payer system across all its States, this not only curbs how much flexibility the States have to run things their own way which is against the spirit of the federation of USA but also the degree of flexibility for medical research corporations is nowhere near what it currently is.

Internationally, if you're researching medicine in a country that has no direct enemy status with US, you're probably going to either want to move to US to do it or work with a US project, corporation etc to finish it. This is all linked to how much the US both invests and sets up in a capitalistic sense to make it lucrative and viable to be a risky research project there. It incentivises it.

 I must rebuke the Round 1 fully, Round 2 I can justify is unfair character limit extortion.

Better outcomes
This is countered by my core case.

Patients more satisfied

Although medical attention remains free, many patients did and still do bring their doctors food, money or other gifts to get to the front of the queue or to guarantee an appointment for an X-ray, blood test or operation.

If you do not have a contact or money to pay under the table, the waiting time for all but emergency procedures can be ridiculously long.

Many Cubans complain that top-level government and Communist Party officials have access to VIP health treatment, while ordinary people must queue from dawn for a routine test, with no guarantee that the allotted numbers will not run out before it is their turn.

And while the preventative healthcare system works well for children, women over the age of 40 are being shortchanged because yearly mammograms are not offered to the population at large.
I saw many hospitals where there was often no running water, the toilets did not flush, and the risk of infections – by the hospital’s own admission – was extremely high.

Healthcare for hard currency
In all fairness, in the past five years, the government has made great efforts to improve hospitals and health centres, but again, lack of resources is making the process painfully slow.

The system is free, but it is neither fast nor efficient for two important reasons. One is obviously the lack of financial resources, and the other – which is related to the first – is the “export” of doctors, nurses and dentists in exchange for hard currency.

Thousands of Cuban doctors go to Venezuela to provide primary healthcare there. Their tour of duty lasts a minimum of two years and they are paid approximately $50 a month, plus expenses. In exchange, Hugo Chavez, Venezuela’s president, sends Cuba petrol, part of which can be sold for hard currency.
When a friend of mine was unable to be operated on as scheduled, because there was no anesthesiologist available, “they are all in Venezuela” was a complaint I regularly heard.

Another way the country is attempting to obtain hard currency is to offer health services to foreigners – something that has been dubbed “health tourism”. But some question whether visitors really get what they pay for.

For years, the country sold itself to the world as a medical powerhouse, but Cuba has long been in a health crisis that has only worsened in the wake of the coronavirus pandemic, just as other sectors of the economy and life in general have deteriorated. Even as the sick, the hospitalized and occasional patients complained about the lack of medicines, the shortage of hospital beds and the few ambulances, the government continued to claim that the island was a medical powerhouse.

Now, the problem is not only the lack of medicine in pharmacies, but the lack of medical personnel in a country that has reported an exodus of over 300,000 Cubans in just two years. According to the National Statistics and Information Office (ONEI), some 12,000 doctors left the Cuban public health system last year.
“They don’t say it, but there are no doctors in Cuba; they don’t want to acknowledge it,” Cuban doctor Lucio Enriquez Nodarse, a member of the Free Cuban Medical Guild, says from Spain. “It is a more serious issue than anyone imagines. They are never going to say that the great Cuban medical school, the great [medical] powerhouse, has no doctors.”

A doctor in Havana looks at a map of the sites where there are Cuban medical missions, before leaving for Mozambique, in 2019.RAMON ESPINOSA (AP)
This year, during a meeting Prime Minister Manuel Marrero Cruz only acknowledged that “the lack of foreign currency income” prevented “the acquisition of resources to meet the health needs” of the population. In other words, the government can hardly take care of its sick citizens.

Cuba has a population of 11.2 million inhabitants and 2.3 million of them are under 18 years of age. According to the 2022 Health Statistical Yearbook, the main causes of death among minors are malignant tumors, septicemia, accidents, congenital malformations, deformities and chromosomal anomalies. While the total number of children who are being neglected by the Cuban health system is unknown, every day there are numerous complaints about this situation from parents on social media.

For years, Yurislay Leyva Vasconcelo, Yurisay Marín Leyva’s mother, has been demanding a better quality of life for her daughter. Now 22 years old, Yurisay was born with achondroplasia (bone growth disorder) and congenital glaucoma, and she also suffers from epilepsy, hypertension and drug-induced gastritis.
“She never has the medicines she needs, because when she doesn’t lack one, she lacks another, and for a year nothing has been coming into the pharmacy,” says the mother of Yurisay, one of the cases presented to UNICEF.

9-year-old Geobel Damir Ortiz Ramírez is another of the cases submitted to the UN agency. Geobel has been diagnosed with a plexiform neurofibroma in his right eye, among other diseases.

“My son has a chronic condition and in Cuba there are no options for surgery or treatment for him,” says his mother, Eliannis Ramirez Baez. “I have even reported the situation to MINSAP. I have asked for help everywhere and no one will lift a finger to do anything. I am desperate, anguished, sometimes depressed, weak, because everything in this country is fruitless.”

Another case is that of 8-year-old Yoahira Lía Zulueta Jorge, who has infantile cerebral palsy (ICP), as well as epilepsy, diabetes, asthma and cleft palate. Her mother has not only asked for help for her healthcare, but also for the housing conditions in which she lives: “The house is at risk of collapse. I have gone to all the agencies and nothing [happened], they just tell me that there are no funds,” she says.

The fifth case, Cristofer Antonio Olivera, 4, has been waiting for an operation for almost his entire life. When he was 1 year old and just learning to walk, he accidentally took caustic soda (lye), which permanently damaged his gastric tube. The doctors have told his grandmother that there are not enough supplies to operate on him; in the meantime, Cristofer is fed with a syringe and a tube connected to his stomach.
Like the rest of the aforementioned parents, Cristofer’s caregivers are requesting humanitarian visas so they can leave the island and care for their children in other countries. Activist Avana de la Torre, who went to the UNICEF offices in Madrid, has since documented the cases of 1000 other minors unprotected by the Cuban government.

“This is a cry from the mothers and grandmothers of vulnerable children in Cuba,” she says. “This situation is probably not going to change anything, other than exposing the Cuban government and UNICEF.”
Round 3
RM's laziness apparently knows no bounds. Another completely copy pasted round. And he complains about character limit, but it is his own laziness than reduces his argument density. 

Framework impact
RM has not denied the fact that he has implictly accepted the validity of this equation:

Healthcare outcomes = resources invested into the healthcare system * how good the healthcare system is. 

This tells us that the quality of the system is about efficiency. A good healthcare system is able to efficiently turn money into health outcomes. But good healthcare outcomes don't automatically imply a good healthcare system. Even a terrible system can produce semi-decent results if you invest enough money into it, similar to how despite not being a master I could make extremely good chess moves if I had enough time to calculate. Similarly, even a perfect healthcare system would produce terrible results if they had minimal budget and no access to the most essential resources and medicines necesary. 

My argument is that if Cuba had even a fraction of the money that the US has to invest in health, they could far ecclipse their health outcomes, because their healthcare system is far better. 

Health insurance

RM does not dispute that because of privatized health insurance, an insane ammount of money and labour time gets wasted on administrative expenses, shareholder profits and legal battles.

Lack of coverage
RM does not dispute that 8% of americans are uninsured and that this leads to 40.000 unnecesary deaths each year.

The American system of health insurance killed 330.000 citizens during the pandemic, all of those lives would have been saved if US had a system of universal healthcare like Cuba.

Abusive tactics
These firms make it as hard as possible to actually claim insurance. You need a lawyer just to understand the contracts. Fear of expensive legal battles discourages those with legitimate claims.

Lack of effectiveness
RM does not dispute that people still rack up insane medical debt even after they "win the lottery" by getting sick enough to make the insurance worth it. 

RM does not dispute that insurance companies fail to negotiate low healthcare prices and instead baloon the overall cost of US healthcare by stacking up administrative expenses. 

Benefits refuted
Even if there was some benefits, they cannot outweight the continuous loss of hundreds of thousands of american lives as a direct failure of privatized health insurance. But RM has not even established ONE independent benefit of insurance companies over a single-payer-system, nor has he refuted the numerous well-documented harms of the system.

The system needs capitalism and not single-payer itself because it has to run for profitable scheme to encourage the end results it gets. 
RM is completely misunderstanding what capitalism means. You can have single-payer system without throwing out capitalism. The government paying for healthcare directly, even if the healthcare providers are private businesses, is still capitalism, and is far superior to a healthcare system built around unreliable and inefficient insurance companies. 

The insurance companies add no utility compared to single-payer system, they are a parasitic middleman that allow prices to baloon out of controll while letting hundreds of thousands of americans die for no reason. They should have no place in the healthcare system, but yet in america they do, and it costs trillions of dollars compared to universal healthcare. Saying they pay for medical research is flat out wrong, insurance companies are not investing in anything, especially not risky medical reserach. PRO in his grand confusion cites an example of BARDA,  a federal agency, funding development of a covid-19 vaccine, which is proof that "pure capitalism" or whatever he wants to call it is not the only way to direct resources towards the advancement of medicine. Add on top of that my ignored sources from R2 that show the US government spent a trillion taxpayer dollars on risky but essential research neither health insurance nor medical companies themselves were willing to pay for, but where more than willing to patent the resulting medicines afterwards and jack up prices so 11% of americans were forced to ration it, leading to deaths by lack of medicines even when more than enough was produced. Also don't forget my R1 argument that RM himself confirmed in R2, that the health insurance companies were utterly failing to cover the american population, despite the purported "local flexibility", and that the government had to step in and start paying for many peoples healthcare like in Cuba.

The fact that malpractise cases are common enough to warrant RM mentioning "civil lawsuits" against them as a benefit of insurance companies is a bad look for the US healthcare system.

Medical boards
RM brought up medical malpractise which is a great point in my favor. In the USA bad doctors with well-documented histories of malpractise can operate for years without having their licences revoked or receive proper disciplinary action, because most medical board are absurdly lenient as they side with the bad doctors over the patient that has been harmed most of the time [1]. Ironically enoughe the opposite goes as well. "medical boards err in punishing doctors who don’t need to be penalized and fail to sanction doctors who should be sanctioned. In my experience, these actions are seldom random. Independent doctors who have no representation on medical boards are often severely punished for minor issues that show no evidence of documented harm to patients. The corporate medical clinics want these doctors gone. The underlying goal is to eliminate competition for patients. Worst of all, this is all done in secret, without genuine due process, and without any accountability to anybody, even the states that created the boards.  [2]. Because nearly all bad doctors are protected and many good doctors are attacked, and with the currently declining number of licensed doctors already being inadequate to meet the populations needs, death and illness are massively increased as a direct failure of the system. 

Medical companies and health outcomes
Even if America had twice as good health outcomes as Cuba it would not prove their healthcare system is better, when they are spending 26 times as much money per person as Cuba does and have unlimited access to medicines and equipment as opposed to Cubas constricting blockade. But PRO has not demonstrated far superior health outcomes to Cuba, not even close.

Human error
As stated before, 10% of american deaths are due to human error, which makes it the third largest cause of death in America. This is because the doctors and medical staff are being massively overworked by the greedy medical companies. They take in too many patients than their staff can handle and guilt-trip them into working around the clock for way to many hours week after week so they are constantly fatigued. They don't care about the health of doctors or patients, only their bottom line, because that is how business have to operate under capitalism. 

RM's own source says the US healthcare system spends far too much money on cancer treatments that are unnecesary, extremely costly and with minimal or even negative outcomes. 

I will not beat a dead horse by writing another essay here but the prices of doctor visits and medicines in the US are literally deadly.

I have not received substantial pushback from PRO on this front so this section will be kind of brief. 

Cuba has long been in a health crisis that has only worsened in the wake of the coronavirus pandemic, just as other sectors of the economy and life in general have deteriorated. Even as the sick, the hospitalized and occasional patients complained about the lack of medicines, the shortage of hospital beds and the few ambulances. [RM's source].
Pay attention to that last part. RM's own source does not blame Cuba's healthcare sytem for any of these problems, the bottleneck is the small ammount of physical equipment and resources. 

for a year nothing has been coming into the pharmacy,
Because the blockade ensures they never have enough money and even when they do the majority of producers of medicines are specifically boykotting Cuba most of the time.

Lack of doctors
In 2024, the US has 36 doctors per 100.000 people, while Cuba has 84 [1]. Even if half of these were in Venezuela to aquire much-needed currency, 48 is stil more than America's 36.

If there is an exodus of people and doctors from Cuba, that is because the 60 year old US blockade is achieving its stated goal of bringing about hunger and desperation. 

Unequal distribution
Let us just grant the unsupported claim that "top officials" and "those that bring gifts" get first place in the queues in Cuba. That is only a minor problem compared to the USA where hundreds of thousands of people literally die becuase they can't afford life-saving medicine like insulin that is cheap to produce and is only expensive because of the ridiculous healthcare system there. Even RM's source grants that people with emergencies get immidiate treatment without racking up an insane medical debt like they do in the US. And these queues for non-essentials in Cuba would not be there if they didn't have an unprecdented lack of resources as a direct result of the US blockade. 

Health outcomes
RM claims Cuba has bad health outcomes. But that is not true.
  • Their life expectancy is 78 years, more than any other developing country, and nearly identical to that of the US.
  • Their infant mortality is less than half of that in Washington DC. 
  • They are a leading player in the fight against cancer.
Cuba's health outcomes  is leages above all developing nations, but "the US lags significantly behind most of the developed world in a wide range of health outcomes" [ncbi]

Dropped arguments
  • The Cuban healthcare system is more desirable because it is based on morally superior foundations, reflects good on the country internationally and respects doctors and patients.
  • Unlike Cuba, America does not guarantee women the right to good sex education, contraceptives and abortion. Many states and regions, those basic human rights are outright denied.
  • Cuban doctors serve communities where they form close bonds with the people. This increases trust and emotional connection which substantially improves patient outcomes.

Cuba’s healthcare system prioritizes public health and preventative care, rather than profit. This means that resources are invested in keeping the population healthy, rather than treating illnesses after they occur. "The health system built by President Fidel Castro's government has produced results on a par with rich nations using the resources of a developing country. Experts say that is because Cuba focused on prevention and because its universal free health care allows Cubans to see a doctor quickly and treat illness before it needs costly procedures" [reuters]. In contrast, the U.S. healthcare system often prioritizes expensive treatments and procedures that generate high profits, even if they are not the most effective or necessary.

If system A can achieve nearly identical results to another system B, despite system B costing 26 times as much, then it is obvious that system A is more efficient.

The Cuban healthcare system is FAR more desirable, satisfactory and efficient than the American healthcare system. That makes it better, affirming the resolution.
Cuba's health outcomes  is leages above all developing nations, but "the US lags significantly behind most of the developed world in a wide range of health outcomes" 
It is very important to realise the source Pro gives after this only had the 'lags significantly' part of the quote, not even remotely the Cuba being leagues above all developing nations part as that's a lie. This lie has been the basis of Pro's entire case. I didn't directly address it in Round 1 because of character limit and preferring to leave rebuttals to Round 2.

In Round 2 you can see in articles that it's explored just how much of a lie it is that Cuba is satisfying its populace and being even medium quality in efficacy, it's subpar across the board. There is a habitual sending off to Venezuela to help the failed socialist state of Venezuela stand on crutches on Cuban healthcare staff making it barely able to function in that department.

This debate really is about which system is better, not which system is trading off more to be better. The US system is better if you understand quality endpoint tradeoffs. It is cutting edge across the board. Cuba's system is barely coping and that's just to meet the minimum standards. It invents nothing in terms of its healthcare methods and products, everything it has in healthcare is taken from what other countries discovered and/or invented.