Soft power the hard way

Exporting Revolution: Cuba’s Global Solidarity
Margaret Randall
2017, Duke University Press
270 pages, paperback

ONE OF the great ironies of Republican efforts under Donald Trump to roll back Obamacare is that if this were ever successful it could undermine a key pillar of the administration’s chaotic foreign policy.

Although attempts to destroy the Affordable Care Act have failed in the face of stiff Democratic resistance and Republican disarray in congress, the US president remains in denial and refuses to abandon his misguided ambition to kill off Barack Obama’s signature domestic achievement.

But among the many contradictions laid bare by Trump’s dogmatic attack on Obamacare, which has resulted in a significant reduction in the number of people lacking health insurance, is the fact that replacing it is going to fuel American “medical tourism” – a key beneficiary of which is likely to be Cuba.

Why does any of this matter? Because the policy adopted by Trump towards Cuba – just the latest in a long line of attempts to isolate the island – is likely once again to founder upon Havana’s shrewd internationalism. While Trump has already targeted Cuba with ideologically-driven restrictions on travel and business, repealing Obamacare will simply increase the flow of US citizens heading to Caribbean island in search of affordable healthcare.

Most Americans seeking to travel to Cuba will not, in fact, be affected by Trump’s new rules. At the same time, since the beginning of a “normalisation” of US-Cuba relations under Obama, healthcare has been seen as one of the most promising immediate beneficiaries of the new business climate and there has been much talk about growing the bilateral medical relationship. Obama’s relaxation of restrictions on ties saw a flurry of hospitals in the US expressing an interest in forming partnerships with Cuban medical institutions, largely because of existing medical tourism.

Indeed, for arcane, political reasons, there has been a close relationship between the Republican assault on Obamacare and its Cuba policy: Trump’s new restrictions on travel to and business with Cuba were a reward to hardline Cuban American congressmen who supported him in opposing Obama’s healthcare legislation, including Marco Rubio and Mario Díaz-Balart, both architects of Trump’s Cuba policy.

This highlights another sharp irony behind Trump’s healthcare fiasco: voting to repeal Obamacare went directly against the interests of many Cuban-Americans in need of affordable health insurance. According to the Miami Herald, Díaz-Balart’s district has the fourth highest number of Obamacare marketplace enrollees in the US.

But if we are to strip away the unwelcome political focus upon Trump and explore the real moral of this story, it is this: high levels of medical tourism among Americans – estimated at 1.4 million in 2016 alone – are fuelled by a lack of access to affordable care, and Cuba is among the top potential destinations for these needy lower-income patients. Cuban healthcare is of exceptional quality and has been at the heart of a highly successful international diplomacy that has overcome the constraints of the US embargo while offering a model of international solidarity that has greatly extended Cuban soft power and influence in the developing world.

The Cuban people receive free healthcare, the country has one of the world’s highest per capita ratios of physicians, and its longevity levels are comparable to those of the US despite far lower per capita GDP.

Cuban medical internationalism supplies about 50,000 medics to 60 developing countries – more than the rest of the G7 countries combined – and its medical brigades were instrumental in controlling the Ebola epidemic in western Africa, a feat recognised by the World Health Organisation. Its Operación Milagro opthalmic aid programme is a showcase of solidarity, and has treated upwards of 1.5 million people all over the world.

This internationalism and its impact upon the world is the theme of Exporting Revolution, another excellent contribution to our understanding of Cuban policymaking compiled by the poet and activist Margaret Randall. This traces Cuba’s extensive commitments abroad in a host of policy areas – healthcare, disaster relief, education, the arts, liberation struggles and sport – and the profound impact such programmes extended out of conviction by a poor and underdeveloped country have had since the 1959 Revolution. Its socialist free healthcare and medical internationalism, in particular, stand in stark contrast to the US notion of healthcare as a commodity.

In foreign policy terms, there is no doubt that these programmes have been one of the principal means by which Cuba has neutralised the US embargo and gained influence far out of proportion to its size and resources. Indeed, the Cuban internationalism that is summarised and explored in Exporting Revolution represents an ideal case study for advocates of “soft power” and of what can be achieved through political will and self-sacrifice.

Randall writes: “Unlike powerful nations occupying weaker ones at will for geopolitical gain or in order to take possession of their natural resources, Cuba’s international outreach constituted a new and far-reaching model of solidarity. That solidarity continues to be seen in the Revolution’s extraordinary humanitarian aid and disaster relief.” [p1]

Randall argues that what sets Cuba apart from other countries for whom aid policy is linked closely to foreign policy is that internationalism has become a pillar of revolutionary identity: Cuba has not used its outreach to increase directly its political influence in beneficiary countries, but to strengthen revolutionary solidarity at home. Inevitably, the author explores the meaning of internationalism when compared to nationalism, and reflexively finds herself making comparisons with the US under Trump.

She writes with great prescience: “Fundamentalist bombast has taken the place of humanity and reason, and we have racist fear, unending war, an increased number of hate crimes, and mounting gun violence as a result … Perhaps the opportunity to experience difference – other people, other cultures and customs – and knowing that one must function within parameters of respect for that difference, makes Cuban internationalism the best antidote to the sort of extreme nationalism that hovers at the uneasy edge of most modern societies.” [pp212–13]