Healthcare: that which is 'free,' public, for the privileged ... and the kind we need
The view that medicine in Cuba is free is widely held around the world. Many signs here speak of free medicine and there is an effort to lead people - workers, housewives and retirees – to believe that medicine in Cuba costs patients nothing, which is not true.
It is true that most medicine in Cuba is subsidized under the State budget. But that budget is not invented, nor does it emerge from a hat with the wave of a magic wand. The resources for this subsidy come from somewhere. There may be others, but these are the main ones:
- The appropriation of two-thirds and more of the remuneration of those medical professionals who nobly serve abroad.
- The low wages paid to workers in the medical sector and other sectors in the country who work for the State, receiving meager wages in Cuban pesitos.
- High prices and insurance for medical services the State charges foreigners and Cubans living abroad.
- The massive revenue the State receives from the sale of internationally recognized Cuban medical products, at high prices on the world market, produced by the blood of volunteer donors and researchers and workers who are paid peanuts.
- The substantial revenue obtained by the State from the sale of medicines, paid for in both local currency and, at its special pharmacies, foreign currency.
In addition, as a result of the low wages earned by medical professionals and workers, in practice unofficial forms of payment have been created and become customary, not technically as compensation, but as signs of gratitude from many patients who offer physicians payment in kind or services, and sometimes money. Although professional ethics bar doctors from receiving them, civility and reality force them to accept them.
It is, therefore, not true that Cuban medicine is free. It is paid for by Cuban workers and patients with their sweat and blood.
But there is a system of public medicine in Cuba for the common people, and another one for bureaucrats, the wealthy, and foreigners.
Public medicine is normally administered by the State to the people at family clinics, polyclinics and hospitals, staffed by talented and dedicated professionals, but the quality of the services rendered is limited by the state of the facilities and the technical resources available, such that often patients wait hours to see doctors, are given appointments with specialists month away, and the results of analyses so late that are only good for presentation at autopsies.
There is another special medical service, speedy and of high quality, for the most privileged, offered at special clinics and hospitals for the political-military bureaucracy and foreigners at the Hospital Cira García, the Center for Medical and Surgical Research, the special MININT (Interior Ministry) clinics, and some floors of the Hermanos Amejeiras National Hospital. There are also important specialized research centers to which high-level bureaucrats and foreigners enjoy priority access.
That difference between the mediocre public service and the high-quality medicine not available to everyone is also evident in the existence of two types of pharmacies: those that accept Cuban pesos, demand prescriptions, and whose inventories are often lacking; and pharmacies where medications are sold in CUC (25 pesos to one CUC). In the latter there are thousands of medicines and drugs that are not available at pharmacies using the national currency, and those without easy access to abundant CUC are unable to take advantage of them.
There is no precise information in this regard, but it stands to reason that, under these circumstances, given these differences and the low wages doctors earn in Cuba, some medical professionals use State media and resources to provide specialized, priority, well-paid services to people with broad access to the right currency.
Consequently, in Cuba medicine is affected by and suffers the same consequences as the rest of the state-centered socioeconomic model imposed in the name of socialism. Consequently, medicine is not socialized, as they say, but nationalized, as the State is responsible for everything related to medical services. Socialization would imply that medicine was in the hands of citizens and their associations.
Thus, Cuba needs a change in its medical system, one which socializes medicine (as should also occur with the country's socio-economic and political systems) to raise it to higher levels and ensure accessibility by all. This would involve comprehensive reform of the current system covering many aspects, including: modifying the revenue sources for the medical budget, establishing a medical tax/insurance for all citizens, municipalizing control over public medicine revenue, costs and expenses; granting administrative and financial autonomy to hospitals and health centers; and paying sector professionals for services rendered, not fixed wages.
The practice of private medicine should also be openly allowed, in parallel to public. After professionals demonstrate their compliance with this system “mutual clinics” should be revived, and a single currency established. A way must also be found to ensure complete, high-quality medicine for the elderly, and freedom should exist to import all kinds of medical and other equipment.
Private, primary care medicine, coupled with a system of (associated) mutual clinics, would place pressure on the public system to provide higher-quality service across the board.