On Cuban Health Care

There have been a few posts here about Michael Moore’s movie Sicko, and those posts eventually get to a discussion of the Cuban health care system. Since it is very likely I’m the only person posting the SDMB who has experience the Cuban health care system first hand I figured I’d come in here and give my experiences.

First of all let’s get this out of the way, the Cuban health care system used to be good. Not great, but good. Until about 1990 there were clinics everywhere, where you could walk in and get seen by a doctor, not every place had the best diagnostics, so sometimes a visit to the doctor meant travelling between several hospitals and clinics, in one place you would get and x-ray, in the next you would get a blood test and so on. Once you were diagnosed, chances were you could get the medicine you needed at a local pharmacy, no charge just like the doctor visit. If your condition required some other kind of treatment, you might have to get yourself to Havana, or if the drug was not available in Cuba a friend or a relative living abroad would have to get it for you.

That was the system back then, like I said, not great, just good.

Sometime in the late 1980’s the Cuban government started to send doctors overseas as a way to get cash. The government had always sent doctors overseas in humanitarian missions, but in the late 1980’s the government started charging for the doctors services. I have two relatives that worked in this capacity in Nicaragua. At about this time local clinics all over the island started to close because of lack of doctors. You could still get seen by a doctor but now you might have to travel to the city or town hospital.

Then the USSR fell and things got really bad. Where before you could get care somewhere in the island, suddenly there were no doctors in the hospitals and there was nothing in the local pharmacies. There were medicines available in Havana in what were then called diplo-tiendas, for foreign diplomats where only dollars were accepted. Right about then Cuban started to develop tourism, including medical tourism, and some previously public hospital became for foreigners only. Any kind of advanced treatment, like chemotherapy was not available. If you needed any kind of medicine, including aspirin it had to be sent by friends or relatives from overseas. During this time in my hometown hospital there was a riot when doctors refused to operate on a local boy until the family paid in cash for the gloves and sutures they would use.

It was also during this time that many people all over the island started suffering from severe vitamin deficiencies and some maladies associated with that, including blindness and death. Eventually there was an actual demonstration in Havana which forced the government to distribute vitamin supplements throughout the island.

Since then things have improved, especially in the big cities like Havana, Holguin, and Santiago de Cuba. Many medicines and treatments that had dissappeared are again available. Most local clinics that closed never opened again, and many Cubans must travel to a hospital to see a doctor. If you’re familiar with the Cuban transportation system then you know that this puts health care almost out of reach for a lot of Cubans. Today I would say that the Cuban health care system is somewhere in between the heights of the 1980’s and the lows of the early 1990’s. So if it was good in the 1980’s and awful in the 1990’s then today I can call the system so-so.

Even during the best years of Cuban health care there had been two systems, one for everyday people and one for government officials. A third one exists now, it is for cash paying foreigners, this one is not available to Cubans even if they have hard currency.

I said a little earlier that you could see a doctor and get medicines free of charge. In fact Cubans pay for every bit of their health care, not only do all Cubans work for the government, which caps the salaries of all Cubans at about $20 a month, (one exception is police officers who can make twice that), but Cubans also pay taxes. Any Cuban who rents their home for tourists, or runs a restaurant, or sells trinkets in the street must pay both an occupational license and a monthly tax on their operation, even if they had no business transactions during that month.

For those who point to Cuba’s current health care system as a mitigating factor in favor of the Castro regime I would say why must it be freedom or health care? Why can’t both be available? Canada does it.

Not merely Canada, but Germany, the UK, Japan, Norway, Sweden, the Netherlands, and every other developed nation. Sure, some of them have flaws – they’re run by human beings – but they all have freedom AND health care.

The bottom line question, seems to me, is how you view health care:

  • If you view it as a commodity, to be bought and sold, then you want minimal or no government intervention.
  • If you view it as a service – like the police or fire department or streets – to be used by everyone and paid for by everyone through taxes, then a “socialized” system is the way to go. (I note that those who fear “socializing” anything never bother to suggest that we allow the police departments to be run on a free-enterprise, for-profit basis. So why is it OK for medicine?)

Did you see Sicko? Because Moore makes that exact point.

The problem with at least part of that analogy is that I don’t view the police department as a service. I view them as the enforcement arm of the government. That is a very different matter.

Pretty much everyone recognizes that government needs to have a monopoly on force (OK, everyone except anarchists). Plus, one of the basic functions of government is to administer justice. You need a police force to do that.

As far as privatizing fire departments, I don’t think that would be an awful idea. You pay the company to provide fire protection. I think the rationale to have this provided by government is that in some areas if one house catches fire then that could threaten a neighbor’s house, thus your lack of fire protection would also destroy your neighbor’s property.

There is no reason to give government control of health care, however. In fact, many reasons why health care is so screwed up in this country is because of government meddling in the system through regulation, tax incentives, and government-run health care programs like Medicaid and Medicare.

Correction: They have SOME freedom. They traded some of it away for their universal health care. Here in Canada, I do not have the freedom to pay extra for better service. I do not have the freedom to choose the treatment I want. The doctor does not have the freedom to set his own price for his services.

There was recently a case in Canada in which the supreme court ruled that the Canadian health care system was violating the basic human rights of a patient for making the patient wait excessively long for treatment while refusing to allow the patient the choice of buying the treatment on the market.

In the British NHS, doctors have a scorecard they use to determine who gets treated at all. If you don’t make the list, you get no treatment, and you die or keep your condition for the rest of your life. That’s not freedom.

What a strange choice of categories. First of all, you’re using ‘commodity’ and service’ incorrectly - apparently because they’re loaded terms. You can buy services on the free market, and governments can provide commodities.

What you should have said is that you either see it as being private, where some free people choose to offer health care and other people negotiate with them to purchase it, or you see it as part of the commons, to be managed by the state for all.

There’s an essential difference between the things you mentioned (streets, firefighters, police) and health care. In the case of streets and firefighters, there is a market failure that has prevented private industry from taking care of the problem (free rider problems, technical problems in assigning cost, risks to 3rd parties when neighbors go uncovered for fire, or inherent monopoly problems that arise when a private entity controls the only means of transportation). In the case of the police, even libertarians recognize that a proper function of government (the MAIN function of government) is to be the sole wielder of the right to use force to compel behaviour. Therefore the police must be in the public sphere and ultimately answerable to the voters.

Well, even recognizing the need for the police to be run by government, I hope you’re not holding them up as a model of efficiency or fair-handedness. We accept the government control of police forces despite the knowledge that they’ll be run inefficiently, not because we think governments are somehow better able to run a police force efficiently than is the private market.

In the case of health care, there is room for the government to address a real problem - a market failure due to information asymmetry in health insurance. It’s the fundamental problem that has driven the insurance industry into a model that generally requires group coverage through employers and risk-sharing and cost control through HMOs, plus the heavy paperwork load required to justify claims.

Government solutions should seek to fix that problem, while leaving as much of the health care industry free as possible.


Private practices still exist in the UK. Don’t extrapolate from Canada to the rest of the developed world.

That’s why I said “here in Canada”. But any system that is partially socialized trades some freedom for improved access, even if the loss of freedom comes in the form of mandatory taxes instead of voluntary payments.

You didn’t provide a cite supporting your claim about the NHS.

When we’re talking about improved access to health care for all, that’s not really a major bind.

My MILs brothers both live in England. Both of them refuse to use NHS, and pay for private care.