By Yuri Maltsev
In 1918, the Soviet Union became the first country to promise universal “cradle-to-grave” health care coverage. The “right to health” became a “constitutional right” of Soviet citizens. The proclaimed advantages of this system were that it would “reduce costs” and eliminate the “waste” that stemmed from “unnecessary duplication and parallelism”—i.e., competition.
These goals were similar to the ones declared by proponents of the Affordable Care Act—attractive and humane goals of universal coverage and low costs. What’s not to like?
A paralyzed system
In the Soviet Union the system had many decades to work, but widespread apathy and low quality of work paralyzed the health care system. In the depths of the socialist experiment, health care institutions in Russia were at least a hundred years behind the average U.S. level. Moreover, the filth, odors, cats roaming the halls, drunken medical personnel, and absence of soap and cleaning supplies added to an overall impression of hopelessness and frustration that paralyzed the system. According to official Russian estimates, 78 percent of all AIDS victims in Russia contracted the virus through dirty needles or HIV-tainted blood in the state-run hospitals.
Irresponsibility, expressed by the popular Russian saying, “They pretend they are paying us, and we pretend we are working,” resulted in appalling quality of service, widespread corruption, and extensive loss of life. My friend, a famous neurosurgeon in today’s Russia, received a monthly salary of 150 rubles—one third of the average bus driver’s salary.
In order to receive minimal attention by doctors and nursing personnel, patients had to pay bribes. I even witnessed a case of a “nonpaying” patient who died trying to reach a lavatory at the end of the long corridor after brain surgery. Anesthesia was usually “not available” for abortions or minor ear, nose, throat, and skin surgeries. This was used as a means of extortion by unscrupulous medical bureaucrats.
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