I wanted to write this article for a while now, but there was never enough time. So, finally I decided to start and slowly over some time write it.
There have been a lot of talk lately about the horrors of socialized medicine on one side and the benefits of universal coverage on the other. So, let’s examine the ultimate socialized health care system – the one in the former Soviet Union. Let’s compare it to what we have here in the US.
Back in the old Soviet Union the health care was free, i. e. paid for by the Government. You can’t necessarily say that it was paid by the taxpayers, since the Government was one huge monopolistic business. The Soviet Government did business with the outside world and conducted commerce internally. It also employed doctors and paid them the money it printed. Back in Odessa we used to say about the free health care: “Лечиться даром – это даром лечиться”. I am just giving you the phrase in the original Russian. Here is the transliterated version: “Lechit’sya darom – eto darom lechit’sya”. The literal translation is: “If you get treated for nothing, it means that nothing gets treated”. The more proper phrase in English, perhaps the one some people might have heard is “The health care is free, and you get what you paid for it”. This indeed does reflect the overall situation. But, amazingly enough, for people who were relatively healthy and had just minor problems here and there, the system actually did work. The primary care doctors saw patients in their offices for 3 hours a day. The rest of the day they made house calls. Yes, if you were sick, you called your primary physician’s office and request for the doctor to come visit you at home. People were actually almost forced to do that if they were sick, even with a common cold. Here is why. There were no finite number of sick days per year. Instead, every time you got sick, you were entitled to stay home, with pay, provided that it could be verified by your doctor. So, if you can go to a clinic, you were considered well enough to go to work. Of course, there was some abuse, but for the most part people remained honest. The doctor was always more likely to err on the side of sending you to work. For those who actually visited a doctor in the office, 2 or 3 days a week the office hours were conveniently from 6pm to 9pm, making it easy to have an appointment without having to take time off work. It was relatively easy to schedule simple procedures you might need. So, the bottom line, for people without major problems the Soviet health care did work. The problem would arise if you got really sick. That is when the lack of proper equipment, lack of proper medicine, shortage of hospital space and general mess would come into play. If you got into a hospital room with 7 or 8 other people, you were lucky. The unlucky ones had to be stationed in the hallways. Sometimes some patient’s family would bribe somebody on the hospital staff, and the space in one of the 8-bed rooms would be made available, often by moving some unlucky soul to the hallway and moving the “paying” patient into the freed-up space in the room. The doctors and nurses were not the highly paid professionals they are in this country. There were good doctors and nurses, but their pay was, like that of engineers, way below any blue color worker. So, to some extend you can hardly blame doctors and nurses for supplementing their income by re-arranging hospital beds for a fee.
On the other hand, there were special hospitals for high government and Communist Party officials. There was always space, equipment and medicine available there, and the staff was well paid. The general public had no access to those hospitals …unless they either managed to bribe someone really well or knew someone in the government or party hierarchy.
What is interesting about the Soviet health care is that there were no especially designed measures to save the resources, like rationing. Although, the different quality of care available to Communist Party officials could be construed as such. However, the poor quality of care in general was not due to rationing, but simply a result of lack of incentive to provide good care. Basically, the whole thing was a mess. It will not be so, if our Government ever gets to control the health care system. As inefficient as our Government can be, its inefficiency pales in comparison to the Soviet Government. So, our Government will inevitable design some cost-saving measures, which will essentially amount to rationing, although they will be called something else. And it will be much worse than the Soviet system. Because in the Soviet Union you could try to ask your friends and acquaintances if they knew somebody who knew somebody. You could try to bribe somebody. Basically, there were ways around the generally messy system to get better quality care. And nobody counted the money spent for people’s care, so if some particular resource was available somewhere, there were ways, sometimes illegal, to obtain it. However, if the Government in this country gets a hold of the health care system, it will be efficient and it will control cost. So, if you get denied some level of care here, it will be the end of the line. There will be no ways around the system, at least not for the first 50 years, until it becomes as messy as the Soviet system. And it may never become as messy. So, there will be some Government bureaucrats who will ultimately will decide who lives and who dies. Yes, I know that a lot of people don’t believe that. But that is inevitable, because the only alternative is to design the Soviet messy system right from the start, without any cost control. And that will never happen.