Glowing appraisals of Cuba's state-run healthcare system are plentiful in the health policy literature. For instance, it is claimed that, from the post-revolutionary decade (1959-1970) through the 1980s and beyond, Cuba has achieved consistently outstanding health indicators across the board.¹ Cuba's infant mortality rate is said to equal that of industrializes nations. Cuban life expectancy allegedly exceeds that of Americans. And at 1 doctor for every 297 inhabitants, Cuba is reported to have one of the highest rates of doctors per capita in the world.² Researchers even enthusiastically note the practice of foreigners flocking to Havana for treatment as "medical-tourists."³ The projected image is that of a country where the state of medicine is not only more advanced, but less expensive.

Is this true?

Such statistical claims would normally either require a detailed review of the researchers methodologies or a new round of data collection in order to be soundly refuted. But why believe that self-reported figures from a dictatorship are credible at all? In Cuba, truth and reliability in such figures is seriously doubtful, and in any case certainly not deserving of any outsider's blind trust. What subordinate party-member would willingly hand Castro an annual report portraying anything less than stellar performance? Under communism, loyalty to the party is the only course of action that has any survival value, since the standard of truth is whatever the men of power desire. All dictators have this problem: Adolf Hitler, Josef Stalin, Pol Pot, Saddam Hussein, and Fidel Castro, too. As a subordinate, the only way to keep one's position, one's livelihood, and ultimately one's life, is to say what one's superiors want to hear.

Those who look at Cuba and see a utopian healthcare system are engaged in a similar evasion. For years, billions of dollars of annual subsidies from the U.S.S.R. helped prop up and make passable a national healthcare system in Cuba.⁴ When those subsidies disappeared, the healthcare system that the communists had dreamed of became even less feasible. The quality of care available to the average citizen deteriorated, facilities became dilapidated, and equipment quickly became outdated.⁵ A general shortage of nurses, assistants, and midwives developed, and had it not been for the exemption of medicines and medical supplies from the U.S. embargo⁶, quantities of those resources would have been practically nonexistent as well (as it is, they are meager). Rather than becoming streamlined and eliminating "wasteful" competition, the Ministry of Public Health ballooned to the point of having the highest overhead costs in the world.⁷

Many researchers in public health praise Cuba for its equality, yet its two-tiered system is even more pronounced than that of other nations. In a market economy, economic demand for care is controlled by graduated price levels. Mechanisms such as price discrimination lower the average cost of healthcare for everyone by charging the rich more for incrementally better or newly-available high-tech services. Both classes of consumers benefit. In Cuba, however, access to care—at least the good care that researchers so frequently cite—is dispensed according to political power. Sometimes dubbed "medical apartheid," Cuban Communist Party officials and those who can pay in hard currency (which is where the medical tourists from richer, freer nations enter the picture) can get first-rate medical services any time they want. Cubans without party credentials receive the squalid quality care that is leftover, in facilities kept separate from the modern, clean ones.

Idealists for Communism and Socialism complain that economic and social organization based on private property does not sufficiently consider the interests of all members of society—that such systems serve only the purposes of a "single strata" (i.e. those who earn their wealth freely through trade and cooperation).⁸ Instead, Cuba has created a political proletariat and bourgeoisie, which has taken down their healthcare industry along with everything else.

____

¹ De Vos, P. "No one left abandoned: Cuba's national health system since the 1959 revolution." Int J Health Serv. 2005;35(1):189-207

² Benjamin M, and Haendel M."Cuba. A healthy revolution?" 1991 Fall;8(3):3-6

³ Charatan, F. "Foreigners Flock to Cuba for Medical Care" West J Med. 2001 August; 175(2): 81

⁴ Cuban American National Foundation. "Health Care in Cuba: Myth Versus Reality." Cuba Issue Brief. See also Section 1705 of the Cuban Democracy Act of 1992

⁵ Charatan, F. "Foreigners Flock to Cuba for Medical Care" West J Med. 2001 August; 175(2): 81

⁶ "An overview of the Cuban Assets Control Regulations Title 31 Part 515 of the U.S. Code of Federal Regulations." U.S. Department of the Treasury Office of Foreign Assets Control. 1999

⁷ Alonso, J., R. Donate-Armada, and A. Lago. 1994. "A First Approximation Design of the Social Safety Net for a Democratic Cuba." Cuba in Transition. 4. Washington, D.C.: Association for the Study of the Cuban Economy (ASCE).

⁸ Mises, Ludwig von. Socialism: An Economic and Sociological Analysis. Yale University Press. 1951. 16

©2005-2010 The Lucidicus Project, all content unless otherwise noted.