Re: Roy Medvedev interview (on Putin)

["Chris Doss" <nomorebounces@xxxxxxx>]

Comments below:

-----Original Message-----
From: Michael Perelman <michael@xxxxxxxxxxxxxxxxx>

>
> I understand that Russian health care may be free, as Chris says, but my Russian
> friends tell me that to get decent treatment you have to bribe people.

Yes. It is free in principle but requires, usually, informal cash transactions. These are usually tips but the doctor(s) may try to extort money from you if they think you can pay.
I have never been asked to pay a bribe myself, but then I have never had to have serious treatment.
Anecdotally the situation is particularly bad in this respect in maternity hospitals.


One possible
> difference between the Soviet and the present system is that today a typical doctor
> might have difficulty surviving on her official salary.

Yes. The same goes for almost all government employees.
As I have said before, the reason for this is the massive tax evasion, which makes the state too poor to pay its employees. This creates a _very_ bad situation with respect to the police. A beat cop in Moscow is usually a pretty
uneducated guy from Podmoskov'ye (the area around Moscow), who earns about $80 a month and carries an AK-47. You can
imagine what happens.
The average monthly salary for a doctor is about $120, as opposed to about $60 a few years ago, from unlivable to barely livable.
Doctors were not well-paid by any means in the Soviet era. (Except for the elite -- I have a friend who was a dentist for the nomenclatura in the 70s-80s. He met Vysotsky and Brezhnev, and used to jet over to Sochi on vacation all the time. Currently, he has his own private practice in Moscow and is not at all a poor man. I see him in his ads from time to time on TV.) But they did not have to rely on tips/bribes for survival. The mother of one of my ex-girlfriends is a doctor in Podmoskov'ye, and she relies almost entirely on tips.
What decline _has_ occurred in the health care system, I think, is a result of the corruption and that talented doctors have fled from the state clinics to private ones.
For some reason, Russian dentistry is superb. Why this is I have been unable to figure out.

>Lou's description of the TB
> cases seems consistent with my informants.

Most of the TB epidemics stem in the prisons, AFAIK, where there is also a great deal of HIV. The hepatitus derives from IV drug use, which is a serious problem in Russia, where heroin from Afghanistan is cheaper than marijuana.

>
> I find the juxtaposition of different views on this subject interesting.  I also
> appreciate that the tone of the discussion has changed.

If you're civil to me, I'll be civil to you.