In the medical response to Ebola, Cuba is punching above its weight | Hacker News Reader

In the medical response to Ebola, Cuba is punching above its weight

washingtonpost.com

200 pointsmegalodon134 comments

Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country.

There is a direct tech analogy with Finland and cell phones.

From the small country PoV, if you can't compete in the strategic nuclear bomber world market, or the manufacturing robot world market, you can probably find some market segment, however small, to focus on and take over. Like cellphones, or 3rd world medical care.

Other countries could, and probably will, do the same.

There is the interesting analogy that Finland isn't doing so well in the post Nokia, iphone and android world. Wonder what could happen to Cuba if the demand for docs dried up (optimistically due to 3rd world advancing into training their own medical workers, and not by the entire 3rd world dying of ebola or in ensuing strife after the epidemic)

What I thought was most interesting in the Cuba case was how little technology it takes to train Doctors. Outside of surgery Doctors tend to have other people doing the high tech hands on work like operating an MRI or Doing blood-work. But, as they training people to operate in the 3rd world even surgery tends to be fairly low tech.

In reality it's the opportunity costs that makes training doctors so expensive. So, in many ways less developed nations have a huge cost advantage when supplying doctors. The real issue is after exporting them they probably don't send all that much money back home.

The real issue is that developed countries refuse to import doctors.

Developed countries have medical doctors associations which keep a close eye on who can become doctor and how, thus limiting the number of doctors in the country and sustaining their high wages.

From what I've heard, you have to get an expensive education and then live thru a long and undercompensated and exhausting internship in order to become a full doctor and get all the perks. Any immigrant will also have to face that kind of internship (not easy for someone without a source of income) plus they have to re-learn a lot of things in order to pass the certification.

I might be fuzzy on the details, but still: we're lucky in our IT, we have comparative small amount of bullshit and entrenching.

It's just the opposite:

http://www.ft.com/cms/s/0/9647519c-207a-11e3-b8c6-00144feab7...

Doctors tend to leave undeveloped countries for developed countries.

It's behind paywall.

Here's the research discussed at the FT link:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...

"and by agreeing to provide care in areas that are underserved by US physicians"

This changes the perspective slightly.

To see this article search for the following on google and click on the top link: "study highlights scale of african doctors brain drain"

>The real issue is that developed countries refuse to import doctors.

That's completely ridiculous. Developed countries actively import doctors, going so far as to genuinely trying to lure them by advertising the kinds of salaries they can get.

Countries like Sweden, Norway, Germany, etc. now get significant numbers of their dcotors from abroad. Because their own population doesn't provide enough doctors. Additionally, the foreign ones tend to be cheaper (both because they're paid less but also because you don't need to put them through education).

It's so extreme that in some developing countries of Europe, half the doctors leave for the above-mentioned developed countries.

Maybe that's because you have some kind of inter-EU arrangements?

The US refuses to import doctors, and throws up protectionist barriers in order to keep them out, but I don't think this can be said about developed countries in general.

http://www.cepr.net/index.php/blogs/beat-the-press/rewriting...

"Any discussion of an alleged shortage of doctors in the United States should include an account of the doctors' efforts to create this shortage to keep their salaries high. It is also striking that, unlike the case of STEM workers, nurses, or farm workers, no one discusses bringing in more foreign doctors to alleviate this shortage. There would be hundreds of thousands, perhaps millions, of foreign physicians who would be happy to train to U.S. standards and work for even half of the pay that doctors get in the United States. This would reduce the cost of health care in the United States, freeing up tens of billions of dollars to be spent in other areas creating hundreds of thousands of jobs.

"And, we do know how to ensure that importing more foreign doctors does not hurt health care in the developing world. If the income taxes paid by foreign trained doctors were transferred to their home country, they could easily train 2-3 doctors for every doctor that came to the United States. This would ensure that developing countries gained from this arrangement as well."

edit:

Path to United States Practice Is Long Slog to Foreign Doctors

http://www.nytimes.com/2013/08/12/business/economy/long-slog...

"The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.

"That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

"The whole process can consume upward of a decade — for those lucky few who make it through."

I'm with dunder.

The flux of Asian immigration in the 60s, after the caps on these countries were lifted, was focused on skilled labor where there was limited US supply. AKA doctors.

We in the US still have this eye towards immigration of the skilled. While it is currently less in the medical field, it continues due to the lack of services in rural areas.

In Europe many Romanian doctors leave Romania and make much better wages in England and other countries. In India and so many other countries, many left for the US. Being a doctor had social weight and financial weight that it no longer carries here, in the US.

>We in the US still have this eye towards immigration of the skilled.

This is untrue in almost all situations that I'm aware of, other than nursing and IT.

http://www.nytimes.com/2013/08/12/business/economy/long-slog...

"'It took me double the time I thought, since I was still having to work while I was studying to pay for the visa, which was very expensive,' said Alisson Sombredero, 33, an H.I.V. specialist who came to the United States from Colombia in 2005.

"Dr. Sombredero spent three years studying for her American license exams, gathering recommendation letters and volunteering at a hospital in an unpaid position. She supported herself during that time by working as a nanny. That was followed by three years in a residency at Highland Hospital in Oakland, Calif., and one year in an H.I.V. fellowship at San Francisco General Hospital. She finally finished her training this summer, eight years after she arrived in the United States and 16 years after she first enrolled in medical school.

"Dr. Sombredero was helped through the process by the Welcome Back Initiative, an organization started 12 years ago as a partnership between San Francisco State University and City College of San Francisco. The organization has worked with about 4,600 physicians in its centers around the country, according to its founder, José Ramón Fernández-Peña.

"Only 118 of those doctors, he said, have successfully made it to residency.

"'If I had to even think about going through residency now, I’d shoot myself,' said Dr. Fernández-Peña, who came to the United States from Mexico in 1985 and chose not even to try treating patients once he learned what the licensing process requires."

>'The real issue is after exporting them they probably don't send all that much money back home.'

It's my understanding that this is not the case. That remittance from the US is a pretty significant part of many developing economies [1][2].

I've yet to a met an immigrant professional in the US who didn't send huge amounts back home along with itent or at least hope of retiring there.

1: http://www.havanatimes.org/?p=94444 2: http://www.bloomberg.com/news/2013-12-17/global-immigrants-s...

I think many immigrants will have children in the US and then they can't return with them (who will be alien to their home culture).

But I guess they may return separately.

Any rich country could replicate Cuba's efforts, but they don't want to. (That is, not sufficiently to actually get it done.) In contrast, some seem to have no problem exporting anti-doctors — uniformed killers and drones.

And all that from an island despite US's decades-long embargo and forcing the criminal Guantanamo Bay prison on them.

Cuba's healthcare niche is not necessarily limited to 3rd world medical care. Throughout the US/Cuba embargo the US had routinely carved out an exception to trade for Cuba's cancer/anti-cancer medications which have been viewed as cutting edge for over a decade. So perhaps another niche 1st world cancer research and treatments.

I'm both astounded and shamed as a US citizen that we enact broad trade sanctions against Cuba today while happily creating exceptions for anti-cancer drugs.

Yea, living in Miami, I see how the embargo negatively impacts people on a daily basis. That said the Cuban ex-pats I know are split on the issue - and fiercely - with half die hard supporters of the embargo and half opposed. As long as the embargo is in place, I prefer we bring in Cuban drugs at least for clinical trials, but I don't think US is happy to create exceptions and it is probably embarrassing a tiny island nation which the US has lead a economic crusade against for nearly 50 years produces any cancer drugs superior to those produced in the US.

I also find it interesting that this option would not be available to Cuba if it were more integrated economically with the rest of the world. The first thing the IMF would force them to get rid of would be high-end public education programs, or at least put them out of reach economically for a large portion of the population.

The IMF can only "force" countries to do things if those countries want to lend money from them. And even then, a country can lie with impunity in a round - unless it wants repeating lending rounds, and lies in important and bad ways.

Also, I've never hear about the IMF forcing a country to dismantle its public-education programs. When Brazil was on their hook they did anything but that, and in the later years IMF helped improving it.

That seems to have been the general result any time a structural adjustment (or the rebranded, poverty-reduction) program was implemented.

Quite often the IMF is an easy scapegoat. You'd be surprised by how often the IMF advice is ignored or by how sound it can be at times.

For instance, in Ukraine a few years ago, the IMF's advice was to cut down on some structural expenses (gas subsidies mostly) and not to touch investment expenses as doing that would trigger a recession.

For political reasons IMF did the opposite.

What it usually is is political cover for local elites to betray their populations; remove barriers to capital flow and trade, gut environmental and labor protections.

> Decades ago Cuba made training and exporting medical personnel their "thing" and they ended up owning that part of the world market despite being a small and very poor country.

Not just medical personnel, in the 60s they were one of the biggest provider of trained personnel in general in the newly independent congo (before being forced out as Zaïrisation ramped up) to both staff the country and provide training (Belgium had avoided/refused to establish a local elite, so when they hightailed the newly independent Congo had no administrators, no teachers, no doctors, …)

I was just discussing this the other day with one of my friends. We both grew up in the Seventh-Day Adventist church, a church that has made "medical evangelism" a big part of its strategy. The discussion was brought about by seeing an Adventist doctor we'd eaten dinner with a few months ago in California, being interviewed on CNN from a hospital in Liberia where she was caring for Ebola patients.

I have grandparents, aunts and uncles who were all trained at Adventist medical institutions, and spent time working at hospitals in 3rd world countries. The Adventist church has its own medical school, as well as a health system (though neither is directly operated by the church).

I took a "student missions" year out of college (somewhat like Mormon mission years, only typically more a religiously-driven piece-corps-type year of teaching, medical assistance etc. than direct-evangelism) and spent it in Belize volunteering at a hospital. 3 of the hospital's 5 physicians were Cubans, and I learned first-hand that Cuba and the Adventist church have remarkably similar strategies when it comes to training doctors, and using them as a PR tool.

In both cases it seems to be quite effective. In Belize, many people I met thought highly of Cuba, because their most direct interaction was through the doctors they sent. Even here in the states, when the Adventist church is mentioned I'll often hear, "Oh, I think my Doctor is one of those."

How interesting, just yesterday I watched a TED[1] talk about Cuba's ELAM (Latin American School of Medicine)[2].

> Established in 1999 and operated by the Cuban government, ELAM has been described as possibly being the largest medical school in the world by enrollment with approximately 19,550 students from 110 countries reported as enrolled in 2013.

[1] http://www.ted.com/talks/gail_reed_where_to_train_the_world_...

[2] https://en.wikipedia.org/wiki/ELAM_%28Latin_American_School_...

It's one of Cuba's top exports.

I assume it must be the same school, but a undergrad friend and roommate was a pre-med and came from a very interesting family. His family was all about immigration in the US, and was very tight with the Latin American community where they lived (he even grew up for a period in Mexico, and spoke perfect Mexican Spanish, as was his American father who raised him there).

He clued me into the existence of full-ride scholarships for Americans to study in medicine. American students with a full medical education in Cuba! I was very impressed. I guess it is this.

http://www.ifconews.org/node/707

This kid was amazing and very altruistic. However, he pulled his application bc of the sad reality of US medicine; he was told point blank by some med school mentors he would never practice medicine in the US with that degree, and it was pointless as he would likely redo all of his medical education and required certification/boards stateside lest he have any intention of ever practicing medicine in the States.

I am still glad, despite all the fucked up political harassment by the USG, this scholarship remains.

Preventing foreign physicians from practicing in USA is kind of the whole point of having a "profession" with lobbyists like the AMA. If they had to compete with H-1B'ers, they couldn't afford to spend so many years and dollars in training. Also health care would be much cheaper, which would step on a lot more toes than just those of the M.D.'s.

I completely agree with you. But this was a group of doctors dissuading them. It was more an argument about stigma (that other US doctors would never hire them, regardless of him re-studying and re-boarding might not save the potential of a career).

I would love such an opportunity. I think we should also open up medicine in the US as you describe, but I also must be honest: expect the quality and knowledge of doctors on average going down. I live abroad in the MENA region, and most of the doctors here are from abroad (the first medical school in country is part of the educational complex I work in; the first graduating class will be this year or next year). Even at good hospitals, people check nationality of the doctor as a result and you always go only to doctors you friends have visited and recommend if not an emergency. Whether it is general fear or racism whatver you call it is another debate. You will notice some doctors meet minimal standards here but I would be afraid to call them doctors (one told me you have to be careful which kind of fish you eat because the Quran explains so; religion has its place but I will not tolerate that from a doctor, and I never visited her again).

Allowing doctors all over the world while maintaining a minimally required level of education and skill with such different education systems and credentials will be awful. I live that every day I visit the hospital with my son, even for a simple doctor's visit.

Off-topic, but I had the opportunity to have several cuban PhDs teach some of the final classses in college (Multi-agent systems, computer intelligence, etc) ... All of them were incredibly good in their fields, better than any other professors I had in school, and as good as some of the brightest I've met in this field.

There were also some docs in other disciplines and they were all incredibly good. Based on that experience I think cuba is hardly "punching far above its weight", but reflecting great care, passion and responsibility as they do in other fields... We just assume a lot of things about cuba. I sure did before.

I don't think the "above its weight" in the title refers to the quality of Cuban education, but the size of its economy.

So, if you look at the number of qualified personnel committed to the epidemic by country, and divide over their per capita GNP, indeed Cuba is punching way above its weight.

Cuba was the world's best experiment in total communism. Unfortunately the US ruined the experiment by imposing an embargo for decades out of spite. Still, when you compare Cuba to neighboring Dominican Republic they're doing better under many measures, including health, education and a GNP per capita of $5890 vs DR's $5620.

Cuba did much better than all the Latin American countries that allowed the US to dominate them; it’s quite amazing, considering the economic strain put on by the embargo.

Though the Cuban regime was hardly friendly to dissidents, journalists, or activists, and hardly democratic (to say the least), their actions are nothing compared to the fascist police states backed by the US up through the 1980s throughout Latin America.

It’s really not until the 1990s when the US stopped worrying quite so much about Communism and focused our attention elsewhere in the world that most of Latin America was able to start acting more autonomously and solving their own problems. US relative non-involvement for the past 25 years has seen the growth of democracy, checks on the power of militaries, de-escalation of border conflicts and increasing economic cooperation.

One can only wonder what would have happened if the US government hadn’t spent the several decades before that installing and propping up puppet dictators, and overthrowing democratic governments.

To be fair, the Soviet-backed police states (eg, Idi Amin's Uganda) were not particularly appealing either. Unfortunately, both parties were too involved in their little games to care about the welfare of their pawns.

Costa Rica has done as well or even better

Costa Rica may be the exception that proves the rule, or at least is notable for what it didn't do -- it didn't let itself become a colony/client state/banana republic, there was a state-led internal industrialization effort integrated with measured open-ness for international trade/investment, it didn't keep a standing military after its revolution.

And Cuba likely still would have done better without the US embargo.

If Communist Cuba didn't exist, may be most of those dictatorships wouldnt have happened.

And Costa Rica may be an exception because their lefties (or liberals) were smart enough to keep their eyes on the price.

You have causation wrong. Cuba is now communist because it was one of those dictatorships. http://en.m.wikipedia.org/wiki/Fulgencio_Batista

The countless dictatorships, puppet governments, and US/European interventions didn't start when Castro and Che came down out of the mountains in 1956.

Would you rather live, today, in Cuba or (the poster boy for malicious US intervention) Chile?

If I was born tomorrow, I would definitely pick Cuba (infant mortality 5/1000) instead of Chile (8/1000). United States is 6/1000 by the way.

Wow, this is the definition of myopia.

If you don't like that measure, suggest another. It's not as though infant mortality is some minor thing that no one cares about.

Respect for human rights? Political liberty? Quality of life? Social Mobility? Economic opportunity?

Myopia means excessive focus on one aspect at the neglect of the whole picture.

I would consider many things in deciding where to live. Each person has different priorities, but for me the most important measure is liberty (political, economic and social).

Chile is one of the freest countries in the world (usually in the top 10 of such rankings) and Cuba is usually amongst the bottom 10.

Chile is one of the freest countries in the world (usually in the top 10 of such rankings) and Cuba is usually amongst the bottom 10.

I'd really be interested to see a link to a ranking placing Cuba at the bottom 10 countries in the world.

Here's one for economic freedom: http://www.heritage.org/index/ranking

Chile is #7 and Cuba is #177 (only North Korea is worse, at #178)

Hehe, ok, yeah, with economic freedom it's no surprise (although with heritage.org I'd really look into the methodology...) . But freedom usually implies human rights, and economic freedom is just a means to exactly that end. A lesbian friend of mine, mother Cuban and father Spaniard, recently moved back to Cuba because of rising homophobic discrimination in Spain. She now lives with her SO in Cuba, they now both operate a café together. Her freedom (as implied by the UN Charta on human rights) certainly is higher in Cuba than in Spain.

I don't mean to question your friend's decision, and I don't know the exact situation, but this is just anecdotal evidence. Was it discrimination by the government or by fellow Spaniards in a private capacity? If it's the latter (which I'd guess), then it's not really a restriction on individual freedom.

Nonetheless, I don't think this would conform to the experiences of the vast majority of Cubans, wrt individual liberty. I know several Cubans myself who fled the Castro regime.

The UN charter on human rights also includes the right to freedom of expression, freedom of assembly, for political action etc.

Take a scale of 1 to 10. Spain may be an 8/10 when it comes to equal treatment wrt sexual orientation. For the sake of argument, let's say Cuba is 10/10 in this measure. For reference, Saudi or Iran (where you can be executed for being gay) are 1/10.

In most measures of freedom, Spain (and Chile) would be 8+ while Cuba would be 1-2/10. Here's another rating (considering political and civil liberty) where Chile/Spain come out perfect and Cuba is one of the worst: http://www.freedomhouse.org/report-types/freedom-world#.VDQw...

Thanks for your response. To make that clear: I'd be very happy if people in Cuba could experience more individual freedoms.

If it's the latter (which I'd guess), then it's not really a restriction on individual freedom.

That perhaps is the main source of our disagreement :) 'Freedom' (or similar concepts like justice) an be approached from to angles. The first is the deontological, or institutional approach, e.g. freedom is what the laws provide. The second way is the consequentialist approach: freedom is what the individual actually experiences. Both ways have advantages and disadvantages. I personally lean more towards the latter, because that approach makes it possible to differentiate between classes of people inside a society.

Another anecdote :) I live in the eastern part of Germany, which as you know was socialist 25 years ago. People could not really vote, dissidents didn't have it easy etc. The current Germany is definitily more free from an institutional viewpoint. Yet, when I look out my office window, I can reguarly see people searching for food in the dumpsters. In the dumpsters! Thats a thing that was unthinkable in the former Eastern Germany. We now have children coming to school without having breakfast because of poverty and mismanagement of their parents. That, too, was unheard of before (schools provided breakfast in those cases, there was no mass unemployment -> way less parents were like that, without hope and self-regard etc.)

People like me definitely practically profit from the new institutional freedom, people like them don't. From a consequential viewpoint on freedom, their score dropped significantly.

I've read a really nice book about the theories of freedom and justice from Amartya Sen, it's called The Idea of Justice. Highly recommended, it's both informative and approachable.

Having spent a good month living in Havana and 5 years in other places across the globe, I can tell you that Cuba is near the bottom of the "places I would choose to be born" list.

I don't care what anyone says about their medical care - I've seen more amputees in that country than anywhere else on the planet. Crushing poverty, a brutal regime that interferes with daily life in large ways, absurdly low education even in the capital.

I have a feeling that a lot of the numbers we see about Cuba come from the government and thus should not be trusted.

Thanks for this. Many people here have some romantic vision of Cuba that is influenced by well-designed Cuban operations to accomplish exactly what they're accomplishing: influencing gullible left-leaning Americans to support Cuba. I remember when I was at the University of Houston, there was a Cuban Friendship Committee that held Cuban 'cultural' events for students. Interestingly many of the students invited to those events were majors in areas of rather strategic interest: journalism students. Interesting even more so were the free and discounted trips to Cuba being covertly offered to select students. The leader of this group even assisted with obtaining Cuban travel permits from the Cuban government. Now just why would that "Friendship" committee be so friendly? I have first hand experience because I was both a journalism student, a Reuters contract photojournalist and the photo editor of the student newspaper; so I was invited to these Friendship events almost constantly. This was back in 1995-1997. There certainly wasn't any other 'student' organization offering free trips for 'cultural' exchange, except for Hillel, but that's another discussion altogether..

The point is that there is a powerful clandestine and covert effort by the Cuban government to manipulate American influencers to present the image of Cuba that is so frequently transmitted. It's exceptionally effective; just read some of the comments posted on this very thread. However the reality on the ground is much different than Michael Moore would have you believe.

Cuba got a subsidy of about 25% of GDP from the USSR. [1]

It's also worth noting that Cuba's per capita GDP in the late 1950s was about the same as Italy of Spain.

[1] http://www.lexingtoninstitute.org/wp-content/uploads/Cuba/su...

[

That is, post-WW2 Italy, post-civil war Spain. People were migrating in droves from Italy and Spain to e.g. Argentina in those years.

> Still, when you compare Cuba to neighboring Dominican Republic

What kind of comparison is that? The DR is practically a failed state. By any rational metric Cuba is an economic and human rights disaster and continues to be. Its other, capitalistic, neighbor Mexico has 2x that GDP per capita. Heck, its only because of Western pressure that Cuba is only now, after decades of spite against its own people, started releasing political prisoners.

http://www.hrw.org/world-report/2014/country-chapters/cuba

>Unfortunately the US ruined the experiment by imposing an embargo for decades out of spite.

Pardon me if I think my nation should tolerate nuclear missiles 90 miles off our coast from a country aligned with our enemies who have a stated doctrine of first strike and tactic nuclear usage with zero warning in advance, held by a dictator who wanted nuclear war.

http://townhall.com/tipsheet/meredithjessup/2009/09/24/nytim...

I'm all for lifting of sanctions, but Cuba needs to up its game first. Rewarding the autocratic and oppressive Castro regime makes no sense. Democratic reforms, regime change, freedom of ownership, open elections, multi-parties, the right to sue, the right to travel, a free press, the right to petition, etc must all be respected. You're not automatically entitled to my money.

> I'm all for lifting of sanctions, but Cuba needs to up its game first. Rewarding the autocratic and oppressive Castro regime makes no sense. Democratic reforms, regime change, freedom of ownership, open elections, multi-parties, the right to sue, the right to travel, a free press, the right to petition, etc must all be respected.

Sure. You must be demonstrating every day for the same sanctions to apply in about all the Middle East countries the US has bases in, right? Moral arguments don't really mesh with real politics. Sanctions against Cuba are a relic of the Cold War, but the US does business every day with countries with a worse humanitarian track record.

I'm pretty sure Saudi Arabia never had nukes pointed at us or tried to. Ignoring the reality of the cold war and the brutality of Catro's regime and pretending everything is fine now is pretty ignorant. Modern Cuba still is the same disaster its always been. Why must the US reward the Castros? Why can't they make themselves a more viable trading partner? You're not entitled to my business, plain and simple.

Whataboutism isn't addressing my issues. Sadly, knee-jerk anti-americanism passes for "intellectualism" around here. Funny how an oppressive anti-capitalist state is applauded on a forum dedicated to VC funded startups. Oh, the irony.

> I'm pretty sure Saudi Arabia never had nukes pointed at us or tried to.

This was in 1963. And they sure don't have nukes now, or are likely to acquire them. Not to mention that you're conveniently forgetting US nukes in Italy and Turkey around the same time, or the Bay of Pigs invasion.

> Why must the US reward the Castros?

Why should it punish the Castros while turning a blind eye to Bahrain, who is busy oppressing its population with a brutality the Castro regime hasn't displayed in a long while?

> Whataboutism isn't addressing my issues.

If you didn't address the issue from a moral angle, your position may look a bit more solid than it is right now. Why not admit morality has a very small role to play in international politics, whatever narrative government dress it up in for internal consumption?

> Sadly, knee-jerk anti-americanism passes for "intellectualism" around here.

Oh, I'm not giving a pass to any government, don't worry.

I'm pretty sure Saudi Arabia never had nukes pointed at us or tried to.

You mean the Russian nukes from 1963? Those that were a response to the nukes the US placed all over Turkey and neighbouring countries? http://en.wikipedia.org/wiki/Cuban_missile_crisis

>Pardon me if I think my nation should tolerate nuclear missiles 90 miles off our coast from a country aligned with our enemies

Don't you think people of other nations may have the same intolerance to their enemies' nuclear missiles deployed right on their borders? The Cuban missiles were symmetric response to deploying the Jupiter missiles in Turkey - which is right on the border with USSR http://en.wikipedia.org/wiki/PGM-19_Jupiter

"They were all removed by the US as part of a secret agreement with the Soviet Union during the Cuban Missile Crisis."

Do onto others what you don't want others do onto you :)

Perhaps the Jupiter missile deterrent was a bit impolite, but the USSR did enslave many hundreds of millions of people while showing every intention of growing this number.

The US "enslaved" vast numbers of people through proxy too, and contributed to several genocides by propping up various puppet regimes.

The US may have been morally superior at home but played just as dirty in large parts of the world.

The USSR was a totalitarian communist empire openly determined to conquer and enslave the entire world. The USA was a champion of liberty that pursued strategies intended only to defend the free world against the USSR. Your moral equivalency game indicates you're either ignorant of recent history, or that you're on the other side.

I hope this is sarcasm.

Sure, the USSR was a totalitarian state. That said, both sides pursued an aggressive, expansionist policy via proxy. The "champion of liberty" installed thoroughly repressive regimes all over South America which had little to envy to the Soviet Union. It didn't prove itself above manufacturing border incidents to trigger the Vietnam war, either. Was the USSR worse? Certainly. But this doesn't make the US the good guy in the story.

The propaganda of the Cold War is breathtaking in its effectiveness. The USSR are the bad guys, comic book villains out to destroy the world. The US are plucky do-gooders, fighting to save the world from evil yet again (after single handedly winning WWII). There is no room for nuance. There is no grey area in perhaps the greyest of all conflicts since the Great Game. Both the US and USSR inflicted terrible damage to nations all over the world through proxy wars, intelligence agency coups. The ramifications of those conflicts are still felt throughout Latin America, the Middle East, and South East Asia.

And that all gets swept aside by "The USA was a champion of liberty that pursued strategies intended only to defend the free world against the USSR." Read the Wikipedia article on "Covert United States Foreign Regime Change Actions" [0], and see how many of those nations benefited in the long run, and how some incredibly brutal regimes were installed or propped up throughout the third world, simply because they weren't communists.

http://en.wikipedia.org/wiki/Covert_United_States_foreign_re...

You should have said "the anti-American garbage that leftist teachers are feeding to grade-school kids is breathtaking in its effectiveness" but in order to do that, you'd have to have some understanding of the true (not the political) version of history.

What's really amazing is that you think your 1960s, nihilistic, self-loathing, theyre-all-the-same cynicism is thoughtful and original, and you assume that the reason I disagree with you is that I haven't heard of such a notion before, and must not be as educated as yourself...

Well, even without opening a history book (sadly, "leftist teachers" did not get rid of Allende all by themselves), one would think that the US military adventurism of the last decade would have equipped US citizens (I'll go out on a limb and assume you are one) with a healthy dose of skepticism.

Governments have most often been waving various pretenses to make their actions look good. Manifest destiny, the white man's burden, the necessity to bring the socialist paradise... "Championing liberty" is just one of them. But you don't "champion liberty" by setting up something like the School of the Americas[1], or selling arms to Iran to fund Contras terrorists[2]. This is a different concept, which is "protecting your interests by whatever means available".

1: http://en.wikipedia.org/wiki/Western_Hemisphere_Institute_fo...

2: http://en.wikipedia.org/wiki/Contras

Please. I lived in Soviet Union and United States for decades (in each). Not it wasn't a totalitarian evil empire. It was an empire. It didn't tollerate criticism of its government but:

* It provided free healthcare

* It provided free housing

* Crime rate was law

* It provided free and quality education (from kindergarten all the way to the highest degrees)

> The USA was a champion of liberty that pursued strategies intended only to defend the free world against the USSR.

Wait, are you being sarcastic. I am confused. Poe's Law in full effect here, ladies and gentlement.

Ignoring the genocides and the gulags for a minute, let's simply explore your theory that the USA and USSR were morally equivalent. The USSR conquered and imposed brutal slavery on every eastern european nation. The USA did not conquer any of the western european nations. We didn't even conquer Cuba. If we had the military power, why wouldn't we?

> The USSR conquered and imposed brutal slavery on every eastern european nation.

Slavery, like US had up until the mid 1800 and with the following oppression and segregation laws?

Or the country that based itself on ethnic cleansing and genocide of countless American Indians.

> The USA did not conquer any of the western european nations

No but it raped all the South American states and some East Asian states (Vietnam, Laos, Cambodia).

Also Middle East. Started Wars.

> We didn't even conquer Cuba.

Sure tried. And send saboteurs to plant IEDs, blow up bridges, plants. Destroy machinery. Can you say "War Of Terror" (https://en.wikipedia.org/wiki/Cuban_Project)

> If we had the military power, why wouldn't we?

Ok USSR didn't conquer Australia. They had the military power. Why didn't they. Probably didn't want to. And didn't care about.

>your theory that the USA and USSR were morally equivalent.

mid-20th century significant share (if not half) of the world population was enchanted with the ideas of socialism/communism with those ideas symbolizing justice and freedom (not mass oppression as it ultimately turned to be). In that respect, _back then_, they were morally equivalent or at least close to it. We know better _now_, after observing of many decades of that failed experiments.

>The USSR conquered and imposed brutal slavery on every eastern european nation. The USA did not conquer any of the western european nations.

They all had their respective zones of occupation in Europe, Korea, Japan after the WWII. With time socialist regime in USSR zone turned to be the regime of "conquest and slavery", while capitalism in the western zones, South Korea and Japan happened to be more freedom conducting. For example South Korea wasn't fan of being occupied by US (for example among others http://en.wikipedia.org/wiki/Autumn_Uprising_of_1946 ) and it took decades for it to ultimately start benefiting from having been occupied by US instead of USSR. Again, back then, it wasn't that clear for huge number of people, and it took decades for the differences to appear clearly.

>We didn't even conquer Cuba. If we had the military power, why wouldn't we?

you think it is easier to fight in Cuba jungles than in Vietnam one or that Cubans would be less fierce fighters than Vietnamese?

Russia was more than welcome to sanction Turkey.

Ending the embargo would probably sweep away their failed economic experiment within 10 years. Keeping it in place gives their leadership an excuse for why the economy is so bad.

> What kind of comparison is that?

Mexico is a giant country with huge (though dwindling) oil reserves, and the advantages of NAFTA (all the Detroit automakers have relocated down there).

Cuba and the DR are similar sized geographically and demographically, and have similar climates and resources.

> The DR is practically a failed state.

Don't know why you say that, DR has been politically stable for decades and is economically similar to many other small Latin American countries.

"...Its other, capitalistic, neighbor Mexico has 2x that GDP per capita..."

Initially, I thought... that HAS to be wrong... because Mexico has 10x the resources that Cuba has. But I looked it up... and you're right... Mexico only has 2x the GDP.

Not really taking any sides here on the whole capitalism v communism thing...

But Mexico has 120 MILLION people, 100 times the energy reserves AND trade with the US... and it STILL cannot even double the GDP of a nation with 11 MILLION people and an embargo (ie - NO trade with the US)... (Cuba: 6,051 Mexico: 10,307)

That's pretty pathetic. I mean REALLY? You have 10x the resources, 100x the energy reserves... and you can only muster twice the GDP ??? Something's not right about that.

I guess that's not really a comment on Cuba as much as it is a comment on Mexico. I didn't realize it was that bad... I don't blame Mexican immigrants for trying to come to the US.

Twice the GDP per capita. The "per capita" part is important.

The GDP of Mexico is 20 times greater than Cuba's. The population is 10 times bigger.

Of course as you point out the lack of an embargo, access to oil, etc would lead you to expect that Mexico's per capita GDP would be higher than Cuba's. Whether you'd expect the factor by which it's higher to be 2 or more or less is an interesting question that I'm not qualified to answer. ;)

> Something's not right about that.

Yes, your understanding of the meaning of "per capita GDP".

> What kind of comparison is that? The DR is practically a failed state.

You've already gotten down voted enough, but wow. DR has had a 7% growth rate for the last 20 years, one of the highest in the Americas...

Your others points are equally off.

http://en.wikipedia.org/wiki/Economy_of_the_Dominican_Republ...

While per capita GDP is a useful number that reveals some information about the economics of a country relative to the world stage, I may be alone in finding that its often misleading - particularly when we're talking about what life is like for the common man.

In those cases, I tend to find that things like: The Big Mac Index [1]; the more general World Price Index (a standardized basket of goods) [2]; or the even more general Purchasing Power Parity [3]; are better reflective of the human scale question, which IMO is "for a common wage, what can be purchased, and how expensive is it."

Basically, its great if our per capita GDP is 2x someone else, if our local prices are also 2x, then our actual wage goes roughly the same distance. Another way is: if I had the equivalent of a $1M in Cuba, went to Mexico, and exchanged it with no fee, how would my relative purchasing power change.

Major Caveat: Findings for PPP are heavily dependent on your reference basket of goods.

[1] http://en.wikipedia.org/wiki/Big_Mac_Index

[2] http://en.wikipedia.org/wiki/World_Price_Index

[3] http://en.wikipedia.org/wiki/Purchasing_power_parity

Ironically (and yes, this is the proper usage of irony) the US embargo on Cuba likely made communism in Cuba more successful than it otherwise would have been. It united the Cuban people in their lack of access to goods on the International market, and helped create an egalitarianism that otherwise doesn't exist if people have access to international trade markets.

Cuba has managed to do a lot with very little, especially with regards to education and health care. Their systems are on-par with those in developed, capitalist countries while their per capita income places them among the most impoverished countries on earth.

Good things came out of this. The embargo prevented cuba from becoming the world's best experiment in total communism but it instead made Cuba the best and ONLY experiment in creating a sustainable "green" civilization. There is no other place on earth where this has been reproduced for an entire society in a way that works.

The Living Planet Report from the World Wildlife Fund in 2007 identified Cuba as the only sustainable country in the world. The study involved two key parameters for measuring sustainable development, a commitment to "improving the quality of human life while living within the carrying capacity of supporting ecosystems". Cuba was the ONLY country on earth to achieve satisfactory benchmarks in both criteria for sustainable development.

You have to see it to believe it. Every inch of rooftop in Cuba is basically an urban/organic farm. Essentially Cuba represents the best possible outcome when modern society finally runs out of gasoline.

Does this then mean that the standard of living in Cuba is about what we could expect from a sustainable society?

Not being snarky (I know it could sound that way). I'm curious if that's the outcome of sustainable living.

Unfortunately, yes. Not even driving a Tesla will make a difference.

I wouldn't think of cuban culture/society as a primitive way of life. It's just different.

Do you have any links (in English) about this? I am having a bit of trouble finding anything really substantive. I have an unfinished environmental studies degree, so I find this interesting.

https://www.youtube.com/watch?v=Vj_DV5ltdes

It's surprising how almost know one knows about this, especially someone with an (albeit unfinished) environmental studies degree.

Not sure what you define as substantive but this is what I know about:

There's a documentary about the topic called, The Power of Community - How Cuba Survived Peak Oil. You can watch at the link below.

https://www.youtube.com/watch?v=UUWces5TkCA

another dense source: http://www-pub.iaea.org/mtcd/publications/pdf/pub1328_web.pd...

google: "cuba sustainability" no quotes for a bunch of stuff.

Thank you.

I had a rather lengthy medical crisis, so I was out of the loop for a long time (and it is essentially the reason my degree was not completed). It is currently resolving and I am trying to get more back in the loop on things.

I was born and grew up in China in the 60. Cuba now is like China under Mao before embracing market economy. Personally US embargo has little to do Cuba's economy development difficulty. Without US, it can still trade with Canada and rest of Latin America. Like China in 60,70, It is the central planning aspect of economy that is killing any incentive for normal people/organizations to be productive.

Thank your for writing this. Many people have commented in this thread that the US embargo on Cuba is responsible for Cuba being a poor country.

However, Cuba can still trade with other countries. They could even buy American products through other countries. They don't do so (in a significant scale) because they have nothing to offer. Cuba offers little of value to the rest of the world.

I couldn't disagree with this more for two reasons:

1. Cuba was historically supported financially by the USSR up until it collapsed; and

2. This belief that the US placed a trade embargo out of "spite" is misguided. Cuba under Castro nationalized assets belonging to US citizens (eg casinos in Havana). Agree or disagree, the US government acted to protect the interests of its citizens.

As to whether that embargo still makes sense, I make no comment on that.

I haven't visited Cuba but it does seem like if I had to be stuck in a communist dictatorship, I'd probably choose Cuba over the alternatives. I'm not sure that's the ringing endorsement one is looking for.

Well the climate sure beats North Korea's.

What a great experiment! Any form of government that tortures people because of their political disagreements is worth an embargo. Most people that write wistfully about Cuba have never lived there. As much as a police state as the U.S. has become, you can still write blog posts against the government without ending up in prison. Try that in Cuba. Remember Che? Brutally murdered opponents in the name of the 'people.' The love-fest some people have with Cuba is astounding. The Cuban Intelligence agency does a great job of propaganda. Blaming the US embargo for the actions of Castro's government brutality is stupid. Are we next going to suggest that North Korea would be a friendly place if it weren't for those pesky South Koreans? The blame America for everything meme is starting to get old. People don't risk their lives trying to escape the Dominican Republic on a raft made from old car tires. Why is that? If the DR is poorer than Cuba, why aren't rafts washing up in the Florida Strait filled with Dominicans? How would Cuba have been doing without the decades of subsidies from the USSR? That experiment in total communism would have fallen flat on its face. The Soviets had a near 100% literacy rate and 'universal' health care, yet you ask anyone over the age of 50 if they would want to live under the Soviets again and it would be an overwhelming 'No.' Let's ask the Polish what they think of Soviet communism.. Any place where the answer to dissenting thought is arrest and imprisonment is a terrible place -- no matter how many doctors there might be. US prisons have universal health care too, but that doesn't mean we would want to live there. When Cuba has free and open elections, then maybe I'll change my tune. But when the people have no voice, then we should not be rationalizing a government just because the kids score well on a math test and it's cheap to get diabetes medicine. I would invite anyone here who thinks Cuba is so great to go live there. Defect to Cuba and let us know (assuming you can) how you're doing in 5 years.

> ask anyone over the age of 50 if they would want to live under the Soviets again and it would be an overwhelming 'No.'

Do you know any such people? I do know a few of them. Not a statistically valid sample, since I don't research such things professionally. But I happen to have a few in my social group, through family and friend connections. And what's most surprising about them is how strongly pro-Soviet they are. The young people are not; they are mostly pro-West. But the older people are much different, much more nostalgic for Soviet times, and anti-West. Especially those who served in the scientific-industrial-military complex, which is many. Congregations of elderly scientists and engineers tend towards a pro-Soviet tone, especially in the form of complaining about how these useless new countries don't do science the way the old USSR did.

Cuba was no such thing. Castro turned to the Soviet Union after his advances to the US were rebuffed. The "sovietization" of Castro's party took years.

It took two years before Castro proclaimed his government socialist, it wasn't until 1965 that his party became the Communist Party of Cuba.

Eventually they became dogmatic Leninist, but substantial parts of the party, including Castro came to Soviet style socialism out of necessity. That's not to say that there weren't many of them that clearly had socialist leanings of various types before that, but the Castro regime was the making of the unholy marriage of rejection by the US and a toxic embrace by the Soviets.

There may have been less of a gap between theory and practice in Cuba than elsewhere, in that the elite appears to have been less greedy and reinvested more in actually making peoples lives better, but it's still an oligarchy with drastic class differences reinforced by the party, rather than fought by it.

Would these Cuban doctors be likely to escape to the US via Liberia? Normally it's illegal for them (doctors) to travel outside of the country:

http://www.bbc.com/travel/blog/20130116-cuba-lifts-travel-re...

(edit) Apparently the US explicitly permits Cuban doctors working abroad to emigrate to the US -- in contrast with most refugees, who have to physically set foot in the country to gain asylum.

https://en.wikipedia.org/wiki/Cuban_medical_internationalism...

http://www.state.gov/p/wha/rls/fs/2009/115414.htm

http://online.wsj.com/articles/SB100014240529702037310045760...

"...a wave of Cubans who have defected to the U.S. since 2006 under the little-known Cuban Medical Professional Parole immigration program, which allows Cuban doctors and some other health workers who are serving their government overseas to enter the U.S. immediately as refugees. Data released to The Wall Street Journal under the Freedom of Information Act shows that, through Dec. 16, 1,574 CMPP visas have been issued by U.S. consulates in 65 countries."

That's funny, the US are keen on maintaining the embargo against Cuba but at the same time don't mind welcoming their doctors and thus admitting their superiority in medical education.

I'm not sure that welcoming Cuban doctors necessarily means admitting superior medical education. Most countries like well-educated immigrants, no matter what their former nation was. The US welcomed Nazi scientists to help build rockets and bombs, too. That wasn't a commentary on the Nazi regime other than that they had good scientists that were willing to defect.

I don't know, hearing stories of immigrants with good degrees having to do menial work in Europe isn't that uncommon.

I agree with your point, but I think the Nazi rocket scientists are a counter example.

Can we end the stupid sanctions now? The USSR is gone and we trade massively with China for F's sake. Cuba doesn't have the best human rights record on Earth, but neither does China or Saudi Arabia to give two other examples with which we trade extensively. All this does is harm the Cuban people and paradoxically actually strengthens the existing regime there.

China can be considered capitalist, they trade actively with us, and honestly we don't have the ability go to against them. Saudi Arabia, needs to be on our side, to provide the natural resources we consume.

Cuba..that would be just us trading with a Communist country. It would mean allowing Americans to consider a communist country, instead of writing that idea off as crazy. Neither political party in the US wants that. Neither party in the US believes a friendly more transparent relationship with Cuba will strengthen American belief in capitalist democracy across all of society.

Cuba already has small private business. It will swiftly transform to China-like capitalism if you let them do so.

"China can be considered capitalist, they trade actively with us [...] Cuba..that would be just us trading with a Communist country." - this is just pure hypocrisy.

America needs China and the Saudis (for investment/loans/manufacturing and oil respectively). It does need Cuba so can happily pretend to be principled by bullying them.

I thought that was the point of seemingly endless bombing campaigns.

Cuba is a brutal communist slave state. But so is China. I think the shameful thing is not that we have sanctions against Cuba, but that we do not have sanctions against China and some of the other barbarian regimes out there (e.g. Vietnam, Saudi Arabia).

> Cuba is a brutal communist slave state

America is a country full of murderous racists who hate gay people, all of whom support their government's meddling in other countries' affairs, and other such ridiculous statements.

If Cuba is a brutal communist slave state, so is China. Do you own any Apple products or anything else manufactured by Foxconn?

What are you going for, here? The old, "if you benefit from something, you're not allowed to criticize it" angle?

Do sanctions actually help reduce the problems caused by these countries, or is this just some sort of principled stand? The fact that Cuba is still ruled by the same oppressive government today as it was when the sanctions were imposed over 50 years ago would seem to indicate that it's not actually a useful thing to do.

You'd be surprised, probably negatively, by how few people actually know we still have an active embargo on them.

A chronically under-recognized point is buried in the article:

It's not a simple picture. Critics have complained that Cuba has begun to sacrifice the health of its citizens at home to make money sending medical workers abroad, and the conditions for these medical workers themselves have been criticized

Cuba now has roughly the same life expectancy as the USA - a bit more than 79 years.

I.e. it doesn't seem that they sacrificed a lot.

The US isn't exactly setting the bar for healthcare.

It's not about the United States being the best, it's about them being the "reference standard" for life quality in developed nations. Everybody compares themselves to the US from economic metrics to quality of life, as one will do when a superpower has dominated geopolitical dynamics for as long as the US has.

In many areas, yes. But from Europe at least, the US healthcare system seems so obviously broken that it's relatively rarely used for comparisons. Sweden is more common, I'd say.

Now if we're talking about innovation, technology, culture -- THEN there will be wistful comparisons to the US

> Everybody compares themselves to the US from economic metrics to quality of life

Which unfortunately, these days, is dragging a lot of countries down.

I see Australia and Canada doing it every day, and it's actively making life in those countries worse, because it's coming "down" to US standards.

They think they are though and convinced themselves and many others that they are.

cutting back on health care will not necessarily have immediate effects on the life expectancy, just as investing won't. At least if you can still provide a good basic level of service.

what if the supply of medical workers in Cuba allows it to send so many abroad with little effect on the local conditions ?

Seems it's not "little effect": Cuba has begun to sacrifice the health of its citizens at home

"Critics have complained"

No data, no study on the effect.

Their contribution will save thousands of lives. Ebola is a slow moving tsunami that we, as a world, can stop. If we don't step up and contribute the needed resources, literally hundreds of thousands of people will die. The sooner the better. Hats off to Cuba, but for the rest of the world, especially countries that can contribute, this should be a wake up call.

Is there any doubt that "hundreds of thousands will die" of ebola in the next year? The reports I've seen are a bit more pessimistic.

Aside from the condescending title, we also have this, in the first sentence:

Cuba, a country of just 11 million people that still enjoys a fraught relationship with the United States

To describe Cuba's position with regard to the U.S. (entering its 6th decade of basically vindictive and pointless economic sanctions) as a "fraught relationship" is certainly an interesting circumlocution. It's kind of like saying that the skinny kid in junior high who keeps getting pushed into lockers "enjoys a fraught relationship" with his peers.

Seems like you got offended just for the sake of getting offended. The title isn't THAT condescending, they're giving Cuba props for weighing in more than another country of its size and GDP.

As to the "fraught relationship" issue, what? I'm not sure what terminology you would have prefered they used but most of the alternative words choices are just 'fraught' synonyms anyway.

The Cuba sanctions are well known and a lot of people (myself included) think they're unwarranted. I'd definitely call what Cuba and the US have a fraught relationship.

Do I think the US bullies Cuba a bit? Yes. Do I think that the word choice was bad? No.

I wasn't "offended"; I was making an observation. You don't have to agree with it, but there's no need to inject an emotional aspect into it simply doesn't have.

Anyway, the point about the "fraught relationship" depiction is that it's basically an elephant-in-the-room thing. Such language might work to describe the relationship between the U.S. and Russia (or China), because those countries are essentially peers on the global stage. But to use it in the US/Cuba case pointedly ignores the fundamentally one-sided and, in the view of many inside (and essentially everyone outside) the U.S., petty-minded and abusive nature of that country's treatment of its much more vulnerable southern neighbor.

There's also an unpleasant blame-the-victim tinge to it.

The Post could have stated the obvious, of course, and acknowledged the elephant in the room. But it knows very well that in order to maintain its image as the (lessor of two) "papers of record" within the center of Federal power, that just would not do.

The only word I objected to was "enjoys." That made me feel like: Yeah, sure, Cuba ENJOYS the bad relationship it has with a larger, more powerful nation next door.

I don't entirely agree with you, but I do think the "enjoys a fraught relationship" was just terrible wording.

Brazil got a program that imports around 10 thousand cuban doctors. And they are nearly slaves to the cuban regime.

Brazil pays around 4k USD for each doctor, but he only keeps 1,2k. Everything else goes to the Castro's regime.

And that's because our oposition made a huge noise about that, because they used to receive about 400 USD, and the rest of the money to castro.

They have a good health program? Maybe. But I won't swap my freedom for that.

It is easier to create new drugs if you are not subject to strict regulations and if you are not afraid of lawsuits from people that participate in trials.

What slows down the research in USA is the safety mechanisms imposed by FDA. This is almost the same for every country that is not a dictatorship.

source: worked a decade for pharmaceutical companies.

There's a more general and more interesting pattern at work here. As humanity, we have grown too fond of our safety and comfort over the past 50 years to the point of being unwilling to take the risks that are necessary for us to grow further. The levels of risk-aversion we have reached, especially in developed countries is actually akin to a terminal disease that is already ensuring the demise of most "western powers". It's paradoxical in a very beautiful way.. that will eventually serve to remind us that life isn't really about being safe and secure. Safety, security and privacy are unnatural values that have been drilled into us, quite elaborately, over generations. They are fake values that only serve to hold us back and inhibit our innate greatness.

Don't be unduly impressed. It's common for a totalitarian state to focus its resources and "punch above its weight" in a specific area or two, but it's at the expense of the rest of their economy and the general well-being of its people. Its also a common tactic used to shore up support at home and win superficial plaudits abroad.

The Soviets were able to keep pace with the US militarily and in space. The also had world-beating athletics, chess and classical arts (ballet, orchestra etc). All this came at the high price of individual freedom and basic human prosperity. Milton Friedman aptly observed this gap between "public affluence and private squalor" as the defining outcome of centralized socialism. Christopher Hitchens, at that time a committed socialist, described his disillusionment w/Cuba while volunteering there in 1968 as follows:

Cuba was torn between grim austerity for its people and flamboyant hedonism for its revolutionaries, and one’s elementary socialist principles managed to register the gross injustice of this even while hoping (perhaps) that the engine of history would make up the deficit. - http://www.city-journal.org/2008/18_2_spring_1968.html

It is, I guess, better that Cuba has chosen to focus on healthcare rather than war-mongering, but it doesn't recommend their method of government as preferable to our own. It doesn't recommend their hundreds (perhaps thousands) of political executions or their death squads or their forced labor camps. It doesn't recommend their complete suppression of free speech and their prosecution of Cubans wanting to leave this self-proclaimed "paradise".

And it seems quite unethical to praise Cuba for it's export of medical expertise while ignoring the fact that relatives of these experts are essentially held hostage to ensure they won't defect. If you don't see something extremely sinister and disgusting about this, I'd posit you don't have the capacity for suspicion and disgust.

.. the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics." - Human Rights Watch, http://en.wikipedia.org/wiki/Health_care_in_Cuba

I'd posit that a fair (and fairly obvious) measure of a political system is the market for voluntarily migration. The fact is that almost no one migrates into Cuba and millions have braved, and continue to brave, incredible costs and dangers to migrate away from Cuba.

American style democratic capitalism is not without its flaws, and we must be eternally vigilant to resist and reverse attempts by both state and corporate power to impinge on our rights & freedoms in their own selfish interests. But, unlike Cubans (and former East Germans etc), we have the political infrastructure and basic human freedom to improve our system for the better. We shouldn't sacrifice these hard earned and extremely rare circumstances in the vain hope of securing marginally better health outcomes (or marginally better security, chess skills, literacy rates etc) by means of totalitarian socialism.

Don't worry. If agencies like NASA and Elon Musk manage to get anywhere with their Mars ventures, we can go back to praising America and free enterprise soon enough (since it apparently is a choice between that and communism/totalitarianism).

Cuban doctors are incredible for doing much with little.

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