Is There A Medico in the House?

Friends of ours took a short cruise from Ft. Lauderdale. It went to Key West, Cuba and frankly one or two other places I forget. There were two notable things that happened. The first was their grandson took very ill in Key West. He’s elementary school age. There seemed to be an easy solution—get off the boat and go home to the doctor. Not so easy.

Apparently, there is a 200 hundred some odd-year-old law that requires payment of $700 per person if you leave a ship and willfully fail to re-board. The easy part is the math. $2100. In discussions with the ship’s doctor, the only solution was to have the ship call an ambulance and take him to a hospital. Mail the paperwork from the hospital to the ship line and they might get a decision in their favor. The child is ok; the case is pending.

Cuba was the second notable thing. They spent a day and a half in Havana. Loved it. Food was great. People were nice. Architecture grand. 1950’s cars–“forgedaboudit!” My wife and I had taken week long a trip to Cuba. The first thing we learned was that Havana is not Cuba any more than Miami is Florida or Manhattan in New York State. While like any big city Havana has its slums and poverty, its history, which is being preserved, is up front and easy to experience. Once one leaves Havana it is a short drive into a third world country. The constant struggle for the government of this Communist anachronism is finding money.

They’ve come up with a system of two monies. The Cuban money, which circulates on the island, is the money of the people. They get paid in it and buy things with it. It is basically worthless. Then there’s the black market. All it takes is a little ingenuity to tap into it. Here is one amazing example.

It is illegal for a foreigner to buy property from a Cuban; there is an abundance of waterfront property that screams “fix me up and I’ll make you a bundle as condos.” A foreigner develops a relationship with a Cuban to the point that they trust each other. The foreigner gives the money for the property to the Cuban who buys the property and then gifts it to the foreigner for a fee of course. The whole deal, hundreds of thousands of dollars, is done on a handshake. Sometimes that is too risky and its done by a wink and a nod.

So this is an example of the people beating the system. Medical care is an example of how the system beats the people. Cuba has a remarkable medical care system. The doctors are well trained and well respected. There are 6 doctors per thousand on the island and the government, which controls everything, makes sure they are spread around fairly evenly. The government also establishes pay rates. Doctors make a fixed salary and if they work in the countryside are often paid with sheep, and goats, and baskets of food. And doctors keep pouring out of the medical schools every year. What to do with them?

Well Fidel, at his wily best, came up with an answer. A lend-lease program. Cuba supplies a myriad of doctors to African and South American countries. They make somewhere between two and six billion dollars a year. The doctors are paid their Cuban wage; the government keeps the spread. The doctors sign multi-year contracts and are not allowed to take their families—cuts down on the potential for never coming back.

Well, the new President of Brazil, Jair Bosenaro has thrown a wrench at the Cuban monkeys in Havana. Brazil is a hefty user of Cuban doctors because they have but two doctors per thousand people and few to none are outside of the cities,\Bolsenaro just pulled the covers off this deal and is screaming bloody murder for equity. Very Trump-like in his manner and politics, the president could cut a big hole in this money making extravaganza for Cuba and in doing so almost bankrupt island already hemorrhaging red ink.  It is going to be a fascinating play to watch, a game half chess and half hockey–mind games with elbows to the head. As Rachel Maddow would say, “Watch this space.” I’ll update you.

Meantime, if you are in Brazil or Cuba and without black market currency, and need a doctor have a goat handy—at least from my perspective.


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