National Review

July 30 , 2007 The Myth of Cuban Health Care

Michael Moore gives it a powerful boost

M ICHAEL MOORE has made another piece of pure propaganda. This film, called Sicko, attacks the American health-care system. You will agree that there is a lot to attack. But Moore glorifies socialist systems, which have problems all their own. And perhaps his worst offense is to glorify Fidel Castros system, as has been done endlessly for as long as most people can remember.

Moore hit on an inspired idea: He took a group of sick Americans to Cuba, to seek health care. Not only are these unfortunate people Americans: They are 9/11 rescue workers, heroes. They have been denied the care they need in America (or so the film alleges), and must get it elsewhere.

As the group is heading to Havana, we hear a song: Im on my way to Cuba . . . where all is happy; Cuba, where all is gay. And it appears exactly this way in Moores film. You may remember that, in his previous film, Fahrenheit 9/11, Saddam Husseins Iraq was portrayed as a nation of happy kite-fliers. The same artistry is applied to Sicko.

The Left has always had a deep psychological need to believe in the myth of Cuban health care. On that island, as everywhere else, Communism has turned out to be a disaster: economic, physical, and moral. Not only have persecution, torture, and murder been routine, there is nothing material to show for it. The Leninist rationalization was, You have to break some eggs to make an omelet. Orwell memorably replied, Wheres the omelet? There is never an omelet.

But Castros apologists have tried to create one. Their hopes rest on three lies, principally: that Castro cares for the sick; that he is responsible for almost universal literacy; and that he has been a boon to blacks. Castroite propaganda has been extraordinarily effective, reaching even to people who should know better. Among the most disgraceful words ever uttered by a secretary of state were uttered by Colin Powell in 2001, when he said, Hes done some good things for his people. The he, of course, was Cubas dictator.

It was hard to know which was worse: the his people, which is certainly how Castro thinks of Cubans. Or the imagined omelet, the good things.

The myth of Cuban health care has been debunked in article after article, for the last several decades. (Remember that Castro took power in 1959.) But Michael Moore has given the myth fresh legs, necessitating another round of such articles. If I had a nickel for every article Ive read entitled The Myth of Cuban Health Care . . . But here is another one.

SEPARATE AND UNEQUAL

To be sure, there is excellent health care on Cuba  just not for ordinary Cubans. Dr. Jaime Suchlicki of the University of Miamis Institute for Cuban and Cuban-American Studies explains that there is not just one system, or even two: There are three. The first is for foreigners who come to Cuba specifically for medical care. This is known as medical tourism. The tourists pay in hard currency, which provides oxygen to the regime. And the facilities in which they are treated are First World: clean, well supplied, state-of-the-art.

The foreigners-only facilities do a big business in what you might call vanity treatments: Botox, liposuction, and breast implants. Remember, too, that there are many separate, or segregated, facilities on Cuba. People speak of tourism apartheid. For example, there are separate hotels, separate beaches, separate restaurants  separate everything. As you can well imagine, this causes widespread resentment in the general population.

The second health-care system is for Cuban elites  the Party, the military, official artists and writers, and so on. In the Soviet Union, these people were called the nomenklatura. And their system, like the one for medical tourists, is top-notch.

Then there is the real Cuban system, the one that ordinary people must use  and it is wretched. Testimony and documentation on the subject are vast. Hospitals and clinics are crumbling. Conditions are so unsanitary, patients may be better off at home, whatever home is. If they do have to go to the hospital, they must bring their own bedsheets, soap, towels, food, light bulbs  even toilet paper. And basic medications are scarce. In Sicko, even sophisticated medications are plentiful and cheap. In the real Cuba, finding an aspirin can be a chore. And an antibiotic will fetch a fortune on the black market.

A nurse spoke to Isabel Vincent of Canadas National Post. We have nothing, said the nurse. 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.

The equipment that doctors have to work with is either antiquated or nonexistent. Doctors have been known to reuse latex gloves  there is no choice. When they travel to the island, on errands of mercy, American doctors make sure to take as much equipment and as many supplies as they can carry. One told the Associated Press, The [Cuban] doctors are pretty well trained, but they have nothing to work with. Its like operating with knives and spoons.

And doctors are not necessarily privileged citizens in Cuba. A doctor in exile told the Miami Herald that, in 2003, he earned what most doctors did: 575 pesos a month, or about 25 dollars. He had to sell pork out of his home to get by. And the chief of medical services for the whole of the Cuban military had to rent out his car as a taxi on weekends. Everyone tries to survive, he explained. (Of course, you can call a Cuban with a car privileged, whatever he does with it.)

So deplorable is the state of health care in Cuba that old-fashioned diseases are back with a vengeance. These include tuberculosis, leprosy, and typhoid fever. And dengue, another fever, is a particular menace. Indeed, an exiled doctor named Dessy Mendoza Rivero  a former political prisoner and a spectacularly brave man  wrote a book called ¡Dengue! La Epidemia Secreta de Fidel Castro.

INFANT MORTALITY

When Castro seized power, almost 50 years ago, Cuba was one of the most advanced countries in Latin America. Its infant-mortality rate was the 13th-lowest in all the world, ahead of even France, Belgium, and West Germany. Statistics in Castros Cuba are hard to come by, because honest statistics in any totalitarian society are hard to come by. Some kind of accounting is possible, however: Cuba has slipped in infant mortality, as it has in every other area (except repression). But its infant-mortality rate remains respectable.

You might suspect a story behind this respectability  and you are right. The regime is very keen on keeping infant mortality down, knowing that the world looks to this statistic as an indicator of the general health of a country. Cuban doctors are instructed to pay particular attention to prenatal and infant care. A womans pregnancy is closely monitored. (The regime manages to make the necessary equipment available.) And if there is any sign of abnormality, any reason for concern  the pregnancy is interrupted. That is the going euphemism for abortion. The abortion rate in Cuba is sky-high, perversely keeping the infant-mortality rate down.

Many doctors, of course, recoil at this state of affairs. And there is much doctor dissidence on the island. Some physicians have opened their own clinics, caring for the poor and desperate according to medical standards, not according to ideology or governmental dictates. The authorities have warned that, in the words of one report, new dissidences in the public-health sector will not be tolerated. Anyone trying to work outside of approved channels is labeled a counterrevolutionary or enemy agent.

Furthermore, the shortage of doctors on the island is acute  which is strange, because there are abundant Cuban doctors. Where are they? Theyre abroad. In fact, a standard joke is that, in order to see a Cuban doctor, a Cuban must contrive to leave the island.

In his film, Michael Moore speaks of the generosity of Castros health programs. What he means, in part, is that Castro has long sent doctors overseas on humanitarian medical missions. These missions are an important part of the dictators self-image, and of his image at large. Cuban doctors go to such revolutionary countries as Chávezs Venezuela, Moraless Bolivia, and Mugabes Zimbabwe. The missions are lucrative for Castro, bringing him about $2.5 billion a year.

Yet they are somewhat risky for him, too. The Cubans abroad are vigilantly watched, and the regime seldom sends unmarried doctors: They want wives and families back home, as hostages. Still, the Cuban doctors defect, and do so by the hundreds. They make a run for it in every country in which they serve, in any way they can. For example, doctors in Venezuela flee into Colombia; others try a friendly embassy, or start yelling in some international airport, during a transfer. Many of the doctors stories are heart-stoppingly dramatic. And when they have secured asylum, they tell the truth, about Cuban medicine both at home and abroad.

One of the things that sicken them, about their foreign service, is that they see what Cuba can provide: in equipment, in medications, in personnel. And yet this bounty is not available to Cubans (ordinary Cubans). It is sold to foreigners, to keep Castros regime in business.

And this brings up a point concerning Castros apologists: If they must concede that Cuban health care is a shambles, their fallback position is that its all the fault of the American embargo. And yet Cuba has no problem taking care of people in other countries, for show and profit. Moreover, American trade with Cuba in medical goods is virtually unfettered, and American humanitar¬ian aid is considerable.

THE PRESENCE OF HEROES

Above, I spoke of doctor dissidence  and a particularly painful aspect of Moore-like myth-making is that some of the most courageous, most admirable, and most persecuted people on the island are doctors: men and women who have rebelled against health-care injustices and injustices in general. Oscar Elías Biscet is possibly the most noted of such people. He is in one of Castros most wretched dungeons. Michael Moore would not even think of taking his cameras to it (and, in any case, he would not be allowed).

Biscet, like so many of the human-rights figures, happens to be Afro-Cuban. And, as Mary Anastasia OGrady of the Wall Street Journal has pointed out, the regime is especially vicious toward such figures, because they are supposed to be grateful for all the Revolution has done for them. Dr. Mendoza, who wrote about dengue, is also Afro-Cuban. So is Dr. Dariel Darsi Ferrer.

He has managed to stay out of prison, somewhat miraculously  perhaps because there has been a fair amount of international attention on him. Ferrer operates the Center for Health and Human Rights. In 2005, he penned a statement called Health Authorities and the Complicity of Silence. Though he has avoided prison, the regime has subjected him to terrible abuses, including actos de repudio, or acts of repudiation. These are those lovely episodes in which mobs are unleashed on your home, family, and friends.

Hilda Molina Morejón is another doctor-dissident  a stunning case. She was the countrys chief neurosurgeon, the founder of the International Center for Neurological Restoration. She was also a deputy in the National Assembly. In the early 1990s, however, the regime informed her that the neurological center would start concentrating on foreigners, who would bring their hard currency. She objected, resigning her positions and returning the medals that Castro had awarded her. Then came actos de repudio and all the rest of it (but not prison). She has been forbidden to leave the island, and is banned from practicing medicine. She manages, despite the circumstances, to speak out.

Live not by lies! said Solzhenitsyn. Live not by lies! And yet Cuban Communism and its enablers have lived by them for a half-century. Totalitarians always depend on these lies. Robert Conquest, the great scholar of the Soviet Union, remembers a health official telling him, in private, that many hospitals lacked even running water. Yet public assertions were much different. And there have always been Potemkin-style visits, such as Moores. He is simply more talented than most of the others.

Once Communism collapses in Cuba  or if it does  will there be a reckoning? When I was growing up, East Germany was presented to me, by misguided teachers and professors, as a fine social democracy. Earlier this year, a movie called The Lives of Others won an Academy Award. It told some of the truth about East Germany. What will future generations make of Sicko, particularly its portrait of Cuba?

In the meantime, the movie will do a lot of harm, cementing the myth of Cuban health care, among other myths. Castros health minister, José Ramón Balaguer, is well pleased. Theres no doubt that a documentary by someone of Michael Moores stature will help the world see the deeply humane principles of Cuban society, he said. You wonder, sometimes  in the face of constant and powerful myth-making  whether articles in magazines, and the daring and anguished testimonies of Hilda Molina et al., and the cries of an entire society, can make a dent.

I have an indelible memory, from the mid-1980s. Armando Valladares was at Harvard, speaking to students. He had emerged from 22 years in the Cuban gulag, and had written the memoir Against All Hope. (Valladares is often called the Cuban Sol¬zhenitsyn.) In the Q&A, the kids spouted at him the usual line about Cuba: health care, literacy, and blacks. They had been carefully taught it by their teachers. And Valladares answered, in essence, Its all untrue  a pack of lies. But even if it were true: Cant a country have those things without dictatorship, without tyranny, without gulags, without torture  with freedom?

There is no omelet. There never is. But even if there were  so what?