April 21, 2011 2:41PM

How Russia Makes Universal Coverage Work

As everybody with a brain knows, Article 41 of Chapter 2 of the Constitution of the Russian Federation protects the universal right of every Russian citizen to health care:

Everyone shall have the right to health protection and medical aid. Medical aid in state and municipal health establishments shall be rendered to individuals gratis....

Free health protection for everyone is an impressive feat, considering Russia spends less than 4 percent of its meager GDP on health care.  The Washington Post reveals how Russia makes it work:

Nationally, statistics show, almost half of Russia’s hospitals lack heat or running water.

There's also the fact that Russians of all ages and sexes face probabilities of dying rivaled only by HIV-plagued sub-Saharan African nations.  Thank God for universal coverage.

A doctor named Leonid Roshal has decided he's mad as hell and he's not going to take it any more.  And he told Prime Minister Vladmir Putin to his face:

Russian medical care is hobbled by corruption, meager salaries, ill-conceived laws, a shortage of medical workers and an overbearing government bureaucracy, one of Russia’s most prominent doctors told a recent medical conference here. He addressed his remarks directly to Prime Minister Vladimir Putin, who was sitting just a few feet away....

In his remarks, he said too much money is being budgeted for equipment, much of it useless, because it is easy for bureaucrats to “saw off” a kickback for themselves.

Actually, that happens in the U.S. Medicare program too, though I believe we confine those rents to the private sector.

Doctors, he noted, have to make do on official salaries of less than $300 a month. (He didn’t mention that most doctors here insist on under-the-table payments from their patients.)

Frankly, the existence of a grey market is the only bit of good news in this entire article.

[T]he result is a shortage of doctors, especially in rural areas, and of hospitals.

“There are regions where more than 50 percent of physicians are of retirement age and only 7 percent are young specialists,” he said.

And all of this, he concluded, is directed by a Health Ministry bureaucracy that is painfully lacking in people with medical training.

The fact that a doctor thinks you need doctors to solve an economic problem is sadly unsurprising.

Roshal said the ministry treats doctors who care about the quality of medical attention as “intrusive flies.” He complained about its rigid, illogical directives and asked Putin when the country will have a plan for reform.  Putin replied that Russia has such a plan but that if Roshal was unaware of it, it clearly needs more promotion.

He did not say what that plan entails.

The non-doctor, non-economist bureaucrats Dr. Roshal criticized would have none of it:

[T]he Health Ministry later posted an unsigned “collective” letter denouncing Roshal and asking Putin to “protect our honor and dignity against such criticism.”...“It is unacceptable to provoke conflict and breed alienation between us and our colleagues: doctors, nurses and other medical personnel,” the unsigned letter from the ministry said.

Putin's response was characteristically smooth:

Putin did not directly dispute the comments; in fact, he said he knew what Leonid Roshal was going to say and wanted to make sure the conference heard it.

Putin [recently] told parliament that Russia will spend about $50 billion over the next five years on its “demographic policy.” He said the government wants life expectancy to grow from the current 69 years to 71, the birth rate to increase by 25 to 30 percent and the mortality rate to drop. But he didn’t detail how that would be achieved.

A five-year plan.  Now why does that sound familiar?