See link below for full report.
Conclusions: Socialism, Public Health, and Social Science
In the introduction to this paper I raised a somewhat radical question:
to what extent is the favorable international image of the Cuban health
care system maintained by the Cuban government's practice of suppressing
dissent and covertly intimidating or imprisoning would-be critics? The
goal of the paper has not been to answer this question so much as to
argue for its relevance in assessing the Cuban case. When speaking
informally, Cubans often make critical comments about their experiences
in the health care system. To my knowledge, however, these locally
articulated criticisms are not included in social science or public
health articles on the Cuban health care system. As a result of this
omission, the scholarly literature on Cuba implicitly validates the
point of view of the Cuban government--that shortages are caused solely
by the U.S. trade embargo, and that that the complaints of dissidents
are not legitimate.
The ethnographic data and analysis presented here are intended to
challenge these assumptions. I have tried to illustrate that material
shortages are endemic to all centralized, planned economies, and that in
addition to devoting resources to hospital construction and expansion of
the health sector, ideocratic states often use very authoritarian
tactics--tactics that individual doctors and patients can subjectively
experience very negatively--to create and maintain favorable health
statistics. When issues of state power and social control are factored
into the analysis, it becomes possible to see how Cuba's health
indicators are at least in some cases obtained by imposing significant
costs on the Cuban population--costs that Cuban citizens are powerless
to articulate or protest, and foreign researchers unable to empirically
investigate.
At this point, it is important to clarify that taking a critical
perspective toward Cuba and Cuban health care does not imply a casual
dismissal of the ideals of the Cuban Revolution or the compelling
rhetoric of social progress and equality that has accompanied Cuba's
health initiatives. As Peter Berger has pointed out, "a critique is not
an attack, but rather an effort to perceive clearly and to weigh human
costs" (1986:71). My primary goal in this work, therefore, has been to
use ethnographic data to illustrate some of the human costs of Cuba's
"socialist health and health care," and to challenge the case for Cuban
exceptionalism with respect to some of the problems that have been
described for other socialist health systems such as the former
Soviet Union.
http://www.miscelaneasdecuba.net/media/pdf/Article-Hirschfeld-Press.pdf
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