Vladimir Lenin enacted universal, “cradle-to-grave” health coverage in the Soviet Union in 1918. The “right to health” was made one of the constitutional rights of all Soviet citizens; it ranked alongside the “right” to vacation, free dental care, housing, and a clean and safe environment. As in other fields, all services were to be planned and administered by a special ministry. The Ministry of Health, through its regional Directorates of Health, would administer medical and sanitary services to the entire population. The “official” vision of socialists was clean, clear, and simple—all needed services would be provided on an equal basis to everyone by the state-owned and state-managed health industry. The cost of all medical services was socialized through the central budget. Advocates of this system said that fully socialized health care would eliminate “waste” due to “unnecessary duplication and parallelism” (Marxist jargon for competition) and provide full cradle-to-grave health coverage nationwide.
Today, advocates of socialized medicine in the United States believe America is spending too much—about 14 percent of its GDP—on medical care. Russia, with its system of central planning basically intact, spends only 4.7 percent of its GDP on health care but over 25 percent on defense and 21 percent on running its highly inefficient government. By diminishing the cost of health care, especially by imposing caps or price controls on the health industry, the United States can achieve the same appalling results as in the former Soviet Union. Life expectancy in Russia is now 61 years for males and 67 for females, 13 years short of the average for American men and 12 short of American women. The child mortality rate in Russia (even without crack babies) is seven times higher than in the United States.
Widespread apathy and low quality of work have paralyzed the health care system as they have all other sectors of the Russian economy. Irresponsibility, expressed by the popular Russian saying, “They pretend they are paying us and we pretend we are working,” has contributed to the appalling quality of “free” services, widespread corruption, and increased loss of life. According to official Russian estimates, 78 percent of all AIDS victims in Russia have contracted the virus through dirty needles or HIV-tainted blood in state-run hospitals. To receive even minimal attention by doctors and nurses, a patient is expected to pay bribes. I personally witnessed a “nonpaying” patient die while trying to reach a lavatory at the end of a long corridor after brain surgery. Under the Soviet system, anesthetics were usually “not available” for abortions, as well as for minor ear, nose, throat, and skin surgeries and were used as a means of extortion by unscrupulous medical bureaucrats. As a People’s Deputy in the Moscow region from 1987 to 1989, I received plenty of complaints about criminal negligence and bribery involving medical apparatchiks, about drunk ambulance crews, and about food poisoning in hospitals and child-care facilities.
Understandably, government bureaucrats and Communist Party officials realized as soon as 1921—three years after Lenin’s socialization of medicine—that an egalitarian system of health care was good only for their private interests as providers, managers, and rationers, but not for users of the system. In all countries with socialized medicine we observe this two-tier system—one for the “gray masses” and a different one for the bureaucrats and their intellectual servants. In the Soviet Union it was not uncommon to have workers and peasants dying in the state hospitals while the medicine and equipment that could have saved their lives sat idle in the institutions of the nomenclatura system.
Russia is obviously in the grip of a horrible health crisis. As Nick Eberstadt has pointed out, in the modern era—with “cheap food, clean water, mass education, rapid communication, easy travel, competent doctors, wonder drugs, and the like”—it is difficult to stay sick for a long time or to die young. Yet in Russia, it is easy to do so. In certain regions of Russia (Sakha, Karakalpakia, Kalmykia, etc.) life expectancy is 20 years less (49 for males and 56 for females) than in the United States. And in rural areas of the Russian Federation, the life expectancy of males is as low as 45 years due to widespread alcoholism and the absence of decent primary health care facilities (36 percent of all hospitals located in rural areas of Russia have neither running water nor sewage systems).
The official infant mortality rate in Russia is more than 2.5 times as large as in the United States and more than five times that of Japan. This rate of 24.5 deaths per 1,000 live births was recently questioned by several deputies to the Russian parliament, who claimed that the real figure is twice as large. In the rural regions mentioned above, the infant mortality rate is close to 100 per 1,000 births, putting these regions in the same category as Angola, Chad, and Bangladesh. Pollution is systemic and growing worse.
Pollution is the most disastrous product of central planning, stemming in particular from the “ratchet principle” of constantly rising output. “It was no secret that on many occasions in the past 70 years, workers’ health had been sacrificed to the needs of the economy—although the cost of treating the resulting diseases had eventually outweighed the supposed gains,” stated Russian State Public Health Inspector E. Belyaev. The misuse and overuse of pesticides and fertilizers and the release of industrial waste and heavy metal solutions into the water supply present deadly threats to the population. The air in Moscow has twice the permitted amount (even by lousy Russian standards) of hydrocarbon pollutants; parts of the Volga River have 700 times too much petroleum; 68 big industrial cities have atmospheric pollution described as “critical.” Two-thirds of Russian drinking water is now below minimum standards of purity. Man-made ecological disasters like the catastrophes at nuclear power stations near Chelyabinsk and Chernobyl, the literal liquidation of the Aral Sea, the serious contamination of the Volga, Azov Sea, and great Siberian rivers—all have made unbearable the quality of life in both the major cities and the countryside. According to Alexel Yablokov, Minister for Health and Environment of the Russian Federation, 20 percent of people live in “ecological disaster zones” and 35 to 40 percent more live in “ecologically unfavorable conditions.”
In Russia today, influenza strikes tens of thousands of infants every year, and the proportion of children dying from pneumonia is on the increase. Rickets, caused by a lack of vitamin D and unknown in the rest of the modern world, kills many young people. Uterine damage is widespread, thanks to the 7.3 abortions the average Russian woman undergoes during childbearing years. Alcoholism is pandemic. In the beginning of the 1990’s, per capita intake of alcohol in Russia was about three times as high as in the United States. As a sad result of socialist economizing, a Russian citizen compared to the average American has to work 25 to 30 times longer to buy meat, 18 to 20 times longer to buy poultry, 6 times longer for milk, 40 times longer for butter, 15 to 25 times longer for eggs, and 20 times longer for bread. “Families in Russia devote nearly the same proportion of their income to alcohol as American families devote to food. Soviet foremen mark their workers as sober if they can stand,” says Eberstadt.
With the failure of perestroika and glasnost—the last attempt to save socialism—the government has finally admitted that it cannot guarantee even a minimal level of health care to its citizens. The situation has deteriorated so far that Russia has had to cut imports of vital medicines sharply, since there is no money left to pay for the supplies after feeding 4 million soldiers and 15 million government bureaucrats. The lessons from the Soviet experiment with socialized medicine are obvious: “We should all be thankful to the Soviets because they have proved conclusively that socialism doesn’t work. No one can say they didn’t have enough power or enough bureaucracy or enough planners or they didn’t go far enough,” says Paul Craig Roberts.
It is beyond the ability of economic analysis to calculate the opportunity cost of the socialist experiment in Russia, but the human toll is estimated by Russian historian Roy Medvedev at 41 million people who perished in a dreadful gulag during Stalin’s collectivization, purges, campaigns against “unearned” incomes, and other devilish deeds. Even today, the agony of socialism takes a human toll. As a sad legacy of the socialist experiment, we observe a marked decline in the population of Russia, and experts predict a continuation of this trend through the end of the century. According to the Russian State Statistical Office as cited by ITAR-TASS last February, there were 1.4 million births and 2.2 million deaths in 1993. Only because of inward migration of Russians from “near abroad”—former Soviet “republics”—was the net decrease in population limited to 500,000.
“Despite the recent collapse of socialism and communism in Soviet Russia and Eastern Europe, socialism is still alive and growing,” says Nobel laureate Gary Becker, meaning it still possesses a mortal danger to freedom, health, and quality of life for us and for the generations to come. Decay and appalling quality of services are characteristic not only of “barbarous” Russia and other Eastern European nations, but of other nations who suffer a government monopoly on health care. In England, for example, the waiting list for surgery is nearly 800,000 out of a population of 55 million. State-of-the-art equipment is nonexistent in most British hospitals. Only 10 percent of health care spending is derived from private sources. Britain was a pioneer in kidney dialysis technology, and yet the country has one of the lowest dialysis rates in the world. The Brookings Institution (very far from being a free market) found that 7,000 Britons in need of hip replacements, 4,000 to 20,000 in need of coronary bypass surgery, and 10,000 to 15,000 in need of cancer chemotherapy are denied medical attention in Britain each year.
Age discrimination is particularly apparent in all government-run or heavily regulated systems of health care. In Russia, patients over age 60 are considered worthless parasites and those over 70 are often denied even elementary forms of health care. In the United Kingdom, 55-year-olds were refused treatment at 35 percent of dialysis centers and 45 percent of 65-year-olds were denied any treatment; patients 75 or older rarely received any medical attention. In Canada, the population is divided into three age groups—below 45; 45-65; and over 65—in terms of access to health care. It is needless to say that the first group (let us call them “active taxpayers”) enjoys priority treatment. Here in the United States, though a system of fully socialized medicine is not yet complete, we can already observe a “parallel” system of health care for bureaucrats. Referring to this system, Stuart Butler says: “Why reinvent the wheel? If a working health-care system already exists that’s good enough for official Washington, why not use it as our model, improve upon it and let the rest of America enjoy the same kind of program as members of Congress and Clinton’s White House staff.”
“The characteristic feature of this age of destructive wars and social disintegration is the revolt against economies,” stated Ludwig von Mises. The failure of socialism in Russia and the enormous suffering and hardship of the people of Eastern Europe should be clear signs of the inherent danger of increased statism.
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