Cuban communism may be repressive, but at least it provides good health care. This is a common trope of left-wing apologias for Castro's brutal dictatorship. This claim is getting recycled yet again in the wake of Castro's recent resignation (e.g. here). One response to this point is that of liberal Berkeley economist Brad DeLong: Cuba would likely have a much higher standard of living (and better health care) today had it not gone communist in 1959. As DeLong documents, Cuba in the 1950s was one of the richest countries in Latin America and rapidly approaching Western European standards of living and health outcomes. Under communism, it became one of the poorest nations in the Western hemisphere - despite receiving vast quantities of heavily subsidized oil from the Soviet Union for decades. Taking Cuban official statistics at face value (as DeLong does), Cuban health outcomes and standards of living are roughly similar to those of Mexico and the Dominican Republic. In the 1950s, DeLong notes, Cuba was vastly better off than these countries and, on some measures (such as infant mortality) better than many Western European nations.

But there is an even more basic problem with the "at least Castro improved health care" excuse: it assumes that official Cuban government health care statistics are accurate. I find that assumption highly improbable. A government that brutally represses dissent and executed over 100,000 political prisoners out of a population of just 6.3 million is unlikely to be above falsifying its official statistics in order to improve its image. That was certainly common practice in other communist societies, including those which Castro used as models for his own.

When the Iron Curtain fell in Eastern Europe, scholars rapidly determined that official Soviet and East European statistics were routinely falsified to burnish the communist regimes' public image. As this foolishly credulous 1973 Time article noted, official East German stats indicated that, by 1970, East Germany had a higher standard of living than Italy and was rapidly closing in on Britain. Anybody with even the slightest familiarity with actual East German living standards knows how far such communist claims were from reality.

How bad is Cuban health care really? I don't know. Probably no one will know until the regime finally falls and honest data can be collected. For now, it's at least worth noting that the government health care clinics available to ordinary Cubans (those not members of the government elite) look like this and this. It's also worth noting that if Cuban living standards and health care really were as good as the government claims, it's unlikely that millions of Cubans would have risked their lives to flee the country - not only for the wealthy United States, but even for such far poorer destinations as Puerto Rico and the Dominican Republic. It's especially telling that many Cuban refugees prefer even Haiti (the one Latin American nation that probably really is poorer than Cuba) to life under Castro. The evidence of people risking their lives to vote with their feet is a lot more compelling than the Cuban government's dubious health statistics.

UPDATE: I am aware that some of the data on Cuban health care comes from the United Nations and other international organizations. However, the UN and the others depend on information provided by the Cuban government. You can't do independent data collection in a totalitarian dictatorship. Thus, the UN numbers are derivative of Cuban official statistics.

As I noted in my last post, Castro's alleged improvements in Cuban health care are often used as a counterpoint to his repressive policies. Maybe he repressed political dissent, apologists claim, but at least he improved health care. For example, CNN urges its reporters to "[p]ease note Fidel did bring social reforms to Cuba -- namely free education and universal health care . . . in addition to being criticized for oppressing human rights and freedom of speech."

In addition to the more obvious objections to this line of argument, it's also essential to recognize that political repression is bad for health. As I discussed in this post, the Cuban communist government executed some 100,000 political prisoners and imprisoned some 350,000 others in brutal labor camps during the the 1960s alone. This in a population of just 6.3 million as of 1960. Obviously, getting executed is bad for your health. Due to the milder climate, Cuban forced labor camps probably have better health standards than Soviet Gulags. Nonetheless, even a tropical Gulag isn't too good for the health of the inmates. A substantial number of the labor camp inmates likely either died before their sentences were up or had their lifespan substantially reduced as a result of privation they endured.

Calculating the odds, this implies that the average Cuban at the start of Castro's regime had a roughly 1.5% chance of being executed by the regime and a 5.6% chance of being incarcerated in a labor camp. In reality, the risks were probably higher than that for those who stayed in Cuba, since the 6.3 million population figure includes several hundred thousand Cubans successfully fled the country in the early years of the regime (the US alone admitted some 750,000 Cuban refugees between 1960 and 1976).

Even if Castro's government really did improve health care substantially for those Cubans who were fortunate enough to avoid being executed or incarcerated in labor camps, the improvement would have to be pretty enormous to outweigh the negative health effects of the regime's repressive policies. How much of an in improvement in health care would be enough for you to be willing to take a 1.5% chance of being executed and a 5.6% chance of being sent to a brutal labor camp for at least several years?

UPDATE: I have corrected a minor calculation error in my estimate of the odds of being sentenced to a forced labor camp in 1960s Cuba. The correct figure is 5.6%, not 4.8%.

Economist/blogger Michael Stastny has recently returned from a trip to Havana, Cuba, where he was surprised by the extent of the "misery and decay" that he found (hat tip Arnold Kling). He has some interesting observations for those who still believe that Castro's Cuba is a paradise for the common people. It's worth keeping in mind, also, that Havana is likely to be far better off than the most of the rest of Cuba. Like other communist regimes, the Cuban government pours a disproportionate share of its resources and public investment into the capital and areas likely to be frequented by foreigners. Other parts of Cuba are likely to be much worse off - especially those where foreigners are not allowed to go.

Stastny is no apologist for Castro. But I think he may be somewhat misguided in this passage from his post:

Unfortunately, Cubans don't have access to "world news" (no foreign newspapers, no internet, no satellite dishes), so the people I talked with were actually quite happy with their situation ("We don't earn much, but as opposed to other countries education and health care is for free!" (translation mine)) and couldn't see that people in developed countries who are considered as dirt poor have a way higher living standard (I didn't have the impression that they were afraid to speak openly).

There is no way to know for sure whether these particular Cubans were genuinely ignorant of the higher standard of living in other countries. However, I doubt that such ignorance is generally prevalent in Cuba. After all, if they didn't know that life in many other nations is far better, why would thousands of Cubans be risking their lives to flee the country? Not only for the wealthy United States, but even for much poorer destinations, such as Puerto Rico, the Dominican Republic, and even Haiti.

If the Cubans Stastny spoke too were not as ignorant as they seemed, why would they lie to him? Perhaps because Cuba has an extensive secret police that regularly tracks down and punishes dissenters, especially those who air the regime's dirty laundry to foreigners. As the Black Book of Communism notes (pp. 655), Cuba's DGCI has "thousands" of agents and anyone coming into contact with foreigners is particularly likely to be monitored; there is even a special division of the agency specifically tasked with monitoring foreign visitors (a standard practice in communist states, which the Cubans likely copied from the KGB).

I'm not saying that the DGCI is so efficient that it can detect and punish any Cuban who says anything critical to a foreigner. But even a small chance of being caught and punished is likely to be enough to deter many people from expressing dissent. How many Americans would be willing to openly criticize their government if doing so carried even a 5% chance of arrest and imprisonment by a brutal secret police?

It's true that Stastny had the "impression" that the people he spoke to were "not afraid to speak openly." But people living under a highly repressive regime learn to be skillfull liars and to keep their innermost thoughts to themselves - especially around foreigners or in other situations where the secret police are likely to be watching.

Stastny's understandable error is part of a more general problem that Westerners have in assessing the statements of people living under oppressive governments. Too often, they take parroting of government propaganda at face value.

None of this means that there aren't lots of Cubans who genuinely support Castro's regime. Even the most oppressive government has its beneficiaries. Moreover, fifty years of communist indoctrination has surely left its mark on Cuban public opinion. Just as there are Russians who even today remember Stalin fondly, there are probably Cubans who feel the same way about Fidel.

Be that as it may, it is important to be very cautious in interpreting pro-regime statements by Cubans and others who live under repressive governments. Some may genuinely love Big Brother. But others are only saying they do because they know Big Brother is watching.

The Wall Street Journal has an interesting interview with Cuban dissident Armando Valladares, an opponent of Castro's communist dictatorship who was imprisoned by the regime for some 22 years. Valladares' memoir Against All Hope is one of the better books produced by dissidents from communist states.

I discussed the Cuban government's massive human rights violations (the scale of which is still rarely appreciated) in this series of posts, where I also explained why its mostly mythical successes in providing health care do not come close to offsetting the harm caused by its political and economic repression.