Disruption in Cuban Medical Mission to Brazil

On November 14,  Cuba’s Ministry of Public Health stated that the island was ‘discontinuing’ its participation in the Program Mais Médicos, or More Doctors, in Brazil. [1]

In response to this Cuban move, a well-known Brazilian lawyer presented an appeal to Brazil’s Supreme Court requesting a “habeas corpus” so that the 8,332 Cuban doctors currently working in  Brazil and were summoned back to their country can remain in their positions as asylees or as permanent residents. The attorney also asserted that even though the Brazil-Cuba agreement for this program barred Brazil from granting the Cuban doctors political asylum or permanent visas, Cuba’s unilateral termination of the program also terminated the ban on granting such relief to the Cuban doctors.

Cuba has received more than $249.5 million a year for its doctors in Brazil, according to a researcher interviewed by the Miami Herald. The elimination of this revenue for Cuba will have a huge negative impact on Cuba’s economy and finances. Just one such problem is Brazil’s demand for Cuba to pay the arrears it owes Brazil for the $680 million loan it provided for the development of the port of Mariel near Havana. Cuba already is $71.2 million in arrears, according to Brazil’s National Bank for Economic and Social Development.

This current set of disputes was predicted by Brazil’s recent presidential campaign when then-candidate Jair Bolsonaro raised questions about the quality of the Cuban doctors’ training and said the doctors would have to prove their medical credentials by getting their diplomas validated in Brazil, a process that has previously been waived for Cuban doctors. He also criticized the Cuban government’s keeping around 75 percent of their salaries paid by Brazil even though the doctors earn more in Brazil than they did on the island. [2]

Another criticism by Bolsonaro was the employment contract between Cuba’s Ministry of Public Health and the Cuban doctors, in which the doctors are banned from having family accompanying them during their mission. In addition, Bolsonaro said his government would offer asylum to Cuban doctors who wished to stay in Brazil.

The Program was launched by former Brazilian President Dilma Rousseff to send Cuban physicians to underserved regions in the South American country and was arranged by the Pan American Health Organization (PAHO). the New York Times reports. Around 20,000 Cuban doctors have worked in Brazil in the span of five years. By the end of 2017 there were Cuban health workers in 64 countries, with Brazil and Venezuela as the main destinations.

The current horrible living conditions in Venezuela has caused many of the Cuban doctors serving there to try to escape to other countries.[3]

Impact on Cuban Health Care[4]

Meanwhile back in Cuba there are reports that its “export” of medical doctors to other countries, including Brazil and Venezuela, has caused a significant reduction in the number of health professionals providing primary care on the island. For example, In 2010 the number of doctors assigned to Family Clinics was 36,478, while in 2017 there were only 13,131; that is, a 64% drop in less than a decade. The result of this imbalance is a sharp decrease in health personnel in Cuba, the closure of infrastructures, a reduction in the number of hospital beds, shortages at pharmacies, and an increase in diseases related to deficient health conditions.

Conclusion

Those of us in the U.S. who want to see both Cuba and Brazil succeed will need to keep watch on this situation and try to assess the merits of the two countries’ arguments and claims.

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[1] Center for Democracy in Americas, Cuba Central News Brief: 11/16/18A lawyer asks the Supreme [Court of Brazil] for guarantees of permanence for Cuban doctors, Diario de Cuba (Nov. 18, 2018).

[2] The U.S. has alleged that the Cuban medical professionals on foreign missions are engaged in illegal forced labor due to their not receiving the total payments by foreign governments for their services. This blog, however, has rejected that U.S. claim for various reasons. (See U.S. State Department Unjustly Continues To Allege That Cuba’s Foreign Medical Missions Engage in Forced Labor, dwkcommentaries.com (Aug. 17, 2017).

[3] See  Cuban Medical Professionals Continue To Escape from Foreign Medical Missions, dwkcommentaries.com (Mar. 15, 2018).

[4] Fernández & Diaz Ezpí,  23,000 Fewer Doctors: A Raw Deal for Cubans, Diario de Cuba (Nov. 12, 2018); More doctors for Maduro: bleeding into the Cuban primary health system continues, Diario de Cuba (Nov. 12, 2018).

Federal Reserve Bank Endorses Need for More Immigrants

On November 13 the Federal Reserve Bank of Minneapolis concluded its second annual Regional Economic Conditions Conference with a strong endorsement of the U.S. need for more immigrants.[1]

Its Senior Vice President and Research Director Mark Wright  summed up the proceedings by saying, ““What’s clear to me is that, in the same way that immigration has played a very large role in shaping the history of this country, it is going to do so again in the future, one way or another. The simple laws of demography and economics demand it.”

Wright added, “But what can’t get lost in purely thinking about the statistics, the spreadsheets, and the government budgets and how that’s affected by immigration, we also have to recognize that behind those statistics are the very real lives of many people, many families who are living in a great deal of uncertainty and great deal of difficulty right now.”

The conference’s keynote speaker, U.S. Senator Ron Johnson (Rep., WI), agreed. He said, “If you don’t have enough human capital, you’re not going to have a growing economy. No policies, no tax cuts, no deregulation is going to make up for the fact that we simply don’t have enough workers. … We’re going to need a vibrant, legal immigration population.”

Therefore, Senator Johnson called on his fellow members of Congress to adopt an approach of continuous (and incremental) improvement of immigration policy to be responsive to current conditions. He also emphasized the need for  a legal immigration system where states would have a stronger voice in determining the appropriate mix of skilled workers it could welcome to address local labor force needs and where greater emphasis was placed on immigrants work skills, rather than family reunification.

More specifically Johnson said he would reintroduce a bill to allow states to administer guest-worker visas allowing the individuals to stay in the U.S. for one year to take jobs, and he previously has suggested having an annual cap of 500,000 of such visas

Political reality, however, said Johnson, requires the Congress first to fix illegal immigration.

Another speaker, Ryan Allen, Associate Professor of  Community and Economic Development at the University of Minnesota’s Humphrey School of Public Affairs, emphasized that as fertility rates among native-born Americans lag and as the population ages, the growth of the labor force will stagnate, but for the inflow of immigrants. For the State of Minnesota, the labor force is growing at what Allen called an “anemic” one-half of 1 percent annually, and that’s not enough to ensure economic growth. In Allen’s view, to maintain the current labor force growth rate, Minnesota needs more than four times the number of immigrants that the state demographer projects will arrive in the state over the next three decades.

These thoughts were echoed by speakers from North and South Dakota. And a Montana immigration attorney redefined what “assimilation” of migrants should mean going forward. “They’re working, they’re providing for themselves and their family, they’re contributing to the economy by spending the money they earn. They are assimilated—perhaps not in language all of the time, perhaps not in skin tone or cultural background. They are assimilated in the sense that they are part of our economy.”

This Federal Reserve Bank’s President, Neel Kashkari, frequently makes these points about immigration.[2]

Conclusion

Recent Minnesota statistics provide further evidence of this need. Its unemployment rate in October remained at 2.8% while the state added jobs at a slower rate than last year and employers were working harder to attract and retain talent. A recent survey by the Minnesota Chamber of Commerce found that the difficulty of finding skilled workers is so pervasive that it is threatening business growth in the state. [3]

These conditions are also true throughout the U.S., Europe and other industrialized countries.[4]

It, therefore, is contradictory for the Trump Administration to increasingly deny and delay applications for legal immigration.[5]

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[1] Weiner, Human capital, demographics,, economic growth, and immigrants, Fed. Res. Bank of Mpls,  (Nov. 14, 2018); Ramstad, Sen. Ron Johnson says illegal immigration needs to be fixed before other reform, StarTribune (Nov. 14, 2018).

[2] E.g., Kashkari,  WSJ Op-Ed: Immigration Is Practically a Free Lunch for America (Jan. 19, 2018).

[3] Ramstad, Minnesota adds 3,400 jobs in October; unemployment holds at 2.8 percent, StarTribune (Nov. 15, 2018); DePass, Minnesota Chamber of Commerce Survey: Hiring woes threaten state’s business growth, StarTribune (Nov. 15, 2018).

[4] Noack, Fertility rates around the world are declining, some Trump supporters won’t like the solution, Wash, Post (Nov. 9, 2018); Freeman, Is America Running Out of Workers?, W.S.J. (Nov. 1, 2018). See also these posts to dwkcommentaries: U.S. Needs More Immigrants (April 14, 2018); Other Factors Favoring U.S. Immigration (May 17, 2018); Impact of Declining, Aging, Rural Population (May 22, 2018); More Immigrants Needed in U.S. (June 23, 2018); Fear of Change Driving U.S. and European Clamor Over Immigration (July 3, 2018); Outstate Minnesota Newspaper Stresses Need for Immigrants (July 27, 2018); Outstate Minnesota City Aided by Immigrants Aug. 5, 2018).

[5]  Bier, America Is Rejecting More Legal Immigrants Than Ever, N.Y. Times (Nov.15, 2018).

 

Outstate Minnesota City Aided by Immigrants

As noted in a prior post, a banker in Worthington, a city in the southwestern corner of Minnesota, estimated immigrants own more than a quarter of the businesses operating in that community. “If we embrace it, it’s what’s going to help rural Minnesota grow again.”

This report was amplified in an August 4 article in the StarTribune, Minnesota’s leading newspaper while another recent article addressed the general problems of outstate Minnesota.

 Additional Report on Worthington, Minnesota[1]

This city’s population has surged from fewer than 10,000 in 1990 to more than 13,000 today and its residents expect it to exceed 14,000 in the near future with immigrants constituting roughly one-third of the population.  And the median age is under 36.

Some of the immigrants are entrepreneurs, who described the difficulties they had in getting their businesses started and frustration over lack of stores with their favorite foods and police forces still almost exclusively locally born white people. But they still expressed optimism about their future in this community.

One of the largest employers in the town, JBS USA pork processing plant, has employees who are native speakers of at least 50 languages and dialects. The company seems supportive of its largely immigrant workforce with its human resources director helping an immigrant community form their own church.

Worthington recently was visited by  Neel Kashkari, the president of the Minneapolis Federal Reserve Bank. At a community meeting in the town he said, “If you do the math, there are three choices we have as a society. One choice is just accept slower growth. A second choice is to subsidize [human] fertility. Or number three, you can embrace immigration. Now the advantage we have in the U.S. is that, while we are not perfect, we are better than just about any other country at embracing immigrants and integrating them in our society.”

 “A Social Contract for Rural Minnesota”

Another recent article in the StarTribune lamented the struggles of “many of our smallest towns . . . to stay relevant” as their aging populations decline.[2] The author, Jim Mulder, the retired executive director of the Association of Minnesota Counties and an adjunct professor at the University of St. Thomas in St. Paul and a policy fellow at Growth and Justice, therefore, proposed a Social Contract for Rural Minnesota with the following six elements:

  1. Education. Develop “new tools and strategies for educating children in sparsely populated areas. . . . [that] focus on outcomes, not on structure and process.”
  2. Health care. With a “shortage of physicians, dentists and mental health professionals . . . . [we must use] mobile health clinics, . . .by housing county social service and public health officials [closer to the people, by aggressively using] nurse practitioners and physician assistants [and by providing ] transportation services for the elderly to get to care providers].”
  3. Housing. Provide assistance to residents to meet their housing needs, including improving the housing quality.
  4. Transportation. Invest in better roads and bridges and transit of all types.
  5. Public infrastructure. Fund and build right-sized water and sewer systems.
  6. Economic development. Increase jobs.

Analysis of the Social Contract for Rural Minnesota

Although I liked the idea of a social contract for rural Minnesota, I thought the one proposed by Mr. Mulder missed the key issue. Therefore, I wrote the following letter to the Editor of the StarTribune, which was published on August 5:

  • “While I agree with Jim Mulder that we need “a shared commitment to success for one Minnesota” (“One Minnesota: Your undivided attention, please,”Opinion Exchange, July 29), his “Social contract for Rural Minnesota” misses the point.”
  • “We all know that rural Minnesota has an aging and declining population, which underlies all the problems he seeks to address. Thus, these parts of the state need more and younger people, and the obvious source of such people is more immigration. This point was made by an editorial in the Mankato Free Press that the Star Tribune reprinted (“The immigrant workforce: It’s critical for Minnesota’s economy,” July 24).”
  • “Thus, the social contract requires development of welcoming rural communities for people from all over the world.”

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[1] Schafer, Immigration and Immigrants are a positive force in Worthington, StarTribune (August 5, 2018).

[2] Mulder, One Minnesota: YOUR UNDIVIDED Attention, Please, StarTribune at OP1 (July 29, 2018).

Criticism of Cuba’s New Regulations for Private Enterprise

Cuba’s 126 pages of new regulations for private enterprise (cuentapropistas), which were published on July 10, have been criticized by U.S. economist Richard Feinberg, a professor at the University of California San Diego’s School of Global Policy and Strategy and a Fellow at the Brookings Institution. He calls them “the revenge of the bureaucrats,” who are jealous of those in the private sector who are making much more money than employees of struggling state enterprises.[1]

The new regulations contain details about potential violations, penalties and fines, oversight and performance requirements. For example, an operator of a private day-care facility must devote at least 21.5 square feet per child plus provide a detailed inventory of personal toiletry items.

These regulations also are designed to virtually guarantee that most private businesses will not grow beyond 20 employees. For example, once a private employer hires more than 20 employees, the 21st employee must be paid six times the average wage for the first 20 employees.

In short, private enterprise is fine so long as they “don’t get too rich, diversify their businesses, open branches, try to evade taxes, resort to the black market, or provide too much competition to the state sector.” Indeed, a major motivation for the regulations is to halt growing inequities between ordinary Cubans and those in the private sector.

Moreover, the new regulations do not allow “for white-collar professionals to work for themselves, . . . private entrepreneurs to directly import for their businesses, and there is no recognition of their businesses as legal entities” and no provision for the creation of wholesale markets for the private sector.

These criticisms of the regulations were echoed in a  recent Cuban public opinion poll carried out by the CubaData Project with a team of academics from Cuba, Mexico and Venezuela. 87.6% believe that Cuban professionals should be able to establish businesses and businesses within their professions. In addition, a high percentage of those surveyed believe other political parties should be permitted and that the election of the island’s president should be direct.[2]

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[1] Whitefield, New Cuba regulations for private enterprise on the island have a long list of don’ts, Miami Herald (Aug. 2, 2018). See these posts to dwkcommentaries.com: Cuba Announces New Regulations for Private Business (July 10, 2018); More Details on New Cuban Regulations for Private Business (July 11, 2018); Comment: Yet More Details on Cuba’s New Regulations for Private Business (July 13, 2018).

[2]  Survey: Cubans want more autonomy for their business, political pluralism and elect president, Diario de Cuba (July 30, 2018).

Good News: Increasing U.S. Travel to Cuba

A website for travel professionals reports that recently U.S. travel to Cuba is increasing. It cites Tom Popper,  the president of InsightCuba, which specializes in travel to the island, who says it has seen an increase of 30% for such travel in May, June and July 2018 over the prior year.[1]

One of the problems many U.S. nationals encounter in planning a trip to Cuba is not finding flights to Cuba on Expedia, TripAdvisor or Orbitz. This is due to such businesses wanting to avoid hassling with the airlines that fly to the island having an obligation to the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC) for confirming that U.S. nationals on such flights are going there for a legal reason under the OFAC regulations.

The airlines, however, have no such difficulty because when you buy a ticket to fly to Cuba, you merely have to hit “accept” on the affidavit pop-up that you are traveling under one of 12 general licenses for U.S. legal travel to Cuba, which are described on OFAC’s website. The traveler, therefore, before buying a ticket must carefully review that website and determine which of the following 12 general licenses fits the planned trip:

  1. family visits;
  2. official business of the U.S. government, foreign governments, and certain intergovernmental organizations;
  3. journalistic activity;
  4. professional research and professional meetings;
  5. educational activities;
  6. religious activities;
  7. public performances, clinics, workshops, athletic and other competitions, and exhibitions;
  8. support for the Cuban people;
  9. humanitarian projects;
  10. activities of private foundations or research or educational institutes;
  11. exportation, importation, or transmission of information or information materials; and
  12. certain authorized export transactions.

U.S. travelers to Cuba also need to review this OFAC statement (para. 32) about spending in Cuba by “persons subject to U.S. jurisdiction:”

  • “There is no specific dollar limit on authorized expenses; however, in accordance with the NSPM [National Security Presidential Memorandum], OFAC is amending the CACR [Cuban Assets Control Regulations] to restrict persons subject to U.S. jurisdiction from engaging in direct financial transactions with entities and subentities identified on the State Department’s Cuba Restricted List, with certain exceptions. See 31 CFR § 515.209 and § 515.421. Consistent with these authorizations and restrictions, authorized travelers may engage in transactions ordinarily incident to travel within Cuba, including payment of living expenses and the acquisition in Cuba of goods for personal consumption there. In addition, travelers are authorized to acquire in Cuba and import as accompanied baggage into the United States merchandise for personal use only. Value imports remain subject to the normal limits on duty and tax exemptions for merchandise imported as accompanied baggage and for personal use.” (Emphasis added.)

As this OFAC statement indicates, the U.S. State Department has published its “List of Restricted Entities and Subentities Associated with Cuba as of November 9, 2017.” Direct transactions with these entities and subentities by “persons subject to U.S. jurisdiction” are prohibited. The State Department also has published “Frequently Asked Questions on the Cuba Restricted List (Nov. 8, 2017).”

Finally Americans thinking about going to Cuba should know that the two major carriers to the island—Delta and American—have taken over many routes abandoned by other airlines and with the experience of the last several years have figured out the best size of aircrafts and frequency of flights to Cuba from the gateways of New York City, Houston, Atlanta and Miami. The result? Round-trip tickets to Cuba from these gateways are inexpensive, such as $300 from JFK in New York.

The traveler will be aided in all of this by working with a company, like InsightCuba, that specializes in travel to the island.

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[1] Cogswell, Under the Radar, Cuba Market Comes Back, travelmarket report (Aug. 1, 2018).

Difficulties in Diversifying Sections of the U.S.

This blog consistently has advocated the need for more immigrants in the U.S., especially in those states, mainly rural, with declining and aging populations.[1] Several  recent articles have emphasized difficulties in pursuing such a goal.

Northern New England[2]

Northern New England has an aging, declining and overwhelmingly white population in a “huge collection of very, very small towns.” These states—New Hampshire, Vermont and Maine—therefore, need new residents, including immigrants.

A major obstacle to attracting new residents is the presence of the huge presence of whites. The  reasons for this white population “stem from a variety of factors, including a lack of big urban areas, where jobs are more plentiful, [where] a wider range of housing is available and [where] cultural differences are a little more accepted than in smaller places.”

According to Peter Francese, a demographic analyst based in Exeter, N.H., “’Housing is at the core of why there aren’t more immigrants — there’s no place for them. An ethnic person who wants to come in with a family of four or five people is not going to find a home they can afford, and there’s almost no rental housing whatsoever.’ In addition, Northern New England has the nation’s highest concentration of second homes, making the housing market especially tight.”

In addition, he said, “much of any newer housing is only for people 55 or older. If developers built housing for younger people, they would likely have children, which means a need for schools, which means higher property taxes — anathema in a place like New Hampshire, which has no income tax.”

Some New Hampshire residents came up with the following ways the state could enhance its ability to draw people of different backgrounds: “a better understanding of licensing and skills that refugees bring with them so they could more easily work here; a system of rewarding businesses that hire a more diverse array of workers; a central location with a database, speakers’ bureau and training opportunities that could help companies understand what ‘diversity and inclusion’ means and how it could benefit them; and a focus on keeping workers as much as hiring them in the first place, since many leave after finding the state inhospitable.”

A possible solution to the woes of Northern New England is a new program, Welcome Home, which is sponsored by the International Rescue Committee, a nongovernmental organization that globally provides services to displaced people, and TripAdvisor and which has started in New York City and Northern California. This program seeks to provide refugees “an understanding of where they now live and help them integrate into their new communities.[3]

Some Whites’ Difficulties in Adjusting to Minority Status

There is a need for everyone to have understanding and empathy for some white persons who are  thrust into a situation in the U.S. where they are now in the minority.

This was the theme of a sensitive article about Heaven Engle, a 20-year old white woman who does not know the Spanish language while working in a rural chicken plant where virtually all of the other workers are Latina or Latino who do not speak English. During the work-day she often feels lonely, alienated and frustrated. She also feels threatened. This takes place in Fredericksburg, Pennsylvania, with a mainly white and conservative population of 1,500, isolated in Lebanon County, population 140,000, which is becoming more Hispanic.[4]

Racialized U.S. Politics[5]

This young white woman’s perspective ties in with a column about U.S. “racialized” politics by David Leonhardt, a former Washington bureau chief for the New York Times. He asserts, “American politics have become more racialized over the last decade. Over the long term, that trend will probably help the Democrats — the party of the country’s growing demographic groups. In the short term, though, it presents some real risks.” (Emphasis added.)

“Many white Americans,” he continues, “felt threatened by both . . .[Obama’s] election and the country’s increasing diversity.” Then “Trump ran the most race-obsessed campaign in decades . . . . [and] won the White House, thanks largely to a surge in white support across the upper Midwest, the Florida panhandle and elsewhere.”

Now “Trump and other top Republicans have made clear that they plan to continue their racialized strategy. They evidently think it’s their best chance to win elections. Cynical as their approach is, they may be right.” Why? “About 68 percent of the voting-age citizen population is white non-Hispanic. . . .  and “these whites vote more often than nonwhites.” Moreover, “when white people are frequently reminded of their racial identity, they tend to become more politically conservative.”

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[1] E.g., More Immigrants Needed in U.S., dwkcommentaries.com (June 23, 2018).

[2] Seelye, New Hampshire, 94 Percent White, Asks: How Do You Diversify a Whole State? N.Y. Times (July 27, 2018).

[3] Vora, From Trip Advisor, a Program to Help Refugees Get to Know the U.S., N.Y. Times (July 31, 2018).

[4] McCoy, White, and in the minority, Wash. Post (July 30, 2018).

[5] Leonhardt, The  Politics of ‘White Threat,’ N.Y. Times (July 31, 2018); Klein, White threat in a browning America. Vox (July 30, 2018).