Who Pays for Health Care and Education in Cuba?

March 30, 2017 | Print Print |

By Fernando Ravsberg

HAVANA TIMES — Cuban workers pay for healthcare and education. Ever since the 1960s, surplus value gained from their labor has gone to the State’s coffers, the State being the main owner of the country’s modes of production and only redistributor of this wealth.

The Revolution’s initial social agreement took away the importance of people’s wages, and the majority of what was distributed was handed out in equal shares among the Cuban people. Regardless of how much they earned, everyone had free healthcare and education, as well as heavily subsidized clothes, food and transport.

Salary caps were established, making it the country in the Americas with the least difference in income between rich and poor. Even privileged leaders didn’t receive their benefits in the form of wages but in the form of rewards (cars) or opportunities (tourism, trips or special stores).

Even if you take the existence of these privileges into account, Cuba continued to have a much higher level of social equality than any other country in Latin America. Extreme Mexican poverty didn’t exist and nobody on the island had a fortune like Carlos Slim.

Along with healthcare, education is accessible to all children and young people and takes one of the larger chunks of the national budget.  Photo: Raquel Perez Diaz

There isn’t free healthcare and education anywhere in the world. However, there are different ways of getting these two services, one is the “every man for himself” way, the other is to create a communal fund between all of the country’s citizens so as to give universal coverage to everyone.

The Cuban Revolution chose the second, giving all of its citizens access to these services regardless of their income or what they contribute to the State. The resources didn’t come out of Fidel Castro’s pocket but it was his government that prioritized public expenditure in these areas.

It was a strategic decision, just like other States within the region prioritized public infrastructure or the telecommunications sector. The general population contributes the hard cash in every country, but it’s the politicians who decide what to do with these contributions.

Normally, when a country sinks into crisis, the first thing that suffers cutbacks are social expenditures and budgets for healthcare, education and culture are the first ones to experience cuts so as to “balance out” fiscal accounts.

I arrived in Cuba in 1990, along with the greatest economic crisis in the history of the Cuban Revolution. I was very surprised when “budget cuts” began with the Armed Forces (FAR), and this didn’t spark any negative reaction from the military.

When the economic crisis began, the sector which suffered the greatest cutbacks in budget were the Armed Forces.  Photo: Raquel Perez Diaz

The FAR drastically reduced the number of troops, it stopped importing arms, they worked in the fields so they could eat, they learned to create businesses so they could be self-sufficient and they were also required to create an effective defense strategy during that time, under those conditions.

While this was happening to the military, ballet schools kept their doors open and 800 children from all over the country, went to ballet classes. Among them was a mulato from a modest Havana neighborhood, Carlos Acosta, who would later go on to dance on the world’s most famous stages.

In the middle of the crisis, my children went to primary school, secondary school and finished the pre-university course without having to buy books or pay enrollment fees. I didn’t even have to pay for their transport, food or lodging for the three years they were at boarding school.

I maybe would have had enough to pay these costs but I’m sure the construction worker, whose daughter studied in the same class as my son, at the Exact Sciences technical college, wouldn’t have been able to. And I prefer it this way; I’d rather every child has the same opportunities.

I was raised in Uruguay, a country where healthcare and education were free. As an adult, I lived a decade in Sweden, a country where children have access to both things from the minute they are born and the State hands out scholarships to students who ask for them.

During the most difficult years of the crisis in the ‘90s, all schools were kept open, even ballet schools.  Photo: Raquel Perez Diaz

I’m sure these experiences have shaped my opinions on the subject and that’s why I can’t help but feel that the “every man for himself” life philosophy makes us more like cavemen than the human beings we like to believe we are.

With the changes in the economy, Cuba is being forced to take a new path towards a new social agreement where salaries will have greater importance. Hopefully this can be done without losing this “communal fund” which finances healthcare, education, sports and culture.

These social advances might seem somewhat “natural”, but they aren’t. If the will of politicians to prioritize these sectors in the public budget vanishes or if the national economy is no longer able to finance them, they could disappear and having equal opportunities would disappear right with them.


What's your opinion?

  • Moses Patterson

    What Fernando fails to include in his analysis is the will of the people. His concerns for what steps the Castro regime may take next are based on the reality that the decisions will be made by a select few ignoring the decisions, good or bad, the Cuban people would make if given a democratic choice.

    • CErmle

      You seem to have very limited understanding of Cuban democracy. The society is set up and flourishes according to the will the people, who are very much involved in the process on every level. This is a wonderful article. It paints a true picture of revolutionary reality, and day to day life. Much is to be learned from the Cuban society. As the Trumpites and the Batistaites try to turn back the clock, they are destined to fail.

      • Eden Wong

        Cuba’s education system is a mere shadow of what it was from the old days when it was propped up and financed by the Soviet Union. It’s kids teaching kids now, turning on an ancient VCR machine to watch a film that was produced decades ago. The erosion that has happened is heart breaking.

        Cuba’s preventative medicine is still the envy of the developing world, but that’s a pretty low bar, isn’t it? The day-to-day care is gruesome by western standards unless you have access to lots of CUC from foreign remittances, or a high paying illegal side job, or political connections.

        • CErmle

          You are totally wrong regarding Cuba’s preventative medicine, which is the envy of the world, and is of a higher standard than most so-called “western” countries. It seems like you might be trying to spread anti-revolution propaganda, and we all know who specializes in that, don’t we.

          It seems odd to me that you express a longing for the “old days” when the educational system was “propped up” by the Soviet Union. That’s really strange, even by your standards.

          • Nick

            Cuba’s healthcare system is not perfect.
            But then neither is healthcare provision anywhere in the world.
            One must remember that healthcare in Cuba is very good when bearing in mind the economic constraints.
            To it’s advantage it does not have to contend with the leaches and parasites otherwise known as Health Insurance Companies and Pharmacutical Industries (and their shareholders).
            Cuban Healthcare has it’s deficiencies but let us remember that just a year or two ago in Cuba there was the first ever instance in the whole wide world of a HIV positive woman giving birth to a HIV negative child.
            A pioneering first and a credit to the state of Cuba’s healthcare provision and advancement.

          • Eden Wong

            CErmle, you seem like a nice guy, but you are so out-to-lunch regarding modern day Cuba that it’s painful to read your fantasies.

            You have zero conception of the medical facilities that are available to a normal Cuban without CUC.

            And please stop trying to put words in my mouth, I expressed no “longing” for anything, I’m simply stating a fact. When Cuba had lots of money flowing in from the Soviets their education system was great by developing country standards. Today it’s a joke. Why do you think private schools are popping up everywhere?!

            You really need to stop giving opinions on situations that you knowing nothing about, and instead venture out of your safe, cloistered world and come see the REAL Cuba. I am more than happy to provide accommodation and give you a tour of what real Cubans face every single day.

            Until you honestly see how Cuba works in the present day with your own eyes your made-up fantasies are quite frankly embarrassing to read.

          • CErmle

            It’s nice of you to offer me “accommodation and give” me a tour of the real Cuba, but do you think your handlers will agree to that (you know who I mean).

          • Eden Wong

            What a cop-out CErmle. That’s a coward’s response.

            You’re honestly too afraid to go visit a few clinics, hospitals and schools in my Havana neighbourhood? You’re honestly too frightened to talk to people on the street, sitting in the park, having a drink in the neighbourhood peso bar and down at the barber shop?

            You’re so frightened to experience anything yourself. That’s sad.

            I pity you and your life inside an Ivory Tower. To be so fearful of the real world is a horrible existence.

          • CErmle

            My dear friend, I believe you mean well, but you have a very powerful imagination. Read the posting by “Nick” below. He describes the real situation “on the ground”. I don’t know why you are so afraid of the Truth. It’s a beautiful world.

          • Eden Wong

            CErmle, you have no clue whatsoever about the situation “on the ground” because you’re too afraid to leave your enclosed bubble.

            If you ever muster up the courage to explore a complicated situation and investigate Cuba with your own eyes then my offer to host you still stands.

          • Linda S Elzer

            I will be in traveling to Havana on April 19th from the US. I am a travel agent , a senior woman who wants to see the real Cuba. This is my 3rd visit to Cuba , having spent one day in Santiago de Cuba in March. My mission is to find off the beaten path experiences for my clients and stay only at casa particulars and eating in paladors. Most Americans are so ignorant of Cuba and its people. They need to open their eyes to the many wonders of this interesting country and what it has to offer. Unfortunately, they are so consumed with making money that their head remains buried. I will be flying back from Camaguey on April 26th. I have certainly enjoyed this discussion. Thank you .lselzer@optonline.net

  • Maureen Bordeleau

    In Canada we have universal healthcare and access to public education. There is really no such thing as “free” anywhere. We pay through our income tax and other forms of taxation and you simply pay less if you have a modest salary. The cost to attend university is one of the lowest around (particularly in the province of Quebec where I live) and we have students from all over the world that come to Canada for their education. However all these decisions were made by the people via their elected representative and these are the choices the majority made.

    • Griffin

      Well said, Maureen. In Canada, we have publicly funded healthcare & education, but nobody is under the illusion it is free. We see the costs in our taxes. Controlling healthcare costs continues to be the single largest budget challenge for our governments.

      By following the state socialist model, Cuba has seen a steady decline in the quality of education. The gains made in the first two decades of the revolution were the funded by subsidies from the USSR. When those subsidies were lost, the Cuban medical system began a steady and inevitable decline.

      If Cuba were to embark upon true economic & political reforms to bring liberal democracy to the island, the standard of living and GDP would grow sufficiently to allow for improvements in a publicly funded healthcare system.

      Absent such reforms, the Cuban nation will continue to decline in all spheres.

      • dani

        Change the record. What does it matter whether it is called free or not. Everyone knows the situation.

    • dani

      But not everyone pays taxes so an orphan gets the healthcare completely free. Does it really matter what term is used? I find this theme really boring.

  • N.J. Marti

    Lot’s of countries provide national healthcare and education. Cuba can build a market sector while still having both.

  • Chuck Bailey

    I’m a man of few words. And I have tried to follow the news from Cuba for many years. All I can say ” No one should be proud of how this system has collapsed!!”

  • Ian Smith

    Follow the people……Cubans have risked their lives to float en masse to Florida. No one from the Bahamas tries to enter the paradise of Cuba described here. Cuba is now turning to capitalism to stay alive. Taxi drivers, hairdressers, restauramteirs, all now capitalists…..market forces will prevail, even in Cuba, and North Korea, eventually. Sweden sounds fine, but Cuba is a hell hole. As for education…..what kind of education is it that stifles criticism of the ruling party? That ain’t education, but brainwashing. As for the medical care……I’d choose my local hospital here in the Bahamas, thank you.