That’s how the health care system should work, in theory. Unfortunately, the reality is different because of the lack of resources in Cuba’s infrastructure. Now, the doctors and nurses have very few supplies, including antibiotics, with which to treat patients, so prevention and treatment become problematic. That’s in addition to a lack of potable water. There is a significant shortage of supplies in the most populated rural areas. For example, clinicas now require patients to bring their own bedding and food. There is a deterioration in sterilizing processes, reusing syringes, issues associated with old X-ray machines, no film available. With this breakdown, the theoretical concept has also fallen apart.

UM News: How is the breakdown of Cuba’s health care system playing out in South Florida?

Ullmann: In South Florida, for example, people with Hepatitis C covered by a major medical insurance are able to access a cure in pill form for which their insurance will be billed $80,000. This treatment has a 90 percent success rate. To access a treatment with a 95 percent success rate, the cost to the insurance company is $160,000. Generally, Hepatitis C is associated with populations who have higher risk behaviors and unprotected sex with multiple partners. Epidemiologists found one group popping out with Hepatitis C: Cuban immigrant women in their 50s. This epidemic is affecting women who, during child birth on the island many years ago, were given their medical injections with syringes that were not properly sterilized. The epidemic reflects the breakdown in the infrastructure of Cuba’s health system.

UM News: How has Cuba adapted their health care system to generate hard currency and barter for commodities and support their economy?

Ullmann: Although there have been movies filmed in Cuba extolling its health care centers, such as Michael Moore’s Sicko, those centers are known as hospitales turista, which are meant for people like the late former Venezuelan President Hugo Chavez. Cuba developed a medical tourism industry because of its high ratio of highly-trained doctors to the general population. The nation also has the infrastructure to attract medical tourists but the Cuban population doesn’t have equivalent access. These very highly trained doctors are paid about USD $40 per month, which barely covers anyone’s expenses, so they take part-time jobs to gain access to the labor market paid with currency, for example, as taxi drivers. The Cuban government proudly says they provide doctors to economies such as Venezuela’s. The doctors may make more money there, but due to the higher cost of living, the Cuban doctors end up living in semi-poverty.

The Cuban government is also using their doctors to barter for commodities from the countries where they’re sent, for example, trading oil from Venezuela and grain from Eastern Europe, received by Cuba as payment for its doctors. The value in commodities that Cuba receives far exceeds the money the government is paying the Cuban doctors to serve outside their island.

UM News: What is next for Cuba and medical tourism?

Ullmann: In 2015, I participated in a panel at the Inaugural Cuba Opportunity Summit in New York City at the NASDAQ. This was the first meeting of this type and I presented on Cuba’s bio tech industry. Due to the embargo, and by necessity after the loss of support from the USSR, Cuba’s economy suffered and providing drugs for its own population was difficult. Fidel Castro decided to develop the biotech sector and created a viable industry with the skill of Cuba’s highly talented professionals. He used this as a means to draw hard currencies from other countries, especially the developing countries, such as China. This sector became self-sustaining under Raul Castro. There have been a few initial attempts at joint ventures with U.S. pharmaceutical companies created during the embargo, with a special waiver from the U.S., to develop a lung cancer drug. There’s potential growth for these joint ventures between the American and Cuban pharma industries, as barriers appear to be slowly coming down between the two countries.

My current Cuba research includes working on a paper with a UK-based coauthor who spent a lot of time in Cuba, and she received wide access to high-level Cuban officials as well as those in the general population receiving treatment. With approximately 900,000 Americans going overseas for their medical care—and the number is growing by 15 percent a year—how many Americans are already going or will go to Cuba? Will Cuba be able to attract large Cuban-American populations in New York, New Jersey and Florida to travel to the island to take advantage of the medical tourism? Americans already travel to Latin America, India and South Korea for medical care. Will the perceived barriers drop to include Cuba on the list?

With the U.S. secretary of Health and Human Services and the U.S. speaker of the House of Representatives proposing to privatize Medicare with the provision of vouchers to purchase health insurance in the private marketplace, and with insurance companies seeking to lower their costs, Cuba could present another option to Americans. What will happen when a health care procedure can be bought in Cuba for 50 percent less than buying it in Miami? Will Americans covered by insurance be allowed and incentivized to travel to other countries, including Cuba, for their health care? For example, Walmart offers their employees the opportunity to cross state lines to get cheaper and higher quality care traveling with their caregiver. What will keep insurance companies from exploring the possibility for paying for care in Cuba, instead of the U.S.?

- ALEXANDRA BASSIL / UM News