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World class doctors for the rich – how Cuba’s flagship healthcare system deteriorated

In 1959, Cuba had more doctors per capita than the NHS.

In October 1960, Marxist historian Eric Hobsbawm gave readers of the New Statesman his glowing appraisal of the early stages of the Cuban Revolution. Nearly two years on from the rebels’ triumph, Hobsbawm understood that the central tenet of Fidel Castro’s 26 July Movement was that to be “free and prosperous, Cuba must be free of imperialism, poverty and ignorance.”

But, as we enter the final five months of the premiership of Fidel’s brother, Raúl, the demise of Cuba’s healthcare suggests that the revolution has not successfully achieved this trio of aims.

In January 1959, in the first weeks of his new government, Fidel Castro told the Cuban magazine Bohemia that he would “decline any relations with dictatorial states…first of all the Soviet Union.” Yet within three years, he had declared conclusively, “I am a Marxist-Leninist and I will be until the last day of my life.” Within four, he was harbouring Soviet missiles on his island.

The rationale for Castro’s volte-face was more geopolitical than ideological. Mutual mistrust between Cuba and the United States pushed Castro in the direction of the USSR. The result was a cash-for-Caribbean-outpost arrangement. This contract enabled the Cuban government, bankrolled by the Soviet Union, to bring in many of the landmark social policies the island has been so lauded for, principally, world-class healthcare.

Until the fall of its Cold War financier, Castro’s revolution was able to live up to many of its ideals. But Castro had made a Faustian pact. When tanks were putting down the democratic ambitions of the Prague Spring, Castro refused to condemn the brutality. For all his nationalist and underdog rhetoric, he was a client of the world’s second most powerful state.

The deal was the bedrock of Cuban prosperity and the catalyst for the democratisation of is health service. However, when the USSR dissolved, so too, did the stream of finance to Cuba. The country entered the era of economic crisis known euphemistically as the “Special Period”. Its fabled medical provision slowly became a two-tiered system and little more than a cash cow.

“For the health tourist, everything. For us, what is left”

When Castro’s rebels toppled the dictator, Fulgencio Batista, Cuba had more doctors per capita than the NHS in Britain, and life expectancy was just behind the United States. The revolution consolidated these advantages and expanded them thanks to funding from the USSR. 

Since the 1990s, though, healthcare has deteriorated. Thousands of Cuban doctors work abroad in Latin America, on state-arranged missions to allies such as Venezuela and Brazil, earning their government approximately $2.5bn each year. At home, world-class facilities for the political elite and health tourists contrast startlingly with the mediocrity and scarcity of medicines for the average citizen.

Miguel, a forty-something musician and percussion teacher in the second city, Santiago, had to wait so long to have a dental operation that he was forced have the work done on the black market.

“Often, there is no water in our hospitals and very often, there are no prescriptions,” he said. “And when the government doesn’t have the prescriptions you need, the only advice we are given is to go to the pharmacies that sell the medicine in the foreigner’s currency, the convertible peso. There, your prescription can cost more than your monthly state wage. For the health tourist, everything. For us, what is left.”

Mauricio, a world-weary bus driver from the central Cuban city of Camagüey, tells a similar story of scarcity and squalor at the hands of the health service.

“I was in hospital for a week and couldn’t have a shower any day I was there. And when my sister was taken in, the cleaner for the ward refused to do anything – the family members of the ill had to sweep the floor.”

Revolutionary Cuba, once commendably free of many forms of poverty, is now struggling to provide basic medical resources. 

Castro, however, did succeed in achieving one of the key aims identified by Hobsbawm. The well-educated Cuban people are not ignorant of the failures of his regime, nor of the tactics they must now employ to secure access to a service that was once the pride of a nation.

“I had a pain in my chest, so I went to the doctor,” says Tyson Gutiérrez (not his real name), a state-worker in Camagüey. “He got his stethoscope out, said indifferently that he couldn’t see that anything was wrong, and that I should go. It was only when I slipped him some money, under the table, that he suddenly he woke up, tried the stethoscope again and, miraculously, his instrument began to work.”

“An excess of Cubatopianism”

Hobsbawm’s 1960  article, while full of acclaim for the revolution, included a prescient note of caution, predicting that “the difficulties which will increasingly arise are likely to be overlooked in an excess of Cubatopianism”. In this he showed foresight. Cubatopianism continues to this day, as defenders of the regime cite the defiance of a superpower and the government's social policies in education, equality and healthcare.

Yet such rhetoric obscures the fact that even in its heyday, Cuba was neither prosperous of itself nor truly free of imperialism. Now that it must stand on its own two feet, Cuba has found that its knees are giving way. Poverty is rearing its ugly head once again.

In March next year, when Raúl retires, for the first time in six decades, Cuba will not be ruled by a Castro. Especially given the parlous finances of the country’s post-Soviet guarantor, Venezuela, Cuba stands at a crossroads. Will Castro’s successor be able to tackle its serious social and economic challenges? How long the island’s political status quo can persist will depend on it. 



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Can a “Momentum moment” revive the fortunes of Germany’s SPD?

Support for the centre-left Social Democratic Party (SPD) has sunk into third place, behind the far right Alternative for Germany.

Germany has crossed a line: for the first time in the history of the federal republic, the Social Democratic Party (SPD) has sunk into third place, polling just 15.5 per cent – half a point behind the far-right Alternative for Germany (AfD). The poll was published on the day the SPD membership received their postal ballots on whether to enter another grand coalition with Angela Merkel’s Christian Democrats, and inflamed debate further.

For the grassroots coalition opposed to the so-called GroKo (Große Koalition) the poll is proof that the SPD needs a fundamental change of political direction. Within the two grand coalitions of recent years, the SPD has completely lost its political profile. The beneficiary each time has been the far right. Yet another GroKo seems likely to usher in the end of the SPD as a Volkspartei (people’s party). Taking its place would be the AfD, a deeply disturbing prospect.

For the SPD leadership, the results are proof that the party must enter a grand coalition. Failure to do so would likely mean new elections (though this is disputed, as a minority government is also a possibility) and an SPD wipeout. The SPD’s biggest problem, they argue, is not a bad political programme, but a failure to sell the SPD’s achievements to the public.

But is it? The richest 45 Germans now own as much as the bottom 50 per cent. According to French economist Thomas Piketty, German income inequality has now sunk to levels last seen in 1913. Perhaps most shockingly, the nominally left-wing SPD has been in government for 16 of the last 20 years. Whatever it has been doing in office, it hasn’t been nearly enough. And there’s nothing in the present coalition agreement that will change that. Indeed, throughout Europe, mainstream left parties such as the SPD have stuck to their economically centrist programmes and are facing electoral meltdown as a result.

The growing popular anger at the status quo is being channeled almost exclusively into the AfD, which presents itself as the alternative to the political mainstream. Rather than blame the massive redistribution of wealth from the bottom to the top, however, the AfD points the finger at the weakest in society: immigrants and refugees.

So how can the SPD turn things around by the next federal election in 2021? 

The party leadership has promised a complete programme of political renewal, as it does after every disappointing result. But even if this promise were kept this time, how credible is political renewal within a government that stands for more of the same? The SPD would be given the finance ministry, but would be wedded to an austerity policy of no new public debt, and no increased tax rises on the rich. 

SPD members are repeatedly exhorted to separate questions of programmatic renewal from the debate about who leads the party. But these questions are fundamentally linked. The SPD’s problem is not its failure to make left-wing promises, but the failure of its leaders to actually keep them, once in office.

The clear counter-example for genuine political renewal and credibility is, of course, Labour under Jeremy Corbyn. In spite of all dire warnings that a left-wing programme was a sure-fire vote-loser, Labour’s massively expanded membership – and later electorate – responded with an unprecedented and unforeseen enthusiasm. 

A radical democratic change on the lines of Labour would save the SPD party from oblivion, and save Germany from an ascendent AfD. But it would come at the cost of the careers of the SPD leadership. Sadly, but perhaps inevitably, they are fighting it tooth and nail.

Having promised an “especially fair” debate, the conflict over the GroKo has suddenly surged to become Germany’s Momentum moment - and the SPD leadership is doing everything it can to quash the debate. Party communications and so-called “dialogue events” pump out a pro-GroKo line. The ballots sent out this week came accompanied by an authoritative three-page letter on why members should vote for the grand coalition.

Whether such desperate measures have worked or not will be revealed when the voting result is announced on 4 March 2018. Online, sentiment is overwhelmingly against the GroKo. But many SPD members (average age is 60) are not online, and are thought to be more conservative.

Whatever the outcome, the debate isn’t going away. If members can decide on a grand coalition, why not on the leadership itself? A direct election for the leadership would democratically reconnect the SPD with its grassroots.

Unless the growth in inequality is turned around, a fundamental reboot of the SPD is ultimately inevitable. Another grand coalition, however, will postpone this process even further. And what will be left of the SPD by then?

Steve Hudson is a Momentum activist and a member of both Labour and the SPD. He lives in Germany, where he chairs the NoGroKo eV campaign group.