Monday, May 14, 2007

More on Cuba

As I've said, I don't think the embargo is a good idea. With a few notable exceptions, my impression is that boycotts of any sort don't really work.

That said, that people going to Cuba need to give the state department some paperwork is still the law.

If you break it and get punished, maybe it isn't a vast right wing conspiracy.
Maybe you just broke the law and got punished.

And Moore hasn't even been punished yet, they are just thinking about punishing him. Which hasn't stopped him from rolling out a massive publicity campaign about how awful it is that he isn't above the law.

Also, I was confused by the apparent disparity between the half of my readers who think Cuba has great hospitals and the half who think they have terrible hospitals.

TheCSO had read up on it at one point and found that both groups are right.

Cuba does have great hospitals--for high-ranking members of the party and for rich tourists.

The regular folks have to go to crappy hospitals.

I did not know this, but it turns out Cuba is a major tourist destination for rich europeans and South Americans, just not Americans.

I can understand that Cuba's lack of research discoveries comes from dictator-imposed lack of contact with the outside world.

But as far as I know, my general point about socialized medicine, that it is dependent upon the Americans to actually cure diseases and discover new treatments, is still true.

If there are a bunch of discoveries coming out of France or Canada, I'm happy to be corrected, educate me.



Henry Louis Gomez said...

The embargo with Cuba isn't a boycott. It's a punishment for the unlawful expropriations of more than $1 billion in US assets (in 1960's dollars). In today's dollars it's more than $8 billion. The largest such expropriation in the history of the US. China and Vietnam have both settled their similar situations, something Cuba roundly refuses to do. So Cuba flouts the rules of international trade and we're expected to say "that's ok, no need to recognize that what you did was wrong, here have some more money."?

Only in the 90s, did the embargo become conditional on political change on the island. Every other country in the world is free to trade with Cuba and many have been since the early 90s and yet there's no change in Cuba. So for those that say that lowering the embargo will bring change, there's little evidence of that. That's because you can't do business with Cuban businessmen. There's no such thing. The only entity permitted to do business in Cuba, on behalf of Cuba, is the Cuban state. Hotel workers are paid by the state in Cuban pesos while the state charges the foreign companies in Euros or dollars. Very hard for any of the liberalizing aspects of trade to take root under such conditions.

As far as Cuban healthcare goes, it's nothing more than propaganda. In pre-castro Cuba, the health sector was quite advanced with a social safety net that included community hospitals and clinics, even in the rural areas. We can not assume that without castro that this system would not have improved. Just like we can't assume that literacy, which had improved from 20% at the time of independence to 80% at the time castro came to power just 60 years later, would not have continued improving without the "benefit" of the totalitarian dictatorship.

And you're right. Socializing medicine in the US would mean the end of American innovation in disease management. The US far and away is the biggest provider of innovative drugs in the world. A few western democracies also contribute but not much in the grand scheme of things.

In the US treatment is guaranteed. If you have an accident or a medical emergency, you will be treated. After they save your life you may owe a lot of money but that's a financial argument not a healthcare argument.

Michael Moore knew what the law was and he flouted it. He shouldn't be surprised or outraged that he got a letter from OFAC. That's standard operating procedure. He is using this as a promotion for his film because God knows he can afford to simply pay the fine and forget about it.

Anonymous said...

Most of the medical innovations and discoveries are not made by medical businesses, but by universities and medical schools.

Chalicechick said...

In France?
In Canada?
In Cuba?

If not, why not if socialized medicine is so great?


PG said...

I think the confusion arises from your focus on hospitals and especially on cutting edge care. Yes, the U.S. has the world's best healthcare system -- if you are wealthy. We are the most innovative in developing patentable devices and drugs, and probably in developing procedures as well (though given that the patents on these are practically un-usable, capitalism creates less of an incentive).

However, if you are a low-income woman without health insurance (like more than 40 million Americans) who needs prenatal care, you're probably better off in Cuba or another country with socialized medicine where basic care is guaranteed. henry gomez's comment about emergency care is nearly useless to such a woman; sure, if she calls 911 when she goes into labor, she can deliver in a hospital and have her premature infant stuck in an incubator, but all that would have prevented such an expensive outcome is not unobtainable for the uninsured. If gomez's vaunted emergency care would have provided for what Moore's tourists needed, I suppose they also could have called 911 and spent the rest of their lives battling debt -- medical debt being one of the most common reasons for bankruptcy, but now we're reformed *those* laws to make declaring bankruptcy more difficult.

I'd be interested in the CSO's sources on Cuba's having lousy general healthcare for middle and low income people. The perception of whether a hospital is "crappy" tends to be shaped by prior experience. If you're a wealthy American, you've generally been only in nice hospitals. When my dad had to be rushed to a Hong Kong hospital, my older sister described it as "crappy," but they did get him well enough to continue traveling.

Incidentally, in comparing the U.S. rate of medical "discoveries" to that of other nations, consider two factors:
1) discovery of underlying disease patterns, etc. versus discovery of patentable cures (the U.S. tends to lead in the 2nd, but obviously it's generally impossible without knowledge of the first, and indeed the rush to find something on which to make money sometimes leads people to under-research the actual health condition);
2) Americans' ability to self promote. There's a famous debate on who was first to discover the virus that causes AIDS -- a Frenchman or an American? It's generally accepted that the Frenchman was first, but the Reagan (ironic!) - Mitterand agreement was that the two would share credit.

PG said...

oops, that should be "is not obtainable for the uninsured."

Chalicechick said...

But Michael Moore IS wealthy.

And it's the patients he brought to Cuba that I'm talking about.

So I'm not sure that taking wealth out of the conversation is appropriate here.

As for the uninsured pregnant woman, she's eligible for medicaid and WIC and most states have programs well beyond those.

And Planned Parenthood has a sliding scale...


PG said...

Unless it was Michael Moore who was getting the Cuban health care, I don't understand how his personal wealth (which presumably allows him to have good health insurance) is relevant to the medical tourists he brought with him. You only get to share your good insurance if you marry or adopt someone. He could have paid out-of-pocket for each of those individuals to receive care, which would be incredibly expensive (the U.S. health care system's gives massive discounts to insurance companies, but the uninsured have to pay the MSRP). However, that's not the point he was trying to make with his documentary. It's perfectly reasonable to criticize Moore for not engaging in huge acts of monetary charity, but this criticism of him for saying that the uninsured might receive better care in Cuba doesn't make sense.

Planned Parenthood is not accessible to every American woman (my 29k population hometown, for example, doesn't have one and the nearest one is over 20 miles away). Even when PP does establish a location, it frequently faces strong attempts by the local community to drive it out, especially if it provides abortions.

Being pregnant doesn't make you automatically eligible for Medicaid -- your family income has to be below 133% of the federal poverty line (i.e. less than $13,580 for a single woman, so if she makes $7 an hour, 40 hours a week, 50 weeks a year, she's too wealthy). Free clinics encounter plenty of people of this sort. There's also those who are below the poverty line but whose immigration status renders them ineligible, which is a lot of what my sister sees working in hospital administration in Houston.