Russia's Medical System Collapse as "Freedom's Toll"

On December 3, 2000, with Michael Wines's front-page article “An Ailing Russia Lives a Tough Life That's Getting Shorter,” the New York Times began a series on the disastrous condition and virtually complete collapse of Russia's health care system. The series provides a great deal of useful information on the subject, but its biases are striking and continue a pattern of apologetics for the new order in Russia that has characterized the paper's coverage of this subject from 1991 to today.

It is acknowledged that Russia has gone through a demographic and health crisis that has reduced life expectancy to “a par with levels in Guatemala” and diminished public health in a way “not seen in a developed country since the Great Depression, if then” (Wines, December 3. His “if then” saves him from an outright misstatement). In fact, by 1994 male life expectancy had fallen below 58 years, almost 8 years less than in 1987; the birth rate had fallen by half in a single decade (see Mark G. Field and Judyth Twigg, eds., Russia's Torn Safety Nets, St. Martin's Press, 2000). The series also documents the rise of tuberculosis to epidemic levels and the rapid spread of venereal and other diseases, as well as HIV (Abigail Zuger, “Russia Has Few Weapons As Infectious Diseases Surge,” December 5). It reports the observation of Raphael G. Oganby, director of the government's National Center for Preventive Medicine (quoted on December 4), who says that under the Soviet regime there was “a good system of health care...The quality wasn't good, of course, but the system was accessible to everyone and free. When the Soviet Union collapsed, they began reforms. These reforms have mostly destroyed what existed before, and nothing has replaced it.”

One ideological slant in the series is immediately apparent in the fact that the articles in the series are all placed under the heading “Freedom's Toll.” The paper has followed the U.S. and Western establishment party line that a highly desirable “reform” process has occurred in Russia that brought “freedom” to the Russian people, even if the “transition costs” have proven a bit steep. But the notion that Russian citizens are “free” is extremely dubious. Their elections are a farce, with no options offered that would serve 90 percent of the public, and there is no way the Russian people can now change the economic or political system even in the direction of social democracy (see my “Russian Election Fraud,” Z Magazine, October 1996, and “Russia: U.S. Rival, Dependent, Victim,” Z, March 2000). A small oligarchy rules and protects itself, its stolen property, and its privileges as aggressively and effectively as the old Soviet apparatchiks—and many of the new elite are former members of that earlier apparatchik cohort who saw greater opportunities to accumulate wealth under a “free” system (a major theme of David Kotz's and Fred Weir's excellent book, Revolution from Above; Routledge, 1997). What is more, the system as a whole has lost much of its independence under the new order, as Yeltsin, his associates, and successors have been joint venture partners with Western governments and financial and other businesses to bring Russia into the global financial system, and to share the spoils in the process. Russia is now a client and dependency of the West.

It is true that terror has lessened, but it had moderated greatly in the 1980s, and the army and secret police are still active. A former KGB official is now head of state, and terror may well revive in the future if the vast numbers under stress get too demanding (Pinochet is a great favorite among the Russian oligarchs and intellectuals). The citizens are freer to complain than under the old order, but they could complain then, and a good case can be made that the old Soviet leadership was more sensitive to their complaints and needs than the new oligarchs. The new rulers have an external constituency to help them pursue “reform” while immiserating 90 percent of the population, whereas deteriorating conditions under the old order would be used externally as well as within to discredit the rulers. This is illustrated by the fact that the slow up of Soviet growth in the 1980s was used as a club in the West to demonstrate a failed system, whereas the truly catastrophic collapse under “reform” has been treated with the utmost understanding and consideration—for the reformers.

We have as an empirical fact the willingness of the leaders of “free” Russia to pursue reforms relentlessly in the face of evidence of a failure of historic proportions and severely damaging probably 90 percent of the population. In the new Russia there seems to be an enhanced freedom of oligarchs to brutalize, ignore, and exploit the population, greater even than under the prior “totalitarian” order.

Another misleading feature of the Times's portrayal of Russia's medical catastrophe as “freedom's toll” is its false implication that the disaster was inevitable in a shift from the Soviet system to a supposedly more democratic order. It would have been possible to move slowly, to preserve the economically integrated Soviet system while enlarging local autonomy and civil liberties, and to proceed cautiously in liberalization and privatization in accord with system capabilities as well as consideration of inherent desirability. The elements of social democracy, including a strong public health system, could have been preserved, if the leaders and their Western sponsors had not had a different and conflicting agenda. The local leaders wanted to rush the transformation either to loot property directly in a chaotic and corrupt environment, or to meet the demands of their Western sponsors. The latter—governments, businesspeople, and the international financial institutions that serve them—had two main motives: to profit from a rapid privatization process, and to move the system irreversibly away from socialism. Both the inside and external leaders/looters claimed that privatization and free markets would work their wonders in short order, and some of them may have really believed this convenient fiction. But it is exceedingly clear that the welfare of the Russian people was not part of the determining calculus of policy-makers, and it is equally evident that real democracy—political and social, as well as economic—was neither intended nor achieved.

In the New York Times series, there is no suggestion that there had been a possible alternative course and that the “toll” resulted from a particular choice imposed from above, under external advice and pressure. While there are occasional suggestions that “reform” has had something to do with the collapse of the medical system, reform and its managers and supporters are certainly not given preeminence and harshly criticized. The collapse occurred “since the Soviet Union entered its death throes in 1991” (Wines, December 28), not ”since reform policies were imposed on the country.” The former Soviet system is repeatedly blamed for the terrible conditions under the new capitalist order, whereas the existing authorities are said to have failed, “but not for lack of trying”—which is followed by a list of efforts like decentralization, recentralization, privatization, and others. Furthering the attempt to put the blame on the old order, one expert is quoted as saying, “In typical Bolshevik fashion, they [the new rulers] decided that this major reform had to be introduced overnight,” a dubious point as the old Bolsheviks were famous for caution and the Russian reforms overnight were pressed by the Free World.

Also mentioned as a causal factor is the “near-depression” that reduced revenues. (One wonders what a “real depression” would look like.) There is also the attempt to blame the medical crisis on alcoholism, which one Russian doctor is quoted as saying, “is in first place,” and there are “ingrained habits” so that mending this safety net will require “surgery on millions of dark Russian souls.” But the articles cannot escape the fact that the drastic decline began with the ending of the Soviet Union and the installation of Yeltsin and reform, and the opening article does note that, “Asked when his life took its turn for the worse, he [Anatoly Iverianov] does not hesitate. ‘The moment the Union ended,' he said.” The authors are ambivalent on the objectives of the leadership of “free” Russia—they have been “trying,” and “Russia [sic] is struggling to preserve the well-being of its people.” On the other hand, there is the evidence of catastrophe, and in the end it is acknowledged that there is a question of whether the leadership “regards its masses as people, not expendable parts in some vast machine.” It is concluded that “a decade of falling life spans, so far unaddressed, is not encouraging.”

A notable feature of the Times's series is the complete neglect of the role of the United States and West in contributing to the crisis. The West encouraged and pressed aggressive reform, without regard to the readiness of the market and political environment to do this without massive robbery and economic collapse. IMF and World Bank loans supported these policies and, in addition, and as usual, called for cutbacks in public spending that exacerbated the crisis in the medical system. In short, not only did the Russian oligarchs-reformers give little or no weight to the impact of reform, and the collapse of the health care system, on the well being of the Russian people, neither did the West. Just as the New York Times has long downplayed the role of the U.S. government in supporting goons of convenience like Mobutu, Suharto, Marcos, Pinochet, and the mass murderer leaders of El Salvador and Guatemala, so the U.S. government's important role in the collapse of the Russian safety net is also kept out of the picture. Looking back, the Times gave minimal attention to the Russian health care crisis throughout the 1990s, possibly because that crisis, and the growing impoverishment of the vast majority of Russians, put the “reform” process, which the Times supported, in a bad light. The Times furnished few details on the general economic decline under Yeltsin and was always looking for signs of upturn, while not stating explicitly how far the base had sunk. In early May 1994, the Russian Ministry of the Economy reported a spectacular 25 percent first quarter fall in industrial output, but Michael Specter's two articles on Russian conditions immediately following that report (May 8 and June 10) never mentioned that figure.

In a page one Michael Specter article of March 6, 1994, entitled “Climb in Russia's Death Rate Sets Off Population Implosion,” and in Nicholas Eberstadt's op-ed column of April 6, 1994, “Marx and Mortality: A Mystery,” both authors expressed great puzzlement at the dramatic rise in suicides, death rates, and infant mortality, the fall in birth rates, and other signs of acute distress. Specter first explained the “implosion” as a possible result of alcoholism, severe environmental pollution, and recent changes in methods of calculating birth and death statistics. Only in the 14th paragraph did he reach “economic chaos,” and in the 17th paragraph he said that “many specialists blame the economy” for the sharp rise in suicides. He provided no information whatever on changes in unemployment, income levels, income distribution, homelessness, or budget allocations to health care and welfare. Specter never acknowledged that “reform” was an utter failure and responsible for the disaster, and the West's support of this process was not mentioned.

Nicholas Eberstadt, an American Enterprise Institute intellectual, was even more at a loss for explanations, and his op-ed is littered with words like “mystery,” “puzzle,” and “strange.” He asked: “Is it entirely coincidental that every communist regime with falling death rates is still in power—China, Cuba, North Korea, Vietnam—while virtually every communist government that collapsed is reporting a sharp deterioration in health?” But he denied that this could provide a key, saying that the disaster in the former communist states, “Does not seem to be associated with any particular social conditions, economic policies or political arrangements.” This lunatic statement, contradicted elsewhere in his article, seemed to deny any policy changes in the wake of the collapse of communism.

Eberstadt asked, how can you explain the demographic calamity in Poland, “where the falling birth rate and rising death rate have coincided with ‘shock therapy' market reforms and the transition to democratic pluralism?” Here we can see the crux of Eberstadt's problem: Market reforms are good by definition, so that just as fossils couldn't be older than 4004 BC for believers in biblical authority on creation, so a transformation to market rule cannot be admitted as the explanation of extreme distress and demographic implosions for a believer in the miracle of the market. We are left with a mystery by virtue of ideological blinders.

Up to today, the Times has found the distress and demographic catastrophe brought about by “reform” in the former Soviet Union a bit of a mystery, and one to be addressed belatedly and blamed more on the Soviet Union than the “reformers” or their backers in the West.                                          Z