When Fidel Castro died last week many on the political left embarrassed themselves by praising the despot. A prime example is Canadian Prime Minister Justin Trudeau who was excoriated for saying that Castro was a “legendary revolutionary and orator” who made “significant improvements” to the healthcare system of his country.

There are few modern myths the have been debunked as frequently yet have been accepted as incredulously as the idea that Cuba has a superior (or even adequate) health care system. Articles have been written since the 1960s debunking the nonsensical claims about health care in Cuba and yet it is invariably the issue that is trotted out to show how socialism can actually be effective.

Although adding one more article to the pile probably won’t make a difference, it can’t hurt to be prepared with arguments in case you’re cornered by a Castro apologist like PM Trudeau. Here are six facts that reveal the truth about the Cuban health care system:

1. Cuban hospitals are a horror show

Michael Moore, the world’s most gullible leftist filmmaker, took a trip to Cuba in 2007 to show Americans what they were missing by not having “free” national health care. In his documentary, SiCKO, Moore takes three New York rescue workers injured in the September 11 attacks to Cuba for treatment.

The Castro brothers, communism’s last great master propagandists, played Moore for a fool. As the news agency Reuters wrote in an article titled, “SiCKO patients got VIP treatment in Cuba”: “The 9/11 responders spent 10 days on the 19th floor of Cuba’s flagship hospital with a view of the Caribbean sea, a sharp contrast to many Cuban hospitals that are crumbling, badly lit, and which lack equipment and medicines.”

Most Americans wouldn’t even take their family pets, much less a family member, to be treated in the hospitals the average Cuban has to endure. Take a look at these videos to get a glimpse of what Cuban hospitals are really like:



2. Cubans endure extreme inequality of healthcare

In George Orwell’s dystopian masterpiece Animal Farm the idea that “all animals are equal” is soon changed to “All animals are equal, but some animals are more equal than others.” That’s also true of the Cuban health care system.

In Cuba, there are three tiers: One for foreigners who can pay with hard currency, one for Cuban elites (government officials, celebrities, etc.), and one for the common people. A primary selling point of socialism is that everyone is treated equally regardless of class or ability to pay. But in reality socialism keeps the inequality of capitalist systems and merely spreads the misery to more people.

3. Cuban doctors are woefully underpaid

In America doctors are well compensated for their years of training and experience. Although the pay varies based on such factors as specialty and region of the country, the average physician in the U.S earns $472,000 a year. In most countries, of course, doctors are not paid nearly as well. In Hungary doctors earn an an annual income of $12,000, while in many regions of China the salary is half that amount, about $5,000 a year.

But Cuba is near the bottom of the least when it comes to compensating health care professionals. Doctors in Cuba earn somewhere between $30 and $50 a month ($360 to $600 a year). At the high end, doctors with two specialties can earn as much as $67 per month.

What about cost of living? Isn’t it much cheaper to live in Cuba? No, in fact it can be quite expensive. A young doctor would have to work for more than a week just to afford a gallon of milk (average cost: $7.10). If he doesn’t have such expensive taste he can go forgo the dairy for cheaper fare: a pound of potatoes only cost about one day’s wage (90 cents).



4. Medical care is free, but medication is costly and scarce

In Cuba, medication for hospitalized patients is free, but all outpatient medications have to be paid for out-of-pocket. And all medications (even aspirin) require a prescription. There are also no private pharmacies (except on the black market) so you have to get your Tylenol at a state-run pharmacy. That is, if you can find one. American pharmacist Donna Kosteva tells of her experience traveling to Cuba:

With a population of 11 million, and more than 2 million in Havana, I found only 2 of the nearly 2100 pharmacies presumably located on the island. The first was situated in a residential neighborhood in Havana. It was large yet incredibility rundown, just like its surrounding area. The narrow shelves lining the pharmacy were bare bones, giving the impression that the store was going out of business. The space focused strictly on pharmaceuticals; there were no cosmetic, greeting card, health and wellness, or candy aisles. In comparison, the second farmacia I visited with my pharmacist colleagues near the Ciengage de Zapata Biosphere Reserve—a 3-hour bus ride from Havana—was no larger than a backyard storage shed. Dressed in a white lab jacket, a female pharmacist manned the Dutch-door prescription window, counseling a patient who stood on the sidewalk. Her female assistant sat at a card table with a cardboard box containing filled prescriptions.

Not surprisingly, the shortages allow health care workers to supplement their income on the black market. As Lucia Newman says, “Some doctors, nurses and cleaning staff smuggle the medicine out of the hospitals in a bid to make extra cash.”

5. Abortion keeps infant mortality low

The doctors are underpaid, the system is unequal, and the hospitals are horrific. But at least they can take credit for having a low infant mortality rate, right? Actually, there’s more to be said for that statistic. As Jay Nordlinger wrote in 2007:

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.

6. Cubans trade freedom for preventive care

There is one aspect of Cuba’s health care system that seems to produce results: preventive care. As the BBC noted last year, the foundation of Cuba’s preventative health care model is for family doctors to oversee the health of those in their neighborhoods. But there’s a catch.

In Cuba when you hear “The doctor will see you now” it often means in your own home. And you don’t have a choice about it. As the BBC says,

Imagine your doctor knocking at your door to give, not just you, but your whole family an annual health check-up. As well as taking blood pressure, checking hearts and asking all sorts of questions about your job and your lifestyle, this doctor is also taking careful note of the state of your home, assessing anything which could be affecting the health of you and your family.

Chances are the doctor is not just checking to see if you’re hiding Twinkies in the pantry, but will be reporting other findings to the local magistrates. Since the U.S. included two amendments to our Constitution to keep government officials from coming into our homes without permission (the 3rd and 4th) that approach isn’t like to work here in states.