However, this also continues a pre-Castro tradition. But the availability of medicine for dollars, in my view, points less to corruption than to the sheer impossibility of providing free health care to 11 million people out of an extremely small economic pie. Tourism is rising, but much of the revenue is being used to construct further infrastructure. This leaves only the money sent by overseas Cubans to their families, sometimes estimated to be Cuba's number-one source of hard currency. This should be noted with irony by Cuban-Americans who insist that the embargo remain intact.
Medical training is free in Cuba, but it also holds out no promise of financial reward.
Cuban doctors are paid in pesos, which have extremely little buying power on the island today. Thus, they are forced to live from hand to mouth, lining up with their ration books for beans and rice to feed their families, while others with access to dollars shop in hard-currency stores. As one might expect, Cuba is reluctant to allow doctors to leave the country. A Cuban woman doctor who married a German businessman recently told me about the hurdles she faced in leaving the island. Few ordinary Cuban doctors can run this gauntlet successfully.