Questioning Michael Moore's Math

In a surprise in their Sunday Week in Review section, The New York Times assigned a correspondent to question leftist filmmaker Michael Moore's math about Cuba having a better health care system than the United States: "How could a poor developing country - where annual health care spending averages just $230 a person compared with $6,096 in the United States - come anywhere near matching the richest country in the world?" Correspondent Anthony DePalma found experts who granted points to Cuba's "universal" health care, but also pointed to the communist dictatorship's high rates of abortion and emigration, and ironically, its shortages - poor transportation and a restricted food supply - as reasons why Cuban life expectancy may be high.

The DePalma piece was highlighted on the Times home page Sunday, complete with a picture of people sitting in a clinic under a painting of Che Guevara. DePalma noted that Moore's new film "Sicko"waxed poetic about the wonders of Cuban health care: It "savages the American health care system - and along the way extols Cuba's system as the neatest thing since the white linen guayabera [shirt]." He began his analysis by quoting Moore promoting Cuba in Time:

"There's a reason Cubans live on average longer than we do," he told Time magazine. "I'm not trumpeting Castro or his regime. I just want to say to fellow Americans, 'C'mon, we're the United States. If they can do this, we can do it.' "

But hold on. Do they do it? Live longer than, or even as long as, we do? How could a poor developing country - where annual health care spending averages just $230 a person compared with $6,096 in the United States - come anywhere near matching the richest country in the world?

Statistics from the World Health Organization, the C.I.A. and other sources all show that the people of Cuba and the United States have about the same life expectancy - 77 years, give or take a few months - while infant mortality in Cuba is significantly lower than in the United States.

Of course, many people regard any figures about Cuba as at least partly fiction. [This is the closest the Timesgets to noting communist regimes lie. It never dares to mention the imprisonment and murder of internal opponents.] But even if the longevity statistics are correct, they are open to interpretation. Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, said statistics also show that Cuba has a high rate of abortion, which can lower infant mortality rates and improve life expectancy figures. The constant flow of refugees also may affect longevity figures, since those births are recorded but the deaths are not.

DePalma turned to a doctor and author for advice on parsing the American and Cuban health care systems, and you soon learn the liberal Times isn't going to shock anyone and be completely anti-communist:

Despite such skepticism, many medical experts say they do believe that average Cubans can live as long as Americans, and the reason may lie in a combination of what Cuba does well and the United States does poorly, if at all.

Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it.

Dr. Butler said some of Cuba's shortcomings may actually improve its health profile. "Because they don't have up-to-date cars, they tend to have to exercise more by walking," he said. "And they may not have a surfeit of food, which keeps them from problems like obesity, but they're not starving, either."

Cuban markets are not always well stocked, but city streets are dotted with hot dog and ice cream vendors. Bellies are full, but such food can cause problems in the future, as they have in the United States.

Dr. Butler has just completed a study that shows it is possible that because of the epidemic of obesity in children, "this may be the first generation of Americans to live less long than their parents."

There could be one great leveler for Cubans and Americans. While all Cubans have at least minimal free access to doctors, more than 45 million Americans lack basic health insurance. Many are reluctant to seek early treatment they cannot afford, Dr. Butler said. Instead, they wait to be admitted to an emergency room.

"I know Americans tend to be skeptical," he said, "but health and education are two achievements of the Cuban revolution, and they deserve some credit despite the government's poor record on human rights."