Let's say you're an opinion writer, and you really, really want to write that Donald Berwick, the new head of the Centers for Medicare and Medicaid services, is a communist. Sure, he's not actually a communist, but why should that stop you? You can try taking some remarks he made about Britain's National Health Service out of context to falsely portray him as a lover of everything you don't like about the NHS, but that only gets you so far.
Well, how about Cuba? Sure, Berwick has never actually said anything about Cuba's health-care system that would indicate he thinks it tells us anything at all about what course reform should take in America. But Fidel Castro is a jerk! And Michael Moore praised Cuba's health-care system, and he's a jerk too! Isn't that a good enough basis to say that Donald Berwick wants to turn our system into something like Cuba's?
It is, apparently, if you're The Wall Street Journal. Bret Stephens, one of the Journal's opinion writers, gives us this in his column today:
Heaven forbid that anyone accuse Donald Berwick -- lately of Harvard, newly of the Centers for Medicare and Medicaid Services, with $800 billion under management -- of being an admirer of Cuba's health-care system. In the matter of CastroCare, progressives of Dr. Berwick's stripe are rarely at a loss for superlatives. But suggest that ObamaCare is a step in the Cuban direction, and these same people will accuse you of rank scare-mongering.
We don't scare-monger in this paper. And for the record, nothing in Dr. Berwick's published record indicates he has ever praised the Cuban system.
But note that when the health-care bill became law in March, Fidel Castro emerged from semiretirement to praise it as a "miracle." Note also that Dr. Berwick has made himself notorious by warning of "the darkness of private enterprise," admitting his "love" for Britain's socialized National Health Service, and insisting that "excellent health care is by definition redistributional."
Without imputing a mutuality of views, then, it's worth noting a certain mutuality of respect.
We don't scare-monger here at TAP. And for the record, nothing in Bret Stephens' published record indicates he's a fan of NAMBLA. Nevertheless ...
OK, I'm kidding. But that's pretty much the logic at work here. After going on for a few hundred words about how the health-care system in Cuba is really bad, Stephens circles back around, noting that Berwick hasn't endorsed Cuba's health-care system. "But it remains the case that for all those for whom 'free' health care has been, as Teddy Kennedy once put it, the cause of their lives, the Cuban system has been a touchstone." This is what happens when you spend a lot of time caricaturing your opponents: You end up seeing them as caricatures. Is the Cuban system really a "touchstone" for progressives? And would they really rather see our system turned into something exactly like it?
Let me explain what progressives actually think about the Cuban health-care system. It's an interesting data point, because it shows that it's possible to get a society a reasonable level of care while spending very little. Cuban doctors may not be the world's best, and they may be chronically short of supplies, but they have managed to achieve life expectancy and infant mortality comparable to that of a first-world country while spending a ridiculously small amount - around $675 a person, compared to the $7,500 we spend. They do a better job than most similarly poor countries. The lesson is that if you're creative enough, you can find ways to save money while maintaining good care. Needless to say, Stephens doesn't consider that maybe the weaknesses in Cuba's system come not from the fact that it's government-funded but from the fact that it has so few funds to work with.
Now because I've said that, Bret Stephens would conclude that I want to turn our system into Cuba's, which of course I don't. Let's make an analogy: Among the many effects of the Cuban embargo is that they can't get (or afford even if they could) new cars in Cuba. So they've managed to keep a fleet of 50-year-old Fords and Chevys running. It's admirable, and shows their resourcefulness. Does acknowledging that mean you'd rather turn in your Camry for a '59 Chevy held together with duct tape and chewing gum? Of course not.
But it might make you a communist.
-- Paul Waldman
