Castro's Dictatorship and Cuban Health Care:

Cuban communism may be repressive, but at least it provides good health care. This is a common trope of left-wing apologias for Castro's brutal dictatorship. This claim is getting recycled yet again in the wake of Castro's recent resignation (e.g. here). One response to this point is that of liberal Berkeley economist Brad DeLong: Cuba would likely have a much higher standard of living (and better health care) today had it not gone communist in 1959. As DeLong documents, Cuba in the 1950s was one of the richest countries in Latin America and rapidly approaching Western European standards of living and health outcomes. Under communism, it became one of the poorest nations in the Western hemisphere - despite receiving vast quantities of heavily subsidized oil from the Soviet Union for decades. Taking Cuban official statistics at face value (as DeLong does), Cuban health outcomes and standards of living are roughly similar to those of Mexico and the Dominican Republic. In the 1950s, DeLong notes, Cuba was vastly better off than these countries and, on some measures (such as infant mortality) better than many Western European nations.

But there is an even more basic problem with the "at least Castro improved health care" excuse: it assumes that official Cuban government health care statistics are accurate. I find that assumption highly improbable. A government that brutally represses dissent and executed over 100,000 political prisoners out of a population of just 6.3 million is unlikely to be above falsifying its official statistics in order to improve its image. That was certainly common practice in other communist societies, including those which Castro used as models for his own.

When the Iron Curtain fell in Eastern Europe, scholars rapidly determined that official Soviet and East European statistics were routinely falsified to burnish the communist regimes' public image. As this foolishly credulous 1973 Time article noted, official East German stats indicated that, by 1970, East Germany had a higher standard of living than Italy and was rapidly closing in on Britain. Anybody with even the slightest familiarity with actual East German living standards knows how far such communist claims were from reality.

How bad is Cuban health care really? I don't know. Probably no one will know until the regime finally falls and honest data can be collected. For now, it's at least worth noting that the government health care clinics available to ordinary Cubans (those not members of the government elite) look like this and this. It's also worth noting that if Cuban living standards and health care really were as good as the government claims, it's unlikely that millions of Cubans would have risked their lives to flee the country - not only for the wealthy United States, but even for such far poorer destinations as Puerto Rico and the Dominican Republic. It's especially telling that many Cuban refugees prefer even Haiti (the one Latin American nation that probably really is poorer than Cuba) to life under Castro. The evidence of people risking their lives to vote with their feet is a lot more compelling than the Cuban government's dubious health statistics.

UPDATE: I am aware that some of the data on Cuban health care comes from the United Nations and other international organizations. However, the UN and the others depend on information provided by the Cuban government. You can't do independent data collection in a totalitarian dictatorship. Thus, the UN numbers are derivative of Cuban official statistics.

Groucho Marx (mail):
What role might the U.S. embargo have played in the stagnation of the Cuban economy? Under the dictator Batista, three-quarters or more of trade was with the United States. If the U.S. had cut off economic relations with Batista, how would the Cuban economy have fared then? This seems a possibly pertinent question.

As to healthcare in Cuba, there are some relevant assessments by non-Cuban and non-leftist experts here
They do not seem to bear out DeLong's inaccuracies.
2.20.2008 7:21pm
Ilya Somin:
What role might the U.S. embargo have played in the stagnation of the Cuban economy? Under the dictator Batista, three-quarters or more of trade was with the United States.

Of course if Cuba had not gone communist, there would have been no US embargo. Moreover, any negative effects of the embargo were likely to a large extent offset by the USSR's provision of virtually free oil to Cuba for some 30 years. Imagine an economy that stagnates despite the fact that most of its energy needs are provided for free.
2.20.2008 7:24pm
Ilya Somin:
As to healthcare in Cuba, there are some relevant assessments by non-Cuban and non-leftist experts here
They do not seem to bear out DeLong's inaccuracies.

The "experts" in question may be non-Cuban, but they are not non-leftist (e.g. - one of them is a British left-winger and another is Kofi Annan, who probably is not an expert on health care anyway). Even more to the point, they rely on the same Cuban government-derived health care stats whose accuracy I question in the post. There is no reason to believe that Cuban numbers are any more accurate than the Eastern European and Soviet ones were.

Finally, even if the numbers are accurate, they don't refute DeLong's point that Cuba would likely be far better off had it not gone communist.
2.20.2008 7:27pm
Curious (mail):
First, I agree completely with Somin that official Cuban govt statistics are not to be believed at face value. I wonder--and I don't mean this in a snarky fashion--whether he's also skeptical, though perhaps not to as great a degree, of official American govt statistics.

Second, a question about the embargo: Granted, the US economy is a large one and it is geographically very close to Cuba, so an embargo should have some sting. But I'm assuming (am I wrong?) that this was merely an embargo on goods produced in America. I'm assuming this wasn't a military embargo universally recognized as an act of war to the effect of prohibiting ships from anywhere in the world from landing in Cuba. Over time, and it's been over 4 decades, as the effects of the American embargo were felt, presumably Cuba began to trade with countries that were otherwise their second-best alternative. I'm assuming the entire world didn't have an embargo on Cuban trade, so despite the fact I'm opposed to trade embargoes on principle, what is the economic argument that this one had any significant effect (beyond hurting American producers)?
2.20.2008 7:41pm
Curious (mail):
Ilya, it is not a very strong statement, given what we know of economic calculation, to say a country would have been better off had it not gone communist. This is largely true without looking at the numbers. Having said that (and not knowing any details of the actual Cuba health care system), it IS possible that economic maldistribution of resources under central planning can lead to OVERsupply of some areas, and that could include health care. Do you agree?
2.20.2008 7:45pm

it IS possible that economic maldistribution of resources under central planning can lead to OVERsupply of some areas, and that could include health care.

There is oversupply, but it's in the area of military and police structures. Medical profession is uniformly one of the lowest paid in a socialist economy (with the exception of the special medical system for the ruling elite) - you might say that the problem of healthcare costs has been solved in those economies. The oversupply area of course is not surprising - the main task of the ruling group is to preserve its power against any external and internal threats.
2.20.2008 7:59pm
Passing By:
Looking at the pictures I am half-tempted to quip, "Walter Reed Medical Center is in Cuba?" But fortunately Walter Reed is not representative of our nation's health care system.

I find Somin's initial argument to be sorely lacking in either - the so-called "genetic fallacy", where the origin of a claim is deemed to refute the claim. His follow-up is a classic example of "poisoning the well" - presenting unfavorable information about a speaker to discredit the speaker's words, even though the criticism has nothing to do with the speaker's claims.

I'm prepared to find out that Somin is correct. But I will await, you know, facts and evidence. We don't necessarily have to wait for the fall of Cuba's communism to start collecting data. I suspect that at least one of the Cubans who have fled Castro's regime is a doctor.
2.20.2008 8:14pm
While it's clear that goverment figures are always suspect- of course things have gone downhill after the revolution!

Unfortunately, Mr. DeLong is missing the bigger picture- if things were so much better before the revolution, why was it successful?

No, I don't want to move to Cuba, no, I'm not a Communist sympathiser, nor do I admire the current regime. I don't even hate capitalism. The point that I'm trying to make is that successful revolutions require societies that have bad enough problems (real or imaginary) perceived by enough people to make it possible to overthrow the government.
2.20.2008 8:30pm
I do not know about Cuba but I have a new friend who married another friend of mine as a internet bride from Russia in 1996. She was a Cardiologist in Russia. She made 40.00 a month and still had to "donate" one week-end a month to "provide for the common good" free. They were still using reusable needles and glass syringes. No pain meds at all for labor. No cardia caths. You would only get treated with morphine for an MI. If you wanted heparin you had to pay. Thrombolytics were not allowed. Penicillin was the only antibiotic used unless you came up with money. No wonder she put herself up as a internet bride. They have been happily married since then and have one child. She practices Family Medicine in Atlanta(after doing a full Residency here). Low paid does not quite describe it. Home video from Russia was amazing. Her two parents both have Phd's and they live in a very small 1930 era "free housing" building. Like my friend said even the cats in Russia are skinny. He had never seen someone eat an apple down to the seeds and cord. Sad. But hey her parents get to buy the apartment now. Oh and she is a LEGAL immigrant who is STILL waiting to become a citizen. She does check in with the immigration authorities right on time.
2.20.2008 8:45pm
Bender (mail):
rfg: The reason Castro was successful in overthrowing Batista was that Batista's strong-man political regime was universally loathed. Castro came to power promising that all he intended to do was replace the Batista regime with a liberal-democratic government. He even denied at the start of his regime that ge was a communist.

As soon as Castro took power he began imprisoning, torturing, and killing opponents. He created an even more ruthless and brutal police state than Batista had. By the time the Cuban middle class (and the majority of the country pre-Castro were middle class) realized how they'd been suckered it was too late. Many of the refugees who were lucky enough to escape from Cuba in the first several years of Castro's reign had been his strongest supporters.

A large part of Cuba's disastrous economic decline can be blamed directly on Castro's policies. He personally destroyed the agricultural back bone of the country by tampering with tobacco and sugar farming. Cigar making, distilling, and tourism were also major components of the Cuban economy. Castro destroyed them all. Financial resources and a large amount of Cuba's population (mostly the more African component) were frittered away on foreign adventures in Angola and other parts of Latin America.

"Bananas" was a funny movie. The real life situation was and is a human tragedy of epic proportions. As to Cuba's statistics: Castro's government is on record as claiming to have educated over 95% of the citizenry to literacy. This is a laughably ridiculous claim if one considers known incidences of extreme mental retardation, dyslexic conditions and the like. Only someone who believes that Mao and Stalin got 105% of the popular vote falls for crap like this.
2.20.2008 8:50pm
Dilan Esper (mail) (www):
Ilya and Brad DeLong are ignoring distributional issues. Cuba may have, as a nation, been prosperous before the revolution, but it was also an extremely unequal society, with a very large mostly dark-skinned segment of the population living as essentially slaves on plantations while a white minority (along with some Americans, many organized crime figures, and some multinationals) got filthy rich.

One doesn't have to be a flaming lefty to understand that talking about the country's prosperity in terms of total GNP in such a circumstance is rather myopic.

I would remind our libertarian friends that while a rich society CAN address distributional issues most efficiently by making transfer payments, that point is only relevant if such transfer payments are actually made. The fact is, Cuba had a peasant revolution because Batista and his friends made sure that the peasants could never share in the riches of the country. If you don't like what happened after Castro took power-- and I don't-- this is a good reminder to conservatives and libertarians to stop thinking growth is the end of all ends and to do something about distributional issues while you can.
2.20.2008 9:31pm
That 100,000 executed figure seems to be, for lack of a better word, arguable. That's no excuse -- one extrajudicial murder is too many. But maybe the writer was using non-decimal notation.....
2.20.2008 11:44pm
theobromophile (www):
Some of the issue is that the United States will report a "live birth" as being something entirely different from that which Cuba will report.

Cuba has one of the highest abortion rates around. It will also report many live births as stillbirths: if the child weighs under 500 grams (IIRC), the government will report it as stillborn. In the United States, pretty much any child born with a heartbeat is considered to be "born alive," so our infant mortality statistics look worse.

Cuba could well be reporting their results accurately, but they are not using the same standards as other countries. It is not a one-to-one comparison.

The more accurate comparison, for infant mortality and maternal health, would be by age, outcome (abortion out of medical necessity, stillbirth, live birth outcomes at various weights and stages of development, etc.). The basic question - how well will a pregnant woman and her child fare, all other things being equal - cannot be answered due to the disparity of standards for statistical reporting.
2.21.2008 12:52am
Smallholder (mail) (www):
My understanding, and am I not an expert on the Cuban embargo, so correct me if I am wrong is that:

1) The Cuban embargo is entirely ineffective and easily skirted.

2) Canadians and Europeans are perfectly willing to sell any good that Cuba can affored.

3) The true impact of the embargo has been:
a) Anti-Castro symbolism that buys support in elector-rich Florida.
b) Propaganda for the Castro regime: Cuba is poor not because out economic system bites but because of the Americans!

If those things are true, it strikes me that blaming poor Cuban health on the American embargo is just more of 3(b).

Am I wrong?
2.21.2008 9:24am
rarango (mail):
If Mr. Marx considers those three citations as relevant, more power to him; those are hardly factual. I apologize for this anecdotal point, but if Cuban health care is so good, why did the Government of Cuba bring in Spanish surgeons to perform relative routine GI surgery on Fidel? My favorite anecdote of the the Cuban system is this: the long term inability of Cuba to feed its population became fertile ground for epidemiologists to study the effects of a reduced caloric intake. We can thank El Jefe for helping us verify that a reduced caloric intake reduces the risk of cardiovascular disease. Of course, I don't think the Cuban population provided voluntary and informed consent as part of the study. Thanks, Fidel!
2.21.2008 9:43am
Pitman (mail) (www):
I can only report what I heard from a friend of mine who is the head of a department in a large hospital after a visit to Cuba. He is not Cuban and was visiting Cuba with his Cuban born father-in-law who left before Castro came to power. He visited a number of clinics and a hospital while they were there and was very impressed with the doctors themselves and their knowldge. He said that they were very book smart, but just had very few supplies and quality equipment with which to work.
2.21.2008 9:49am
Justin (mail):
Two things.

One: what Dilan said.

Two: "Of course if Cuba had not gone communist, there would have been no US embargo" seems like a pretty weak response to the concerns about the effect of the US Embargo. While technically true, it seems like the best argument one is left with, looking at the Cuban example, is "if you piss off America, we crush you like bug." Which is hardly a strong defense of sociopolitical freedom (which I am a huge fan of), and markets (which I think are good when properly regulated, though not necessarily in health care).
2.21.2008 10:40am
Justin (mail):

you're entirely wrong. The cuban embargo can be skirted for small type things, but it completely devastates large corporate transactions with Cubas most natural trading partner. This would cripple any mass-commercial products that Cuba had, such as rum, tobacco, and sugar, while also raising the cost of attracting tourism. There's a large spectrum between "impenetrable" and "of no consequence," and the Cuban embargo was probably closer to the former than the latter.

Let's not forget, it was the Bacardi family that drafted the Cuban embargo - they knew what they were doing.
2.21.2008 10:43am

There's a large spectrum between "impenetrable" and "of no consequence," and the Cuban embargo was probably closer to the former than the latter.

An embargo is absolutely unnecessary for a communist economy to be chronically crippled. If there was ever a country with an abundance of human and natural resources to succeed in implementing even Juche it was the Soviet Union, the sponsor and the model for Castro. We all know the results (I hope).
Sticking to healthcare, I had an "instructive" experience of having one child born in the USSR and one in the USA. Suffice it to say that only in one of those places was there a ward with 8 women in it with bloody bedsheets that were not replaced for days.
I realize it may be hard to convince those who first look at American policies when searching for blame. When the keeper of Che Guevara "Museum" in Buenos Aires cited the same fantastic claims about Cuban healthcare to me he would not care about facts to the contrary. Hopefully, some of the commenters here are more open to information.
And to anticipate those who might say that Cuba succeeded at something better than its sponsors. I used to know a Soviet military attache in Cuba. The only department in which they were ahead was "joie de vivre", but that's simply Caribbean culture vs. a more dour Russian culture.
2.21.2008 12:01pm

Looking at the pictures I am half-tempted to quip, "Walter Reed Medical Center is in Cuba?" But fortunately Walter Reed is not representative of our nation's health care system.

Correct. Just a reminder: Walter Reed is part of a healthcare subsystem managed by the government.
2.21.2008 12:25pm
Smallholder (mail) (www):

Can you link me some sources that explain why other nations' corporations aren't engaging in trade with Cuba? I seem to recall that a major reason the American business community opposes the embargo is that Cuba is still buying things - just not from America.

In 2002 the State Department concluded the embargo was ineffective except for a slight increase in transportation costs for food items (shipping grain from Canada vs. the Midwest). I would guess that Bush's State Department would be unlikely to underestimate the efficacy of one of Bush's policies.

At any rate, Justin, I'd like to compare evidence - I can be convinced, but would like to see some data.
2.21.2008 1:08pm
Shtetl G:
If George Bush promised universal free health care but in return he would be president for life and would suspend the constitution, would anyone accept that deal? Personally it disgusts me the effort that certain people will go to shill for the Castro regime. The enemy of my enemy is my friend is not a reason to support a brutal dictatorship. I get it, you don't like the United States and George Bush and republicans. That does not excuse Fidel Castro for the crimes he has committed against the Cuban people.
2.21.2008 1:28pm