The Nightmare of Sociahzed MedicinernThe Soviet Examplernby Yuri N. MaltsevrnVladimir Lenin enacted universal, “cradle-to-grave” healthrncoverage in the Soviet Union in 1918. The “right tornhealth” was made one of the constitutional rights of all Sovietrncitizens; it ranked alongside the “right” to vacation, free dentalrncare, housing, and a clean and safe environment. As in otherrnfields, all services were to be planned and administered by arnspecial ministry. The Ministry of Health, through its regionalrnDirectorates of Health, would administer medical and sanitaryrnservices to the entire population. The “official” vision of socialistsrnwas clean, clear, and simple—all needed services wouldrnbe provided on an equal basis to everyone by the state-ownedrnand state-managed health industrv. The cost of all medical servicesrnwas socialized through the central budget. Advocates ofrnthis system said that fully socialized health care would eliminatern”waste” due to “unnecessary duplication and parallelism”rn(Marxist jargon for competition) and provide full cradle-togravernhealth coverage nationwide.rnToday, advocates of socialized medicine in the United Statesrnbelieve America is spending too much—about 14 percent ofrnits GDP—on medical care. Russia, with its system of centralrnplanning basically intact, spends only 4.7 percent of its GDP onrnhealth care but over 25 percent on defense and 21 percent onrnrunning its highly inefficient government. By diminishing therncost of health care, especially by imposing caps or price controlsrnon the health industry, the United States can achieve the samernappalling results as in the former Soviet Union. Life expectancyrnin Russia is now 61 years for males and 67 for females,rnYuri N. Maltsev is an associate professor of economics atrnCarthage College in Kenosha, Wisconsin, and a formerrneconomic advisor to Mikhail Gorbachev.rn13 years short of the a’erage for American men and 12 short ofrnAmerican women. The child mortality rate in Russia (evenrnwithout crack babies) is seven times higher than in the UnitedrnStates.rnWidespread apathy and low quality of work have paralyzedrnthe health care system as they have all other sectors of thernRussian economy. Irresponsibility, expressed by the popularrnRussian saying, “They pretend they are paying us and we pretendrnwe are working,” has contributed to the appalling qualityrnof “free” services, widespread corruption, and increased loss ofrnlife. According to official Russian estimates, 78 percent of allrnAIDS victims in Russia have contracted the virus through dirtyrnneedles or HIV-tainted blood in state-run hospitals. To receiverneven minimal attention by doctors and nurses, a patient isrnexpected to pay bribes. I personally witnessed a “nonpaying”rnpatient die while trying to reach a lavatory at the end of a longrncorridor after brain surgery. Under the Soviet system, anestheticsrnwere usually “not available” for abortions, as well as forrnminor ear, nose, throat, and skin surgeries and were used as arnmeans of extortion by unscrupulous medical bureaucrats. Asrna People’s Deputy in the Moscow region from 1987 to 1989,rnI received plenty of complaints about criminal negligence andrnbribery involving medical apparatchiks, about drunkrnambulance crews, and about food poisoning in hospitals andrnchild-eare facilities.rnUnderstandably, government bureaucrats and CommunistrnParty officials realized as soon as 1921—three years afterrnLenin’s socialization of medicine—that an egalitarian systemrnof health care was good only for their private interests asrnproviders, managers, and rationers, but not for users of the system.rnIn all countries with socialized medicine we observe thisrnJUNE 1994/21rnrnrn