Hygiene first! Doctors and nurses in Cuba should go on strike and demand that the government install public lavatories in all cities and major villages. And make sure they are kept clean. And also that in all snack bars/ restaurants and hotels there are clean toilets with running water to flush them and to wash your hands. Further, that workers will be fined personally, if they serve snacks/drinks/meals with a swarm of flies! Such a strike would save more lives than it would cost. The Cuban health care system is excellent, but the lack of basic hygiene defiles it. Tourists don’t like this situation either. They get sick (as happened to us) and won’t return because of it. And don’t give us the crap (pun intended) that ‘it’s the blockade!’ So, doctors and nurses: ‘Go get them!’
Doctors and nurses are well paid, according to Cuban standards. But this is even more crap! If our info is correct, doctors earn on average approx. 600 to 800 Cuban pesos (MN) a month. That would be between US$ 25 to 35. Is that crap, or what?
Obviously, this should be understood within the Cuban context, where all wages are at starvation level. Furthermore, not all things are for profit. The so-called ‘free professions’ are for the sake of it, or the ‘honor’, if you like. As soon as we leave this standard (as has long since been the case in capitalist countries), the excellence of the service is contaminated with an element that defiles its quality and sincerity of purpose. Hospitals are not money-making machines! They are places where dedicated people do what is humanly possible to help their sick fellow-citizens regain their health. So, doctors and nurses have no business to strive to become millionaires.
Having said that, this does not mean they should have to live off crap! On the contrary, they should be exceptionally well paid, so that they don’t have serious money problems, allowing them to dedicate all their time to the difficult work they do. A Cuban doctor should earn a basic monthly salary of 500 CUC and nurses at least 250 CUC.
Nice slogans! Where’s the money going to come from?
One source of money could be the Caribbean Seabed Authority. See www.arcocarib.com for more details. But this, for the time being, is just an idea, which so far hasn’t even drawn attention, let alone money. So, let’s stay real.
The money will have to come from:
a) a system of health care insurance, to which every single citizen will have to contribute;
b) the patients who receive treatment;
c) other income;
d) savings.
Now, this means that the whole Cuban health care system would have to be drastically turned around. It is impossible to go into any further details here. It is obvious also that no more can be paid than the above four points can produce, unless other sources of income can be found (which is why the Caribbean Seabed Authority idea should be looked into).
The role of Solidarism
Health care expenses are not productive. This means that the solidarist money creation engine operated by the Cuban Central Bank could only be used to build hospitals, provided certain conditions are met (the main one being that the investment would have to be paid back in full, by means of taxation or any other way; cf. Rule 3 for safe money creation). All other expenses would have to be covered by the income generated by the hospitals themselves. In this respect, Solidarism has no magic wand.
However, a re-organization of the operation of hospitals in accordance with solidarist principles could make a marked difference. Although we have to stress again that we’re only hinting here and that a proper study and analysis of the whole Cuban health care situation could lead to entirely different recommendations, we venture to suggest that Cuban hospitals be organized as follows: 1/3 ESOP, 1/3 CSOP and 1/3 government held. This would give all 3 participants a direct financial stake in the proper and profitable operation of Cuba’s hospitals.
All rigid principles lead to hell
The CSOP-shareholders would be those individuals who take out private health care insurance with the individual hospital of his choice. The hospital would act directly as health care insurer, receiving all premiums without any ‘middleman-cut’, which is one way to generate extra income. The insurance would be subject to a reasonable deductible for each treatment, so that all work performed would be a second source of income.
The government organizes its own system of mandatory health care insurance for lower income workers. The government would have to pay for all treatments given to government patients at reasonable fixed rates (for all other treatments, rates are set by each individual hospital). This is a third source of income.
Now, the health care workers themselves will have to make sure that the best service is provided and that everything runs as efficiently as possible, so as to generate maximum income and make substantial savings. They have a financial motive to do so also, for 1/3 of profits will flow to them on top of their basic salaries. This is a violation of the non-profit principle ruling the free professions, but then, aren’t there exceptions even
to sacred principles to avoid them leading to hell?