Even in retirement, Fidel Castro exerts outsized influence over our country’s political life. Even now, he may affect the access Floridians have to health care.

How can this be? To teach Castro a lesson, a state legislator is fighting to ban American doctors, educated in Cuba, from practicing medicine in Florida, and already a committee has acted to move this proposal forward.

This story, about a small and largely symbolic issue, speaks volumes about how Fidel-o-phobia can cause even our most well-meaning public officials to do the strangest and most self-defeating things.

Nearly a decade ago, President Castro founded the Latin American School of Medicine, also called “ELAM,” where foreign students are given a medical education for free. They come largely from developing countries’ poor and indigenous communities where medical care is desperately needed, and they are encouraged to return to those communities to practice. ELAM is a classic example of Cuba’s application of soft-power in its international diplomacy.

Over a hundred American students—mainly from minority communities-- are now enrolled there. Who are these students? They are whip smart, highly motivated kids, desperate to become physicians, yet unable to afford a medical education in the United States, or unwilling to shoulder the $200,000 debt that now hits the average US medical student the day after graduation.

So, they go to Cuba, learn Spanish (coming home bilingual), take bridging courses in sciences if necessary and spend six years being trained as physicians in Cuba alongside students from 28 other countries. After which, the hope is, they will return to the United States and practice medicine in some of the thousands of our country’s under-served communities.

Is a Cuban medical education any good? According to experts we’ve consulted, the answer is yes. Dr. Fitzhugh Mullan, a former U.S. Assistant Surgeon General, says Cuban medical education is well-respected and that Cuba’s achievement in scaling up physician training is an important example for other countries. The first US graduate has already passed his medical boards and is in his first year of residency in New York City. With the latest class, a total of 17 will have graduated by this summer.

Enter Rep. Eddy Gonzalez.

His bill, HB 685, which was passed by the Healthcare Council, and will now go to a floor vote, will strictly prohibit any of these American medical students currently enrolled at ELAM from practicing medicine in Florida.

According to the Federation of State Medical Boards, this would make Florida the first state in the nation to ban all physicians who graduated from any school in a particular country.

Even though Rep. Gonzalez has called facets of Cuba’s health care system "state of the art," he says that students educated in Cuba, whose government he despises, “do not possess the basic judgment and character required for the ethical practice of medicine in Florida."

Rep. Gonzalez vastly underestimates the idealism and the devotion to medicine possessed by these doctors, and nothing in his legislation will change the Cuban system. What it will do is stop Florida from getting young, talented physicians to practice where they are surely needed.

Dr. Karl Altenburger, president of the Florida Medical Association, calls the state’s doctor shortage severe. He’s said that young doctors don’t want to come to Florida to practice; the state lacks internships, residency programs, and fellowships. The average age of doctors in Florida is 51 and a quarter of the state’s physicians are over 60.

Florida, the fourth most populous state, is ranked 20th in its number of active physicians by the Association of American Medical Colleges. Tad Fisher, executive Vice President of the Florida Academy of Family Physicians, said that Florida needs an additional 12,000 primary care physicians by 2020 to meet its health care needs.

And there are plenty of underserved people in Gonzalez’s home district: the Health Council of South Florida’s Miami-Dade County’s 2007 Community Health Report Card gave “access to health care” a pretty scary “F”.

Florida acknowledges these problems and advertises on the internet to recruit physicians to treat patients in the state who don’t have adequate access to doctors. It even offers waivers to attract foreign-born, foreign educated physicians to serve. But American students educated in Cuba? They need not apply.

When Floridians come down with Fidel-o-phobia, they torment each other (and the rest of us) just to show Castro up. More often than not, we end up with silly ideas like this which hurt us, not him. Now that Fidel’s retired, we should stop dancing at the end of his string, look squarely at our own interests, and decide for ourselves the right way to pursue our nation’s ideals.

-- Sarah Stephens and Gail Reed

Gail Reed M.S., is a journalist who serves as International Director of Medical Education Cooperation with Cuba (MEDICC). Sarah Stephens is Director of the Center for Democracy in the Americas.

Comrade and General Raúl Castro Ruz has now, it seems, taken full control of the reins of government in Cuba and el commandante y jefe, Fidel Castro—who for nearly half a century successfully defied nine (not counting Ike, who knew better) American presidents—has receded more and more into the background noise of a slowly changing Cuba. But what does this successful and now almost complete transition portend for the 11 million Cubans who deserve a better life?

Well, that is the question on everyone's mind who follows Cuban affairs. From a very cynical viewpoint like that of Patrick Symmes in the most recent edition of Harper's Magazine ("The Battle of Ideas"), to the very realpolitik views of U.S. Senator Christopher Dodd, to the yammering of strident right-wingers like Roger Noriega, we receive frequent prognoses, plans, or pronunciamientos.

But what is really going on?—apart from the carefully contrived rhetoric of Dade County spinmeisters, Administration hacks, or even on-island government mouthpieces. It's hard to tell, really.

Cellphone use, limited property rights, incentives for farmers, moves toward shaped privatization, increases in salaries, and other initiatives reach our ears and entice but it's very hard to tell what they mean for average Cubans. And, as with most situations of rising expectations, we don’t know if the situation will get out of hand, as viewed by the leadership, and a severe backlash result, or further openings will occur, or what.

Whether Symmes knows it or not is debatable, but the central theme of his very film noire-like article is that Cuban dissidents are few and far between, ill-equipped, ill-resourced, and compose an inchoate group of ne'r-do-wells. Irony of ironies, but they appear in Symmes' descriptions to be much like those who tried to wade ashore at the Bay of Pigs in 1961 and whose remnants, aged but still defiant, now occupy a decrepit training camp in southern Florida.

On the other hand, if there is a sound statement of strategy with regard to how the U.S., el coloso del norte (and, under George W. Bush, el coloso sin una cabeza!), ought to be responding to all this ferment and creeping change in Cuba, it is without mistake that of Senator Dodd's:

Our Cuba policy has been agonizingly static for almost fifty years.

It has neither served America’s interests nor brought democracy to the island.

When Fidel Castro ceded power to his brother Raul, we reached a critical moment.

We all now have a choice -- either we engage the Cuban people and leadership to help shape the landscape for the next fifty years, or we remain on the sidelines to no one's benefit.

I believe we must dramatically alter our posture towards Cuba, by ending the trade embargo, lifting travel restrictions and caps on remittances to the struggling Cuban people, and by engaging in bilateral and multilateral talks on issues of mutual interest.

The only certainty guaranteed by our Cuba policy over the past forty years has been the continuation of Fidel Castro’s grip on power.

Once we embark on this road to reform, I am confident that it will be nearly impossible for the Cuban government and its people to turn back.

And the same will be true for us.

I'll take Dodd's prescriptions even further:

If the U.S. does not change its policy toward Cuba—and change it more or less along the lines Dodd proposes—then regardless of the outcome of the changes now taking place on the island, plus those changes undoubtedly to come, the United States will be on the outside peering in, not on the inside helping to shape change. Indeed, not even on the outside ready to assist change. We will be, as we have so often been under the feckless leadership of Richard Cheney and George W. Bush, out in the cold—with no influence, no weight, and no friends.

If only our presidential election were tomorrow morning!

- Lawrence Wilkerson

The conventional wisdom in Washington holds that there are two big obstacles for Cuba becoming a salient political issue in the 2008 presidential campaign. First is the electoral college math. Miami/Dade County is the second-largest metro area in a swing state with 27 electoral votes--10 percent of those needed to elect a president. And if there is a third rail of politics in Miami, it would be the embargo: touch it and die.

The second obstacle, according to conventional wisdom, is the spectre of being soft on Communism. The recent New York Times article profiling John McCain's senior campaign advisor Charlie Black talked about how in the 1980s Black's Political Action Committee "set a new standard for negative advertising with its campaigns against six liberal senators in 1980, portraying them as “baby killers” for their support of abortion rights, cozy with Castro and soft on national defense." Little has changed in the art of negative politics in the intervening twenty years and we can expect the same kind of attacks in the winner-take-all general election.

But time has had an impact on the Cuba issue and the conventional wisdom is seeing some cracks. Specifically, there is an interesting demographic trend that pollsters are calling "the generation gap." Sixty-five percent of Cuban-American residents of Miami/Dade County support dialogue with the regime in Havana, according to the latest Florida International University poll. That's up 10 percent since 2004. Similarly, 64 percent of this same population support an immediate, unilateral return to the pre-2004 embargo rules.

The reason is simple. The more recent waves of Cuban immigrants have a different relationship to the island. Recent immigrants were more likely economic migrants, fleeing the lack of opportunity and taking advantage of the loose, wet-foot, dry-foot asylum policy that effectively means citizenship for anyone who makes it to dry U.S. soil. It was a calculated gamble: they left behind their families to make the treacherous 90 mile sea voyage for the chance of supporting their loved ones back home with hard-currency remittances.

The old generation left more for political reasons. Comprised in large part of the families who supported, Haiti-style, the U.S.-backed dictator Battista, these families saw their businesses and property nationalized, collectivized, in other words, stolen by the Castro revolutionaries. They brought their extended families with them and after fifty years in exile, their ties back home are generally weaker.

But the issue that made the generation gap into something more than an interesting demographic discussion was George Bush's 2004 tightening of the embargo in areas that hurt newer immigrants disproportionately: family travel and remittances. Now children in the United States have to decide which parent's funeral to attend. Their economic survival strategies, based on risking death to come to America to send back remittances, were suddenly defeated. This was a major wedge.

Add to this a new dynamic. Local economic issues are beginning to compete with the anti-Castro orthodoxy and what was once a solid voting bloc is beginning to splinter. Again, the division is between the older generation and the younger. Older Cuban emigres are more economically established, while the younger are more vulnerable. Florida has been one of the epicenters of the housing slump, and with it, young families will be voting their pocketbooks, not their parent's party line.

Of the registered voters surveyed by FIU, 74 percent responded that the Cuba Embargo has worked not very well or not at all; 53 percent want to see agricultural trade with Cuba expanded or kept the same; even 51 percent want the U.S. to extend full diplomatic relations to Cuba.

Those kinds of numbers, combined with the deep economic concerns all Floridians face, seem to argue against the conventional reading of the electoral math. The Cuban-American community is no longer a solid bloc. What remains is the soft-on-communism question. On this issue, there is also room for a change in the terms of the debate.

With 74 percent of Cuban-American voters agreeing with the statement that the embargo has not worked, that is the place to start. The embargo has not worked because it is unilateral and the rest of the world, especially Europe and including Israel, is profiting from trade with Cuba. These nations look at Cuba the way we look at China or Vietnam: an opportunity for using trade and the slow force of popular expectations of rising prosperity as a lever for change rooted in the citizenry of Cuba, not the fantasies of an empowered exile minority.

But the real failure of the embargo is that it helps prop up the Castro regime. Today, Cuba's integration to the rest of the global economy gives it security. Though dependent on the largess of other powers, Cuba has diversified that dependence, with support coming from Venezuela, China and Brazil, supplemented by real trade with Europe and Canada. In that kind of economic environment, the embargo does more for the revolution than against it.

First, the embargo provided a ready-made excuse for Fidel, and now Raul, to explain why the Cuban revolution is underperforming the people's expectations. It's not the fact that they have two generals controlling two-thirds of the hard currency earnings that the economy is in desperate shape, it's the embargo. It's not that their state-owned tourism industry cannot convince European and Canadian holiday-makers to return for a second time, it's the embargo. It's not that the lack of private property eliminates the chance for collateral, the foundation for all modern economies, it's the embargo.

Second, the embargo is the cornerstone of Cuban Nationalism. Every national movement needs an enemy to give it a sense of shared adversity, what sociologists call a "super-ordinate goal." Take the embargo away, and the foundation of the the Castro power base, intense, loyal nationalism born of the conflict with the United States, will gradually erode.

If most Cuban-Americans agree that the embargo has failed, then it should not be too hard to convince them that the embargo is, in fact, shielding the Cuban regime from internal forces that in other societies, would be shaping a new politics.

And if that's the case, then being "cozy with Castro" really means supporting the embargo.

Clearly, the generation gap in Miami-Dade County will change the politics of Cuba policy in the United States. Without the electoral math and the soft-on-communism to protect it, the only question is whether change happens sooner, or later.

In an unpublished letter to the editor of the Miami Herald, John McAulliff, Executive Director of the Fund for Reconciliation and Development in New York (director@ffrd.org) , wrote about "The Cuban Five" and Luis Posada Carriles:

It is often said that terrorism lies in the eyes of the beholder.

Cuba has a new leader, as soon will the US. They must show the courage to bridge
90 miles with a spirit of mutual respect. After a long conflict, wishing that the other
were different is normal. However, setting preconditions for talking, insisting that the antagonist must first change itself to become an acceptable interlocutor, means one
is not serious about solving problems.

Mr. McAuliff went on later to add that, today, the Cuban 5 and the US 59 seemed particularly to fit this mirror perspective. In Havana, the Cuban 5:

…are heroes and people of conviction who were unfairly arrested, tried by a biased
legal system and sentenced to inappropriately long and harsh terms.

From my perspective, both sets of people are victims of the hostile relationship
between the countries.

Now, the Vatican has weighed in. The Catholic News Agency, reporting on a meeting between Cardinal Bertone and Cuba's new president, Raúl Castro, reported in late February that:

Cardinal Bertone said, 'the President emphasized the importance of reciprocity at the international level. He said he was willing to address all the problems with great openness and even to make concrete gestures in an atmosphere of reciprocity.' In that regard, Cardinal Bertone mentioned 'the crucial problems of Cuba' related to the US-led embargo and the European Union sanctions, which 'slow its development and do not allow for the serious socio-economic difficulties that afflict the island to be faced.'

The Vatican cardinal said President Castro also brought up the issue of five Cuban prisoners in the United States and their humanitarian treatment, 'with the eventual possibility of an exchange.' (my emphasis)

What an excellent opportunity for a new president in January to reach out and settle in a spirit of newfound cooperation—and in a more profound sense of real U.S. security needs—this festering problem. Let's exchange the Cuban Five for the US 59. Moreover, let's use that exchange as the start of something new and different, discarding the failed policy of half a century and replacing it with one that works.

- Lawrence Wilkerson