The Corner

Health Care

If Only We Had Communist Health Care

Cubans attend a public political discussion to revamp a Cold War-era constitution in Havana, Cub, August 13, 2018. (Tomas Bravo/Reuters)

Nicholas Kristof, in the New York Times:

Cuba is poor and repressive with a dysfunctional economy, but in health care it does an impressive job that the United States could learn from. According to official statistics (about which, as we’ll see, there is some debate), the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9.

In other words, an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant. By my calculations, that means that 7,500 American kids die each year because we don’t have as good an infant mortality rate as Cuba reports.

. . .

There are also allegations that Cuba fiddles with its numbers. The country has an unusually high rate of late fetal deaths, and skeptics contend that when a baby is born in distress and dies after a few hours, this is sometimes categorized as a stillbirth to avoid recording an infant death.

Dr. Roberto Álvarez, a Cuban pediatrician, insisted to me that this does not happen and countered with explanations for why the fetal death rate is high. I’m not in a position to judge who’s right, but any manipulation seems unlikely to make a huge difference to the reported figures.

Oh . . . kay, then.

Like Kristof I’m “not in a position to judge” how much a Communist regime fiddles with its numbers, though he and I seem to have very different priors on that question. But even the numbers he’s comparing change an awful lot depending on what sources you rely on and how you choose to cut them.

The CIA World Factbook, for instance, puts Cuba’s infant-mortality rate at 4.4 rather than 4.0 per 1,000 (as of 2018). And the U.S. rate varies by racial and ethnic group, with whites and Hispanics having rates around 5 per 1,000 but blacks having a rate above 11 per 1,000 in 2016, according to a Centers for Disease Control report.

And by the way, if you use the CDC’s online infant-mortality tool to look only at Americans of Cuban origin, their rate was 3.8 in 2016, and 4.0 for the entire period running from 2011 to 2016. So Cubans in the U.S. have about the same infant-mortality rate that Cuba claims to have domestically.

It’s possible, of course, that a better health-care system would help to narrow these various gaps. But it’s not going to eliminate them, because health care is not the only thing that drives racial health disparites. Yet that is what Kristof assumes when he calculates what would happen if our entire country suddenly had an infant-mortality rate as low as the one Cuba reports, and links this comparison to Cuba’s health-care system.

Like everyone I’d like to make sure that infants get the care they need. But if we’re looking for good examples to follow overseas, why turn to this “poor and repressive” country with a “dysfunctional economy” on the basis of its own claims about the success of its health-care system? Even the reported results are not as impressive as Kristof makes them seem, and it’s not clear we should trust any information coming out of the country to begin with.

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