Paul Roderick Gregory, a Forbes contributor, is a research fellow at the Hoover Institution at Stanford University.
Barack Obama, fresh from his historic opening to Cuba’s Castro brothers, was effusive in his praise of Cuba’s socialized health care system. Speaking to a town hall in Argentina, Obama gushed: “Medical care–the life expectancy of Cubans is equivalent to that of the United States, despite it being a very poor country, because they have access to health care. That’s a huge achievement. They should be congratulated.”
Obama has been equally emphatic in his condemnation of “barbaric” and “evil” slavery, which is “wrong in every sense.” In Havana, Obama empathized with the Cuban people that slavery left its negative imprint on “Cuba, [which], like the United States, was built in part by slaves brought here from Africa.”
In the internet dictionary, slave labor is defined as “labor that is coerced and inadequately rewarded.” Coercion is the use of force to get people to do something they would not do otherwise. Inadequate reward means earning much less than the value that has been created. Karl Marx used the term surplus value to denote workers being paid considerably less than their value. Under Marxism, surplus value is the original sin of capitalist exploitation. Seems like the Castro brothers live off of surplus value too.
According to the definition, Cuba’s vaunted medical care system is built on slave labor. Cuban medical personnel are coerced by a dictatorial state and inadequately rewarded from the profit they generate (Marx’s surplus value), which accrues primarily to the Castro dictatorship. As pointed out by a Cuban doctor who served overseas before defecting: “We are the highest qualified slave-labor force in the world.”
The World Affairs Journal explains why Cuba’s health care professionals are coerced into slave labor by Cuba’s totalitarian state:
“With the state the sole employer, health professionals are forbidden from leaving the country without permission; issuing them proof of their medical studies and credentials is punishable by law. When they are sent on a foreign mission, they must leave their families behind as hostages to their return. With the average monthly salary of a doctor only around $25, barely guaranteeing subsistence, the system ensures a steady pool of temporary workers, ‘exportable commodities’ primed for exploitation.”
Widely heralded as an act of international goodwill, Cuba sends thousands of its doctors and nurses abroad, largely to Latin America and Africa. But pro-Cuba propaganda masks a much more important economic benefit. Health care professionals are Cuba’s biggest export, far outpacing tourism and sugar. Since 2008, medical exports have brought in more than three times the revenues from tourism and produce more income than any other branch of the economy. Cuba receives more than $8 billion from sending doctors and nurses abroad annually. Thus, revenues from medical workers abroad account for more than 10 percent of Cuban GDP. If Russia survives through its petro dollars, Cuba gets by with its Castro care dollars.
Apparently, Obama has not looked into how Cuba’s medical internationalism works in practice: the Castro government follows the 1820 to 1860 American slave trader practice of leasing out slaves, rather than selling them. In Richmond, Virginia, more than half the slaves were leased out. In the American South, such leases of slaves were typically for a year’s time, but in the case of railroads the lease was for the duration of the project. The return to slave renting was in the range of 10 percent, much higher than traditional forms of investment.
In a way similar to the US slave trade, the Castro regime leases out Cuban medical doctors and nurses according to contracts with Latin American, Caribbean, and African countries. The terms of the lease are usually secret, but the Cuban government is paid in foreign exchange or barter (such as Venezuelan oil) for each lease. While abroad, the Cuban doctor is paid an allowance and living expenses that add up to more than he or she makes at home but is a fraction of the lease revenue the government receives. At their foreign destination, Cuban medical personnel are kept under constant surveillance, forbidden to drive a car, leave their homes after certain hours, communicate with media, or associate with local residents, all measures designed to prevent them from defecting.
In his remarks Obama marveled that a poor country like Cuba can afford such a health care system. How Cuba does this is simple: it uses wage controls to hold down health care costs. Even after a near doubling of salaries in 2015, Cuban general practitioners (GPs) earn $44 a month, about 75 percent higher than the average in impoverished Cuba. In OECD countries, GPs earn more than 200 percent of the average salary.
Obama, in his admiration for Cuban medicine, has fallen into the trap that communist regimes set for the unsuspecting. Experts, however, understand that a communist system is good at focusing its scarce and misused resources on narrow but visible goals, designed to divert attention from its failings. East Germany had its drug-induced Olympic champions. Impoverished North Korea has its primitive nuclear bomb and missile programs, and the USSR had its space program and a defense establishment that challenged the United States. Cuba claims that its socialized health care system places it among the world leaders in life expectancy. Beyond those shiny baubles, the communist countries like Cuba have few accomplishments and many failures.
That Bernie Sanders is making a serious run for president should raise serious alarm. As an avowed socialist, he is pushing socialist and communist programs like Cuba’s socialized medicine without understanding, like Obama, how they work. Our most prestigious campuses do not teach that communism has failed in all cases or that textbooks cannot cite one real-world example of Sanders’s vaunted democratic socialism. We must repeat the old Edmund Burke refrain: “Those who don’t know history are doomed to repeat it.”