Tuesday, June 26, 2007

"The healthy debate over Cuba's medical care"

It's a title of a piece in the Scotsman - prompted, I assume, by Michael Moore's forthcoming film Sicko. While I am likely to agree with many of Moore's criticisms of America's bloated and fantastically unequal health care provision, I'm not sure if much of the 'debate' over Cuba's health care system is healthy at all. I've got a couple of problems with it:

1) The over-emphasis on longevity and infant mortality as indicators of how good a health care system is. Apart from mass vaccination programmes, historically medical advances and the expansion of health care has been much less important for life-expectancy than more basic aspects of public health, such as the provision of a clean water supply, efficient sewerage, and improvements in diet. It is the last of these, for example, that is the most likely explanation as to why Americans - despite spending something in the region of 26 times more on health care than Cubans - have only a marginally higher life-expectancy.

2) Those using the Cuban example aren't making a narrow point about the superiority of socialised medical care; it is being used to make a wider point about the deficiencies of liberal capitalism and in some way to rehabilitate a one-party dictatorship. I get the sense that people trying to nail this down are failing slightly because they're making the wrong point. It may well be, I wouldn't know, if Cuba's health care system isn't all it's cracked-up to be - but that isn't the point. As no fan of America's private insurance model, I have no problem at all believing that the Cuba system works better and gives a more equal provision. But so what? It certainly cannot be taken to vindicate more widely the Soviet model, as economic history has shown - still less that living under a Brezhnevian regime in the sun is preferable to liberal democracy.

If people disagree, they should say so; if not, they should really stop using Cuba as an example. For what is it an example of, exactly - if not what some people imagine to be a benign dictatorship? Showing that it isn't benign in any respect is almost certainly inaccurate and misses the point anyway. It should be sufficient to point out that it is a dictatorship.

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