For those of you who don’t follow the news from Brazil (which I am guessing is all of you), allow me to share an interesting and distressing story.
First, some background. The interior of Brazil is not well developed. Smaller towns often lack basic services, various things from paved roads to banks to medicines can be in short supply. Frequently the schools are not particularly good. As you can imagine, these small towns are not places where an average middle class professional is keen to live. For one thing, depending on the field, there might not be work for them. And, even if there is, you have to tolerate the shortages and absences of services. Among the other things that can be in short supply are doctors.
Monetary incentives for doctors to work in the interior do exist, but not many find them compelling enough, or if they do, they don’t end up staying in the interior for long. One can hardly blame them – particularly if they have families. A spouse might not be able to find work. Children are likely to get a poor education.
Enter Cuba. As of 2010 Cuba had the highest number of doctors per capita in the world at 6.7 per 1,000 (http://data.worldbank.org/indicator/SH.MED.PHYS.ZS). For comparison, the US has 2.4 and Brazil, 1.8. I don’t know what’s considered ideal, but there are many industrialized nations that are in the neighborhood of 2 per 1,000, so if Brazil is low, it’s not very low. So, while Cuba has a very high number of doctors, it’s not like Brazil is facing a critical shortage. It’s facing a problem of distributing them, of getting to to work in the places where no one else wants to work either.
Doctors in Cuba are paid a pittance, the equivalent of around US$20 a month (http://en.wikipedia.org/wiki/Healthcare_in_Cuba). They frequently quit being doctors to take up more lucrative work in the tourist industry. Those that don’t become tour guides often engage in the medical black market where patients can pay doctors for preferential and/or better service. So, bottom line, while there are a lot of doctors in Cuba, and, at least from the UN stats on infant mortality and life expectancy, they are doing good work, it’s not a great place to be a doctor.
Enter Brazil’s president, Dilma Rousseff. She comes up with a plan to import 6,000 of Cuba’s overabundance of doctors and pay for them to work in the interior. She wants to do this without revalidating their medical expertise, something nearly every country does except in emergency situations. And as we discussed above, there’s no emergency.
She and Cuba also wants to pay them less than their Brazilian counterparts. A lot less. A general practioner in one of the larger cities of Brazil can expect to make at least R$10,000 a month. Specialists make more of course. And, as mentioned, working in the interior gets you more. Each Cuban doctor will cost Brazil R$8,000 a month, but only R$2,500 goes to the doctor. The rest goes to the Cuban government.
Enter the Cuba fans. No, not fans from Cuba, but fans of Cuba. These are generally socialists or communists who buy into the notion that Cuba is a Marxist success or would be if it weren’t for the US trade embargo. Never mind that Cuba can and does trade with many other countries from Asia, North America and Europe. Never mind that physicians there earn less as doctors than they do as bellhops. Never mind that the economy is in such a shambles that they needed handouts from other countries to keep their economy afloat.
It may very well be that a strongly centrally planned economy can work and work well. I’m not taking a position on that one way or the other. I’m simply saying that regardless of whether Marxism can work, it clear the way Cuba implemented it was a failure. It’s not a shining example of Marxism thwarted because one country wouldn’t trade with it, it’s an embarrassment that failed its citizens despite being propped up by billions annually from the USSR until its dissolution and later by cheap oil from Venezuela.
Back to the Cuba fans. They think Rousseff’s plan is great. They think it shows how much more ethical and moral Cuban doctors are than Brazilian ones. They think it’s a great victory for Cuba. They’re so blinded by their fandom of Cuba, their nationalism if you will, that they can’t see that Brazil is doing something that most people, but especially socialists and communists, abhor: taking advantage of workers. Exploiting them. This doesn’t show that Cuba is great, it doesn’t show that Cuban doctors are inexplicably more altruistic than other doctors, it show that as crummy as it is to be a doctor in the middle of nowhere in Brazil with no banks, no paved roads, shortages of medicine and more, it’s still better than being a doctor in Cuba.