| By Dr. Anna Ebeling
In October 1917, the Bolshevik dreams of coming to power came true. Now that everyone was to be equal in all aspects of their lives, people would no longer die in the streets from illness, since medical care would be available for all, rather than reserved only for the "greedy rich."
But what did the Bolsheviks destroy and what did they create?
In Old Russia, medical care was a consumer oriented business. Doctors' income and standard of living were totally dependent upon professionalism and reputation in the wider community. The patients decided which doctor to use; which hospital to go to; and which pharmaceutical products to trust. Doctors worked hard to establish their reputation, an important part of which came from providing charity care for the poor. As in the West, every Russian doctor upon graduating from medical school took the Hippocratic Oath, in which he swore to never reject any who needed medical assistance--and as a rule they were loyal to their oath.
In Russian urban areas, there were charity hospitals and out-patient care for the poor and their families. In the rural areas, peasants would often pay doctors with agricultural products and domestic service, or received medical treatment for free. Under the private medical system in Old Russia, doctors were able to earn a comfortable living, and therefore could afford to be generous in supplying charity services to those who were in need.
The expected high income, along with the status of being a member of a respected profession, generated strong competition for acceptance into medical colleges. The best were accepted as students and the most qualified were hired as professors. At the beginning of the 20th century, the quality of Russian medical care and medical research were internationally recognized.
This then was the system the Bolsheviks wanted to destroy. Unfortunately, many Russian intellectuals, including medical doctors, were infected with the socialist disease. Seeing so much poverty in their medical practice led many doctors to believe that the "better society" could be created in terms of living conditions, education, and medical care. Thus, with their own hands and wrong ideas, the members of the medical profession helped to destroy the health care system that, while imperfect, provided people with skilled medical treatment, regardless of their income or social background.
In 1917, like everything else, medical services were nationalized by the Bolsheviks. Gradually, small medical practices disappeared and a network of big, factory-like hospitals and out-patient clinics were established all around the country. Everyone was registered in both out-patient clinics and hospitals according to their government-assigned residence. Patient choice was taken away by the Soviet State.
The patient no longer had financial responsibility for his own medical care. Instead, the State was responsible for all medical expenses for everyone in the country. With private expenditures being eliminated and health services not being a budgetary priority for the State, all members of the medical industry were put on low fixed monthly salaries, and medical research became dependent upon inadequate annual budgetary allocations from the government.
Doctors' and nurses' incomes no longer depended on their professional skills or the number of patients they treated. Total unionization of the medical profession made it practically impossible for anyone to be fired. The result was the rationing of medical services and pharmaceutical products.
Specialized services (mammograms, ultrasound, and so forth) were available only in a few select hospitals where the doctors were supposed to treat patients as well as participate in research. For example, in the case of brain or cardiovascular surgery and treatment, there were a mere three to five hospitals available in the entire country. People died waiting in line to be admitted for these treatments.
Medical care became a producer-oriented industry, instead of the consumer-oriented market that it had been in Old Russia. But even the State cannot kill the market, just as the State cannot repeal the laws of nature. The market is simply driven "underground," and became the black-market. The black-market response to State-rationing occurred immediately. Doctor's services and pharmaceutical products (both domestic and foreign-made), as well as access to medical-testing equipment, became available for bribes. Unfortunately, expensive black-market medical services were available only to the wealthy or the elite, while the poor could no longer count upon charity.
Not surprisingly, those in the government did not want to be treated in the medical system available for "the people." Special hospitals were created all around the Soviet Union. These were reserved for the members of the Central Committee of the Communist Party, the Council of Ministers, the local and regional Party elites, etc. The "servants of the people" received a qualitatively different level of medical care than "the masses."
The nature and quality of medical education was affected, as well. Bribes and connections often determined both the hiring and admission processes in medical schools. Skills and professionalism mattered little, and service to the community did not matter at all. At the end of the 20th century, Russia was famous for having one of the worst health care systems in the world.
In bitter situations, Russians often respond with jokes and anecdotes. In one of them, involves two doctors examining a patient. One of them says, "Shall we treat him or let him live?" In another, an American and Soviet doctor are talking and the American says, "Dear colleague, our profession is imperfect. You treat the patient for one disease and he dies from another." The Soviet replies, "No, dear colleague, that is not the case with me. Mine die from what I treat them."
It is easy to say, "the present system is imperfect and a radical change will make it perfect in ten years." But there are always lessons from history from which to learn. Sometimes, your neighbor's history can warn you which path not to follow.
ABOUT THE AUTHOR
Dr. Ebeling, an advisor to the Lincoln Heritage Instute on the nations of the former Soviet Union, is a native of Russia and received her Ph.D. from Moscow State University. Before coming to the States, she served as the Senior Researcher and Group Coordinator for Western European and American Studies at the Soviet Academy of Sciences. Dr. Ebeling is married to Professor Richard Ebeling an economics Professor at Hillsdale College, also an advisor to the Institute.
Dr. Ebeling's maiden name is Shapiro, and her father was one to the top ranking nuclear physists in Russia. The family was very active in the free market movement in Russia and partricularly with many of the Government officials that now hold office. The relatoinship is personal, as well as professional.
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