People are making a fuss over the Cuba statements of @BernieSanders. Yes, Cuba is a dictatorship but there is good healthcare and good education. Can we sort the wheat from the chaff! The answer is "No" #econtwitter -- lets do the economics of dictatorships here
Dictators are utility-maximizers like you and I. What they maximize is the rents they extract from acquiring and holding on to power. They select the public goods to produce as a willful decision to continue rent extraction jstor.org/stable/4072669… #econtwitter 
In essence, the public goods produced reflect the efforts to preserve the predatory features of the regime. academic.oup.com/jleo/article-a… #econtwitter
Thus, why would the Cuban rulers invest in literacy and health care? Because it keeps them in power and allows them to continue extracting the rents from power.
Cuban health care, as I pointed out in this piece in Health Policy and Planning academic.oup.com/heapol/article…, is used as a monitoring tool against political dissent. Physicians are members of the army and must report dissent. They are the first line of surveillance.
Sociologist Katherine Hirschfeld wrote extensively on this topic in an amazing ethnographic study of the Cuban health care system and also wrote in reply to my own work
Its worth noting that in the former USSR similar investments were made in the health care systems and as Liz Brainerd pointed out: the USSR massively improved health outcomes
But this was, just as in Cuba, an accidental outcome of the regime politicizing health care to preserve the regime. For example, there is a wide literature on the political abuse of psychiatry in the USSR where political dissent was deemed a mental disease
A dictator will care about health care if it helps him enforce his will, punish dissent and identify potential nests of rebelliousness. If its too costly or inefficient to use this channel of control, a dictator will not use it! If its a cheap and efficient way, he will use it.
This applies to education as well. True, increasing literacy is a good thing, but its good for the rulers if it allows for propaganda to be disseminated efficiently.
See, a literacy program whereby money is given to kids in school is probably good. A literacy program operated by a government that has a monopoly on school provision, schooling contents and materials is a whole different thing.
Such a mix is a great lure for a dictator who, if he can produce it cheaply, can preserve himself in power by indoctrinating the population.
Thus, when one praises Cuba's achievements in health care and education, one indeed praises falling infant death rates and rising literacy rates. But he is also celebrating the political abuses of the regime. The wheat cannot be separated from the chaff!!!
And I am not even going into whether or not Cuba was made better off. As I point out with my friend @JamiePavlik in a paper now under consideration, infant mortality would have been inferior *without* Castro's rise to power papers.ssrn.com/sol3/papers.cf…
And even if Jamie and I were wrong on whether or not the programs were successful, we know that Cuba went from being one of Latin America's richest country to being one of the poorest. The cost of "improved health through repression" was a massively poorer society.
You cannot "pick and choose" when it comes to dictatorships! They are bundles just like when you get cable! I would like *not* to have ESPN, but I have to. Same thing with dictatorship in Cuba: you take poverty, repression and longer lives (a ceteris paribus) as a package deal
I wish that journalists like @andersoncooper understood that and had actually asked serious questions to Sanders. By the way, the same logic I laid out here can be applied with different terms to Pinochet, Franco, Ortega or any other dictators!
But, if we go beyond social science and into the realm of normative claims, we ought not to allow anyone to make this pick and choose.
If we care about human development (as per the Amartya Sen philosophy of development as the expansion of positive freedom), we ought to refuse any excuse of what dictators did "well" (we can explain, but never excuse).
I am CCing @kmanguward whose discussion on the @reason podcast made me want to share my research on Cuba and the political economy of health under dictatorships (in a positive way). I hope others will pick up on the finer points I am making here! #econtwitter #econhist #cuba
