"Garfield is still by far the best source you have, and he's dated- he's a source on Cuba in the early-to-mid-90s. So, what do you think about NOW? Do you still think that the embargo is causing medical hardship in Cuba as of 2013?"

Last things first, because you still seem to be misunderstanding my position. I have stated at least three times now that the effects of the embargo were felt most severely in the early 60's just after it was imposed, and again in the early-mid 90's after the withdrawal of Soviet aid, with consequences that are still felt today. The embargo is no longer the problem it once was, and I have never stated that it is. Period. In the beginning, it was disruptive to the industrial infrastructure of Cuba, and forced them into the arms of the Soviets because nobody else in the developed world would do business with them and risk retaliation by the US. At that point the die was cast, because Cuba became locked into a system that was not suited to human nature at this point in our evolution, and may never be. When the Soviets withdrew and left Cuba pretty much on its own, the shortcomings of the system became clear. There is no question about that. The CD and Helms-Burton Acts were cynically devised and timed to take advantage of Cuba's plight and hopefully bring the Castro government down. They failed at that, but in the process caused considerable suffering to the Cuban people due to the impact on food and health care. The Cuban government adjusted and things became better as time went on, partly because more and more Western nations, outraged by our actions began to trade with Cuba again, but there was a period in the early-mid 90's when the Cuban people suffered enormously from the embargo. That is the gist of all the medical articles I cited, and the outrage of those sworn to do no harm is palpable in all of them, so no surprise that they wax political at times.

"I can't find the full text of the PubMed abstract about epidemic neuropathy anywhere. I'd have to have my library send out for a copy, and I can't really do that ethically for the sake of an internet argument. :)"

I couldn't access it either, which is too bad considering that it was potentially a strong argument for my position. :(

"Since the subject came up, here is EVERYTHING I could find on PubMed about the embargo that was published since 2000:

Int J Health Serv. 2005;35(4):797-816.
Economic crisis and access to care: Cuba's health care system since the collapse of the Soviet Union.
Nayeri K, López-Pardo CM.
SourceUniversity of California, Survey Research Center, Berkeley, CA 94720-5100, USA.

Well, it's no surprise that this travesty came out of Berkely. They mention an economic recovery around 1995. Since the embargo didn't change then, presumably this is a recovery from the withdrawal of Soviet aid. The article is based on interviews conducted in 2003, mostly Cuban government officials but also a few patients- class 4 or 5 data at best, Cuban government propaganda at worst. It does include some economic figues that in no way show that medical hardships were caused by the embargo. It's just a litany of the collapse of Cuba's economy. By 1993 Cuban GDP had dropped to 65% of it's 1989 level due to withdrawal of Soviet aid. They mention the drop in caloric intake. They show that Cuba's medical budget in 1993 was 25% of what it was in 1989- and that wasn't due to the embargo, Brother, it was simply a function of a failing economy. Etc. They mention that the recovery was incited by changed economic policies, such as legalizing possession of foreign currency, and allowing entrepreneurship and even some free markets. Then the paper just becomes a list of remarks by official Cuban sources that blame all ills on the embargo (i.e. the offical Castro regime's excuse). "The combined effects of the well-functioning universal and equitable health care system in place before the crisis, the government's steadfast support for the system, and the network of social solidarity based on grassroots organizations mitigated the corrosive effects of monetary and market relations in the context of severe scarcities and an intensified U.S. embargo against the Cuban people." That's not a very convincing paper.

Not to mention that it simultaneously tries to argue that as Cuba climbed out of the crisis of the early 90s that everything improved again to 1989 levels, but that the embargo nonetheless causes terrible suffering. (So, at least from my perspective of debating the emabrgo as it is NOW, this paper supports me, even using official Cuban figures.) And from what I've been reading elsewhere their conclusions about differential access to care- which seems to have been the main goal of the study- sound like utter BS. It's probably also another official position of the Castro regime. Countless other sources I've seen mention that the Cuban elite and foreign medical tourists get much better care than average Cubans. The acknowledgements mention all of the help the author got from various official Cuban government agencies. Also, one of the responses to the article is titled "Cuban health care: consider the source", and questions the proposition that ANYTHING the Cuban government says about healthcare can be believed, so clearly it isn't just me... :)"

AS you say, they don't sound very convincing, and I would not have cited them had I run across them. They are also considerably later than the period I was addressing.
What I find at least as interesting is that you still can't find any articles from the period I was addressing that contradicted the articles I cited. Telling me that such "negative" articles would never have been published does little to assuage my concerns, especially when the subject is as controversial as this one. Generally, in scientific/medical journals, if someone publishes something really egregious there will be critical responses; is this not so?




"Qual Prim Care. 2008;16(4):269-77.
The health of a nation: perspectives from Cuba's national health system.
Offredy M.
SourceUniversity of Hertfordshire, Hatfield, UK. m.v.offredy@herts.ac.uk

This article actually isn't very relevent except in that it demonstrates that there is no current healthcare crisis in Cuba. It's really a sort of overview of how the Cubans run primary care. Admittedly, they are clearly better at disease PREVENTION than almost anyone else. Most other systems focus on disease treatment, instead. We could certainly learn something from them. It does mention Helms-Burton and other aspects of the embargo but only briefly as a historical aside in the background section. (It also admits that it avoids including any comments from the AIDS patients who are segregated into sanitoria. I wonder why.) In conclusions it fawns over the Cuban primary care system and their polyclinics, though in this case the fawning might be warranted- their system of primary care is clearly an excellent one."

As before, I was not addressing the period after 2000. They did mention Helms-Burton, presumably for a reason. Fawning is a pretty value laden word. Might they not have been expressing genuine admiration for the Cuban achievement under such difficult circumstances. Even you are expressing grudging admiration. ;)

"Science. 2010 Apr 30;328(5978):572-3. doi: 10.1126/science.1189680.
Global health. Fifty years of U.S. embargo: Cuba's health outcomes and lessons.
Drain PK, Barry M.
SourceSchool

Note- Barry is second author. The first half of the paper does again bemoan the 1990s- it is essentially a restatement of Barry's prior paper. The second half lauds the current state of Cuban healthcare (so, even Barry agrees with me about there not being much of a crisis NOW) and again fawns over their primary care system."

So, the first half supports my position, and the second half lauds them for overcoming the obstacles thrown up by the US and achieving a world class primary health care system in spite of them? As an aside, do you automatically consider anything with which Barry is associated to be suspect, without assessing the content? Just wondering. :)

"It does mention the 2009 US Senate report, which concluded "the unilateral embargo on Cuba has failed to achieve its purpose," with which I agree, as I have said. End the embargo because it doesn't work and gives the Castro regime a boogeyman to blame for everything."

And also demonstrating once again our total inability to let other people pursue their destinies in peace, using tactics that are perennially reviled by the vast majority of the nations of the world, 188 of them at last count. The embargo not only failed to achieve its purpose, it has been a major foreign policy disaster.

"That's it- three articles, all told. (Other than a few more epidemiologic papers about optic neuropathy, the abstract for one of which mentions that the Cuban epidemic ended in the late 90s.)"

Which also confirms that it was a problem in the 90's, i.e. 6-7 years of unnecessary suffering in a failed attempt to bring the Castro government down.

"One paper is clear propaganda, and two support my position that since at least 2000 there is no healthcare crisis in Cuba. Heck, even the propaganda one supports my position, it just simultaneously tries to complain about the US in any way possible."

Again we are talking about 2 different periods, but I am delighted that you have finally brought some new information to the discussion. It has broadened my understanding of how Cuba has evolved since the Soviet withdrawal and confirmed that
it has far outlived its original misguided purpose. The only losers now are the US
government and companies that could be doing a land office business down there. Thanks for going to the trouble, Dean.

I think we are at the point of truly going into hamster wheel mode. We've been going back and forth now for about 3 iterations of our positions with incremental refinements and some new information. There is actually a fair bit of agreement, although we disagree on the overall impact of the embargo and its roll
in bringing Castro into the Soviet orbit, with ultimately severe consequences for Cuba. That I have moved you at all on a medical issue is to this layman a minor miracle. It gives me a warm and fuzzy, along with newfound respect for your intellectual integrity. So, I'm going to call it a day for now. I've learned a lot from this one, among other things the dark side of the peer review process, and look forward to our next encounter, whenever that may be.

Edited for sloppy syntax, typos, etc and content.

Edited by ouzel on 03/11/2013 20:14:46 MDT.

@ "[your entire first paragraph]"

Yes we are arguing different things- you about the 90s, me about right now. I'm not misunderstanding anything- I pointed that entire point out before, several times. My point is that your argument was that one good reason to end the embargo was because it was evil because it was causing a humanitarian crisis. (Well, actually the INITIAL argument was about economics, back on pages 13-15 or so, and then you brought up the medical crisis as some sort of smoke-and-mirrors distraction.) I claimed it was not causing a humanitarian crisis. I'm now willing to grant that it at least significantly contributed in the 90s, but I maintain that whether it caused a crisis in the past is moot. That's why I've kept harping on the subject. What YOU clearly still don't understand is that I'm arguing with your basic premis that the humanitarian crisis in the 90s is even relevent right now. It is pointless to the debate on the embargo today. Heck, as you say you did grant that "The embargo is no longer the problem it once was..." I just get puzzled when you keep trying to establish how horrible the 90s were after you've said something like that, because TO ME this discussion appears to be taking place in 2013.

But, at least I've moved you to the point that you are willing to mention Cuba's bankrupt economic policies instead of just knee-jerk blaming the US for everything that's wrong in the world while implying that everyone else is an innocent victim. I'm not sure that trying to say that Cuba got better because the "rest of the world" suddenly decided to trade with them is correct, though. Source? :) I'm more inclined to put that one on the liberalization of the Cuban economy. They are trading more with the rest of the world now because Cubans are now finally allowed to keep reserves of foreign currency, which makes trade much, much easier.

@ "The CD and Helms-Burton Acts were cynically devised and timed to take advantage of Cuba's plight..."

Got a source for that one, too? I mean- it wouldn't surprise me, but I'm more inclined to cut it with Hanlon's Razor: 'Never attribute to malice that which can be adequately explained by stupidity.' We are talking about Congress, after all. :)

And, can you address this? :"By 1993 Cuban GDP had dropped to 65% of it's 1989 level due to withdrawal of Soviet aid. ... Cuba's medical budget in 1993 was 25% of what it was in 1989."

Given that you made such a big deal out of the 1% hit to Cuban GDP caused by the embargo, can you argue with a straight face that this didn't affect Cuba more than the change in the embargo in the 90s? I mean, look at that drop in medical funding! I still think that their joke of an economy was more to blame (which they are liberalizing). The more I learned about the 1992 embargo the more it seems to have clearly contributed significantly, but I'll still put more blame on the Cuban economy and the degree to which it imploded without Soviet aid. They improved in the 2000s by liberalizing.

@ "I couldn't access it either, which is too bad considering that it was potentially a strong argument for my position. :("

From Jeremy's description I doubt it. (Thanks, Jeremy, and yes, the link was pay-per-view. I didn't know that anyone else was still listening.)

@ "AS you say, they don't sound very convincing, and I would not have cited them had I run across them."

Nice to know that you have standards. :) But seriously, I could almost argue that the only reason I included that one was for laughs. It was quite blatant propaganga.

@ "What I find at least as interesting is that you still can't find any articles from the period I was addressing that contradicted the articles I cited."

As I've explained ad nauseum, the period you're addressing is moot. Show me something from the period I'M addressing- i.e. after 2000 or so- that proves that the embargo is 1) causing a humanitarian crisis as of 2013, or 2) so crippling the Cuban economy that they can't buy medical supplies or food.

@ "...if someone publishes something really egregious there will be critical responses; is this not so?"

You'd be surprised. If the paper is bad it usually simply gets ignored. Maybe someone is spiteful enough to write a response, like with the propaganda piece, but mostly the professionals in the field just sort of talk amongst themselves. A good example are those papers I mentioned that tried to argue that laparoscopic unilateral inguinal hernia repairs are cheaper and faster than open repairs. Ha! I didn't search for responses to your papers- they are often not indexed well in the search engines, especially for older articles, so they can be hard to find. Now, if you do something really bad like falsify data THEN there is hell to pay.

@ "As before, I was not addressing the period after 2000."

Correct. You are not. Why not? :) In all seriousness, though, I acknowledge that you grant that the current state in Cuba is not the disaster it was in the 90s. I just think that you're saying that... but still harping about the 90s.

@ "Fawning is a pretty value laden word."

Hmm. Yeah, probably. I may have had it on my mind because it was used more appropriately to describe that first joke of a paper. Oh, and my admiration isn't grudging. As I said, clearly the Cubans are good at primary care- something we are bad at. I suspect that some things are just easier in a dictatorship. :) For instance, an organized, centralized primary care schema. As I said earlier- communist dictatorships can do any ONE thing very well if they make it a priority, but when everything else is going to hell it becomes sort of a Pyrrhic victory.

@ "As an aside, do you automatically consider anything with which Barry is associated to be suspect, without assessing the content?"

Would you automatically be suspicious of anything that Hwang Woo-suk published? If not then you're a fool. People have reputations, for good or ill. But to answer your question, no, I was more trying to point out that much of the flap you're describing is really just the same small cabal of people. And then other people who are actually doing research- such as those neuropathy articles- then just reference their drivel in their discussion sections and claim "this was all caused by the embargo."

@ "And also demonstrating once again our total inability to let other people pursue their destinies in peace, using tactics that are perennially reviled by the vast majority of the nations of the world,..."

Presumably under the heading of "pursue their destinies in peace" you would include being able to be critical of their own government without being thrown in jail or shot? :) I mean, let's not be disingenuous, here- the Cuban government are Bad Guys. The debate about whether or not sanctions ever work or if they just entrench a regime while causing suffering in the populace at large is a complex issue that is still being argued in the halls of power today. Clearly it didn't work with Cuba, though...

@ "... Cuba has evolved since the Soviet withdrawal and confirmed that it has far outlived its original misguided purpose. The only losers now are the US government and companies that could be doing a land office business down there."

Yes, clearly on all of that we agree. Except that I would include the Cuban people among the 'losers' here, too. They are getting the shaft from both ends.

@ "So, I'm going to call it a day for now."

Oh, no! I tried to leave this debate and you wouldn't let me. Hippocrite. :)

Edited by acrosome on 03/12/2013 13:08:07 MDT.

Sorry to interupt thread hijack : )

I just got email from Boy Scouts to Eagle Scouts asking them (me) how they feel about allowing homosexuality.

I will allow that Boy Scouts are "between rock and hard place"

Although maybe "they made there bed so now they have to sleep in it" - when I was in Boy Scouts in 1960s homosexuality and religion were non-issue, but recently the Boy Scouts have moved in the direction of more controlled by a few religious groups that pushed their agenda, and now more moderate people are un-happy how Boy Scouts has been hijacked.

As has been the rest of the country - hijacked by extreme right wingers.

To quote a well known provocateur: "You're sucking me in again". ;)

"Yes we are arguing different things- you about the 90s, me about right now. I'm not misunderstanding anything- I pointed that entire point out before, several times. My point is that your argument was that one good reason to end the embargo was because it was evil because it was causing a humanitarian crisis. (Well, actually the INITIAL argument was about economics, back on pages 13-15 or so, and then you brought up the medical crisis as some sort of smoke-and-mirrors distraction.)"

I think the difference here is that you seem to me to be trying to compartmentalize the two periods, whereas I see them as two points on a historical continuum, where events in one period had effects that persist into the present. I have been trying to approach the issues we have been discussing that way from the beginning. Thus I connect the initial impact of the embargo with Castro's decision to rely on the Soviet Union, which led to adopting their economic system, which left his economy in a shambles when they withdrew, which left Cuba particularly vulnerable to the CDA and Helms-Burton, which led to the humanitarian crisis whose effects very likely persist to this day in some segments of the Cuban population, i.e. those who were children then who are now impaired to some degree, cognitively and/or physically, or adults who were blinded by their neuropathy. This is just the way I was trained to analyze issues like this, and I think it is a valid approach. Cuba since 2000 did not just appear out thin air like some deus ex machina. As for smoke and mirrors, more of the same; I consider health care and an economy to be inseparable, each influencing the other. Do you consider them as entirely separate issues? Can an unhealthy population be as productive as a healthy one? Consider one historical example, the impact of opium on China back in the 18th and 19th centuries, after the British forced the Chinese to allow it to be imported. Estimates are that upwards of 25% of the civil service became addicted, not to mention business people, etc. Do you think that might have had an impact on the Chinese economy and society, say 10-15 years later? Or would you consider that a moot point as well?


"I'm now willing to grant that it at least significantly contributed in the 90s, but I maintain that whether it caused a crisis in the past is moot."

Which would indicate that you consider at least part of the data I supplied reliable?


"That's why I've kept harping on the subject. What YOU clearly still don't understand is that I'm arguing with your basic premis that the humanitarian crisis in the 90s is even relevent right now. It is pointless to the debate on the embargo today. Heck, as you say you did grant that "The embargo is no longer the problem it once was..." I just get puzzled when you keep trying to establish how horrible the 90s were after you've said something like that, because TO ME this discussion appears to be taking place in 2013."

Again, you want to compartmentalize and forget the past, whereas I see the past as connected to the present. I said the embargo per se is no longer the problem it once was. I also said its impact earlier had lingering effects, as I reiterated above for perhaps the 4th time in our dialogue.

"But, at least I've moved you to the point that you are willing to mention Cuba's bankrupt economic policies instead of just knee-jerk blaming the US for everything that's wrong in the world while implying that everyone else is an innocent victim."

I have never argued otherwise, Dean. For me it's a matter of degree. There is no question that the Soviet economic model ultimately proved unworkable, that is history. It will also ultimately be the case with Cuba. What I have argued is that the embargo made things even more difficult for Cuba and was responsible to a considerable degree for the humanitarian crisis of the 90's. I have also argued that the embargo forced Castro to rely on the Soviets and adopt their economic model in the early 60's, which set Cuba on a course to the near economic collapse we are seeing today. As for the knee jerk remark, it always gives me a warm and fuzzy when you start to flail around. ;)
"I'm not sure that trying to say that Cuba got better because the "rest of the world" suddenly decided to trade with them is correct, though. Source? :) I'm more inclined to put that one on the liberalization of the Cuban economy. They are trading more with the rest of the world now because Cubans are now finally allowed to keep reserves of foreign currency, which makes trade much, much easier."
Trade helps, especially when the Cubans are trying to recover from the huge disruption caused by the Soviet withdrawal of support. Liberalization helps, too, no doubt about it. My guess is that they will end up with a more market oriented economy, but without some of the excesses that characterize the current US system

""The CD and Helms-Burton Acts were cynically devised and timed to take advantage of Cuba's plight..."

Got a source for that one, too? I mean- it wouldn't surprise me, but I'm more inclined to cut it with Hanlon's Razor: 'Never attribute to malice that which can be adequately explained by stupidity.' We are talking about Congress, after all. :)""

Some things shouldn't require a source. I mean, if you think that CDA and Helms-Burton were introduced and passed because Torricelli and ol' Jesse woke up with hangovers one morning and decided it would be a good day to rattle Fidel's cage, well, all I can say is I've still got one bridge left in my portfolio that I might be willing to let go to a fellow BPLer for a very reasonable price..... ;0)

""And, can you address this? :"By 1993 Cuban GDP had dropped to 65% of it's 1989 level due to withdrawal of Soviet aid. ... Cuba's medical budget in 1993 was 25% of what it was in 1989.""

I could speculate that it doesn't do much good to budget for things that are not available, due to the embargo, withdrawal of the Soviets, and a lack of hard currency, but I don't know what their thinking was. They put a very high priority on health care, so they had to have had their reasons. Do you have any other ideas?

"Given that you made such a big deal out of the 1% hit to Cuban GDP caused by the embargo, can you argue with a straight face that this didn't affect Cuba more than the change in the embargo in the 90s?"

I would respond that both had an impact. Can I quantify it? No. Can you? In any case, both had an impact due to the embargo, by your own words. I doubt it makes much difference to some kid with a vitamin deficiency which one had the greater impact.

"I mean, look at that drop in medical funding! I still think that their joke of an economy was more to blame (which they are liberalizing). The more I learned about the 1992 embargo the more it seems to have clearly contributed significantly, but I'll still put more blame on the Cuban economy and the degree to which it imploded without Soviet aid. They improved in the 2000s by liberalizing."

Can you quantify which had the greater impact? I think we both agree that the embargo had a significant impact, and that their economy was a mess after the Soviet withdrawal. Yes, they improved by liberalizing, but who knows how much they would have improved without the embargo had they stayed the course? Probably not as much as by loosening up, but I'll bet things would have been better than they were with the embargo. It caused a lot of unnecessary suffering. As I said above, I'd guess they'll end up with some sort of mixed economy along the lines of the Scandinavian countries if we just get out of their face.

"Nice to know that you have standards. :) But seriously, I could almost argue that the only reason I included that one was for laughs. It was quite blatant propaganga."

Did you really think I'd bite on something like that? :)

@ "What I find at least as interesting is that you still can't find any articles from the period I was addressing that contradicted the articles I cited."

"As I've explained ad nauseum, the period you're addressing is moot. Show me something from the period I'M addressing- i.e. after 2000 or so- that proves that the embargo is 1) causing a humanitarian crisis as of 2013, or 2) so crippling the Cuban economy that they can't buy medical supplies or food."

This IS getting to be ad nauseum. I have stated and restated my position that the events of the 60's-90's had effects that persist into the 2000's, including the economic model that Castro was forced to adopt early on due to the embargo, not to mention a very likely a cohort of permanently impaired Cubans who were unable to get the nutrition and medical treatment they needed because of the embargo. You probably know better than I the outcome of untreated nutritional optic neuropathy, Guillain Barre syndrome, and esophageal stenosis in infants. Would not a lot of these people be less productive, perhaps require extended care, etc, all contributing to a drain on the economy? The ones that survived, that is.

"You'd be surprised. If the paper is bad it usually simply gets ignored. Maybe someone is spiteful enough to write a response, like with the propaganda piece, but mostly the professionals in the field just sort of talk amongst themselves. A good example are those papers I mentioned that tried to argue that laparoscopic unilateral inguinal hernia repairs are cheaper and faster than open repairs. Ha! I didn't search for responses to your papers- they are often not indexed well in the search engines, especially for older articles, so they can be hard to find. Now, if you do something really bad like falsify data THEN there is hell to pay."

So presumably the articles I cited at least did not falsify their data. In which case, they present a sobering view of the embargo's impact.

"Correct. You are not. Why not? :) In all seriousness, though, I acknowledge that you grant that the current state in Cuba is not the disaster it was in the 90s. I just think that you're saying that... but still harping about the 90s."

See above, I can't make myself any clearer than I already have.

@ "Fawning is a pretty value laden word."

"Hmm. Yeah, probably. I may have had it on my mind because it was used more appropriately to describe that first joke of a paper. Oh, and my admiration isn't grudging. As I said, clearly the Cubans are good at primary care- something we are bad at. I suspect that some things are just easier in a dictatorship. :) For instance, an organized, centralized primary care schema. As I said earlier- communist dictatorships can do any ONE thing very well if they make it a priority, but when everything else is going to hell it becomes sort of a Pyrrhic victory."

I wouldn't consider achieving a world class primary health care system in spite of our considerable efforts to undermine them a Pyrrhic victory. :) For me a Pyrrhic victory is more like the one we say we achieved in Iraq. But if you want to experience a real Pyrrhic victory, be patient just a little longer. There's one just around the corner, when we start our next war, with Iran.

@ "As an aside, do you automatically consider anything with which Barry is associated to be suspect, without assessing the content?"

"Would you automatically be suspicious of anything that Hwang Woo-suk published? If not then you're a fool. People have reputations, for good or ill. But to answer your question, no, I was more trying to point out that much of the flap you're describing is really just the same small cabal of people. And then other people who are actually doing research- such as those neuropathy articles- then just reference their drivel in their discussion sections and claim "this was all caused by the embargo."

I've been called worse. However, I at least attempt to assess what they are saying before making a fool of myself. Interesting, though, from my perspective that no counter cabal has come forth to present the true picture of how the embargo affected Cuba and send those comm-symps scurrying back into the bushes.

@ "And also demonstrating once again our total inability to let other people pursue their destinies in peace, using tactics that are perennially reviled by the vast majority of the nations of the world,..."

"Presumably under the heading of "pursue their destinies in peace" you would include being able to be critical of their own government without being thrown in jail or shot? :) I mean, let's not be disingenuous, here- the Cuban government are Bad Guys. The debate about whether or not sanctions ever work or if they just entrench a regime while causing suffering in the populace at large is a complex issue that is still being argued in the halls of power today. Clearly it didn't work with Cuba, though..."

Ideally, yes, but that is really none of our business, particularly given the current deteriorating state of civil liberties in our own country. Then there is the troubling question of why we don't apply that same standard to the likes of the Saudis, Bahrainis, Ethiopians, and so on, not to mention a long list of our former buddies down in Latin America, The Philippines, various parts of Africa. The list is long. Why the solicitous concern for the long suffering Cubans? Disingenuous? A government that establishes a world class primary care system is not all bad, at least IMO. As for sanctions, show me a case where they have worked. North Korea? The centrifuges are still humming away and they just conducted test #3. Iran? Undeterred to date. Iraq? There emerges that troubling question about the deaths of 500,000 Iraqi children due to lack of clean drinking water and access to medicine, and it still took two wars, hundreds of thousands of Iraqi civilian deaths, several million refugees, 4500 plus US combat deaths and over 32,000 visibly wounded, along with hundreds of thousands of soldiers apparently suffering with varying degrees of PTSD, and the complex issue of whether sanctions are effective is still being debated in the halls of power? Sanctions have never worked. Their impact falls almost entirely on the innocent, and we stand alone among the nations of the world in employing them, or at least initiating them and then assembling coalitions of the more or less willing to join us. This is not knee jerk criticism, Dean, so please don't go there again. It is a well considered position. Argue against it if you will, but don't call it knee jerk.

@ "... Cuba has evolved since the Soviet withdrawal and confirmed that it has far outlived its original misguided purpose. The only losers now are the US government and companies that could be doing a land office business down there."

"Yes, clearly on all of that we agree. Except that I would include the Cuban people among the 'losers' here, too. They are getting the shaft from both ends."

There is a Russian proverb: The shortage will be divided among the peasants.

So it has ever been, and so it will always be I fear. It doesn't make much difference what economic system we are talking about, there will always be peasants. And shortages. We've got more than a few "peasants" of our own these days, wouldn't you agree, particularly as regards health care. Best to take care of our own peasants and stop making things more difficult for Cuba's.

"Oh, no! I tried to leave this debate and you wouldn't let me. Hippocrite. :)"

OK, OK. Anything but a hippocrite. Have at it. ;0)

@ "I think the difference here is that you seem to me to be trying to compartmentalize the two periods, whereas I see them as two points on a historical continuum, where events in one period had effects that persist into the present..."

Gimme a little credit- I understand that the past shapes the present. I have considered the the 90s crisis- I've just come to different conclusions about its significance than you have. All things considered, if there currently is no medical crisis in Cuba then it is moot to argue to remove the embargo because of the medical crisis that it is not causing. Eh? Because, again, this debate is about removing the embargo NOW. (I'm repeating myself for more than the 4th time, here...) That there was a medical crisis in the past to which a more restrictive form of the embargo contributed is worth noting, yes, but it isn't an argument to repeal the current form of the embargo which IN NO WAY restricts importation of medical and agricultural supplies to Cuba (other than any smaller effect it has on the economy in general).

Let's spell this out: the current embargo does not restrict food or medical exports to Cuba. So arguing that a PRIOR form of the embargo did so is utterly moot when we're debating ending the current form of the embargo. Let's say solely for the sake of argument that the 1992 embargo was solely responsible for the crisis. As of 2000 that embargo no longer exists, so even in this hypothetical case I'd argue that the current for of the embargo allows essentially unrestricted food and medical exports and thus you can't argue to end it because a prior embargo DID limit those exports.

Am I making sense, here? Because this seems so self-evident to me that I wonder if I'm just communicating very badly.

@ "Thus I connect the initial impact of the embargo with Castro's decision to rely on the Soviet Union, which led to adopting their economic system, which left his economy in a shambles when they withdrew, which left Cuba particularly vulnerable to the CDA and Helms-Burton, which led to the humanitarian crisis whose effects very likely persist to this day in some segments of the Cuban population..."

No. Just... no. I'm pretty sure that Castro was an ardent communist long before the embargo. (If you can show otherwise feel free- I haven't read extensively on the subject.) We didn't "push" him to be a communist. Heck, the embargo was in response to his nationalizing billions of dollars worth of US-owned property in Cuba. It has since morphed into something... else.

@ "i.e. those who were children then who are now impaired to some degree, cognitively and/or physically, or adults who were blinded by their neuropathy."

Clearly, yes, this will have an effect. But you do realize that now I'll want to see numbers before I commit to HOW MUCH of an effect this has? For instance, yes there was an optic neuropathy epidemic, but an 'epidemic' of something like that can still be a damned small number. I'll review that paper again when I get a chance. And also- this still ignores the issue of which was the more significant cause of the medical crisis- the embargo or the collapsing Cuban economy? Just saying "there will be residual effects of the medical crisis" is not helpful when we at root disagree about what was the most important cause of that medical crisis. You seem to think that I'm granting that the embargo was. I'm not. I'm granting that the embargo was significant, but still put more blame on the Cuban economy.

And, that was still a prior embargo we're talking about. The embargo that we are arguing to end today does not in any way contribute to a medical crisis. If you're arguing to end the 1992 embargo, well, mission accomplished. It no longer exists in that form.

@ "I consider health care and an economy to be inseparable, each influencing the other. Do you consider them as entirely separate issues?"

Clearly not. I have pointed out several times that when you can't pay for a medical system, that system suffers. But I severely doubt that the 'residual effects' of the medical crisis of the 90s is sinking today's Cuban economy. If there is any medical difficulty in Cuba today it is due to economics or policy- because it surely is not due to the embargo or these 'residual effects.' But all indicators are that Cuba is improving in almost every way as it liberalizes a bit.

@ "Which would indicate that you consider at least part of the data I supplied reliable?"

I'm saying that Garfield at least tried to find data to support his proposition. Most of it was still from Cuban sources, but it at least looks believable. None of your other sources tried- they just cited Garfield. I've also read other sources that we haven't discussed.

@ "Again, you want to compartmentalize and forget the past, whereas I see the past as connected to the present."

You really need to stop saying that- it's a bit insulting. Sort of like our Iran argument (wherein I very much did understand WHY the Iranian government act like puerile psychopaths at times, but I just didn't think as you seemed to that it EXCUSES their behavior). I'm not compartmentalizing anything. I merely acknowledge that the situation has changed in the past two decades. As do you. What are we arguing about? Are you saying that the crisis of the 90s is still a good argument to remove the embargo as it exists today? You seem to be. I'm merely arguing otherwise. There are better reasons to do away with the embargo than a crisis that has been resolved. You mention "lingering effects", which certainy are present, but probably not significant to the embargo debate circa 2013. After all, those papers I cited show that Cuban healthcare has recovered quite well. That's why I say that the "medical crisis" isn't much of an argument to remove the embargo- because there is no medical crisis, and there is unlikely to be another. (At least, not due to the embargo.) Do you dispute that?

So... I understand the past, I have included it in my analysis, and I don't find it terribly pertinent to the debate about ending the current embargo.

@ "Some things shouldn't require a source."

But this isn't one of them. If Jesse et al really wanted to hit Cuba while it was down I wouldn't be surprised AT ALL if they stated so somewhere. Supposedly you could produce a quote. But, as I said, I wouldn't be surprised- I'm more curious. I'm also more inclined to blame idiocy than malice. After all- consider who we're talking about. :)

@ "I could speculate that it doesn't do much good to budget for things that are not available,..."

You also can't budget when you don't have the money, eh? :) Well, unless you're the US... But look at that GDP drop! You're really reaching on that one, Tom.

@ "Do you have any other ideas?"

Well, no, Brother, beause that's exactly what I'm saying- that the poor Cuban economy was the 'most significant' factor in the crisis of the 90s. They had no money. I'm boggled that you can see numbers like that and not say to yourself "Christ, that looks Really Bad. That HAD to be a major factor." Instead you put it squarely secondary to the embargo. And this is the root of our disagreement- which was the larger factor, the embargo or Cuba's travesty of an economic system? I think that we just have to agree to disagree on some of these points- thus far they seem very subjective.

@ "Interesting, though, from my perspective that no counter cabal has come forth to present the true picture of how the embargo affected Cuba and send those comm-symps scurrying back into the bushes."

Correct, there is no 'cabal.' There is the State Department and the US Chamber of Commerce.

@ "I have never argued otherwise, Dean."

Well, for a bit I felt that you did, by implication, by trying to utterly dismiss my economic argument in favor of attributing the medical crisis to the embargo. But I know what you mean- yes, when needed you readily made formal statements about the Cuban economy. I still think that you underestimate it's effects in the crisis of the 90s, though.

@ "What I have argued is that the embargo made things even more difficult for Cuba and was responsible to a considerable degree for the humanitarian crisis of the 90's."

At this point I'm quite willing to agree with you on this, subject to discriminating exactly what "considerable" means. I maintain that it means something like "significantly, but less than effects of the collapsing economy." Feel free to debate what is to blame for the collapse of the Cuban economy in the 90s.

But... I maintain that that's moot. That's the 90s. The current embargo- the one we're talking about ending- is NOT contributing to a humanitarian crisis in Cuba.

I'm going to keep repeating that.

@ "I would respond that both had an impact. Can I quantify it? No. Can you?"

I thought that I did. Even if we assume that the entire drop in the value of licenses to import medical equipment was due to the red tape imposed by the 1992 embargo, we can compare that to the drop in medical funding to 25% of the 1898 level and see that the latter is clearly much, much larger. I'm not asking for a doctoral-level economic analysis here, Tom. I just want you to look at those numbers and form an opinion. I'm trying to decide if I'm really not making my point, if my point is in error, or if we are just caught in a cycle of being argumentative.

@ "Yes, they improved by liberalizing, but who knows how much they would have improved without the embargo had they stayed the course? Probably not as much as by loosening up..."

I'm sure you'll want to re-state that. That last sentence sounds like an admission that the effect of the economy was more than that of the embargo. Since I doubt that's what you mean, either you or I are mis-communicating.

@ "This IS getting to be ad nauseum."

Yes, it is. You seem to have latched on to this 'residual effects' argument, but IMO that's still pointless to the current embargo. If you're trying to argue something like "Let's not take a chance on anything like that happening again", then that sounds more reasonable to me, though not very strong.

@ "I can't make myself any clearer than I already have."

Oh, you've made your position clear. It's just wrong. :)

@ "So presumably the articles I cited at least did not falsify their data."

The authors? Probably not. :)

But there are reasonable doubts about their sources. But as I said I give Garfield credit- he used some statistics from US agencies, too. These show that budgets changed, imports changed, etc., but the correlation/causation issue remains. Why did imports drop? because of licensing issues or because Cuba ran out of money> because CLEARLY Cuba ran out of money. This is why I only acknowledge that the 1992 embargo contributed, but I'm still doubtful it was the MOST significant factor.

And, again, as you said- ad nauseum, this is moot because we aren't arguing about ending the 1992 embargo.

@ "I wouldn't consider achieving a world class primary health care system in spite of our considerable efforts to undermine them a Pyrrhic victory."

I consider it a Pyrrhic victory when one is starving outside of the Worlds Best Health Clinic, yes.

@ "But if you want to experience a real Pyrrhic victory, be patient just a little longer. There's one just around the corner, when we start our next war, with Iran.

@ "Then there is the troubling question of why we don't apply that same standard to the likes of the Saudis, Bahrainis, Ethiopians, and so on, not to mention a long list of our former buddies down in Latin America, The Philippines, various parts of Africa."

@ "Iraq? There emerges that troubling question about the deaths of 500,000 Iraqi children due to lack of clean drinking water and access to medicine, and it still took two wars, hundreds of thousands of Iraqi civilian deaths, several million refugees, 4500 plus US combat deaths and over 32,000 visibly wounded, along with hundreds of thousands of soldiers apparently suffering with varying degrees of PTSD, and the complex issue of whether sanctions are effective is still being debated in the halls of power?"

All ignored as off-topic attempts to start a different argument. That we don't sanction Saudi Arabia shows that the US, like all nations, is hypocritical, but does not prove that Cuba is undeserving of sanctions. Etc.

@ "A government that establishes a world class primary care system is not all bad, at least IMO."

then by your definition no government is all bad. They all do SOMETHING for their citizenry. probably even North Korea. But that's ok- we don't live in a world of absolutes. This does not mean that we cannot make value jugements. Otherwise we end up excusing everything. Something that I seriously suspect of you at times. :)

@ "This is not knee jerk criticism, Dean, so please don't go there again. It is a well considered position. Argue against it if you will, but don't call it knee jerk."

My 'knee-jerk' comment wasn't about sanctions. I have my doubts about them, too, as I indicated. They HAVE worked, though- just not reliably, and not against dictators. Dictators can weather them, and just seem to entrench more.

My 'knee-jerk' comment was more about having a default position critical of the US, which I feel is unwarranted. But I shouldn't have used that, as you say, value-laden term. Lord knows I am critical of the US, too- it just isn't my default position. I have no default position- I have no litmus issues. I find them limiting. But clearly the US does Good Works.

We've got more than a few "peasants" of our own these days, wouldn't you agree, particularly as regards health care

Yes, my opinions on the healthcare debate are ever-evolving, and I tend to lean a hair left of center on the issue. But do you really want to go there? :)

@ "Anything but a hippocrite."

Come, now. EMBRACE your hypocrisy. I do. :)

After all, pointing out someone's hypocrisy isn't a good argument. A smoker is still justified in preventing his child from picking up the habit.

Edited by acrosome on 03/16/2013 07:33:11 MDT.

"Gimme a little credit- I understand that the past shapes the present. I have considered the the 90s crisis- I've just come to different conclusions about its significance than you have. All things considered, if there currently is no medical crisis in Cuba then it is moot to argue to remove the embargo because of the medical crisis that it is not causing. Eh?"

OK, I think I just wanted you to say it out loud, because I wasn't getting that impression from your seemingly single minded focus on the "NOW" of it all. :) Beyond that, I think we are talking past each other a lot of the time, which I attribute to this having gone on so long that we have each lost track of what the other has said in the past. To wit: I have not argued that a current medical crisis in Cuba is a reason for removing the embargo. There are several other reasons that currently apply. What I have argued is that the embargo did have a serious impact in the past, some of whose effects persist to this day. I have also argued that this plays into other nations' perceptions of us and thus the sooner we drop it the better for us. And Cuba to the degree that the embargo still hinders their development. Go back thru my posts and see if this is not so.

Oops, got to go. To be continued.

Edit: I'll be out of town for a few days and will reply briefly when I get back. Suffice it to say for now, that I think we've arrived at an end point where we have come to agreement on a few points and know where we disagree on others. If this is the case, there is not much point in doing another lap in tandem around the hamster wheel. I'll apologize if you feel I have insulted you; rest assured it was not intentional. As for my perceived default position that the US is at fault for everything that is wrong in the world, that is flat out wrong. I think you perceive that because the two discussions we have had involve situations where I do feel the US is seriously off course. The one involving Iran, and by extension Iraq and Afghanistan,is by far the more serious of the two. We don't need to get into my reasoning here, at least not in this thread, but let me just say that it originates not from self loathing or left wing sympathies, but from a genuine concern about the
long term impact on our country, as well as the peoples of those nations. Perhaps we can get into that one next winter, when cabin fever once again slips unnoticed into our psyches. For now, I just can't spare the energy it takes to deal with someone as intelligent and tenacious as you, as I am starting to seriously ramp up my training for another season in the Sierra. It has been a most interesting debate, at least for me, and I look forward to our next one somewhere down the road. :) :)

Edited by ouzel on 03/16/2013 16:13:48 MDT.