One of my best friends for many years was a Cuban fellow named Miguel Cárdenas who left the island much later than the Mariel boatlift, and somehow ended up in Ohio. At first he did very well for himself, but eventually got in trouble and lost his US residency privileges and was returned to Cuba. I was able to talk to him a couple of times after he was back in Cuba, but also stayed in touch with his family.

Once I visited Miguel when he was in Cali (long before I lived in Colombia) where his sister, an official in the Cuban government, was allowed to travel. At the time, a rendezvous in a third country was the only way they could meet. His sister, who had achieved a prominent position in the agriculture ministry, eventually left and resettled in Miami. She now tells me that her quality of life working at Walmart in Miami is much better than when she was a government bureaucrat in Havana. Because of her position, she was one of the first Cubans allowed to have an internet connection and actually had a Facebook account before everyday Cubans even had internet.

After Miguel was back in Cuba, he got in an auto accident, and was in pretty bad shape. This was around 2011. I remember getting a call from his sister (she was still in Cuba). Miguel was in the hospital, but there was no medicine, no bandages, no supplies, and and she asked me to find these items in the US and send them to her in Cuba for his treatment. What many people don’t realize is that medicines and food can be sent to Cuba from the United States, and that in any case, the US trade embargo does not prevent commerce in medical goods-or any products from any other countries. Cuban hospitals, like Cuban grocery stores are empty because their totalitarian, communist system is a failure.

My friend died shortly after I spoke to his sister, before I was able to ship medical supplies for his treatment. The “revolucionario” Cuban medical system cannot provide basic supplies; not because of any US embargo—remember during the COVID pandemic, all the supplies were coming from China?—but because the Cuban economic, political and health systems are BANKRUPT.

“There is all the difference in the world between treating people equally and attempting to make them equal.”—F.A. Hayek

Is this Francia’s idea of “vivir sabroso?”

Colombia’s Vice President Francia Marquez was in Cuba last week, where she continued to trash Colombia’s health system and pour accolades on the Cuban system.

“We are proposing a health reform where it is once again administered by the State. Of course, this is not going to be easy because there is a very strong dispute. It is taking away the business of the elite and private sectors that have turned health into a commodity and not a fundamental right. The preventive health that you (Cubans) have maintained as a central axis is what we want to do in Colombia today,” said Vice President Márquez.

Francia Márquez en ?? dijo que estamos proponiendo una reforma a la salud donde el Estado recupere su manejo y que se le quite a las “élites”que se han enriquecido. Alaba el sistema cubano y busca que aprendamos de su experiencia.

Es una vergüenza. pic.twitter.com/jwrxzav5D0

— Ani Abello (@ANIABELLO_R) February 13, 2023

Colombia has a mix of public and private hospitals and clinics, with many doctors in private and specialty practice. Doctors have a choice of participating in public or private healthcare plans or participating in no plans at all. The vast majority of doctors participate in the country’s EPS system.

In Colombia, clinics, or points of care where patients are seen, are called IPS – Institución proveedor de Salud, or health providing institution, in English. Colombians with formal employment choose from a number of health plans, called EPS – Entidad proveedor de Salud, which serve as intermediaries. EPS plans may be private businesses, for example the insurance giant Sura, or they may be government owned, like the city of Bogotá’s Capital Salud. Some EPS systems are poorly managed, corrupt and insolvent, others are very well managed. Doctors and IPS facilities can choose to accept one or more EPS plans, or accept none. Most accept multiple EPS providers. Some EPS providers are notoriously slow payers.

Colombians below a certain income level also qualify for Sysben subsides designed to allow those of the lowest income levels to access the same health care benefits as the rest. Victims of auto accidents are also covered by mandatory SOAT insurance, which covers death, injury, lost wages, and physical therapy due to vehicular accidents.

Colombian President Gustavo Petro presents his proposal for reworking the Colombian health system (photo

Higher income Colombians may also pay cash for services, or purchase a private, prepaid medical plan that usually, but not always, sits atop an EPS plan. The government mandates that all employees and independent contractors participate in EPS. There is also a worker’s compensation system called ARL that covers workplace accidents.

Doctors generally make a good living in Colombia, though the pay is not exorbitant. You might see a typical doctor making between the equivalent of $40,000-$60,000 USD which in Colombia is quite a bit. Specialists and aesthetic surgeons can make quite a bit more, with owners of successful practices pulling in several hundred thousand dollars per year, but this is the tiny exception. In Cuba? $32 USD per month.

No health system is perfect. In the US, there is groundbreaking treatment, but heartbreaking prices. Canada and the UK claim to offer “free” health care, which of course is not free, but disguised through taxation, and patients often have to wait years suffering painful conditions before treatment. Treatment may also be rationed based on cost and staffing limitations.

In Colombia there are several inadequacies, but the biggest is an unequal availability of services based on geography. Bogotá, Medellín and Cali all boast world class hospitals, and many modern specialized treatment centers. MRI, CAT scans, even PET scans are available. Many foreigners come to Colombia for knee replacements, back surgery, and of course, cosmetic surgery. The cost of the entire procedure might be less than the co-pay plus deductible in the patient’s home country.

On the other hand, travel to rural regions of Colombia, or tertiary cities, and it is a different story. Not only is there a lack of facilities, but a lack of medical professionals, especially specialists. Add to this a high incidence of corruption in regional EPS providers and local governments. This stark inequality means that in the same country, one may receive world-class treatment, or practically no treatment at all based on a combination of one’s income and geography.

Meanwhile, there is no shortage of medicines or durable medical supplies. Pharmacies are plentiful and well stocked, and most medicines are affordable. The government maintains a list of critical medicines and has measures in place to assure that these critical medicines are available and affordable.

Marquez has been explicit in her desire to destroy the concept of healthcare as a business in Colombia. But fortunately, it is unlikely that she will ever get the chance. Grocery stores and pharmacies in Colombia are full, and there are mobile phones in every pocket in Colombia, because they are provisioned by businesses. Overall, Colombia has an excellent electrical grid compared to many other Latin American countries, and much of the electricity is provided by private businesses. Even the utilities like EPM or EEB that have government involvement are indirectly owned and must follow corporate government best practices. For example, petroleum giant Ecopetrol is between 80-90% owned by the Colombian government, but because a minority of shares are traded on the New York Stock Exchange (NYSE: EC), the company must behave as a corporate citizen and cannot be treated by the Colombian government as a sinecure for friends and cronies. Voluntarily trading on the NYSE, the company, its employees and directors are subject to US securities law.

The good news

Leftist President Gustavo Petro, formerly a militant guerilla, would surely love to have an entirely government-controlled health system—an entirely government controlled economy if his wishes came true—but fortunately Colombia has enough institutionalism to prevent a Venezuela-style usurpation, or Cuban style “revolución,” though groups like the FARC and ELN did try.

Petro wants to get some kind of reform passed, and that still may be difficult. However, the president has pledged via the country’s official presidential website that:

“Complementary plans, prepaid medicine or health policies will continue to function normally and will not be affected by the project.”

This is critical. And let us also be clear, one of President Petro’s stated objectives to provide an equal basic level of care throughout the country is a very good thing. This is something the country currently lacks. People in Tumaco or Catatumbo do not have the same access to healthcare as people in the south of Cali or the north of Bogotá. However, increasing the quantity of health care throughout the country, should not come at the expense of the quality of health care.

Colombia is in fact a very unequal country, and this inequality should be addressed by creating more opportunities, providing better, more universal education, and yes, challenging the pretty awful class hierarchy that exists in Colombian society. However, Friedrich August Von Hayek admonished us all that:

Even the striving for equality by means of a directed economy can result only in an officially enforced inequality—an authoritarian determination of the status of each individual in the new hierarchical order.

Headline photo: Vice President of Colombia, Francia Márquez Mina (left) with Cuban President Miguel Díaz Canel (Photo: Colombian Government) during her visit last week.

1. Don’t wear expensive watches or gold necklaces. In big urban areas, Colombians don’t, and neither should you. You will not see Colombians walking around with expensive jewelry on the street because of the risk of theft. If they are going to attend a formal event, they will go in private vehicles. A pedestrian wearing these expensive items will not look wealthy, he will look clueless.
2. Don’t use your high-end smartphone on a busy street. If you must make or take a call, best to duck into a corner store or coffee shop, buy a soft drink and conduct your business there. If you wish to take a photo, that’s fine but just look around and be sure you aren’t the object of anyone’s attention.
3. Don’t carry lots of cash. The vast majority of retail establishments and commercial restaurants in Colombia accept bank cards like Visa and Mastercard. Leave your stash in your hotel safe, or a secure area of your apartment, and don’t walk around with more cash than you expect to spend that same day. ATMs, or automated cash machines are widespread in Colombian urban areas, and generally work fine with foreign cards enabled for international transactions.  When withdrawing cash or purchasing items with a bank card in Colombia, you may be presented with the option of accepting a conversion from pesos to dollars. Generally you want to decline this, as they are almost certainly offering you an unfavorable rate compared to your own bank or financial services provider. Of course, rural areas and small artisan vendors or “mom & pop” restaurants may not always accept charge cards. Large shopping malls often have options for licensed money exchangers. Be sure to count your money and store it in your wallet or purse before leaving their service counter.
4. Be careful partying with strangers. In the US and Europe, we hear about “date rape drugs.” Similar substances are used in Colombia to rob tourists—and Colombians of their belongings. Even when the police investigate, few tourists have the means in time or money to stick around for the prosecution to make its way through the courts, so with no witness, the criminals eventually go unpunished. Some criminals have a modus operandi targeting foreign visitors, using for example, attractive young women or friendly “bros” who know “where the party’s at” as bait. You may notice that when liquor is ordered at most clubs and bars in Colombia (but not in international hotels), the bottle is opened at your table in your presence. This is to show you that the drink is not adulterated, and the bar staff is not “slipping anything into your drink.” When drinking with people you do not know, do not leave your drinks unattended. Drinking a beer and headed to the restroom? Take your beer with you.

5. Be prudent about transportation. Taxis in Medellín are generally straightforward, and the price in pesos is whatever is shown on the taxi meter. The official white cars to and from the airport operate at a fixed rate, which you should confirm before leaving. In Bogotá, the taxis have a notoriously bad reputation, and even many Colombians avoid them, using either Über, or InDriver ride hailing apps. InDriver has the advantage of allowing the passenger to “make your own offer” of how much you wish to pay. It also takes a much smaller cut of the fare, so the drivers prefer it. In Cartagena, there are no taxi meters so be sure to agree on a price before entering the taxi. Most hotels also can arrange transportation with providers they trust, but the transportation is more expensive. You can rent a car in Colombia but understand that there is no legal limit for blood alcohol. Driving with any detectable alcohol in your system whatsoever is an arrestable crime.
6. Don’t abuse drugs! Not only is it illegal in Colombia, and Colombian prisons are “not pleasant,” illegal narcotics are often a means of delivery of the disabling hallucinogens like Rohypnol or the more common Scopolamine, made from a flowering tree found in Colombia distantly related to the Tomato. Crime victims are often reluctant to report the crime because their drug use will show up in the resultant medical attention. The situation is worse when the victims are not fluent in Spanish, or don’t have resources to pay for medical care. Along with not abusing drugs, public drunkenness is not only ugly, it puts you at risk for victimization by criminals.

Colombia’s Minister of Commerce, Industry and Tourism José Manuel Restrepo, explained that as there has been a high demand for these products that are required domestically for attending Colombian patients, the measures are taken to ensure supply.

“We are going through a health situation that leads us to adopt different measures to contain this pandemic, and the restriction on the export of these products is one of those measures that is also allowed by the World Trade Organization, of which we are part. This body allows exceptional, temporary restrictions on exports to prevent or control the shortage of products, in this case essential for health,” said the minister.

The regulation, Decree 462 of March 22, 2020 also establishes that both producers and importers of these goods must prioritize their distribution to the following beneficiaries:

• Health Service Provider Institutions that have a neonatal, pediatric or adult or hospitalization, adult or pediatric or emergency intensive or intermediate care unit and those authorized by the Ministry of Health and Social Protection
• Urban mass transport companies
• Airlines and ground transport companies
• Airports and transport terminals
• Government, national, departmental and municipal entities
• State security forces, fire and civil defense
• Delivery companies and direct-to-home marketers. These companies will limit the retail sale of these products to two units per household, per week.
• Drugstores, department stores and retail marketers, as long as the sale is limited to two units per family group per week.
• Legal persons and companies, authorized by the government, provided that the sale is limited to the units necessary to attend to the number of employees or personnel necessary for their operation, for a week.

The rule also states that in the case of older adults, the purchase of products in commercial establishments at home and in drugstores may be made by a family member or the person who cares for him.

The Decree restricts the export or re-export of goods such as latex medical gloves, protective glasses, electrocardiographs, vital sign monitors, neonatal cribs, ventilators, respiratory devices and respiratory protection masks, X-ray equipment and beds. and hospital stretchers. Also, alcohol, soap, toilet paper, gloves for medical or care use, other medicines for human use, disinfectants, damp cloths and towels, antibacterial gel, face masks of various types and medical equipment of various types are some of the goods that may not be exported during the next 6 months.

Monthly, the Ministry of Commerce, Industry and Tourism will review the supply of the 24 products contemplated in the decree, and if it determines that there are sufficient stocks to serve the national market, and if there are surpluses, it may authorize export at the request of interested merchants or producers.

Image by Christian Slater from Pixabay

Jaqueline Polo and her two-year-old son Juan David will spend two days aboard the USNS Comfort, where Juan David will have surgery to repair a congenital umbilical hernia. Jaqueline thanked those who work in the mission. “They make a sacrifice leaving their homes, their land and their customs, to dedicate themselves to such a beautiful work as helping people like me.”

68 year old Miguel Angel Santana lives in the San Jorge neighborhood of Santa Marta, and is excited about his upcoming operation on the USNS Comfort. He expresses his hopes in the operation procedure for his optical cataracts and said he wants to “Be able to see again how God originally gave me sight. To see clearly. ”

The mission expects to serve thousands of patients throughout the week. This humanitarian mission reflects the close and continuous cooperation between the governments of Colombia and the United States.