For Cubans, a bitter pill

[Canadian] National Post, July 7, 2004

(Even as Cuba is abandoned by long-time allies for its human rights violations, Canada continues to display affection for Fidel Castro’s one-man state. In the second of a three-part series, Isabel Vincent explores the myth of of the Caribbean nation’s health care system.)

by Isabel Vincent

MORON, Cuba – In this historic town of 70,000 people in central Cuba, a small bottle of tetracycline costs US$5 and a tube of cortisone cream will set you back as much as US$25.
But neither are available at the local pharmacy, which is neat and spotless, but stocks almost nothing. Even the most common pharmaceutical items, such as Aspirin and rubbing alcohol, are conspicuously absent. In their place there is a neat display of green boxes of herbal diet teas from Spain.

One of the myths Canadians harbour about Cuba is that its people may be poor and living under a repressive government, but they have access to quality health and education facilities. It’s a portrait encouraged by the government, but the reality is sharply different.

Antibiotics, one of the most valuable commodities on the cash-strapped Communist island, are in extremely short supply and available only on the black market. Aspirin can be purchased only at government-run dollar stores, which carry common medications at a huge markup in U.S. dollars. This puts them out of reach of most Cubans, who are paid little and in pesos. Their average wage is 300 pesos per month, about $12. [...]

Still, the residents of Moron are luckier than most Cubans because many of them work in the nearby resorts, where they often receive foreign medications as tips.

“We know how difficult life is here, so when we come for a vacation, we always bring a few bottles of antibiotics and Tylenol,” says Laura, a housewife from Oakville, Ont., who was recently vacationing at a large resort in nearby Cayo Coco.

A 72-year-old pensioner from Toronto who did not want to be identified also said she had arrived for her recent vacation well- stocked with tubes of antibiotic cream, Aspirin, decongestants and bandages.

“My doctor in Toronto told me that there is nothing available in Cuba, so I came prepared just in case I needed any of these things for myself,” she said. “But I am leaving most of what I brought for the maids and the bartender.”

For years, supporters of the Communist regime of Fidel Castro have praised the island’s universal health care system as a model for the developing world. Indeed, Cuba has the world’s highest concentration of physicians and health care is free. “If you need the most complicated operation, you can get it at a Cuban hospital,” [a local pharmacist] said. “But medicines are the problem.” [...]

[H]ospitals are falling apart, surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays.

The situation is so bad that a Canadian pro-Castro group urges tourists in a recent issue of its monthly newsletter to take “a suitcase full of medical supplies to drop off at a local clinic or hospital with a letter about humanitarian aid.” [...]

[T]ourist hospitals in Cuba are well-stocked with the latest equipment and imported medicines, said a Cuban pediatrician, who did not want to be identified. [...] “Tourists have everything they need,” said the pediatrician, who spoke on the condition he would not be identified in any way. “But for Cubans, it’s different. Unless you work with tourists or have a relative in Miami sending you money, you will not be able to get what you need if you are sick in Cuba. As a doctor, I find it disgusting.” [...]

These days, officials in the Castro government say they rely on money earned from joint-venture operations on the island with foreign companies to finance the universal public health system. Cuban workers contracted for joint venture operations are paid indirectly. The Cuban government receives about US$450 per worker per month from the foreign company. While the worker typically makes 5% of this total amount –in pesos– the government directs most of the foreign currency earned in this scheme to pay for its social services, including health care for ordinary Cubans. [...]

[W]orld labour regulatory bodies such as the International Labour Organization have condemned the practice, in which the Cuban government essentially pockets 95% of a worker’s wages. “There is absolutely nothing free about Cuban health care and other social services,” says Ismael Sambra, president of the Cuban-Canadian Foundation. “Social services are financed from the sweat of the poor Cuban workers.” [...]

But for most Cubans, the question of who is financing health care is rather academic. “We have nothing,” said Jasmin, a nurse who lives in Moron. “I haven’t seen Aspirin in a Cuban store here for more than a year. If you have any pills in your purse, I’ll take them. Even if they have passed their expiry date.”

##########

This basic information about the Cuban healthcare system was obtained in A MERE TEN MINUTES of web-searching. Is there really any excuse for being so ill-informed as to believe that Cuban medical care should be held out as an example of anything but the total incompetence, brutal callousness and extreme dysfunction of Cuban leadership ?

At current oil prices, that’s $ 7 trillion worth of production that would benefit the American economy, not overseas producers. Calling that an “insignificant difference” is CRAZY – and that’s putting it mildly.

Master of foresight that he always was, Reagan removed Carter’s solar collectors from the White House and rolled back the CAFE fleet mileage standards, because that oil was going to last forever.

Reagan was right about that for TWENTY-SEVEN YEARS, which is a full generation. That indeed makes him a Master of Foresight, especially among politicians. Further, he was right about how to bring down the late, unlamented Soviet Union.

And global climate instability? Ha!

Since nobody was talking about that until six years after Reagan left office, and indeed at the time Reagan was elected the prevailing fear was of a new ICE AGE, to knock Reagan for not being a Global Warming Cultist is both petty and irrational.

Reagan’s administration also transformed the U.S. from the world’s largest creditor nation to its largest debtor, and transformed the inherited trade surplus into a trade deficit.

The U.S. is not the world’s largest debtor, except in the most crude, basic, and therefore misleading sense. As Thomas Sowell has written, “Donald Trump probably has a bigger debt than I do — and less reason to worry about it. Debt means nothing unless you compare it to your income or wealth.”

As a percentage of GDP, Spain, Italy and Japan are all more indebted than are the U.S. – and all are also going to have far lower economic growth than will the U.S. over the next few decades. Relative demographics guarantee that.

As for the trade-surplus-to-debt… That’s the fault of American consumers and workers. Are you going to take the average American to task for wanting high pay, (which prices American goods out of reach for most of the world), and low-cost goods, (lately mostly produced by Asia) ?

And when you get done upbraiding the American for wanting to be well-paid and yet not wanting to pay a lot for consumer goods, will you then castigate the Chinese, Vietnamese, South Korean, etc., for bettering their lot by meeting a demand ?

A person who would do that is at best a self-centered, selfish scold.

[Reagan's] is the administration that also created the worst political and financial scandal in U.S. history — the S&L bailout.

The S&L debacle was indeed a horrible political and financial scandal, but let us not forget that it originated in THE U.S. CONGRESS, and so again, blaming it on Reagan is both petty and irrational. Further, calling it “the worst political and financial scandal in U.S. history” demonstrates a lack of knowledge about U.S. history.

Why on earth is the U.S. continuing to build sprawl, a development style that literally sets long commutes and a high demand for petroleum in concrete — even though the market clearly prefers the pedestrian-friendly, mixed-use alternative? Ya got me, pilgrim.

Maybe because the market clearly doesn’t prefer urban living over suburban.

But, if you’re completely convinced that Americans long to live where they can walk to everything they need, then now is an EXCELLENT opportunity to snap up downtown condos almost everywhere for a song. You’ll make a killing !!!!!
(Not).

From 1990 – 94, Cuban GNP declined 34% [but Cuba] continued to supply free education and medical care to an extremely stressed population.

A) There’s rarely such a thing as “free”. For instance, in America, students at public schools don’t pay a per-head fee, and so it is “free” to them, but anybody who owns or rents housing is paying part of the cost of educating the students.

In Cuba, the cost of educating students is similarly borne by the extremely stressed Cuban population. The resources to do so don’t just fall from the sky.

B) In the Cuba of the 90s, “free” medical care DIDN’T INCLUDE MOST DRUGS, which not only had to be paid for, but COULD NOT BE PURCHASED USING CUBAN PESOS, which tells a thinking person everything they need to know about the Cuban medical system and Cuba in general.

Bad Cuban Medicine :

“Begging for medicines is common in Havana – next to begging for money to feed children, it is the most common plea…

“Cubans with access to dollars – typically those in the tourist industry who receive tips in dollars – can obtain the drugs they need. Others have relatives in the United States who can ship them. The rest – middle class Cubans included – must resort to begging, the black market or, increasingly, to prostitution.

“Cuba is renowned for having a universal health-care system and, in fact, doctors are plentiful and doctor visits are free. But without access to antibiotics, insulin, heart drugs and other life-saving medicines, doctors cannot perform their duties. Too often, for lack of medicine, doctors have no choice but to amputate limbs, or to put patients through painful therapies without painkillers. In one celebrated case, Dr. Hilda Molina, the founder of Havana’s International Center for Neurological Restoration, returned the medals that Fidel Castro had awarded her for her work and resigned in protest, outraged that Cubans were denied critical care…”

Like the peak oil comments above, supporting Hubbert’s “theory.” The US is almost the only place in the entire world where exploration has been extensive enough to apply the King’s ideas.

“Peak oil” in Saudi Arabia, for example, is due to poor production and maintenance practises and limited exploration, combined with the desire of the royal family to preserve the wealth for more generations–in lieu of any plans to develop a real economy in the kingdom.

As Sallie discusses, it is a problem for a democracy–particularly one less constrained by constitutional rules than in the past–to have such a large and growing share of residents not paying any tax because these folks are unconstrained in campaigning for more benefits for themselves at the expense of others.

This is incredibly important, because it is the exact problem of your utopian vision outlined above: once the state takes over, which you fully endorse, you can’t go back.

But that’s entirely unimportant to you, because you think you’re just being a reasonable, responsible, and intelligent citizen, when in fact you know absolutely nothing about economics and liberty.

You are the cause of the very problems you seek to eliminate.

But you won’t, because you are stupid.

Yoshi, most of your statements are economic crap, culled from incredibly ignorant left-wing blogs. I recommend from commenting about matters economic henceforth.

Aren’t you late for your monthly Leo DiCaprio fan club meeting or something?

I am not here to get you to agree with me, or anybody else; I’m here to correct your numerous economic misconceptions and factual misstatements, of which you have very many.

The high marginal rates of the 1950′s (with a 92% top bracket) coexisted with the best GDP growth. The lower rates of recent decades have seen less growth.

This is an incredibly stupid statement. What do you mean by “best?” That is economically meaningless. The 1940′s and 50′s saw dramatic percentage gains in GDP, due to factors such as postwar private sector recovery, demographics, and a variety of other factors (such as size of government, which was not nearly as large as it currently is, though the New Deal had expanded it significantly).

It had little or nothing to do with high tax rates, which actually hindered growth, robust though it was. And as we saw during the Carter years, nobody paid those taxes, with enormous loopholes and catches built into the tax code.

See here.

Leaving aside for the moment that income tax “progressivity” is somehow desirable, you state

The average tax burden for most people has risen as, in the name of fostering “growth,” taxes have grown less progressive in the U.S.

Wrong. Also see here,

There are so many problems with you arguments that is just don’t have time to go through each and every point. So, I’ll just stick one. You said:

“The bankruptcy of this theory of lower-progressive-tax-induced growth is amply demonstrated by the fact that the theory has worked exactly backwards in practice. The high marginal rates of the 1950′s (with a 92% top bracket) coexisted with the best GDP growth. The lower rates of recent decades have seen less growth. Q.E.D.”

Here is a question about a your high progressive tax, lets say if you work the last day of week you could earn another $300. This will get taxed at the 92% rate. So your take home on the $300 is $24. What would you do if something broke in your house that needed to be fixed right away, and you were capable of fixing it? Stay home and fix it your self and for go you $24 income? Or get someone to come in to fix it for $50 and bring home your $24, a net loss of $26 on the day. This would have a huge effect on the economy.

It’s been awhile since I’ve study GDP numbers, so I might be a little off on this. But if I remember correctly, the service industry numbers are under estimated in the calculation of GDP. The service industry has probably been the fastest growing industry since the 1950’s as machines have started to replace people in the work place. So, your GDP growth comparison is useless.

Sorry Econoguy, no comprendez. I didn’t mention China. How is this germane?

Incidentally, this is fairly typical for several replies I’ve read on this blog, too – an unsupported statement or invective followed by irrelevancies unconnected to the previous discussion. I’m just as bad as the next guy at following the thread of reasoning, so I won’t complain too loudly, but y’all really need to read what I wrote, not what the voices in your head are saying if we’re going to have a conversation.

Then Mesa Econoguy says “Germany’s per capita oil consumption has little to do with economic competitiveness, especially since Germany’s economy is approximately 1/5th the size of the US, and geographic size is slightly smaller than Montana. Bad comparison.”

Again, Econoguy, it’s not controversial that all of Europe (and Japan) use half the energy the U.S. does per dollar of GDP. Confining this observation to a single economy or country isn’t really germane, IMHO. If you’ve got some other point to make — besides agreeing that the U.S. is a high-energy-use economy that subsidizes petroleum use orders of magnitude more than it does renewables or things like transit — then you’ve got to clarify before I’ll be able to get it.

Mesa Econoguy says: “Massively subsidizing economically nonviable sources (wind, solar, etc.) forcing adoption results in massive inefficiencies and competitive disadvantages. Dumb idea.”

But is that dumber than the orders-of-magnitude bigger subsidies for petroleum? Straining at a gnat, swallowing a camel is what I’d call this kind of comment. And subsides = inefficiencies in both our worlds, I’d say.

Incidentally, I won’t disagree that wind, solar, etc. are not going to have as high a rate of return as petroleum (energy returned on energy invested, or EROEI actually). That’s a no-brainer, but doesn’t make renewable energy nonviable.

Or do you say an infant is “non-viable” because he can’t run a decathlon or get one of the really well-paid jobs?

Oil has the highest EROEI, without a doubt. It stores the solar energy of millenia, so how could solar for a day or a year be comparable? The real question is not “Why is solar so expensive?” It’s “Why is oil so cheap?”

The motivation to try something that might be less-than-optimum in the short term is that the oil, or at least the cheap oil, is running out. Google “peak oil” if you don’t believe me. — and the sun and wind aren’t running out.

Should we have the foresight to build the infrastructure alternative that takes advantage of energy that won’t run out before the high-short-term-return one that is running out runs out?

And should we send our children out to work in the coal mines because they’re not pulling their own weight either? Unreasonable expectations lead to that kind of conclusion.

Reasonable people can disagree about how soon their kids should get jobs, what to fund and how much renewable energy we’ll need, and how much to encourage conservation. But dismissing all such impulses as “garbage economics” seems extreme, if not extremely short-sighted, to put it mildly.

Econoguy again: “Many (most?) countries (including Germany) exploring alternatives to oil are hopelessly mired in high-tax, high-intervention economically burdensome socialist policies putting them at serious economic disadvantage.”

Of course, and those not exploiting child labor are at (at least) a (temporary) disadvantage because they don’t have as much labor at their disposal as those who sanction child labor. Again, this is a fairly short-sighted remark.

Public policies (governments) can, and have made important contributions to new discoveries. Oh I know Rush Limbaugh claims only individuals can innovate, but ask him where nuclear energy would be without the Manhattan project, or the internet without DARPA, or semiconductors without NASA, or the 30-year mortgage without FHA, to name a few.

Incidentally, the high tax, etc. German state you criticize was put together that way with the consent of the governed when last I checked. Is that not OK? On a smaller scale, could a neighborhood pool its resources and buy a swimming pool, or does everybody have to build their own?

IMHO, the difference between the Europeans’ willingness to put up with a relatively high tax burden, and the intolerance for that idea expressed repeatedly on this blog, is twofold: 1) Europeans understand that building a public or neighborhood pool is orders of magnitude cheaper than making everyone own a private one (and probably more fun for the kids to play in), and 2) the Europeans see and appreciate real personal good coming from collective action, rather than the toxic waste that the “conservative” U.S. administrations of the last 30 years have made.

Actually “toxic waste” is not an accurate description. The average tax burden for most people has risen as, in the name of fostering “growth,” taxes have grown less progressive in the U.S. Successive administrations, with the exception of Clinton’s, have lowered the top income tax brackets while increasing the payroll tax fourfold. Something like this occurred in Europe too, BTW, but less dramatically.

The bankruptcy of this theory of lower-progressive-tax-induced growth is amply demonstrated by the fact that the theory has worked exactly backwards in practice. The high marginal rates of the 1950′s (with a 92% top bracket) coexisted with the best GDP growth. The lower rates of recent decades have seen less growth. Q.E.D.

Anyway, when people see public policy distorted to favor a few (while median income has stagnated for the last three decades in the U.S., the top .01% of income earners have seen their incomes increase 400% plus) they aren’t likely to look kindly on government that is robbing poor Peter to pay rich Paul. This observation isn’t my exclusive property. Read David Cay Johnston’s “Free Lunch” for many more such tales of woe.

Anyway, if the Germans see high taxes bringing benefit to their public realm, then that’s their right, isn’t it? Or will you compel everyone to adopt your point of view, Econoguy?

Econoguy writes:”Also, from the first post, the trade deficit is not a [meaningful] deficit.”

Wow, a naked, unsupported assertion that has no connection to facts or footnotes, or, as far as I can tell, meaning. Quelle surprise!

OK, that was just rude. What I really need to say is this: Econoguy, if you want me to even have the possibility of agreeing with you, you’re going to have to explain this further.

Econoguy: “One correct point: the influence of “speculation” on oil prices is highly overblown.”

Nice! See, we’re not that far apart after all!

I just stopped reading about there. It’s foolproof to say that you know nothing about what’s going on.

In 1998, oil was at 7-9$. Now, 140$. Divide 140 by four and see if you get 9$, you dolt.