Free single provider Medicine in the USSR (the Union of Soviet Socialist Republics = the Soviet Union = Mature Socialist Country = The Country of practically built Communism.)
In the USSR and Europe medical care service is called medicine. Medicine in the Country of Matured Socialism was provided by same single entity – the communist government. It was Medicine of a single provider and they called it “free” although a patient had to pay for all medications, prescribed or not, and many other things. We had several physicians in our family – my sister and her husband, my wife’s cousin, etc. - and therefore we maybe heard and knew about “free medicine” a little bit more than a common person. Let me first to describe general characteristics of “free medicine” in the USSR and then talk about our young (period between 1960 and 1975) family interaction with the world of “free medicine”.
In the USSR there was no such a concept as a family doctor, nobody could chose a doctor. There were only state district doctors who served every person in their districts. Any citizen in case of any sickness, except of emergency, could visit only his/her district doctor. In Moscow, where, by any measure, medicine was better than in any other city or village, to have an appointment with a district doctor a patient had usually two options. The first option, a patient visited district clinic usually before noon time, stayed in line to his district doctor for several hours, was invited to a doctor office for 5-6 minutes, where a doctor asked several questions, wrote a prescription and send a patient home with doctor’s certificate that the patient is ill and may not go to work; since the government health ministry limited time that a doctor could spend on one patient visit (about 5 to 7 minutes) and, at the same time, requested detailed description of sickness and treatment, which could be written only by a doctor, doctors practically did not have time to talk to a patient and to check him/her; they asked question and at the same time wrote all the time till a patient was in their office. The second option, a patient could stay at home and call (if he had a phone in his house, which was very unusual in our district) the district clinic with request that his district doctor visited him at his apartment. To justify such home visit a patient should be very sick. If a patient could not go to clinic and could not call, a member of patient’s family or a neighbor had to go to the district clinic, which for our neighborhood was about 30 min drive by bus from any apartment building, and request a doctor’s home visit, which usually happened in the afternoon. In our area there were mainly five stories multi-apartments buildings without elevators. So, to visit a patient at home a district doctors used public transportation (bus, trolleybus, etc.) from district clinic to the apartment area, walk to the apartment building, climb two or more stairs, treat the patient and go to the next patient. Government salary of district physicians was from 70 to 90 rubles a month all around the country. It was the same salary as salary of people without any education or for young technical and office workers. Such salary could not support minimum needs of a family of two or three people. It explains why absolute majority of district doctors in the USSR were women, who graduated from a high school and then from a medical university after six years of studying. It also explains why there was a shortage of doctors in many cities, towns and rural areas. In many rural areas there was no doctors at all and people had to go to the closest town to have any medical service. If something serious happened and an emergency call has been made it could easy take from 45 minutes to several hours before ambulance comes. More often than not ambulance had come when it was too late. It is the “free” socialist medicine, which works (better to say does not work) about the same in any country of the world, where it is introduced.
Unfortunately, many years later, I came across and learned how “free” single provider system works in Canada, where I had a back surgery in about 1983. Although I was an American citizen and therefore paid complete cost for whole service, to my surprise Canadian medicine worked very badly, not much better than free single provider medicine in the Soviet Union. When my wife brought me to hospital in Montreal we saw classical Soviet hospital scene: there was no wheel chairs for visiting patients, nobody met us, we walked some distance from parking to registration area, where three nurses were very busy talking to each other and ignored completely our arrival; after several minutes of staying and waiting my pain drastically increased and I could not stay anymore; but there was no chairs to seat; I laid down on the floor right in front of a register desk; nurses, who were in three or four feet from us, continued to have fun till somebody in white gown came and asked nurses what is going; only after that my registration started but I laid down on the floor till all formalities has been completed including whole advanced payment for hospital room, meals, surgery, etc. After registration they took me to a large hospital room with about eight patients and with small restroom for one person. I spent several days with seven or eight other patients before and after an unsuccessful surgery. These visit taught me that socialist single provider medicine works (better to say, does not work) about the same in any socio-economic system.
Common knowledge in the USSR was, that, if something is “free”, it usually meant very bad news, since it meant that this thing does not exist in real life. Medical service was one of those “free” things and health of my family worried me very much, though both, I and my wife, were about 34-35 years young and in reasonably good health by Soviet Socialist/Communist standard. One of the most frightful days of my life in the USSR was the day, when my wife and I heard that the woman of about 60+ years old, whom we knew as a relatively healthy person, broke her hip and was told in a hospital, that she is too old for a hip surgery. Practically that statement from a government hospital official was the death verdict and the woman has died in a couple of weeks. All that time she was a victim to unbearable pain, she screamed and groaned day and night. But it is the “free” socialist medicine and nobody would make a surgery to a patient without government permission.
My family, relatives and friend’s experiences with medical problems also did not encourage me very much. Wife of my brother-in-law, who was an engineer-chemist, died in age of 38 from a blood poisoning caused by a flu shot, and left two children 15 and 3 years old. This blood poisoning was a common result of using the same syringe until it becomes unusable in any soviet clinic or hospital. It is the “free” socialist medicine.
Watching my parents, who at that time were 62-63 years old, was very painful. By Soviet standards, they were old people and they were on retirement. Retirement age in the Soviet Union was 60 years for a men and 55 years for a women. But in the country of Matured Socialism not many people lived to their retirement age. Therefore they could not expect that, in case of serious sickness, they will get good or, for that matter, any medical service. My mother’s younger sister and brother were already dead for several years. My father’s two sisters and several brothers were also dead. My parents-in-law, who were younger, than my parents, were in about the same situation. Later, when we brought my parents and my wife’s parents to the USA, all of them lived very long by Soviet standards. My father lived up to 96 years. In single provider system of “free” socialist medicine he would be dead in much younger age.
We had two sons. Both times my wife gave birth in a district birthing home in Moscow. It was new and was considered as one of the good birthing homes. All time, she was in the birthing home, she spent in the one room together with 17 or more other women. When a woman came to a birthing home, they took her cloth and gave her an old shirt from a soldier. This soldier shirt was washed before it was given to a woman and it was used by a woman all the time (no additional washing of the shirt) till she left home with a child. Nobody, including her husband, could visit a wife till she was in a birthing home. All contacts between a wife with a child and a husband were through windows to the street, most of which could not be open. When a woman with child was released from a birthing home, they brought both of them to the front room, where the husband and relatives waited. All nurses and aids, who contacted the woman and her child during days of their stay in the birthing home, came to this front room and expected tips from the husband and relatives. A bribe is one of the most important features of the “free” socialist medicine.
Another very bad memory of the socialist medicine comes from the time, when our older son, who was 6 or 7 years old, suddenly felt pain in low part of stomach. As I mentioned above we had several doctors in our family and one of them helped me, “by backstairs”, to take our son in pediatric department of the hospital, where a good pediatric surgeon worked. When the doctor checked my son he said that it is possible that there will be need in a surgery and he will tell me, for sure, tomorrow after several tests. It was very bad news since we knew that a lot of children died during and after surgeries in Moscow. My wife was advised to buy silver spoons to give the doctor before the surgery, otherwise, the surgery may not take place at all or results of the surgery could not be as good as we expected. It is the “free” socialist medicine. Every family was in similar situations many times.
Unfortunately, I have gained some personal experience in using “free” medical service. In about 1964-65 I was one of relatively small number of people in Moscow, who has been attached to special hospital for all my medical needs. I was attached to Kremlin Hospital #2(?). It sounded impressive for everybody. I was the only member of my family who could use this hospital.
During my childhood and teen years I had chronical swollen glands and angina. In about 1965 during a checkup the doctor said that I should have tonsillectomy and the surgery can be done in the special hospital I was officially attached to. I will never forget that surgery. They put me in a chair in sitting position and said that I should hold my chair supports by both hand. I could not move my head backward since there was a special support. They did not give any general or local anesthesia and I felt every cut that a surgeon made in my throat. When pain was too much I stressed myself and the surgeon stopped surgery and suggested me to relax. When I relaxed the surgeon continued. After surgery they put me in the room with only three other patients. I believe that they hold me in the hospital after surgery two or three weeks before releasing me home.
Later, when we arrived to Detroit as refugees and all of us went through a medical checkup, a doctor told us that our older son, who was 18 years old at that time, needs tonsillectomy surgery. I told doctor that it is very lengthy and very painful surgery and I would not like my son to have it if it is not critical for his health. He could not understand what I mean. When I told him about my experience, he said that in the USA a patient lays down, anesthesia starts and whole surgery takes few minutes. Next day after surgery our son was with us.
My second personal encounter with a soviet surgeon was in 1969 when I had appendicitis problem. I asked about anesthesia and they said that everything will be OK. They put a mask on my face; I lost capability to move but I felt pain, when they cut my body; I felt as the surgeon moved my guts and at the same time I heard how the surgeon and the nurse discussed a movie, they watched night before together, and after that I felt pain as they were sewing up my belly. It was not too bad and I was OK, but when I told it to American doctors they could not understand it. I tried to explain it by shortage of the anesthesia medications in the socialist/communist medicine.
My next and the last encounter with the soviet medicine happened in 1973, when I had an attack of Steno cardia being in metro (Moscow underground trains) on my way home from my office with one of my friends. We waited for a train on a metro platform, when strong pain started in arms, neck and abdomen, and then I lost capability to breath, move and talk. I have felt on platform and thought that it is the end of me. My friend tried to lift me but I could not make a smallest movement. He started to scream asking for help. A militiaman (police in the USSR) on duty came to us, looked at me and said that I am totally drunk and he will call other militiamen, who will take me to militia station, where they will sober up me very fast. He added that he has several cases like mine every day. My friend told him that I do not drink at all and suggested him to smell my breath. First, he could not believe it and started talking on radio. But after sometime he decided to check if what my friend said is true. He smelled my face and talked on radio with a nurse on duty in metro. She arrived in twenty minutes, made me an injection of camphor and nitroglycerin. In thirty minutes I could move, walked slowly and my friend helped me to come to my apartment. I was sick for two weeks. Last 42 years I am sure that if my friend would not be with me at that time I would be taken to militia station, “sobered up” by socialist/communist militia methods and be long time dead.
All those events, and especially the last one, gave additional pushes to my emigrant thoughts.
Additional notes:
B.V. November 2015
In the USSR and Europe medical care service is called medicine. Medicine in the Country of Matured Socialism was provided by same single entity – the communist government. It was Medicine of a single provider and they called it “free” although a patient had to pay for all medications, prescribed or not, and many other things. We had several physicians in our family – my sister and her husband, my wife’s cousin, etc. - and therefore we maybe heard and knew about “free medicine” a little bit more than a common person. Let me first to describe general characteristics of “free medicine” in the USSR and then talk about our young (period between 1960 and 1975) family interaction with the world of “free medicine”.
In the USSR there was no such a concept as a family doctor, nobody could chose a doctor. There were only state district doctors who served every person in their districts. Any citizen in case of any sickness, except of emergency, could visit only his/her district doctor. In Moscow, where, by any measure, medicine was better than in any other city or village, to have an appointment with a district doctor a patient had usually two options. The first option, a patient visited district clinic usually before noon time, stayed in line to his district doctor for several hours, was invited to a doctor office for 5-6 minutes, where a doctor asked several questions, wrote a prescription and send a patient home with doctor’s certificate that the patient is ill and may not go to work; since the government health ministry limited time that a doctor could spend on one patient visit (about 5 to 7 minutes) and, at the same time, requested detailed description of sickness and treatment, which could be written only by a doctor, doctors practically did not have time to talk to a patient and to check him/her; they asked question and at the same time wrote all the time till a patient was in their office. The second option, a patient could stay at home and call (if he had a phone in his house, which was very unusual in our district) the district clinic with request that his district doctor visited him at his apartment. To justify such home visit a patient should be very sick. If a patient could not go to clinic and could not call, a member of patient’s family or a neighbor had to go to the district clinic, which for our neighborhood was about 30 min drive by bus from any apartment building, and request a doctor’s home visit, which usually happened in the afternoon. In our area there were mainly five stories multi-apartments buildings without elevators. So, to visit a patient at home a district doctors used public transportation (bus, trolleybus, etc.) from district clinic to the apartment area, walk to the apartment building, climb two or more stairs, treat the patient and go to the next patient. Government salary of district physicians was from 70 to 90 rubles a month all around the country. It was the same salary as salary of people without any education or for young technical and office workers. Such salary could not support minimum needs of a family of two or three people. It explains why absolute majority of district doctors in the USSR were women, who graduated from a high school and then from a medical university after six years of studying. It also explains why there was a shortage of doctors in many cities, towns and rural areas. In many rural areas there was no doctors at all and people had to go to the closest town to have any medical service. If something serious happened and an emergency call has been made it could easy take from 45 minutes to several hours before ambulance comes. More often than not ambulance had come when it was too late. It is the “free” socialist medicine, which works (better to say does not work) about the same in any country of the world, where it is introduced.
Unfortunately, many years later, I came across and learned how “free” single provider system works in Canada, where I had a back surgery in about 1983. Although I was an American citizen and therefore paid complete cost for whole service, to my surprise Canadian medicine worked very badly, not much better than free single provider medicine in the Soviet Union. When my wife brought me to hospital in Montreal we saw classical Soviet hospital scene: there was no wheel chairs for visiting patients, nobody met us, we walked some distance from parking to registration area, where three nurses were very busy talking to each other and ignored completely our arrival; after several minutes of staying and waiting my pain drastically increased and I could not stay anymore; but there was no chairs to seat; I laid down on the floor right in front of a register desk; nurses, who were in three or four feet from us, continued to have fun till somebody in white gown came and asked nurses what is going; only after that my registration started but I laid down on the floor till all formalities has been completed including whole advanced payment for hospital room, meals, surgery, etc. After registration they took me to a large hospital room with about eight patients and with small restroom for one person. I spent several days with seven or eight other patients before and after an unsuccessful surgery. These visit taught me that socialist single provider medicine works (better to say, does not work) about the same in any socio-economic system.
Common knowledge in the USSR was, that, if something is “free”, it usually meant very bad news, since it meant that this thing does not exist in real life. Medical service was one of those “free” things and health of my family worried me very much, though both, I and my wife, were about 34-35 years young and in reasonably good health by Soviet Socialist/Communist standard. One of the most frightful days of my life in the USSR was the day, when my wife and I heard that the woman of about 60+ years old, whom we knew as a relatively healthy person, broke her hip and was told in a hospital, that she is too old for a hip surgery. Practically that statement from a government hospital official was the death verdict and the woman has died in a couple of weeks. All that time she was a victim to unbearable pain, she screamed and groaned day and night. But it is the “free” socialist medicine and nobody would make a surgery to a patient without government permission.
My family, relatives and friend’s experiences with medical problems also did not encourage me very much. Wife of my brother-in-law, who was an engineer-chemist, died in age of 38 from a blood poisoning caused by a flu shot, and left two children 15 and 3 years old. This blood poisoning was a common result of using the same syringe until it becomes unusable in any soviet clinic or hospital. It is the “free” socialist medicine.
Watching my parents, who at that time were 62-63 years old, was very painful. By Soviet standards, they were old people and they were on retirement. Retirement age in the Soviet Union was 60 years for a men and 55 years for a women. But in the country of Matured Socialism not many people lived to their retirement age. Therefore they could not expect that, in case of serious sickness, they will get good or, for that matter, any medical service. My mother’s younger sister and brother were already dead for several years. My father’s two sisters and several brothers were also dead. My parents-in-law, who were younger, than my parents, were in about the same situation. Later, when we brought my parents and my wife’s parents to the USA, all of them lived very long by Soviet standards. My father lived up to 96 years. In single provider system of “free” socialist medicine he would be dead in much younger age.
We had two sons. Both times my wife gave birth in a district birthing home in Moscow. It was new and was considered as one of the good birthing homes. All time, she was in the birthing home, she spent in the one room together with 17 or more other women. When a woman came to a birthing home, they took her cloth and gave her an old shirt from a soldier. This soldier shirt was washed before it was given to a woman and it was used by a woman all the time (no additional washing of the shirt) till she left home with a child. Nobody, including her husband, could visit a wife till she was in a birthing home. All contacts between a wife with a child and a husband were through windows to the street, most of which could not be open. When a woman with child was released from a birthing home, they brought both of them to the front room, where the husband and relatives waited. All nurses and aids, who contacted the woman and her child during days of their stay in the birthing home, came to this front room and expected tips from the husband and relatives. A bribe is one of the most important features of the “free” socialist medicine.
Another very bad memory of the socialist medicine comes from the time, when our older son, who was 6 or 7 years old, suddenly felt pain in low part of stomach. As I mentioned above we had several doctors in our family and one of them helped me, “by backstairs”, to take our son in pediatric department of the hospital, where a good pediatric surgeon worked. When the doctor checked my son he said that it is possible that there will be need in a surgery and he will tell me, for sure, tomorrow after several tests. It was very bad news since we knew that a lot of children died during and after surgeries in Moscow. My wife was advised to buy silver spoons to give the doctor before the surgery, otherwise, the surgery may not take place at all or results of the surgery could not be as good as we expected. It is the “free” socialist medicine. Every family was in similar situations many times.
Unfortunately, I have gained some personal experience in using “free” medical service. In about 1964-65 I was one of relatively small number of people in Moscow, who has been attached to special hospital for all my medical needs. I was attached to Kremlin Hospital #2(?). It sounded impressive for everybody. I was the only member of my family who could use this hospital.
During my childhood and teen years I had chronical swollen glands and angina. In about 1965 during a checkup the doctor said that I should have tonsillectomy and the surgery can be done in the special hospital I was officially attached to. I will never forget that surgery. They put me in a chair in sitting position and said that I should hold my chair supports by both hand. I could not move my head backward since there was a special support. They did not give any general or local anesthesia and I felt every cut that a surgeon made in my throat. When pain was too much I stressed myself and the surgeon stopped surgery and suggested me to relax. When I relaxed the surgeon continued. After surgery they put me in the room with only three other patients. I believe that they hold me in the hospital after surgery two or three weeks before releasing me home.
Later, when we arrived to Detroit as refugees and all of us went through a medical checkup, a doctor told us that our older son, who was 18 years old at that time, needs tonsillectomy surgery. I told doctor that it is very lengthy and very painful surgery and I would not like my son to have it if it is not critical for his health. He could not understand what I mean. When I told him about my experience, he said that in the USA a patient lays down, anesthesia starts and whole surgery takes few minutes. Next day after surgery our son was with us.
My second personal encounter with a soviet surgeon was in 1969 when I had appendicitis problem. I asked about anesthesia and they said that everything will be OK. They put a mask on my face; I lost capability to move but I felt pain, when they cut my body; I felt as the surgeon moved my guts and at the same time I heard how the surgeon and the nurse discussed a movie, they watched night before together, and after that I felt pain as they were sewing up my belly. It was not too bad and I was OK, but when I told it to American doctors they could not understand it. I tried to explain it by shortage of the anesthesia medications in the socialist/communist medicine.
My next and the last encounter with the soviet medicine happened in 1973, when I had an attack of Steno cardia being in metro (Moscow underground trains) on my way home from my office with one of my friends. We waited for a train on a metro platform, when strong pain started in arms, neck and abdomen, and then I lost capability to breath, move and talk. I have felt on platform and thought that it is the end of me. My friend tried to lift me but I could not make a smallest movement. He started to scream asking for help. A militiaman (police in the USSR) on duty came to us, looked at me and said that I am totally drunk and he will call other militiamen, who will take me to militia station, where they will sober up me very fast. He added that he has several cases like mine every day. My friend told him that I do not drink at all and suggested him to smell my breath. First, he could not believe it and started talking on radio. But after sometime he decided to check if what my friend said is true. He smelled my face and talked on radio with a nurse on duty in metro. She arrived in twenty minutes, made me an injection of camphor and nitroglycerin. In thirty minutes I could move, walked slowly and my friend helped me to come to my apartment. I was sick for two weeks. Last 42 years I am sure that if my friend would not be with me at that time I would be taken to militia station, “sobered up” by socialist/communist militia methods and be long time dead.
All those events, and especially the last one, gave additional pushes to my emigrant thoughts.
Additional notes:
- Average life expectancy in the USSR of that time was an absolutely secret information, which in any Socialist/Communist country means that it is negative or extremely negative information.
- By some estimates 90% of men and 30% of women died from alcoholism.
- “Free” medicine and other “free” services in the USSR attracted attention and envy of all world. Famous American economist Milton Friedman, Nobel laureate, visited the Soviet Union during several months in 1987(?). He studied the level of taxation in the Matured Socialist country. In spite of Soviet Government claim that taxes were 11% Friedman came to conclusion that real taxes were close to 97%. In other words, since government is the single provider of employment in the country, government pays people for their work about 3% of what they produced and kept all other money for itself. Small part of those 97% taxes, deducted from each citizen without his/her knowledge, government spent on medicine and other services and called them "free" services.
B.V. November 2015
