Communist Medical Care
A former student, an officer in the U.S. Navy, gave me permission to post an edited version of his story of growing up in the Soviet Union and his and his family’s experiences with the Communist system of medical care. He is LCDR Ilia K. Ermoshkin and this is his story:
I grew up in the USSR and became familiar with the healthcare system both from the beneficiary point of view and from that of a provider, as my grandmother was a dentist. The government owned and ran all health care, and it was free to the people. However, the quality and the “care” in the health care system were dismal: long waits for specialists and advanced procedures, etc. But, as anywhere, people have developed ways to get around and get what they want. Here are some examples of wonderful free health care in the USSR.
Birth was to take place only at birth clinics, of which there were about half a dozen in a city of five million people. Husbands or any other family are not permitted to even enter, under the premise of keeping the place free of germs, etc. My delivery was very difficult for my mother, she was in labor for three days, and it was deemed unnecessary to give her any pain medication or do a Cesarean. So she roamed the hallways of this clinic/hospital howling with pain. Nobody was permitted to use the phone (there were only a few in the administrative offices), so she could see my father and her parents only through a window once a day. When I was finally born, I was taken away from my mother immediately to be placed in a post-birth unit (this was done to all newborns), and my mother did not see me until about 24 hours later. We were released from the hospital after 7 days, and that was the first time my father saw me. This is a story that was a fairly normal routine for the Soviet women, and no other options were available as it would be then nearly impossible to get a birth certificate for the newborn. When my mother told this to my wife, who is American, she was horrified and had nightmares about it. [DRH note: for similar stories about the birth process, see Red Plenty. I reviewed it here.]
When I was two, I got severe pneumonia. I was at home with fever of 42C [DRH note: this is over 107 degrees Fahrenheit] and the doctor decided that this was a lost case and would not even prescribe penicillin to try to fight the disease. It took my parents and grandparents pulling all their connections and bribing to get penicillin that fairly promptly took effect and saved me.
The health care was provided on the basis of one’s residency. Everyone was attached to a clinic close to where they lived and had a general family practitioner that was the “primary provider” and who was able to refer patients to specialists, procedures, etc. So in some way it was very similar to the HMO system in the US. On average doctors received about half of what a skilled industrial worker received and had to put in longer hours, years of study, etc. Still there were about the same number of doctors per 100,000 of population as there were in the US, but there were fewer specialists than here. One of the reasons that there was no lack of people wanting to become doctors was the prestige and respect of the profession and possibly a self-selection of individuals that were caring and wanted to help others. However, as shown by previous examples, such attitudes quickly disappeared once these doctors became part of the system. There was very little incentive within the official system for the doctors to provide better care for their patients as it did not affect their pay in any way. All health care was free, but it was customary to bring something for the doctor: chocolates, gifts, etc. To get better, prompter care, and get referred to a better specialist required more valuable “gifts”. “Out-of-town” people could get emergency care, but were turned down for any chronic disease treatment and had to go back to their primary care provider at their place of residency and get referred locally. But the higher class specialists were in Leningrad and Moscow and they were in high demand. So there was a widespread and highly illegal private practice by specialist doctors and dentists. They would see patients at home and receive cash for their services. My grandmother was a dentist and was practicing after work from her apartment. For decades she was looking over her shoulder, afraid that she would get arrested. She had to pay her neighbors monthly not to tell on her. But the money she made was such that it was worth the risk, as it provided for a much better life for my grandparents, and allowed them to help my mother and her brother and their families. And the story was the same for thousands of other doctors and dentists, so in the end a market, albeit “black market”, was the vessel that enabled people to get what they wanted and needed, and quite possibly saving countless lives in the process.