Sep 12, 2009

Contentious Cuba

In the contentious debate about health care reform in the United States, Cuba is used on all sides as either a model of success or a model of failure. It all depends on who you ask.

One popular--and incredibly controversial--example is Michael Moore's 2007 film Sicko, which lauded the preventative health care system in Cuba. The film took a highly critical look at health care in the US, and Moore decided to use Cuba as an example to prove his point--a decision that may have backfired. Here is the film's trailer:



Reviews of Moore's film reflect the highly divisive nature of the health care debate, which is often split across ideological and political lines. For example, blogger Michelle Malkin responded to the release of Moore's film by writing, "Michael Moore is playing martyr to full effect in advance of the premiere of his latest crockumentary effort." Christopher Hayes at The Nation summed up the film in this way:

Sicko is far, far less partisan than Fahrenheit, but much more ideological. And as such, it is more consistent in what it offers--with one major caveat. The film's final half-hour, in which Moore takes 9/11 rescue workers to Cuba, serves only to reinforce the decades-old slander that equates social democracy with repressive socialism. It's a major miscalculation and nearly squanders the first hour and a half of the film in which Moore so deftly guts arguments that socialized medicine represents the vanguard of Marxism. But that final section aside, the film functions as a compelling advertisement for an alternative way of ordering society, one in which, as in France, there's vacation, paid sick time, doctors who make house calls and even, amazingly, a state-supplied nanny who will come to your house and do your laundry after you've had a child. Who wouldn't want that?

CNN's Tom Charity had similar criticisms:

If Moore missteps, it's in the one sequence he and the Weinstein Company have made sure everyone has already heard about (with a little help from the U.S. government): the boat lift to Cuba for three ailing 9/11 heroes. It's Stunt Man Mike at his crudest, and not as effective as he intended.

To be sure, it's bitterly ironic that Guantanamo detainees have access to better medical care than the soldiers who guard them, but Moore is easily diverted into a silly commercial for Cuban socialist medicine that plays exactly like the kind of Soviet propaganda films he sends up earlier in the movie.


Charity did, however, recommend the film to his readers, despite the flaws. For Charity, the health care system is "sick, no question," and Moore's film might just make the idea of reform a more pressing issue on the national political agenda. It has certainly increased attention on the subject.

In September of 2007, ABC journalist John Stossel ran a series called "Sick in America," with one specific segment in which he directly challenges Moore's claims about health care in Cuba:



Reviews and commentaries on Moore's film run the gamut, and political debate about the health care system in Cuba (which is often held up as a comparison to the health care system in the United States) has continued up to this day. Cuba is both the hero and the villain in this national discourse, which in many ways isn't about Cuba at all--it's about health care in the United States, and whether or not there should be any changes to the system we have in place.

So where are the anthropologists in all this? Good question. Since anthropologists work all over the world, there must be one or two working in Cuba who can provide some insight, right? Indeed, there are. In 2007, University of South Florida medical anthropologist Linda Whiteford, along with Laurence Branch, a professor of health policy and management at USF, published the book Primary Health Care in Cuba: The Other Revolution. Carolyn Sargent, the current president of the Society for Medical Anthropology describes the book as, "a groundbreaking work. Primary Health Care in Cuba makes a significant contribution to medical anthropology and public health by documenting the history, political economy, and ideology that has produced the Cuban primary health care system" (from the back cover of the book).

Whiteford and Branch write:

One of the great achievements of the Cuban Revolution has been its "other revolution," its revolution in health care. This other revolution resulted in the successful reduction in health disparities and inequalities throughout Cuba between 1959 and 2000. This reduction is partly visible in the design and practice of primary health care, the focus of this book (Whiteford and Branch 2007: 7-8).

Anthropologist Katherine Hirschfeld, however, has a very different take on Cuba and its health care system. In a highly critical review of Whiteford and Branch's book in March of this year, Hirschfeld argues that it has oversimplified and over-romanticized the reality of health care in Cuba:

Had more rigorous methods been employed, some very different conclusions might have been reached regarding the respective costs and benefits of the Cuban system. Even a modest attempt at community ethnography, for instance, would have revealed local voices that are often at odds with, or even humorously dismissive of the health claims made by Cuban officials...Even a minimal investigation of lifestyle and income differentials between political elites and disenfranchised populations (such as the families residing in squatter settlements on the outskirts of Havana) would have revealed a gulf between rich and poor that has come to rival that of previous Cuban regimes (Hirschfeld 2009: 294).


Cuba plays a strange, and often contradictory role in political discourse in the United States. In regards to the current debate about national health care reform, the Cuban system is held up by all sides. Some see it as a model to find inspiration from, while others see it as a symbol of the road to disaster. Pundits disagree, journalists disagree, and anthropologists seemingly disagree. It seems clear that romanticizing ANY health care system is not going to get the debate anywhere.

The primary fault that I see with Michael Moore's film, for example, is that while it promotes dialog about the health care debate, and certainly has a number of strong critical points about the US health care system, his choice to color the Canadian, French, British, and lastly Cuban health care systems as idyllic Edens of public health was a serious mistake. Does sugarcoating the possible alternatives really accomplish anything? In the public debate about possible reform, losing a critical perspective about the benefits, flaws, and alternatives to the current system is certainly not going to push the debate forward. While the Cuban health care system may have certain highly laudable aspects to it, ignoring its faults (and clearly there are some serious faults to the system) will only serve to hinder this critical national conversation.

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