I am always amused when I read things like this headline: “Castro could live to be 100“.

Well, how nice for him.

But that’s not what’s important. The important question is: Why does Castro think that he (and his brother) are the only people on the island of Cuba capable of running the place?

The reason is that he essentially thinks he is king: Able to dictate to his people how to live, where to work, and what to read,
Dissidents may end up in jail. There is freedom of worship, but some churches are banned and the Catholic church is restricted in many ways: no independent press, for example, that can monitor and report on human rights violations as is done in many other Latin American countries.

But most people aren’t dissidents or religious fanatics, so they will benefit from the advantages of the revolution.

Ah, but for the average person the bad news of the revolution is the busybody “Neighborhood committees” who poke their nose into your daily life and can order you to do “community work” and attend rallies, never mind if you want to stay home and sleep in and make love to your wife on your day off. And these committees are in charge of making sure you get your shots,  have a pap smear, get your blood pressure checked, and can even force you to abort your deformed kid.
P.J. O’Rourke once described the women who run these committees as “the bossy type of women who in modern countries would be known as my first ex wife”.

However, such organizations are greatly loved by those who want to organize and clean up the messy lives of ordinary folks.

For example, in private practice, if Nelly missed her pap smear, we would simply re schedule. Maybe she is having her period, or maybe she forgot. We can’t force her to come to the office. Of course, we have Home health to help our elderly, but most of our elderly have family or friends who help them so they can live at home. But for the rest of our patients, we expect them to be adults and make their own decisions.

Now, this is not true everywhere. Some HMO’s can put a lot of pressure on you if you don’t comply. And when I worked in the Indian Health Service, we could arrange rides and translators for traditional people  who are often too shy to come in to clinic. But unless it was a case of child or elder abuse, or a case of active TB, we couldn’t force a person in under penalty of law.

But in Castro’s Cuba, everything is organized, and unlike HMO’s they have the power of the neighborhood committee to order people around.

Here’s an excerpt from a website that just loves Castro. And indeed,he’s done a lotfrom a public health standpoint:

Each family practitioner is required to see every patient in his or her catchment area at least twice a year. The physician maintains a record of preventive services and conditions for all patients in the catchment area; this record is updated and reviewed at least monthly with a clinical supervisor, who is an academically based family physician. The monitored services and conditions include prenatal care, immunizations, cancer screening by Papanicolaou smears and mammography, risk factors such as smoking and hypertension, and follow-up for chronic conditions, as well as psychosocial problems and sources of stress in the family or at work. Under this surveillance system, it is expected that all patients in the catchment area receive preventive services appropriate for their age, gender, and risk factors.

And how is all this wonderful work done?

Compliance is assured by routine epidemiologic surveillance at the neighborhood level by family physicians, in cooperation with the neighborhood-based mass organizations such as the Cuban Federation of Women and the Committees for the Defense of the Revolution.

Yup, a public health doctor’s dream: controlling those lazy patients who miss appointments, don’t get their shots on time, and who don’t like to visit doctors.
But as a human being, a lot of this disturbs me: because it means you lose your freedom.

In the past, we had religions telling us to go to church, what to eat, and when to take a day off.

Now we have the health police, and unlike religion the health police are now imposing their restrictions against transfat and smoking by rule of law. What’s next? Employers mandating exercize and social workers checking if we smack our kids for bad language?

There is a lot of stuff on the internet arguing about losing our freedom in the name of the war on terror.

But if the US gets nationalized medicine, will we lose our freedom in the name of health?
Just wondering…


Nancy Reyes is a retired physician living in the Philippines. Her website is Finest Kind Clinic and Fishmarket and she writes medical essays to HeyDocXanga Blog

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