• Ludwig Liberty

No, coronavirus doesn’t show the benefits of the Cuban health system

Writing in The Independent, Ahmed Twaij applauds the decision of the Cuban regime last Wednesday to allow MS Braemar onto its shores. Aboard the British ship, five people had tested positive for COVID-19, with a further fifty in self-isolation.

Barbados and the Bahamas refused docking permission, so after petitions from British diplomats, the Cuban government stepped in. It cited “humanitarian concerns” and evangelised “a shared effort to confront and stop the spread of the epidemic.” The ship docked in Mariel, west of Havana, and Braemar’s passengers were repatriated by the following day.

Twaij praises Cuba for this generous display of kindness during a bleak time for humankind. Passengers expressed their gratitude on social media: “Thank you, Cuba…We will never ever forget that you reached out to us when absolutely nobody, and I mean nobody, else would.”

In the week since the rescue, it has also emerged that interferons – signalling proteins used to respond to infections, extensively developed in Cuba – may provide a treatment for COVID-19. They were used in China to stem the outbreak; more than ten countries have since requested access to the drug.

For the Braemar rescue, Cuba should rightly be praised, and nobody denies that the Caribbean country can make a powerful contribution in fighting the pandemic. Welcoming its efforts and expertise into the international community will save lives – something threatened by sanctions and poor diplomatic relations, as the Taiwanese experience has shown.

But Twaij’s article takes a drastically wrong turn. He sees the Braemar rescue as emblematic of all that is good about Cuban healthcare and concludes: “If we needed proof that a nationalised system works better and keeps citizens safer, this was it.” A non sequitur if ever I saw one – and a dangerous one at that.

Cuba’s pretence of high-quality healthcare is one of the regime’s “pillars of legitimacy”. If it can be seen to deliver high-quality healthcare, socialism must work. But it’s just that – pretence.

Behind flashy tourist hospitals, manipulated statistics and lucrative international volunteerism is a decrepit system for ordinary Cubans, a regime devoid of patient rights, and one of the world’s biggest operations of state exploitation.

Cuba spends 12% of its GDP on healthcare, more than any European country bar Switzerland. With one physician per 122 people, it has the highest number of doctors per capita. They are trained in family medicine before being allowed to specialised, leading to high-quality primary care. The highest-paid doctors make $67 a month, more than other professions – though not enough to push many doctors and nurses into second and third jobs.

So it should be no surprise that Cuba outperforms its neighbours by healthcare standards, albeit to the expense of other sectors where Cubans might prefer higher spending. Even before the Revolution, Cuba enjoyed better healthcare outcomes than much of South America – but since then, its neighbours have experienced higher increases in life expectancy. In contrast, Cuba’s infant mortality rate has fallen from the 13th lowest worldwide to the 49th.

The country operates a two-tiered system of healthcare. First, there are hospitals for paying foreign tourists. A significant source of American dollars for the socialist regime, these provide high-quality healthcare at prices that compare favourably to Uncle Sam’s. When Michael Moore brought a boatful of sick Americans to Cuba in his 2007 documentary Sicko, it was this elite treatment that they received.

In 1991, Dr. Hilda Molina, formerly Cuba’s chief neurosurgeon and a deputy in the National Assembly, became an outspoken critic of the regime after her renowned centre in Havana was instructed only to treat foreigners paying in American dollars. She was barred from leaving the island for two decades.

Then there’s the system for everyone else – with its “unsanitary conditions, crumbling facilities, and hospitals where patients are expected to bring their own bedsheets, soap, towels, food, toilet paper and even light bulbs.” Doctors reuse latex gloves; household drugs must be sourced on the black market. The system might be free, but it is freer for the rich: those who bribe receive better healthcare.

To hide this reality, the government manipulates healthcare statistics. It systematically recategorises early neonatal deaths, which count towards the infant mortality rate, as late foetal deaths, which don’t. To avoid losing their jobs, doctors forcibly abort complicated pregnancies; would-be mothers are not allowed to refuse treatment. This partly explains why the Cuban abortion rate – 41.9 per 100 pregnant women – is among the world’s highest.

What about the medical internationalism – the cornerstone of Cuba’s foreign policy and the state propaganda machine? Over 50,000 Cuban doctors work in 67 countries under bilateral agreements worldwide. Ban Ki-moon, former Secretary-General of the United Nations, praised Cuban doctors for being “the first to arrive and the last to leave” in crises.

Yet the regime pockets up to 90% of the salary paid by the host country, bolstering the public coffers to the tune of $11 billion per year. Doctors are pressured into serving abroad: 57% say that they did not even volunteer. Once enrolled, security officials remove their passports, track their movements, and prevent them from befriending natives. They protest that they are modern slaves – paid a pittance and forced to work up to 64 hours a week. They are resented by local doctors and instructed to steal scarce medical supplies to be sent to Cuba.

In Brazil, in an effort to break free, 179 doctors filed lawsuits in local courts. Two thousand vowed to stay after Cuba ordered them home. Thousands more have fled from Venezuela, assimilating with native-born refugees.

In recent years, it has not been uncommon for islanders to find their local surgery closed after their doctor is posted to Venezuela. Over 21,700 have been dispatched in exchange for oil, while one in five surgeries have closed due to shortage of personnel or equipment. As the novel coronavirus has spread, Cuba has offered to send humanitarian missions to afflicted countries. The United States has advised countries not to accept – prompting a furore from critics of global American imperialism.

But before scoring political points out of this crisis, these critics should remember: Cuban healthcare is as cheap and available as forced labour for a reason.

Ludwig Liberty is a pseudonym attributed to all anonymous contributors to our blog.

The opinions expressed in this article are those of the author, and not necessarily of the Oxford Hayek Society.

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