|
As Beijing
prepares to
host the
Olympic
Games in
August 2008,
the entire
People’s
Republic of
China is
preparing
for a
celebration
of its
newfound
economic and
political
preeminence.
Schoolchildren
across the
country are
taking part
in
performances
devoted to
the advent
of the
Games; signs
urge
pedestrians
to “promote
Chinese
culture” by
being more
polite; and
whole
neighborhoods
are being
razed in
order to
make way for
shiny new
stadiums and
high-rise
apartment
buildings.
These would
all seem to
be
indicators
of China’s
great
progress and
ascent as a
developed
nation. But
in some
respects,
China still
has a long
way to go.
Pollution,
human
rights,
freedom of
the press:
all have
received
attention in
the Western
media as
areas of
conduct for
which the
People’s
Republic has
received
international
censure.
However, one
of the most
critically
underdeveloped
aspects of
Chinese
government
and society
– and one
from which
we have much
to learn in
the U.S. –
is something
that we
often take
for granted:
the
availability
of basic
health
care.
The average
American
would find a
Chinese
hospital
surprisingly
dirty,
crowded, and
dark. It is
not unheard
of for
disposable
syringes to
be reused
over and
over again
without
disinfection,
IV drips to
be filled
with fake
protein
plasma, and
rat poison
to be found
in hospital
food. The
hallways are
full of
families who
have
traveled a
long way
from their
home
villages to
visit a city
hospital.
They must
pay
exorbitant
prices in
order to
receive a
very low
level of
care. The
situation
for most
patients has
become so
dire that in
November
2006, over
two thousand
people in
Sichuan
Province
rioted in
anger at the
high cost
and low
quality of
health care
available
there.
How did
health care
in China get
this bad?
And could it
happen in
the U.S.?
The case of
China
provides us
with a
unique and
important
example of a
country that
has
functioned
under both
socialized
and
free-market
medicine.
Medicine in
China is in
a sorry
state today
in part
because of
the
government’s
longstanding
reliance on
a national
health care
system – one
that failed
to provide
advanced
health care
to its
citizens and
overburdened
the national
economy. In
studying the
evolution of
China’s
health care
system,
American
policymakers
can better
understand
the risks
involved in
both systems
as they
consider the
prospects of
universal
health
insurance in
the U.S.
China’s
health care
infrastructure
has its
roots in
Communist
policies of
the 1960s
and 1970s
that gave
universal
but basic
medical care
to the
entire
nation. In
the early
days of the
People’s
Republic,
Mao Zedong
set up a
highly
effective
system in
which
“barefoot
doctors”
were given a
minimal
amount of
medical
training and
sent into
the
countryside
to treat
villagers
with a
combination
of modern
Western and
traditional
drugs. In
urban
centers,
free clinics
and
hospitals
were set up
for
citizens.
The
government’s
emphasis was
on making
basic public
health
available to
as much of
the
population
as possible
– and to an
extent, they
succeeded.
Thanks to
the work of
barefoot
doctors,
there was a
dramatic
improvement
in basic
care
availability.
The life
expectancy
of Chinese
citizens
jumped from
35 to 68
years
between 1952
and 1982.
Citizens had
access to
Western
medicine for
the first
time in many
rural areas,
and infant
survival
rates
surged. In
fact, the
rapid
advances in
quality of
care made
under Mao
are
considered
one of the
chief
administrative
achievements
of the
Communist
regime to
date;
economist
and Nobel
laureate
Amartya Sen
has touted
the system
as a model
of
socialized
medicine.
However,
China’s
national
health care
system
demonstrated
some
characteristic
pitfalls.
For
instance,
during the
Cultural
Revolution
of the
1960s, many
surgeons and
advanced
specialists
received
censure for
their elite
social
standing,
and were
sent to
rural labor
camps for
“re-education.”
Uneducated
revolutionaries
were left in
charge of
China’s
national
health
system, with
correspondingly
disastrous
results.
Professional
schools were
shut down,
and an
entire
generation
of medical
students was
barred from
receiving a
suitably
rigorous
education.
The horror
stories of
doctors in
the Cultural
Revolution
may seem
extreme, but
their
implications
are
applicable
to a broader
perspective
on universal
health care
as we
consider an
American
plan for
nationwide
coverage.
While
instituting
national
health care
in the U.S.
clearly
would not
involve the
mandatory
assignment
of medical
leaders to
rural
fieldwork,
it could
have a
detrimental
effect on
American
health care
professionals.
In a
universal
health care
scheme, for
example,
U.S. doctors
would face
the risk of
losing their
salaries and
clinical
autonomy to
a big
government
bureaucracy
that could
eventually
dictate who
gets seen,
at what
time, and
what course
of treatment
to take.
Perhaps the
most
important
point for
American
policymakers
to consider
is that the
successes of
universal
health care
in the U.S.
would be
limited by a
resulting
lower
quality of
medicine.
Communist
health care
demonstrated
that
nationalizing
medicine
could be
accomplished
with
relative
facility,
but totally
modernizing
it was a
much more
difficult
and
expensive
task.
The old
Communist
system of
medicine
died out in
the wake of
Mao Zedong’s
death and
Deng
Xiaoping’s
rise to
power, when
the
government
moved to
privatize
many state
industries
in the 1980s
and 1990s as
part of a
push to
modernize
the economy.
At this
time, the
People’s
Republic
abandoned
much of its
financial
support for
medicine.
With only
minimal
official
control or
support, the
costs of
medical care
skyrocketed
up to
market-competitive
levels while
its quality
remained low
– resulting
in the
dirty,
crowded
hospitals
still
functioning
in many
cities and
rural areas
today.
Furthermore,
rampant
corruption
was soon
pervasive in
hospitals
and clinics.
For
instance,
the
government’s
attempts to
keep prices
artificially
low created
a common
situation
known as
“the red
envelope” in
which
surgeons
often demand
extra
payment from
a patient
before
performing a
procedure;
the bribes
are handed
over
covertly in
traditional
red packets
filled with
cash.
The
deplorable
situation of
China’s
market-based
medicine
ultimately
has its
roots in the
nationalized
medicine of
the 1950s
and 1960s.
As a
state-run
system,
health care
had grown
too
financially
burdensome
for the
Chinese
economy to
support. As
procedures
became more
advanced,
costs rose,
so that
privatizing
medicine
merely
shifted the
growing cost
burden of
increasingly
advanced
care from
the
government
to the
people
themselves.
Where the
Chinese
government
did retain
some control
over the
costs of
medicine,
the result
was
disaster.
When
state-run
medicine was
dissolved,
local
governments
were left
with the
responsibility
of providing
health care
to citizens;
with fewer
resources
available,
these
administrations
could not
afford the
hospitals
and health
care
facilities
that the
national
government
had
provided.
Private
entities
bought many
of these
facilities
and began to
provide
health care
at
increasingly
high costs.
Meanwhile,
Communist
work units
were
dissolved as
part of a
push for
privatization
of industry,
and the
universal
health
insurance
system that
had been in
place until
now was also
totally
dismantled.
According to
Princeton
economist
Gregory
Chow, the
result was
that the
catastrophically
low supply
of available
health care
could not
meet the
growing
population’s
demand for
it, prices
skyrocketed,
and
subsequently
a vast
percentage
of Chinese
workers –
especially
in rural
areas –
ended up
without
minimal
medical
access. In
short, the
government’s
retention of
partial
control over
health care
contributed
to the poor
quality of
medical care
available
today by
manipulating
the
“free-market”
health care
system.
What lessons
can U.S.
lawmakers
learn from
China’s
failed
experiences
with
state-run
and
market-based
health care?
One is that
they must
not
underestimate
the sheer
cost of
socialized
health care.
Just as
China’s
national
economy
couldn’t
support it,
our
government
faces the
prospect of
limiting the
amount and
quality of
routine care
available to
American
citizens if
it chooses
to take
control of
the
country’s
medical
system.
Another
important
take-away
message is
the more
grievous
error of
mixing two
disparate
systems of
health care;
as China’s
example
demonstrated,
applying
market
principles
to
socialized
medicine
resulted in
a severe
discrepancy
between the
supply and
demand for
health care
with
disastrous
consequences.
For U.S.
policymakers
attempting
to achieve
the opposite
transition –
to
nationalize
a
market-based
system of
health care
– the
consequences
could be
equally
severe.
As Congress
tackles this
issue, it
must take
care not to
sicken our
already-struggling
health care
system by
reforming it
too hastily
– and more
importantly,
it must not
forget that
the health
of the
American
people is at
stake.
-###-
Mary A.
Brazelton is
a student at
Harvard
University
and editor
for the
school
newspaper,
The Crimson.
An editorial
assistant at
the Ripon
Forum this
past summer,
she is
completing
her
undergraduate
thesis on
the history
of American
medical
education in
China.
|
