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Almost half of Puer­to Rico’s doc­tors have fled the island over the past decade, lead­ing to a lack of spe­cial­ists and treat­ment and incred­i­bly long wait times. And this isn’t just an incon­ve­nience. Peo­ple are dying from lack of care. Why is Puer­to Rico’s health care sys­tem col­laps­ing, and why are doc­tors flee­ing the island?

We take a look at its deeply dys­func­tion­al pri­vate med­ical sys­tem and why attempts to fix it, and cre­ate a uni­ver­sal health care plan on the island, are being hin­dered by Puer­to Rico’s sta­tus as a US colony. Its mas­sive unpayable debt, held by investors in the US, means that it can­not make its own eco­nom­ic deci­sions, even when it affects the liveli­hood of poor Puer­to Ricans liv­ing there. But there might be a fix, get­ting rid of Puer­to Rico’s debt and rethink­ing its colo­nial rela­tion­ship to the US.