I’ve been thinking about Castro and Cuba over the last few days, and have come to the reluctant conclusion that my usual anti-Castro rants are less than constructive. With that in mind, and trying to look at Cuba and the achievements of Castro with some degree of objectivity and non-partisan alignment, I agree that he has provided good public policy, i.e. public goods, in some important, if very limited, areas. Health and education are prerequisites for civilised society, and by all accounts, Cuban health and literacy levels are high for the region and high given Cuba’s poverty. However, it is also the case that Castro runs a communist dictatorship. He has jailed and killed dissidents. He has presided over the economic ruin of Cuba. There are no free elections and there is no free press.
The health indicators, according to the Wikipedia article Healthcare in Cuba, are impressive and compare favourably to the first world.
According to the World Health Organization (WHO), the chance of a Cuban child dying at five years of age or younger is 7 per 1000 live births in Cuba, while it’s 8 per 1000 in the US. WHO reports that Cuban males have a life expectancy at birth of 75 years and females 79 years. In comparison, the US life expectancy at birth is 75 and 80 years for males and females, respectively. Cuba’s infant mortality rate is better than the US with 5 deaths per thousand in Cuba versus 7 per thousand in the US. Cuba has nearly twice as many physicians as the U.S. — 5.91 doctors per thousand people compared to 2.56 doctors per thousand.
Cuba has been able to reach such high standards despite its lack of wealth by using a preventative model of healthcare – in fact by seemingly not distinguishing between proactive and reactive healthcare – and by placing a lot of emphasis on community care, as described in a UK Select Committee report. All this has been accomplished despite annual per capita health spending being a meagre $260. America spends 25 times that amount.
Castro’s education system has also had some positive outcomes. Literacy levels are around 100%. Education is free, and compulsory.
As I see it, the influence of a variety of different factors determines these results. They do not simply represent Castro’s benevolence, the efficiency of his pet projects or the ignored triumphs of Marxism-Leninism. (Permit me as well some cynicism regarding figures provided by official Cuban bodies). Unfortunately, the press has generally stuck to its romantic view of Cuba and the revolution and uncritically accepted the Castro regime’s claims. Michael Moynihan at reason.com has an invaluable round up of pro-Castro pieces in recent mainstream publications. The conventional wisdom is that the Communists are “not so good on free speech, but oh-so-enviable on health care and education.”
In some ways, Cuban healthcare is a function of its economic weakness. As The Guardian notes, “millions of Cubans are forced to exercise because cars and public transport are so scarce”. In addition to the involuntary effects of weak transport capability, the scarcity and lack of resources forced the Cuban government to innovate and develop its preventative system. The Guardian states that, “Cuba is admired by public health experts in Britain and around the world for putting the horse before the cart. Unable to afford too many hi-tech operating theatres, it focuses its efforts on keeping its people well and picking up illness early – when it’s easier and cheaper to treat.”
The ideological concerns of the original revolutionary movement drive healthcare and education policies, and the regime uses them to legitimise its rule. An even less laudable cause of Cuba’s impressive policies is the other half of their revolutionary origin: the political institutions and culture that the revolution created. Cuban healthcare and education are universal. They are also coercive. A BBC article states that, “According to the doctor we met, there is also one particularly important thing: your annual house-call will probably take you by surprise.” The Guardian reports that, “Everyone is supposed to be visited at home at least once a year, often without warning, so the GP can scrutinise a patient’s lifestyle.” The UK Select Committee had “concern regarding freedom of choice both for patient and doctor.” School is a vehicle for indoctrination. The state uses the so-called “Cumulative School File” to measure the ideological integration of students. Literacy levels may be high, but there are heavy restrictions on what Cubans can read. A tightly controlled surveillance society like Castro’s Cuba is well suited to the enforcement of good social policies, as long as those good social policies represent the best interests of the holders of political power.
Finally, present day healthcare outcomes also reflect a long history of Western medical practice, dating back to the 19th century. Cuba led first world states on many health indicators before Castro took power. In the 1950s, Cuba had more doctors per head than Britain, France and Holland. Cuba had the lowest infant mortality rates in the region, and was ranked 13th lowest in the world, ahead of a various first world states who would nevertheless come to outrank Cuba during the current regime’s existence. Similarly high levels of literacy were also present before Castro took power.
In fact, Cuba in the 1960s was, in terms of development, comparable to southern European states like Italy or Portugal, or Latin American states like Northern Mexico, Puerto Rico, or Costa Rica. Measured by this indicator, Castro’s regime has been an abject failure. He turned one of the most prosperous countries in the region into one of the poorest, and he did this himself, without the say-so of the Cuban people, for the glory of the Communist revolution. Havana was once a prosperous modern city, as its ruins now attest. Castro murdered thousands – he brought poverty and decay. According to Kirby Smith and Hugo Llorens, in their paper “Renaissance and Decay: A Comparison Of Socioeconomic Indicators in Pre-Castro And Current-Day Cuba”,
An enduring myth is that Cuba in the 1950s was a socially and economically backward country whose development, especially in the areas of health and education, was made possible by the socialist nature of the Castro government. Despite the widespread acceptance of this view, readily available data show that Cuba was already a relatively well-advanced country in 1958, certainly by Latin American standards, and in some cases by world standards. The data show that Cuba has at best maintained what were already high levels of development in health and education, but that in other areas, Cubans have borne extraordinary costs as a result of Castro-style totalitarianism and misguided economic policies. Indeed, with the possible exception of health and education, Cuba’s relative position among Latin American countries is lower today than in it was in 1958 for virtually every socioeconomic measure for which reliable data are available.
The effects of the trade embargo are less obvious. It is true that the trade embargo will inevitably have had some impact on the quality of life in Cuba. Trade matters. The unintended irony of the “Stop the Blockade” campaign is that the anti-capitalists argue that the trade barriers should come down in one of the few instances where they are in power. “Stop the blockade” indeed. Stop all the blockades. It is also true that the blockade will not improve the amount or quality of medical capital available to the government for purchase. But the effects are often overstated. In the BBC article linked to already in this post, the embargo looms large as the prime cause of Cuba’s ruin. It states that, “Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess.” According to the BBC, then, Cuba’s highly regulated economic life is clearly not as important a factor in determining its poverty as the American trade embargo. We know differently: Castro’s disastrous economic policies keep Cuba poor, not the embargo, and the “Stop the Blockade” campaign is a tacit acknowledgement of that fact. Castro’s government wants to trade goods for its own personal profit and be given lines of credit and do all the things that it forbids its own subjects from doing. Prof Brad DeLong sums it up perfectly,
You know, there is something very wrong with an argument that goes (a) Leninist centrally-planned communism is necessary because market exchange is inherently exploitative an destructive, and (b) it’s not Castro’s fault Cuba’s economy is in the toilet–America won’t trade with it. That simply does not compute.
To understand the real effects of the trade embargo, consider the effects of removing it. Not being Cuba isn’t everywhere helping other developing nations climb out of poverty. There is a lot of disagreement about what causes growth, but it’s surely more complicated than merely not being the subject of a US trade embargo. To capture the real benefits of trade and to disperse those benefits throughout the population, the regime would have to open Cuba to the global economy. As it stands, the limits on which Cubans can trade and what those Cubans have to offer in trade would massively lesson the positive effects of trade. Obviously at present Cuban industry is limited and Cuban spending is undertaken mostly by the government. The person with the dollars in Cuba trying to buy medical equipment would be the government, and the person who sold the goods to acquire the dollars would be the government. This means that the government would be capturing the chief benefits of trade, because the government is the only Cuban entity involved in the exchange. This fact dictates US policy. I personally think that the embargo aids the Castro regime by helping to keep Cuba a closed society, but I can admit that the principal benefactor of increased international trade will be the group that controls it and decides how to divide the profits.
To conclude, and trying still to extend every courtesy to Castro’s 46-year reign, yes, he has achieved some limited success with healthcare and education policies. However, Cuba already had high levels of health and literacy before Castro took power. The Communist Party’s ability to enforce its social policies represents the extent of its control over the population: In a totalitarian state, the government does what it likes, and the people have to like what it does. More damningly, Castro has wrecked Cuba’s development. He did this (with Soviet subsidies, it must be added) through his terrible economic policies. The opportunity cost of the revolution has been to exchange the potential of a Latin American Spain or Portugal for a country on a similar level of development to Bolivia or the Dominican Republic. Cuba’s poverty is not a function of the US trade embargo, because the US trade embargo stops trade with the regime. No trade with Cubans is possible. Castro, then, has murdered thousands, wrecked Cuba’s economy, destroyed its cities, brainwashed and oppressed its people, and completely derailed its development. Crow all you want about his incremental improvements to Cuba’s health and literacy levels, but I think that this is his real legacy.
Hasta la victoria siempre!