By Mark Falcoff

Tuesday, March 24, 1998; Page A19

Like everything else in Cuba, that country's health care system is in a state of rapid decomposition. But Molly Moore's article ["The Hemorrhaging of Cuba's Health Crisis," news story, Feb. 23] misrepresents the real nature of Cuba's economic and social crisis. This piece says Cuba's medical delivery systems are "crumbling beneath the pressures of national economic crises and a U.S. trade embargo that have left hospitals short of equipment and patients without access to drugs." Cuba, we are told, "cannot buy medical equipment or medicines from U.S. companies or subsidiaries of those firms without the approval of the U.S. government," an approval which, it explained, "is so cumbersome that few companies even apply for licenses."

Even worse, with U.S. pharmaceutical giants buying out increasing numbers of medical companies in Europe, Cuba has effectively been shut out of "many of the newest advances, in equipment and treatments because of embargo restrictions."

Who says so? "Cuban government officials." "Critics." "International physicians groups." The American Association of World Health, which Moore describes as "the U.S. committee of the World Health Organization." She does not tell her readers that the president of that body is Peter Bourne, author of an admiring biography of Fidel Castro.

There is no U.S. embargo on the sale of medicines or medical equipment to Cuba. What our government does ask is that some credible third party monitor their ultimate use. This licensing process is far from cumbersome and, indeed, has been interpreted very liberally. Almost anybody outside the Cuban government is acceptable -- the Pan American Health Organization, CARITAS or third-country diplomats. As a result, since 1992 the United States has approved 35 of 39 license requests for medical sales. Five licenses were issued for travel to Cuba by representatives of American pharmaceutical companies to explore possible sales. Countless Cuban physicians and medical and scientific personnel have been granted visas to attend professional meetings here. Our government has licensed more than $227 million in humanitarian donations of both medicine and medical equipment.

This figure does not include gift packages from Cuban Americans or others in the United States, which run into millions of dollars and arguably represent the single largest source of medicines used on the island today. We are not talking here about Band-Aids and merthiolate but more sophisticated devices such as catheters, syringes, diagnostic kits, fine chemicals for medical and scientific research, cytometers and liquid chromotography gradient programmers.

Why is end-use monitoring necessary at all? We do not want Cuba's purchases to be resold abroad, used in psychiatric hospitals to torture dissidents, employed in the production of biotechnological products, diverted into dollar-only stores or to the health care system exclusively reserved for members of the Communist Party elite, or Cuban military or to special hospitals run for the benefit of foreign "health tourists."

Moore greatly exaggerates the degree to which the embargo affects Cuba's capacity to go to other foreign sources. Most of its needs are readily available in Mexico, Canada and elsewhere, often at virtually no additional cost. But in 1995, while the country imported roughly $2.8 billion worth of goods and services, it spent a paltry $46 million (1.5 percent of its overall foreign acquisitions) on medical imports for its 11 million people. The nearby Dominican Republic spent $208 million on the same products for 7.5 million citizens. Meanwhile, Castro spent millions on an international youth festival.

There is a direct relationship between the kind of government and economic system under which Cuba is forced to live and its deteriorating quality of life -- whether it be in the areas of health care, nutrition, medical care, education or sanitation. It would be surprising if this were not so. Command economies do not work anywhere else in the world -- why should Cuba be the signal exception? U.S. policy may often have been mistaken, even wrongheaded. But even with the worst will in the world it could not have created the dilemma in which the island finds itself.

The writer is a resident scholar at the American Enterprise Institute.