While I hesitate to predict that this change will be all for the good, I do believe that the poorest in Cuba will benefit significantly from increased trade.
I don't think that matters - the op's point still stands. Do you think criminalising homelessness solves the problem? It just (poorly) hides it. There may be a different between the 'working' poor and the mentally ill that you point out but I'd be willing to bet the mentally ill aren't left to live on the street and fend for themselves in Cuba.
I don't believe in criminalizing homelessness as it's a public health issue but I would contest the opinion that it poorly hides it. Look at any thread about New Yorkers complaining about SF and count how many times they talk about how the streets of New York have so many less homeless people. Of course, they probably don't understand the reasons very well (Rudolph Giulianis war on the homeless, etc.) but it certainly seems effective at hiding it when you either lock up homeless, force them to go underground and out of sight, or buy them a bus ticket to sunny California.
Yes, let's criminalize homelessness. How dare those homeless people refuse to stay in their mansions and apartments.
Do you think we should send the worst of them to Gitmo?
1: http://www.sfgate.com/bayarea/matier-ross/article/S-F-spendi...
$34*365 = $12,410.
It depends on your definition of worse. In Cuba there was a general shortage of several basic items (toilet paper, eggs, meat... etc.) were most people (the only exception is the political class) have to face rationing and long lines. As far as I know that is inexistent in Costa Rica.
It has more to do with the incompetence in economic areas rather than a capacity of making wealth.
- average life expectancy in Cuba is almost the same as the USA (and higher than Mexico, Belize, Bahamas, Brazil, etc.).
- literacy rate in Cuba is higher than that in the USA
- Physicians per 10,000 people: Cuba has 67, USA has 24
In the Ebola crisis, Cuba has been leading from the front.
As engineers we would never compare uptime statistics from a small, niche startup serving a couple thousand people to uptime statistics from, say, Google. Why do we immediately ignore these principles outside of engineering?
Edit: wording
therefore, if you want to bring in the analogy of startups and Google, it should be even more impressive that small countries (viz. people in small countries, viz. Cuba) live longer than Google (viz. people in large countries, viz. United States).
Do you really think the US couldn't beat Cuba on those metrics if they decided spending money on those topics was more important than spending money on the military?
Citizens of the US have wildly varied views about what it means to be a good American, and we often have greater cohesion to groups such as race or state, etc. Just about the only thing we do agree upon is when there is an existential threat to the country, hence military growth over time.
Cuba or Norway have much less divided societies to govern, and Cuba's leadership is so small that it can focus on specific issues in a way US politics cannot.
The parent was comparing the proportion of physicians in Cuba v.s. the US and claiming that the US couldn't match Cuba because of its heterogeneous population.
Now if you look at the WHO report on density of physicians[1] you see first-wold countries like Japan and Canada ranking below the US on the number of physicians per-capita.
I think numbers like these have a lot more to do with how the health care system is structured than the sort of population you have. E.g. maybe nurses in Japan and Canad have a bigger role in health care than the US.
1. http://www.who.int/gho/health_workforce/physicians_density/e...
Cuba is small. Does it have an homogeneous population?
No, amigo!
2nd highest in the world, behind Monaco (70): http://kff.org/global-indicator/physicians/
For comparison: Sweden (38), UK (27), Japan (21), Canada (20)
Makes you wonder if that number has any significance at all. Japan has 1/3rd the number of doctors, but the highest life expectancy in the world.
They just aren't unhealthy enough to demand more doctors?
Edit: Arguably the high food prices reduce obesity which is really important.
Canada, which has even fewer physicians, has a life expectancy only 2 years less than Japan.
If nothing breaks there is little need to fix anything.
I don't think it's the food prices, because the cheapest foods tend to be the ones that lead to obesity (among other health problems). Fast food burgers and white bread are not expensive here in Japan, but fresh fruits and vegetables are.
I think there are many factors, but the pretty great universal health care system has to be a big one. As a working adult in Tokyo, I receive tons of preventative care and thorough annual check ups. It's cheap, and virtually all health care for my kids is completely free until they turn 15.
The lack of equal access to health care in the USA is almost certainly a reason that poor people die 5 years earlier than affluent people[1]. I would guess good access to health care is a big reason that Cuba does so well on that front, despite its obvious economic obstacles.
[1]: http://news.rice.edu/2012/06/21/poorer-us-citizens-live-five...
[1] http://www.amazon.com/Guide-Perfect-Latin-American-Idiot/pro...
The "life expectancy" figure can't be gamed, unless you out and out lie.
Here's a recent article for thought: http://www.wired.com/2010/04/cuban-health-lessons/
I'm not saying that agrochemical proponents are right (I've heard that crop rotation is as good or better than synthetic fertilizers, though it's hard to argue against the labor efficiencies of huge tractors and lots of pest/herbicides), but the simple fact that agriculture is possible without agrochemicals doesn't disprove the argument that it might be better with them.
The US figure reflects very long careers; late retirements; investment in large teams of trauma specialists due to high war, car crash, and gunshot wound rates; a high percentage of women physicians working part time; and a high concentration of expensive specialists with no documentation that they improve outcomes and paid for by large federal government subsidies.
The actual amount of primary physician and general surgery time available to Americans is very low compared to other countries with similar numbers of doctors. Most countries also allow as many as half the cases administered by fully licensed doctors with 12-20 years of post-secondary schooling in the USA to be handled by nurses and pharmacists. Prescriptions for sniffles or heartburn, basic non-controlled medications, simple physical assessments, and vaccinations are handled by professionals the USA would consider nurses or pharmacists or unlicensed assistants in most first world countries. In the USA those jobs take the time of physicians.
And that is the top reason, among many other unrelated ones, that health care is so much more expensive in the USA. US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages or else some must go without care. It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.
Cuba, on the other hand, appears to be counting nurse practitioners as physicians. That's fine to do because they're highly qualified, but it makes the numbers not comparable across countries.
At the south of the continent, it is far more common to travel to Argentina, to get free health care. As Argentina has a large public health system, (that has been gradually loosing a lot of quality in the past 20 years) it's common that poor people from Bolivia, Chile and Paraguay travel and get attention for free in Argentina's public hospitals.
Your pharmacist is part of a system that got your health care right this time.
Sort of. There are a lot of very common misconceptions around this.
The AAMC (not AMA!) limited the number of medical school students until about ten years ago, at which point they announced an explicit goal of expanding the number of graduates from medical school.
However, this doesn't mean anything in practice[0], because the bottleneck isn't the medical school graduates - it's the residency programs. As a medical school graduate, you have an MD, but you are not actually qualified to practice medicine. That requires usually four years of training (minimum), plus several more for various specialties.
These programs are costly to run, and so hospitals that offer residency programs are funded by the federal government to do so (through Medicare). The only way to expand the number of practicing physicians in the US is to skimp on quality during training (which nobody wants to do), or to increase funding through Medicare (which nobody wants to do.
> US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages
They also have to be paid a hefty amount to pay off massive debt. If you see an attending physician in his 30s (or even 40s), even if he's making a respectable amount of money, there's a good chance he still has a negative net worth. The level of debt of course varies by location, specialty, and quality of education, but it's rather misleading to look at an e.g. $200K/year income for a physician and compare that to the equivalent amount in the tech industry.
[0] pun not intended, but very a propos!
In this case, the bureaucracy eventually overcame institutional resistance of the wealthiest professional Americans to reform of a system that limited doctors and thus vastly expanded their incomes. I expect that same government and institutional bureaucracy to eventually increase significantly the residencies, but it will move in that typical slow motion of bureaucracy eventually doing good.
When it eventually adds to our production of new doctors, it will have a bigger impact than ten Obamacares or single payer plans or HIPAAs.
The debit of American medical students is as legendary as the vast incomes of doctors, both wildly out of proportion to the rest of the first world. Hazing practices during residency are also still crazy, though much reduced after glacial bureaucratic reforms.
I don't know if there's any better idea there than to hire and appoint good administrators to plan better. A violent revolution like the one in Cuba that built a better health care system seems too extreme.
That said, I do hope it does help some people in Cuba who have fallen victim to unnecessary stresses caused by the embargo.
Nothing trickles down to the poorest, spontaneously, almost anywhere in the world.
Think about this: the major health issue nowadays across the world is obesity, not hunger.
We were talking about everything below that scale.
Finland in 1994 had a very high standard of living. Their GDP per capita in '94 was equivalent to roughly $40,000 in today's dollar.
Maybe Finland of 1914. Nigeria's GDP per capita today, for example, is $3,000.
http://www.davidbahnsen.com/index.php/2013/11/10/the-rationa...
I read Scott Ridley's book. And I recommend it highly.
The Cuban revolution could ignore this for 30 years, because of their ties with the USSR and emphasis on redistribution of existing resources; and then the old problems came back once the USSR crumbled. Now they are trying to build an economic identity around healthcare and education, and without the embargo (which stops technology from entering the country) they might actually succeed in ways that will hopefully inspire other islands.
I will be very careful with that statement. Cuba government is very good at propaganda and making people to think that.
In Venezuela we have a first hand experience about that since there is a lot of "collaboration" between both countries (basically oil in exchange of medical and education services). The result is a lot of cases about medical malpractices.
Also education is very opinionated with a strong emphasis in political indoctrination.
This is, unfortunately, not a problem unique to Cuba. I had this very same reaction when my wife and I vacationed in Jamaica. To get to this lush, tropical all-inclusive resort, you spend two hours riding in a minibus across bumpy barely-paved roads through some of the most abject poverty I've witnessed anywhere. It was very difficult to reconcile the insulated world of endless food and finely manicured lawns inside the resort with the world you witness just outside its gates.
If, on the other hand, people are able to eek out improved standards of living, in general, with savings on food costs, they can increase health and education spending and get into a virtuous cycle of increased living standards.
There's a bigger context necessary.
Trade with the US for DR has not helped much - US dumps Agro products (Powdered milk, meat) and bans Sugar.
The country is surprisingly politically free for a tiny nation facing an existential threat from a hostile super power that has invaded, attempted to assassinate it's leader, and funded militants dead set on violent revolution for decades.
American leadership immediately resorted to torture and illegal domestic surveillance when faced with the loss of two skyscrapers and 3,000 lives from an enemy that is more like an annoying gnat than an existential threat.
Cuba is a success story for socialism, and that is why US policy has sought to punish it, and to make it fail. The US did not want a successful socialist nation in it's sphere of influence, it gives the other nations subject to the Monroe doctrine ideas.
I don't think your argument is supported by any of the facts.[1]
[1]http://en.wikipedia.org/wiki/Human_rights_in_Cuba#Contempora...
How come nobody hit the ceiling when we didn't close our embassy with China today?
Cuba is third world poor. A country where the average person earns $300 to $500 per month, is a slave pen. State sponsored slavery is the only way you can repress people to such an extreme extent as to hold their standard of living that low for 50 years.
Given there has never been an economically successful Socialist nation in world history, it makes perfect sense that Cuba would be a failure just like all the rest.
Honestly, I'm not into communism and am very surprised that their figures are as good as they are. It's dumbfounding.'
I guess it's more a statement of how hard it is to come up from the bottom whatever your system is. Russia and China both showed great results in their first couple 5-year plans before communism petered out and didn't deliver further gains.
The mortality rates for children under five in 2007 were as follows (World Bank): Cuba, 6.5; Latin America and Caribbean, 26.37; United States, 7.60;
http://en.wikipedia.org/wiki/Health_care_in_Cuba#Comparison_...
You are right, Cuba is third world poor and they still beat their capitalist neighbors and even the wealthy and powerful US in life expectancy and infant mortality.
Cuba does so much with so little because of the radical idea that we are all in this together. Cuba spends $300 per citizen on health care, the US spends $7000. I spent $5000 personally just this year on health care and I'm young and healthy.
Those in capitalist countries are getting fleeced, and Cuba shows us that. If Cuban socialism didn't exist I couldn't point out these facts, and that is why Cuban socialism was such a threat and why the US has acted so insecure towards the tiny island's revolution.
I don't want the US to adopt the Cuban system, I just believe we had no right to violate their sovereignty, and having different political systems out there lets us have a sort of A/B test for politics. I don't believe a global political and economic monoculture is healthy.
As an American I wouldn't want to trade places at birth with a Cuban, but if I had the choice between being born to asset-less parents in Jamaica or asset-less parents in Cuba, I know I would be healthier, more materially secure and far safer from violent crime in Cuba. I also would have a much greater chance of not dying during my birth.
With that type of success who needs failure.
Despite the fact that I spend much of my working life writing "if" statements, I am going to ignore everything after the sixth word of this sentence and express disbelief at how you can claim that Cubans are politically free.
if cubaFree
> True
What I meant:
Considering how much political freedom was jettisoned by the US after 9/11, I am amazed that Cuba sits as close to the free side of the freedom spectrum as it does considering its been under existential threat for five decades.
Cuba is not a completely free and open society, and I don't claim to be able to pinpoint with certainty where on the freedom spectrum it sits exactly. I have never been there, as a US citizen I have not been free to travel there.
We are not free to go see for ourselves, we just echo the dominant ideology.
From the reading I have done I know that Cuba is more free than I was led to believe in school. It is not an Orwellian state.
I cite a comment from this thread on the topic:
> When I was there I was struck by people saying how hard it was and how they had to get by on about US$2 a week - this was a while back now.
Cubans are free to complain, I've heard it's a national past time.
They are free to engage in politics within socialism.
They are not free to oppose socialism and work to end it.
Americans have never been free to undermine capitalism. Anarchist/Marxist revolutionaries in the US have always been monitored, harassed, imprisoned and sometimes killed. See the history of the FBI, the Palmer raids, the Wobblies, Joe McCarthy, the black panthers, SDS, etc...
The US has given the Cuban government justification to curtail rights. This justification would not exist if the US would have respected Cuban sovereignty and not tried to murder it's leader, invade and destabilize.
How do you tell the difference between a sincere citizen activist and a foreign spy when the most powerful empire the world has known is actively trying to sabotage your government?
In the US in the years after 9/11 we heard a dire meme repeated over and over that went something like "If we get hit again it will be martial law" and we mostly accepted that as inevitable.
I find the finger pointing at Cuba to be unfair and lacking historical context.
Cuba actually has an incredible socialized medicine healthcare system, and the US embargo specifically carves out an exception for cancer pharmaceuticals developed and manufactured there. Its not that far fetched that you would see medical tourism take off from Florida with its vast retiree population.
If I were in the travel business in Florida, I'd start advertising now to get your name out there, and fly to Havana to have a conversation with Raúl Castro about how much yearly revenue you could be bringing in (all in USD I might add). About $39 billion/year is spent in Florida on Medicare; taking only a small piece of that is an incredible proposition for a country the size of Cuba.
"Despite a 50-year trade embargo by the United States and a post-Soviet collapse in international support, the impoverished nation has developed a world-class health care system. Average life expectancy is 77.5 years, compared to 78.1 years in the United States, and infant and child mortality rates match or beat our own. There’s one doctor for every 170 people, more than twice the per-capita U.S. average.
Not everything is perfect in Cuba. There are shortages of medicines, and the best care is reserved for elites. But it’s still a powerful feat. “In Cuba, a little over $300 per person is spent on health care each year. In the U.S., we’re spending over $7,000 per person,” said Drain, co-author of Caring for the World and an essay published April 29 in Science. “They’re able to achieve great health outcomes on a modest budget.”"
Nice healthcare system!
http://www.nerdwallet.com/blog/health/2014/03/26/medical-ban...
“In 2013 over 20% of American adults are struggling to pay their medical bills, and three in five bankruptcies will be due to medical bills. While we are quick to blame debt on poor savings and bad spending habits, our study emphasizes the burden of health costs causing widespread indebtedness. Medical bills can completely overwhelm a family when illness strikes,” says Christina LaMontagne, VP of Health at NerdWallet. “Furthermore, 25 million people hesitate to take their medications in order to control their medical costs. Unfortunately this can lead to even worse financial outcomes as preventative treatments are not rendered and patients end up using expensive ambulance and ER care as their health worsens.”
Then I also grew up in Soviet Union, where supposedly great healthcare was developed. And I can tell you they had a horrible health care like they have it in Cuba today.
If Cuban health care is so great, where is their great health research and studies? When did they publish the last time in Lancet on in NEJM? Where is that?
Cuba invests heavily in cancer research.
"Even in times of economic hardship, the Cuban Government has remained constant in its political and financial support for biotechnology. In the last 20 years it invested around one billion US dollars in research and development. Today, the Cuban biotech industry holds around 1200 international patents and markets pharmaceutical products and vaccines in more than 50 countries. Exports are soaring and generate yearly revenues of several hundred million dollars."
http://www.who.int/features/2013/cuba_biotechnology/en/ http://investmentwatchblog.com/cuba-develops-anti-cancer-tre...
That's because you're an anesthesiologist, and you see the acute cases which have already been admitted to the hospital. Poor people don't receive comparable long-term care. They don't receive comparable followup care after procedures. They can't afford lifesaving medication, they can't afford physical therapy, and they can't afford psychiatric care. They're denied for transplants, and many surgeons won't accept them as patients because their recovery stats are so much lower due to the aforementioned lack of followup.
All of this, without even mentioning the increasing number of specialty surgeons that operate on a cash-only basis, or the poor who don't go to the doctor simply because they cannot afford to. There's no comparison between the care that the rich and poor receive in this country, except possibly once they're unconscious in the OR.
I have worked in one of the top medical schools in the US, with world-class researchers, and know that there is very little there that is directly applicable to a population of rural farmers and impoverished city dwellers.
Elites, in other words.