TCS Daily

The Miracle of Cuban Healthcare?

By Marian Tupy - August 22, 2006 12:00 AM

"Newsnight", as the cognoscenti of British politics know, is one of the most popular and highly regarded news programs in Great Britain. Airing on BBC2 every weeknight at 10.30, the program is known for its hard-hitting interviews and thorough, if somewhat left-leaning, reporting. Therefore, it came as a bit of a surprise that John Harris, a shameless propagandist, was allowed to film and broadcast a "Newsnight" report about healthcare in Cuba that fails the usual standards of objective reporting.

The report starts with the sounds of jolly Cuban music and happy children playing football in the street. There is no sign or, for that matter, mention of the political prisoners who fill Fidel Castro's prisons. Yes, there is a mention of food shortages and lack of consumer goods, but those are, Harris tells us, America's fault. In reality, the U.S. trade embargo is almost totally meaningless, since Cuba can trade with the rest of the world. All it needs to do to prosper is to produce goods and services that other people want to buy -- not an easy task for a socialist economy.

Moreover, we are told in typically Orwellian fashion, shortages are really a blessing in disguise. After all, are the Cubans not lucky to be spared the scourge of fast food and passenger cars? Walking and a "balanced" diet, Harris informs us, are the ingredients for a long and healthy life. The Cubans even have an association that promotes healthy living on the island. The vice-president of the 120 Club, Professor Gerardo De La Vera, recommends that in order to live to 120, one has to start by moving to Cuba. A government employee praising Cuba to high heaven? What a surprise.

The "Cuban miracle," as Harris puts it, rests on the prevention, rather than treatment of disease. And for good reason! Treatment of disease requires advanced prescription drugs and expensive medical equipment that have to be purchased in the capitalist West. And how can an inefficient socialist economy produce enough foreign currency to afford such purchases? It cannot.

Not surprisingly, Harris does not mention the availability of drugs. Therefore, a viewer who is otherwise ignorant of Cuba might simply conclude that they are readily available. After all, to get drugs in the West, all you have to do is to walk into the nearest pharmacy. Yes, many Westerners grumble because drugs can be expensive and the insurance companies will not pay the full cost. It is also true that some Americans don't have health insurance. But life without access to prescription drugs at all? Try living on the paradise island.

As Matus Posvanc, an economist who works for the Hayek Foundation in Slovakia, wrote to me after his recent trip to Cuba, "The people have no access to prescription drugs. The pharmacies are empty of even the most basic medicine. In fact, I had to help a Cuban lady buy drugs at a special clinic that has wonderful facilities and is well stocked with drugs. That clinic, however, only caters to tourists and prominent members of the Cuban Communist Party." Other acquaintances, who have been to Cuba, found that the locals had to supply their own medicines and linen, because hospitals simply did not have them.

Both of my parents are medical doctors and I grew up in communist Czechoslovakia. As such, I find the problems of the Cuban healthcare system very familiar. As in Cuba, so in Czechoslovakia and throughout the supposedly egalitarian Soviet bloc, the prominent members of the Communist Party enjoyed superior healthcare in special hospitals or hospital wards. As in Cuba, the lack of hard currency resulted in the shortage of medicines, which had to be bought on the black market. As in Cuba, the availability of advanced medical technology was low. Socialism, it turns out, does not work no matter where you go -- Central Europe or the Caribbean.

In an article in the British daily The Guardian, Harris recently opined, "Cuba may look forlorn, all peeling buildings and pockmarked roads. Its economy may have long since tumbled into creaking anarchy. But unlike the old states of Eastern Europe, the revolution has a few genuine jewels to defend: chiefly, its education system, and globally acclaimed healthcare."

Strange, the superiority of communist healthcare was exactly what the Western socialists, like Harris, raved about during the Cold War. When the Berlin Wall fell and with it the veil of ignorance that shrouded the life behind the Iron Curtain, communist healthcare came to be seen for what it really was: far from equal and far from excellent. The same, I suspect, will become obvious in Cuba once the Castro brothers finally depart.

Marian L. Tupy is assistant director of the Cato Institute's Project on Global Economic Liberty


Downhill as well
I am always amaised at how leftist glorify the dictatorship of Cuba. I often hear about their relatively long life expectancy and good health care, but the leftists always fail to mention that life expactancy was longer and health care better BEFORE THE REVOLUTION.... Cuba was richer than spain before the revolution! Today the gap is tremenduous, in the opposit direction.

As with fortunes - it is easier to create a small fortune if you start with a big one - so with life expectancy.

THAT is not believable
"[...] life expactancy was longer and health care better BEFORE THE REVOLUTION."

What?! It means that Cuba under Batista was in the end of 50's a more developed country considering the health of the population - than USA! Or perhaps the most healthy and long-living country in the world!

The life expectancy at birth in the USA was in 1960 for both sexes about 70 years. According to CIA World Factbook (in internet) the life expectancy for Cubans (both sexes) is now 77 years.

OK, one always may suspect that these statistics are corrupt.

But an alternative explanation still exists. Perhaps also a dictatorship can do some - politically incontroversial - things right.

When I visited eg. in the Soviet Union in the 80's the land as such was poor and miserable in very many respects but the children there were healthy and happy, I remember. And I think that also for the adults the very sudden (even if not very violent) change was the main reason why the life expectancy and health of the (mainly male) population deteriorated significantly after the collapse of Soviet regime.

So, I also do not think that the original TCS-article was very balanced. It is not possible to love one's enemy but it is a good advice to acknowledge it's achievements, nevertheless.

Heikki Jokipii

Sorry, I can't find my source, you might be right
Qoute "Before Castro, Cuba was as rich as Italy, and richer than Spain. Cuba has not merely lagged behind, it has actually grown poorer, and is now more than five times poorer than these countries. It used to be among the richest in Latin America, now it’s among the poorest.

Cubans had better access to food than all other Latin American countries except Argentina before Castro, but now they have worse access than almost all the others. Cubans are the only people in Latin America who have seen their intake of calories decrease since then. It is now better than in the 90s, but more than every tenth Cuban is chronically undernourished.

Cuba had lower infant mortality than all other Latin American countries before Castro, and lower than France, Italy and Japan. It is the only area where progress has continued since then, but it has been much slower than in other similar countries."

I can't find my source for the original claim, and if the statistics you qoute are right the I flattly admit that it seem improbable. But with more than 10% of the population cronically undernourished I doubt the 77 years life expectancy. One of the problems with dictatorships - you can never really know.

Bailey's paradox
Quote: "But with more than 10% of the population cronically undernourished I doubt the 77 years life expectancy. One of the problems with dictatorships - you can never really know."

Yes, this undernourisment is true and official FAO statistics. And I am very angry that this Cuba is a hero county of the organic food movement (eg. FoodFirst!), presented as an example and as an alternative for efficient modern farming in developing world.

But Ronald Bailey already presented this paradox in his article in "Reason":

"The Poor May Not Be Getting Richer
(But they are living longer, eating better, and learning to read)"

(Also in India - of the counties mentioned in Bailey's article - there is occasional problems with nutrition etc.)

Indeed, you were right
I know it sounds like a paradox, but it's true. Having a longer life expectancy is not always a virtue of the medical system: culture and biology always plays their parts. I'm Spanish, and I was married to a Cuban girl for almost eight years. The Spanish immigrant in Cuba, for yet unknown reasons, used to live longer there than here in Spain.

I have always heard a theory about why life expectancy in the US is not as large as it is assumed it should be: low selenium in the grass. I don't know how trustable is this theory, but I only mention it to show there could be many reasons for these apparent paradoxes.

And about the current life expectancy in Cuba: remember that starving rats live longer. A low calories diet may be in play there. Anyway, I saw people in the 90's dying from vitamin B shortages. And it was the Cuban dictatorship the only one to be blamed for that shame.

you are too negative
While very few people will argue about the shortages of drugs and the degree of poverty in Cuba, many numbers in the social area are in favor of Cuba. According to UNDP Human Development Report, Cuba's overall Human Development Index rank was 52 out of 177 countries ranked, way above its ranking according to GDP per capita and better than earlier (55 in 2000). It did very well in terms of access to sanitation and percent of population undernourished. Cuban kids are unquestionable leaders in Latin America in terms of performance in literacy and math tests (see "Cramming them in", The Economist, May 9, 2002). Despite the shortage of medical equipment, drugs etc, Cuba is likely to have excess doctors. It is able to provide various social services to Venezuela and other countries in exchange for oil subsidies. As far as the U.S. embargo and its effects are concerned, imagine the cutoff of mexico from Nafta with 80 percent of its exports gone...Overall, there is no point in taking extreme positions here.

Extreme positions?
Freedom will never be an extreme position. Defending a dictator is, indeed, the extreme and shameful position.

shameful mix of political values with facts
Trying to properly understand social realities is far from trying to defend a dictator. The main point of my comment was to call for distiction between the facts and political views/wishful thinking. And the facts show that, despite the obvious lack of political freedom, shortages of necessities, and general inefficiency of the centrally planned system (again, in purely economic terms!), in the area of education and HDI Cuba does fare better than many of its Latin American peers. Therefore, an exclusively negative description of the Cuban health care system is not entirely correct. And, freman, let's not label anybody for expressing their views freely :)

Trying to understand a social reality? The problem, as I can see, is that you have no first hand accounts for that "reality", and then, you're bound to repeat the official propaganda from the Castro's regime. There's nothing good in the Cuban healthcare system... except, as you have mentioned, that there are too many graduated "doctors" for the total population of the island. As a matter of fact, it neither is a fair system: the Cuban regime has special hospitals "only for tourists"... and man, compared with a public hospital, they are first-class.

Regarding education, the situation is even worse. Have you ever been in the Biblioteca Nacional (the National Library), in Havana? Do you know how many books are forbidden for a Cuban to read? Yes, Cuban people are smart people, and as it happened in the gladly dissapeared Soviet Union, all they know their only opportunity may be mastering a discipline... to run away from they supposed benefactors.

I know what I'm talking about. I have a first hand experience. You're free to express your views, of course, but please, make them as accurate as possible...

Do you remember Maradona?
By the way, did you know the whole affair regarding Maradona's addiction to cocaine? He spent a lot of time and money in the "Caribean miracle system" hospitals (those "only for tourists", of course). And look to the results...

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