Friday, February 22, 2008


"Are you such a loser you can't tell when you've won?" –Jacob, From Dusk Till Dawn.

Anyone wanting to see some background to this, can visit Brad Delong's blog, here:

I first ran into the curious fact that Cuba had close to the lowest infant mortality statistics in Latin America over a decade ago, when I was boning up on epidemiology, partly as the result of a small contract I had, but also just because I do things like that every now and then.

In fact, Cuba's infant mortality rate is a bit lower than that of the United States. There are various claims that are made as to the source of this relatively minor statistical discrepancy, including noting that there are more low birth weight births in the U.S. due to a greater number of premature births, possibly as the result of more intensive pre-natal medical intervention. I'd be more receptive to such arguments were it not for the fact that non-Hispanic whites in the U.S. have a lower infant mortality rate than does Cuba overall, but infant mortality in African-Americans is more than double that of Cuba. For Native Americans it's about 50% higher than non-Hispanic whites, with considerable variation among tribal groups. Similarly, infant mortality is higher in some sections of the country overall, especially in the Southeast, but this may reflect the greater African American population there.

Of course, mentioning these facts immediately leads some to begin talking about "fetal alcohol syndrome," "crack babies," poor nutrition, etc. In the United States, you see, there are very few public health issues; it's always a matter of individual choices and responsibilities.

We're all such rugged individualists, you see. We cauterize our wounds by pouring gunpowder in them and then lighting it.

Anyway, I also noticed that, in any given academic article that addressed the issue of Cuban infant mortality, there was an obligatory first paragraph or two, explaining that Castro was, nevertheless, a Very Bad Person, a dictator, for heaven's sake, and the author certainly should not be taken as an Apologist for Castro. That would apparently make the author a communist, or at least a Left Wing something or other.

In "Rethinking Communism," I remarked on the fact that you can easily trace the outlines of the old USSR in southern Asia by looking at literacy statistics. The Russian Communists believed in teaching children to read, and they did something about it. And literacy, no matter what we'd like to think, is not a given. It requires some public policy decisions to result in a high literacy rate, and it requires a commitment of resources.

Cuba also has a high literacy rate, again, one of the highest in Latin America, a bit higher than that of Mexico, or even Costa Rica, and 'way higher than Guatemala, The Dominican Republic, or Haiti, to name some other countries that have had the benefit of U.S. invasions over the years. The Duchy of Grand Fenwick would not have been so keen on losing a war with the U.S. if they'd been in Latin America, I think.

So here we have Cuba, a dirt poor country, whether owing to the inherent inefficiencies in a centrally planned Communist economy, or to the fact that it has the most militarily powerful country in the world just a few miles away, trying to cut off all its trade, occasionally making invasion plans, and certainly requiring it to maintain a military far greater than it would otherwise need. (And let's stipulate here that Cuba also tried exporting its revolution and lent some of that military to Soviet purposes in Africa; I'm not trying to make the case that Castro is the Good Guy here). Yet Cuba, this dirt poor country, has managed to nevertheless maintain a effective structure of public heath and education.

Again, I don't think that this is all that mysterious. Those who make the decisions of public policy in Cuba decided that these things were a priority. In fact, you could argue that cutting off other, entrepreneurial avenues of advancement in Cuba, actually assisted the public health and education priorities, diverting manpower into those areas. I might personally think that you can do a better job with a richer economic base and a bit less labor input, but I'm not absolutely sure that this was an option.

Another thing that I'm pretty sure of is that ideas like "democracy" are rather secondary to the whole anti-communism thing. I don't want to try to gin up some sort of body count comparison between Cuba and, say, Guatemala, or to compare Pinochet to Castro. But it's undeniable that the United States routinely subverted (to put it mildly) democratically elected governments during the Cold War, in favor of dictators who were more "anti-communist." And this habit continues; how many people in the U.S. think it matters that Mahmoud Ahmadinejad is the elected President of Iran? Hell, how many even know that he was elected? Or that it isn't even the most powerful office in Iran? Very few, by the looks of things. Ahmadinejad's sole purpose, for U.S. foreign policy, seems to be to serve as a boogieman, someone to frighten the kids with.

Besides, if an election gives the wrong results, there are ways to make it all come out right.

But there is one other thing that has occurred to me in this ruminating-on-Castro thing, and that is this: the big foreign policy mistakes made by the U.S. concerning Castro were made in the early 1960s, on Kennedy's watch. There are those who try to blame the Eisenhower Administration, or even, so help me, Nixon (because Nixon was given such a lot of power during Ike's term, 'cause Ike trusted him so much). But Kennedy gave the go-ahead, and he did it because part of his thing was being as much of a "Cold Warrior" as anyone. The Cold War was not the invention of the Right Wing, they were the crazies who wanted a hot war. They were the "it's okay if that last two people left after nuclear war are Americans," people.

The Cold War was a product of American Liberalism. The Right learned to love it, or at least loved the anti-communist witch hunts. But Cuba was a bi-partisan screwup, and I think there's a lot of guilt still buried there. Some people are indeed such losers that they can't tell when they've won.


black dog barking said...

For-profit health care is a profoundly bad idea. On its face. We bundle up a pretty fair chunk of weal, hand it off to a third party financial administrator with specific instructions that these resources are to be applied to 1) our health, and 2) his profit. His choice.

He chooses that we pay more, get less. Go figure.

James Killus said...

Ah, but you've forgotten the most elegant part of the con, the appeals to "choice," thereby insisting that the entire load of quality control and efficiency in the health care system be handed over to either, a) people who aren't currently sick and who therefore aren't that engaged, or b) people who are sick, and therefore least able to fend for themselves.

It's con job poetry, really.

I'll also note that I should have emphasized the literacy point more. The U.S. decided as a matter of national policy in the 1950s and later, that it was not acceptible to leave a large segment of the population out of the educational system. So the public educational system has been under unremitting attack ever since.