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It Could Be Worse
In 1998, a relative who worked as the head doctor at a village hospital in the Saratov region came to my grandfather’s funeral. His tales still ring in my ears. At the time, he was not being paid in cash, but on a “barter scheme”—in vodka or eggs or some other village produce. The money for his ticket to Moscow had been collected in nearly all the surrounding villages. They scraped together enough for a one-way ticket, so the Moscow relatives had to send him back again. When he got back, he planned to butcher a calf in order to pay his debts. The situation regarding his hospital’s supplies of medicines, bandages, and gasoline was pretty much the same. And I believe that his situation was not exceptional, given the state of medicine in the first ten years after the fall of the Soviet Union.
But I remain optimistic, guided by the classical formula from the years of developed socialism: It could be worse.
In the Soviet Union, socialized medicine was a matter of official pride, subjected to the contempt and scorn of the people, first because there was a feeling of social injustice, and second because of the multiple inconveniences associated with receiving medical attention. The injustice had to do with the fact that there was a separate healthcare system for party functionaries—clean clinics with virtually no lines, spacious hospitals equipped with world-class equipment housing wards for a small number of patients, and special drugstores with no shortage of medicines.
In contrast, ordinary people had to spend hours in line at their clinics. If, God forbid, they had to be taken to a hospital, they would lie in the corridors and scour drugstore after drugstore to find anything more complicated than aspirin. And, of course, medicine at that time was not entirely free—in a deficit economy, any medicine could be procured for a bribe, good spots in the hospital were bought underground, and time spent waiting for an operation could be decreased with the help of an additional donation to the doctor or hospital involved.
But the basic level of care was quite high nonetheless, and medical services, as far as I can tell, were universally available. Satisfaction was derived not so much from overcoming everyday discomforts as from contradicting socialist ideology. That medical care was free and universal was taken for granted, but everyone wanted better quality of service, first, and for public servants not to be in a privileged position vis-a-vis the populace, second. It is possible that these priorities could have been reversed.
As a result of all our reforms and transformations, Russian healthcare—which had never quite reached the stated goals of equality—is now in a de facto legal state of stratification. The new democratic ruling class maintained, or even expanded, the privileges of its communist predecessor, and continued to be treated in the same clinics, the same hospitals and the same sanatoria—although it is true that the newly rich could also now afford to get in. Paid services became legal and private clinics and doctors appeared. But most people simply had the option of obtaining free medical care at a lower level.
I don’t think that anyone now is seriously troubled by the issue of providing better medical care for officialdom. Normal people understand that at the end of the 1980s, the democrats led them into a fight against communism under purely Bolshevik slogans—deprive the nomenclature of their privileges and distribute them among the people.
As a result of the victory of the anti-communist revolution, the new elite got it easier than the old, while the people were materially worse off. So it is not really surprising that no one is actively working to change things again.
The appearance of private medicine is also in some ways a godsend. After all, the possibility of choice is a good thing in and of itself; and if people have the means and are prepared to pay for better service standards, then this can only be welcomed. Whether treatment is better or worse there, nobody knows. People still remember that patients at “Kremlin clinics” did not trust doctors there, since their treatment was aimed not so much at curing patients but at removing all responsibility from themselves should something go wrong.
As for popular medicine, I am hard pressed to say whether it has gotten worse or better. Compared with the Soviet era, it is probably worse. However, it could become worse still. Ask anyone, and they will tell you that the paramedics duly answer calls at any time, day or night. Despite their low pay, pediatricians—at least the ones I have come across—are invariably well qualified and really care about children’s health. Injections are given, orders for necessary treatment signed promptly, and examinations carried out.
Doctors in Russia are wonderful, I think, and no liberal reforms have managed to do anything to change this. And if their salaries are raised and they are given modern equipment—as proposed under the national projects—then we’ll manage to survive.