Biden plays electoral politics, doubles down on Trump’s attacks on Cuba's medical missions to poor countries

During the 2020 election Trump and Biden battled for Florida and its crucial Cuban-American vote. Early on each tried to outpander the other by assuring voters that they were the ones who would be the most punitive and unreasonable towards Cuba’s key ally Venezuela.

In the end Trump had more staying power. Biden said in September that he would “reverse the failed Trump policies that inflicted harm on Cubans and their families.” However, Trump charged ahead, his ludicrous Spanish-language ad “Progresivo”--which likened Joe Biden to Fidel Castro--winning the day.

Trump won more than 60 percent of the Cuban American vote—the most any candidate has won in two decades—and took Florida, and the Democrats lost two key House seats in Miami. While upon taking office Biden immediately reversed many Trump policies, he has played it close to the vest on Cuba—until now.

Almost five months after Biden moved into the Oval Office, not one of the 240 measures adopted by Trump to toughen the embargo on Cuba have been rescinded. Washington’s reproaches over the island’s human rights record are on the rise and the new White House administration recently stated that Havana has not been fully cooperative in the fight against terrorism, and as such it remains on the US list of state sponsors of terrorism to which it was added during the final days of the Trump presidency.

For the 29th consecutive year, the United Nations General Assembly voted overwhelmingly in favor of a resolution condemning America’s embargo on Cuba. Before the June 23 vote, many diplomats urged the US to abandon history’s longest-running embargo.

The Obama administration abstained in 2016, but the Trump administration, like previous ones, opposed the resolution each year. In the Biden administration’s first vote, it decided to continue Trump's policy by voting against the resolution, which passed 184-2.

Cuban medical missions--through which roughly 50,000 Cuban doctors and medical personnel have been working in over 60 countries--were a bugaboo for the Bush and Trump administrations, both of which showed Florida voters their anti-Castro credentials by taking measures to undermine them.

Now Biden’s State Department takes aim at Cuba’s medical missions in its newly-released “2021 Trafficking in Persons Report,” which accuses the missions of using “forced labor”. The Administration names Cuba 268 times in the 644-page report and places Cuba in Tier 3--the worst tier--lumping it in with Iran, North Korea, South Sudan, and Syria.

Cuban-American CNN host Andres Oppenheimer recently commended Biden's action, but also recognized the move’s clear electoral calculations.

Cuba’s medical missions emphasize the preventive primary care so many people in poor countries lack. At the 2009 Summit of the Americas meeting in Trinidad, President Obama said:

[i]n very specific terms [I] was hearing from these leaders…about the thousands of doctors from Cuba that are dispersed all throughout the region, and upon which many of these countries heavily depend.

Indiana State University Political Science professor Michael Erisman explains:

Cuban brigades almost invariably operate where the most rudimentary medical services have long been essentially non-existent and they do so at no cost whatsoever to the recipients…they are dispatched to urban slums…and to isolated rural areas that the local medical providers have avoided, often because there is little available to them there in terms of monetary rewards.

Dr. Julie M. Feinsilver estimates that between 1961-2009 135,000 Cuban medical personnel treated 130 million patients, performed 3 million surgeries and vaccinated 10 million people across 107 countries. Feinsilver estimates that nearly 1.8 million patients had their vision saved or restored by Cuban medical personnel, and that Cubans saved roughly two million lives.

While Cuba provides medical services to about two dozen countries free of charge, its missions earn an estimated $7 billion a year in hard currency.

The Report condemns Cuba for “capitaliz[ing] on the pandemic by increasing the number and size of medical missions.” However, longtime Caribbean diplomat Ronald Sanders explains:

…the presence of Cuban medical personnel has made a huge and beneficial difference…to manage COVID-19 and its spread. It is no exaggeration to say that without the Cuban medical personnel the medical system of several Caribbean countries would have collapsed.

The Biden administration accuses Cuba of giving medical workers “only a portion” of what host countries pay for their services. But Cuba provided them an expensive medical education free of charge--it’s not unreasonable to seek to recoup part of that investment.

The US has sought to entice Cuban medical personnel abroad, particularly doctors, to defect or otherwise move to the US--what Erisman calls “brain drain politics.” For example, from 2006 to 2017, doctors and other Cuban health care personnel could apply for asylum at any US embassy. Once accepted, they received a visa and a guarantee of permanent residence status.

US Representative James McGovern (D-MA) condemned this policy during a 2007 visit to Colombia, explaining:

The idea that we're going in to try to lure away Cuban doctors who are trying to administer to poor people in Latin America is cynical and I think is counterproductive. A lot of poor people who did not have health care now have health care. What's wrong with that? Why should we be trying to undermine that program? We should have a similar program.

Nor is it true that Cuba forbids doctors from ever applying to emigrate to the US. Erisman explains:

It is true that medical personnel, especially doctors, are not allowed by Havana to apply for authorization to emigrate whenever they wish. They can, however, do so after having provided three to five years of post-graduation service in Cuba, a provision which Washington is highly prone to conveniently overlook and which certainly is not unreasonable given the fact that medical educations are completely free there.

Not only is the education free, the Cuban government paid them to study. As in the old Soviet bloc, going to school is the student’s job, for which they are paid a stipend while in school.

Also, while these Cuban doctors are abroad, the Cuban government continues to provide doctors’ families with the free medical care and education, and the heavily-subsidized rent and food that all Cubans receive.

The Report criticizes Cuba for withholding doctors’ passports, but Cuba does this because there is a huge economic incentive to defect. While American doctors graduate medical school with an average debt of $250,000, Cuban defectors arrive free of any obligations, and can trade Cuba’s 3rd world, no-frills living standard of an upper middle-class professional in America.

The US military’s Health Professions Scholarship Program pays medical students’ tuition and most other education-related expenses. In exchange, doctors generally owe four years of active duty service.

Americans who want to become military officers often go to one of the three major military academies--West Point (Army), Annapolis (Navy), or Colorado Springs (Air Force). The 13,000 cadets currently attending these schools--and the hundreds of thousands who have done so over the past two centuries--did so with the agreement that upon graduating, they owed the US government a certain amount of service, generally five years.

Is this “forced labor”? When the US government deploys them overseas, is this “human trafficking”? American taxpayers wouldn't be OK with these personnel skipping out after the government paid for their expensive education, and Cubans feel similarly.

The Report concedes “some participants…stat[e] the postings are voluntary.” Havana-based British journalist Ed Augustin says, “In seven years of conversing with medics in Cuba, I’ve never met a doctor or a nurse who said they were forced to work abroad. Waiting lists are oversubscribed.”

Cubans on medical missions can earn hard currency, giving them and their families access to consumer items generally unavailable in Cuba.

Latin American Studies professor John Kirk of Dalhousie University says since 1998 he has interviewed 270 Cuban doctors, nurses and technicians and has stayed with them on missions, and asserts that critical claims about the programs are exaggerated. He explains:

One thing the doctors always said to me is how they can earn more than in Cuba. Another motivation mentioned was the experience they gained in some of these places, which they described as a living medical textbook. They go to places others won’t go...in Brazil [Cubans] brought healthcare to [Amazon] indigenous populations…that had never seen doctors before.

Dr. Gracilliano Díaz, who served in the Cuban medical mission to fight Ebola in Sierra Leone in 2014, explains:

We do this voluntarily…what matters to us is that we contribute to the world.

Dr. Leonardo Fernández, who has volunteered in Cuban medical missions on three continents, asks:

How can I be a slave when my family receives my full salary while I’m abroad?

Sanders asserts:

Caribbean countries have no basis for believing that the medical personnel are ‘forced labor’…Cuban medical personnel have conducted themselves with professionalism, integrating well with local medical teams, and passing on their knowledge and experience.

Gaston Browne, prime minister of Antigua and Barbuda says:

…for over 30 years we have been utilizing Cuban specialists…to suggest…employing the services of Cuban professionals is a form of forced labor and therefore human trafficking, that is not true, we do not accept it.

Cuban nurses and doctors are a significant part of the health infrastructure of many Caribbean countries and if they were to force us to get rid of these Cuban professionals, then they will dismantle our health system.

Cuba doesn’t just help poorer countries by sending doctors there—they also train thousands of foreign doctors, for free. Erisman explains:

Havana has and continues to provide totally free medical education, both in Cuba and in their home countries, to tens of thousands of students, almost all of whom come from impoverished Third World nations and are committed to serve marginalised communities in their native lands once their studies are completed…It is probably not an exaggeration to suggest that the magnitude of these programmes can, for a small country such as Cuba, be characterised as spectacular.

According to the World Health Organization, Cuba enjoys the lowest patient to doctor ratio in the world, 155-1. The US ratio is 396-1.

Cuba leads the world in exporting medical services. The US leads the world in exporting weapons. Cuba’s medical exports are not the problem: Trump’s--and now Biden’s--Cuba policy is.

Note: This column was written a week before the July 11 demonstrations in many Cuban cities. For commentary on what is driving those demonstrations, please see Cuba–Conservatives’ New Club Against BLM, AOC and Bernie Sanders (Florida Daily, 7/20/21).