Cuban health statistics

Every so often, an enemy of liberty will point out that Cuba has fantastic health care, in fact it's overflowing with health care, it has so much great health care that it sends doctors to other countries to give them something to do because everybody is just so darned healthy in Cuba.

I don't know if it really amounts to anything but I did run across this paper (pdf) which critically examines the assumption that the Cuban health statistics are reliable. The author points out that

ideocratic states often use very authoritarian tactics--tactics that individual doctors and patients can subjectively experience very negatively--to create and maintain favorable health statistics. When issues of state power and social control are factored into the analysis, it becomes possible to see how Cuba’s health indicators are at least in some cases obtained by imposing significant costs on the Cuban population--costs that Cuban citizens are powerless to articulate or protest, and foreign researchers unable to empirically investigate.

The author highlights a telling anecdote that illustrates the atmosphere of intimidation and secrecy in Cuba:

One family doctor told me that she once led an instructional seminar for medical students at the University of Havana. During the seminar they reviewed several problematic cases, one of which involved a patient who had died due to mistakes made by a doctor. The case was included as a warning to the students to be careful in following established treatment protocols and surgical procedures. After the seminar, one of the medical students approached the doctor and told her that after reading the case file, she realized that the patient in the case study was actually a close relative of hers. She said that the doctors who treated him told her family he had died of natural causes, and she was very traumatized to find he had actually died from malpractice. The doctor running the seminar sympathized with the student’s grief and anger, but told her it would be better if she kept quiet and made no complaint against the hospital. To do so would be to risk being labeled a political dissident or a counterrevolutionary. The student reluctantly concurred.

 

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My visit to Cuba:

I did not see any feces smeared floors in the Cuban hospital that I visited, though like most government health care facilities even in advanced countries, it could have done with some hot water and soap. What, however, I did observe was antiquated equipment and a near total absence of medicine.

Government facilities in advanced countries tend to expend medical supplies as if they were magical artifacts, expending these artifacts without much regard for the instructions on the wrapper, as if the use of these magic artifacts in itself treated the patient. Cuban facilities, however, did not expend medical supplies at all

The paper you cite tells us:

After just a few months of research, however, it became increasingly obvious that many Cubans did not appear to have a very positive view of the health care system themselves. A number of people complained to me informally that their doctors were unhelpful, that the best clinics and hospitals only served political elites and that scarce medical supplies were often stolen from hospitals and sold on the black market.

It took me only a few days to discover that many Cubans
did not appear to have a very positive view of the
health care system

Your source tell us:

Conversations on these topics can be quite cryptic, and meanings are deliberately obscured.

Indeed so.

During my field research I observed an overwhelming popular reliance on the black market or informal economy to satisfy basic consumer needs, including health needs.

I observed the same.

Unfortunately, these practices serve to bankrupt the formal economy, leaving it almost an empty shell, while much of the actual business of medicine (diagnosis, treatment, and obtaining pharmaceuticals) is conducted through personal networks of socios using pilfered medical supplies.

I observed the same, but it seemed to me and to at least some Cubans to be fortunate rather than unfortunate. Most of the medicine would never reach ordinary Cubans except through theft.

Theft is a vital mechanism that substantially relieves the brutal inequality characteristic of socialism, just as corruption similarly relieves the rigidity of regulation in mixed economies.

Cuban Health

Dave http://www.nytimes.com/2007/05/27/weekinreview/27depalma.html The New York Times has opened up its archives and editorials to free viewing. The above is a recent article that confirms the fact that Cuban medical care is nothing to envy. Various artefacts and the fact that Cubans avoid obesity, heavy smoking and drinking, and a sedentary live style for all too obvious reason, may explain their good health. Also when the Russians subsidized the economy, more was available to promote a well-financed medical system which was a powerful propaganda tool. The naïve fools who tout Cuba for its education or health care don’t grasp underlying reality. A command economy such as Cuba or Russia can select certain goals and do well at them. For instance Soviet Russia had world class space programs, military jet plane programs and nuclear weapons programs but at the expense of the underlying economy. The goal of government was international power and status and underling deficiencies were papered over with coercion and propaganda. The bill eventually comes due on this unsustainable situation and the whole country collapsed. Likewise Cuba promoted an image of health, education and egalitarianism all built on an inherently unsustainable foundation. But many people will never learn to look beneath the surface so they want to travel the same predictable road.