Healthcare costs a lot in America. For 2017, the most recent year for which the Centers for Disease Control presents statistics, the cost per capita was $10,739, twenty percent of which was for doctors and clinical services. Sixteen percent of persons under 65 were in families that had problems paying medical bills.
Fortunately, Anastasia O'Grady, reporter for the WSJ, has looked south to a Brazilian-Cuban arrangement that offers a solution: STOP PAYING DOCTORS.
According to her report, Cuba sent Dr. Ramona Matos Rodriguez to Brazil as part of a medical mission in 2013. Brazil agreed to pay Ramona for her services, but she received only ten percent of the salary. Brazil sent the rest to the Pan American Health Organization (PAHO), which is part of the United Nations system with its headquarters in Washington, DC. Allegedly, PAHO forwarded 85% of the doctor's salary to Cuba and kept five percent for itself. (Eighty-five percent to Cuba, ten to the doctor and five to PAHO would account for everything.)
While working in Brazil, Dr. Ramona lived in poverty. She could not quit. She had a minder who enforced a 6 p.m. curfew. She was forbidden to socialize in her free time, her family was not allowed to visit her in Brazil and she could visit them in Cuba only once a year.
In January, 2014, the doctor escaped to Brasilia, where she told her story to the Brazilian Congress. Opponents of the administration were willing to listen because the story implicated then-President Dilma Rousseff in a smelly, previously secret arrangement with Cuba and PAHO. Striking back, Rouseff ordered Ramona to be arrested and deported to Cuba, where she would have been punished. Fortunately, Ramona was able to camp out in Congress, where she was immune from arrest, until the Brazilian Supreme Court granted an order preventing deportation and the US gave her a visa on humanitarian grounds. (Someone tell Netflix and Michael Moore there's a sizzling documentary waiting to be made. And one wonders what became of Ramona's family in Cuba.)
After reaching the US, Ramona filed a federal class-action suit alleging that PAHO, Cuba and Brazil had trafficked her into slavery. O'Grady reports that Cuba has been trafficking medical professionals and others for decades and that the resulting hard currency income was on the order of $10 billion in 2018. Ramona's situation is unique because she escaped to tell her story and it involves PAHO, which has a substantial presence here and is vulnerable to US legal proceedings. PAHO denies its role in the alleged trafficking.
But let's get back to the cost of healthcare. Should we reject the idea of not paying doctors just because the extreme version Ramona experienced is so ugly?
Could we strike a deal with President Diaz-Canel to import Cuban doctors who would work in the US for a rate of compensation that is lower than the market rate for American doctors? To make it ethically tolerable, we'd have to require that the compensation be shared more equitably. Dr. Ramona got only ten percent of what Brazil paid and ten percent seems too low. Our hypothetical doctor ought to get more and it ought to be at least enough to avoid living in squalor or triggering revulsion on the part of tender-hearted Americans. But the docs would have to get significantly less than the compensation earned by American docs of comparable skill if we are to bend the cost curve the right way and Cuba is to have an economic incentive.
A reasonable term of service might be ten years, which is in the range of traditional indentured servitude. At the end of the term, the doc would be offered permanent resident status and be let loose into the market for medical services, however free that might be.
Impossible? I think not. Odds are the requisite legislation would be co-sponsored by Senator Marco Rubio (to demonstrate the snarly face of Cuban communism) and Representative Joaquin Castro (to demonstrate the smiley face of same) and would be enacted easily.
Of course the viability of the scheme depends on the compensation of American doctors remaining substantially higher than that of comparable Cuban doctors. The political risks associated with that are difficult to assess.