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June 06, 2007


As the Bush administration continues to try and isolate Iran, it's worth taking a moment to examine the success of our last target for international marginalization:

The continuing hostilities with the US have played into Castro's hands. It was as an embattled nationalist leader of a small island, standing up to an aggressive, neighbouring superpower, that Castro preserved his revolutionary credentials most effectively. The shortcomings of life under his regime were, he argued, attributable mainly to the US embargo. Many swallowed the argument. He knew, too, how to capitalise on the latent anti-Americanism in Latin America, Europe and Canada to give his struggle more universal appeal.

Indeed, the embargo is so good for Castro's hold on power that he manipulates events to perpetuate it:

In fact, the regime seems to act with zeal to ensure that the embargo continues. When it looks as if the US government might consider ending it, some heavy-handed Cuban act ensues that the status quo prevails. In 1996, when Clinton was keen to initiate rapprochement, the regime shot down two US planes manned by members of a Cuban exile group rescuing those escaping the island on rafts. When, in 2003, an influential cross-party lobby in the US seemed set to dismantle the embargo, the Cuban government promptly incarcerated 75 prisoners of conscience and executed three men who hijacked a tugboat with a view to getting to Miami.

Meanwhile, Michael Moore's Sicko is coming out soon, and it includes a hefty section on the wonder of Cuban health care. I'm not inclined to trust such reports, mainly because so many reporters seem to exit the nation with stories like this one:

Healthcare and education are supposed to be the redeeming graces of the regime, but this is questionable. There are a large number of doctors, but, according to most Cubans I know, many have left the country and the health system is in a ragged state—apart from those hospitals reserved for foreigners—and people often have to pay a bribe to get treated. Michael Moore, the American film director, who has recently been praising the system should take note of the real life stories beneath the statistics. I went into a couple of hospitals for locals on my latest visit. In the first, my friend told me not to say a word in case my accent was noticed, as foreigners are not allowed in these places. I was appalled by the hygiene and amazed at the antiquity of the building and some of the equipment. I was told that the vast majority of Cuban hospitals, apart from two in Havana, were built before the revolution. Which revolution, I wondered; this one seemed to date from the 1900s.

What's interesting about the Cuban system is that their sparse resources force much more attention to early intervention and preventative health measures. Those are laudable efforts, and they've paid off handsomely. But the health system, in the way we think of a health system, is actually quite poor. Medicine is a technology-intensive practice, and Cuba lacks the resources -- in no small part because of our embargo -- to keep pace with new discoveries. There's no doubt that they do a lot with a little -- and invest quite a bit of thought and energy into presenting the best face of their system for foreigners -- but in the end, being a sick Cuban is no enviable condition. Castro, after all, had his surgery botched, and called in a Spanish specialist to correct the procedure.

June 6, 2007 | Permalink


The point, as always missed, is not that Cuba is the centre of cutting edge medicine, but that on an incredibly small amount of spending manages to serve the day to day needs of the population to a level that you only get in the US if you have a seriously good health plan from your employer.

A quick look around some of the charity hospitals and emergency rooms reveals that US health hygiene isn't all it's cracked up to be, if you're not rich.

Also, a well maintained old building isn't actually that big an obstacle to good healthcare provision. The obsession with shiny new offices and theatres is one of the major kabuki elements in US medicine.

Posted by: Meh | Jun 6, 2007 1:39:26 PM

Fidel is 80 now, and his brother Raul, 76. After outlasting 9 (or 10?) US Presidents, has gotten somewhat more mellow except on communism. (A tracksuit now, instead of military fatigues, as he playes the role of senior stateman and newspaper columnist).

It looks like he'll outlast Bush in office (unless the neo-cons take on Cuba instead of Iran - out of frustration with their slipping powers - and want to invade some country that they have some hope of defeating.

I'm glad Cuba isn't asked about in Dem. Presidential debates (so far), because they would be pressured to reinforce the sanctions yet again. Surely the next President will have some major opportunities/decisions in regard to Cuba, and face the reality that ignoring and sanctioning them hasn't worked so well for 60 years.

Posted by: JimPortlandOR | Jun 6, 2007 1:51:17 PM

And what exactly? is so awful about a care facility that is clean and well run...
however aged or even decrepit it may be.
We provided pretty good care, for the day, in Baragwanath which was...fuc*king quonset huts

In America we pay for glassed and atrial palaces as hospitals...in some of which...care sucks.
[Watch out for any institution that has has to have the
shiniest in hi-rise, marble floored, mahogany vaulted...
I speak 'Insurance', 'Hospital', 'Bank'...you know the list]

Posted by: has_te | Jun 6, 2007 2:22:20 PM

Of course Cuba wasn't the 'last' country we have worked to marginalize due to their actions, we have also employed signifigant pressure against Iraq, Libya, North Korea, and a variety of other nations.

Certainly economic sanctions have a mixed track record at best, and I myself am not a huge fan of them, but Cuba is certianly not the only example out there.

Posted by: Dave Justus | Jun 6, 2007 2:35:42 PM

actually, "brothers to the rescue" was not actually, you know, rescuing anybody. they may have radioed in coordinates and whatnot to the coast guard, but they were mainly dropping anti-castro pamphlets out of the sky. they had also been warned about entering cuban airspace before, and did it anyway. i'm not so sure that that was a move "calculated" to maintain the embargo.

Posted by: rigel | Jun 6, 2007 3:08:18 PM

just checked the wikipedia page, which says that they did actually rescue rafters. however, their source for this cite is the brothers to the rescue website. for my part, growing up and living in miami for most of my life, i had never heard of them until they were shot down, and i dont recall any news outlet claiming they had rescued anyone, just that they were dropping leaflets or something, and violating cuba's airspace.

Posted by: rigel | Jun 6, 2007 3:11:19 PM

South Africa.

Posted by: Sanpete | Jun 6, 2007 3:21:24 PM

Directly across the street from
Southwest Township (Soweto)...

Posted by: has_te | Jun 6, 2007 3:46:22 PM

Ezra, why are you comparing Cuba's health record against the US, when the more obvious comparison would be against it's Latin and Central American neighbours with similiar per capita incomes?

Posted by: Phoenician in a time of Romans | Jun 6, 2007 3:46:32 PM

One of the reasons that Cuban doctors are considered quite good is because they are trained to have excellent clinical skills, maybe because of a lack of fancy technology and tests. They listen to the patients, examine them, and narrow down the problems before running batteries of tests ... the opposite of what is done in the U.S.

As a side note, I was in Spain a year ago and visited a friend in the hospital (the same hospital my husband worked in before he moved here). The building was obviously pre-Franco, so it was quite industrial, and it was in late August, so it was blessed hot inside. Otherwise, everything was clean, patients were well taken care of, etc., etc. That building would never have been acceptable in the U.S.; it was way too un-modern. But again, preventative care in socialized medicine both encourages doctors' clinical skills and emphasizes saving money on truly unnecessary programs in order to focus on excellent patient care.

Posted by: carrar | Jun 6, 2007 5:35:07 PM

I would guess that Ezra has health insurance and a reverent attitude towards shiny medical things. Having worked in the industry and having been a patient, I'm not so impressed.

For Cuba, the relevant comparison is other similar countries, although we might well ask why Cuba can provide universal coverage while we can't, or how the Cubans can send doctors to help other countries, while our aid consists of loans so they can buy weapons.

Whether you look at our 100,000 hospital-caused deaths per year, or our role in deposing Aristide and preventing the outbreak of democracy in Haiti, it's hard to be too impressed with gripes about Cuba. If there's one country in the Carribean basin that has a really good excuse for what they do, it's gotta be Cuba.

Posted by: serial catowner | Jun 6, 2007 6:58:43 PM

Costa Rica has an excellent national health care system, part of the dividend of getting rid of its military. My oldest sister and her fiance went there for him to get dental implants and, after three visits of at least a week each time still save some $6K over what it would have cost in the US.

Best of all, Costa Rica has multiparty elections, doesn't imprison dissidents and has such a clean human rights record they don't even turn up on the pull down country bar "What's Going on Where" bar on Amnesty International USA's web site.

Posted by: Randy Paul | Jun 6, 2007 9:30:56 PM

I'm not the one comparing Cuba to the US. I'm saying, quite explicitly, that it's foolish to do so, and others should stop.

Posted by: Ezra | Jun 7, 2007 12:05:48 AM

It's preventive, not preventative, health care.

Posted by: BJC | Jun 7, 2007 9:13:45 AM

Actually...and I hate that this is so -
It's both.


Posted by: has_te | Jun 7, 2007 11:13:23 AM

If you go back a few centuries and compare the pre-hygiene era with our hygienic era, the results can be quite astounding.

Even in the 19th century, in Europe, it was common for a quarter to a third of the population to be totally indigent and unemployed- hardly the conditions in which overall productivity can rise, or a domestic market develop.

Even more amazing, in 1782 a Dutch fleet of ten ships left the Netherlands, bound for the Indies. Of the 2653 men aboard, 1095 had died by the time they reached the Cape of Good Hope, and 915 of the survivors were admitted to hospital. Perhaps unsurprisingly, the Dutch maritime declined substantially in that century, and even the population of the Netherlands seems to have declined.

Could we in our turn be suffering from a lack of hygiene? It seems reasonable that the average person could live to be 80, and the lucky to 100, in the absence of environmental insults and 'accidental' injuries.

Nor, in fact, is it so unreasonable that your major expense should come in the last year of life. Better that than a lifetime of interminable medical interventions.

Posted by: serial catowner | Jun 7, 2007 12:00:59 PM

I was able to study in Cuba for a semester in 2003 before the State Department banned education travel to the island.

As an adventurous and clumsy traveler, I visited the hospital there more times in 4 months than I had in the US 5 years prior and 4 years since.

My experiences were mixed: while I had a doctor smoking a cigar(!) while he removed sea-urchin spines from my foot, I also received excellent treatment and follow-up after hurting my elbow in a motorcycle accident. And I didn't pay a dime for treatment OR medication... as a caveat I had the general impression throughout that Americans received a white-glove treatment...

One of the points that often gets overlooked about the Cuban health care system is just how many trained, professional and knowledgeable doctors exist in the society. Cubans act as first responders in natural disasters throughout the southern-hemisphere. Low entry barriers and access to education can't be left out of this argument.

Also of note, is that in Cuba you do not see the abject poverty of parts of Mexico, Nicaragua, Ecuador, etc. And even though I question any government reported statistics, the infant-mortality rate is better than the US, and average life expectancy dwarfs other countries in the region.

One last point of consideration is how the island responded to the AIDS crisis: completely quarantining infected citizens in modern-day leper colonies and banning homosexuality altogether. Infectious diseases are a scary prospect for an island-nation... while I was there an epidemic of pink-eye swarmed the entire country for two weeks.

Posted by: Jon | Jun 7, 2007 1:44:16 PM

From an editorial in the Seattle P-I today by Wendy Johnson- "there are fewer than five [doctors] for every 100,000 people in most of Africa."

What I'm getting at, Ezra, is that when you say "in the way we think of a health system", you actually mean, "in the way I think of a health system".

I've had lots of formal education and employment in what you think of as a health system, but to me that's the medical system.

When the man from Public Health addressed us, he said the big issue for the future was clean water, and the major disease we would see as a public health issue was food poisoning- in rural areas, most frequently spread at church potlucks. Seems to me he wasn't far wrong.

Posted by: serial catowner | Jun 7, 2007 2:02:19 PM


According to the WHO, Cuba's life expectancy at birth is (m/f) 75/79, the US's is 75/80 as is Costa Rica's (click the countries link to find out specifics on the other two).

The infant mortality rate is 7 per 1,000 live births for Cuba v 8 for the US and 12 for Costa Rica. Not to sound callous, but the difference between Cuba and the US is statistically insignificant on the infant mortality rate.

Posted by: Randy Paul | Jun 7, 2007 2:11:56 PM


I think we're agreed, and I reiterate that I strongly question Cuba's self-reported statistics. I was just trying to add breadth to the discussion based on my anecdotal experience and observations. Cuba is "achieving" impressive numbers ostensibly on the back of human capital, since infrastructure improvements are non-existent and medical-resources are extremely limited.

The real test for Latin America, I believe, is what a populist like Chavez will do with petro-dollars to provide health care. Cuba is bone dry, aside from extremely deep deposits. They are doomed to be a tourist economy.

Posted by: Jon | Jun 7, 2007 3:03:45 PM


Good points. I'm not trying to idealize Costa Rica, but I believe strongly in the demilitarization of Latin America, especially given the bad history of the military in Latin America and the amount of money that gets blown on the military vs. the real infrastructure and social needs, I wish more attention on these discussions would be visited upon Costa Rica as it appears to have achieved good results in a democratic setting.

Posted by: Randy Paul | Jun 7, 2007 3:58:14 PM

I'm puzzled at why everyone thinks that the United States is so powerful that only our embargo sustains Castro (or, alternatively, that our embargo is the cause of poverty in that virtuous socialist country). Plenty of dictators manage to keep going around the world without U.S. embargoes, and most socialist countries are desperately poor. I realize that it can be difficult to accept that you're not the center of the world, but consider the possibility that, if there were no U.S. embargo, Cuba would still be a lot like it is now.

Posted by: y81 | Jun 8, 2007 12:13:10 PM

If Cuban health care is so modern why do they remove the brass staples off of the bottom of card board boxes so that can be jammed into both side of an incision to hold it together - rather than use stitches?

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