Great America

Coronavirus and Medicare for All: The Russian Version

Russia illustrates the classic failure of Medicare for All in dealing with pandemics. Yet this is just the sort of system that Bernie Sanders and Alexandria Ocasio-Cortez would love to foist upon America. Are we ready for such an abomination?

Acommon refrain on the Left today is that if only we had Medicare for All (a shorthand for socialized medicine, where the government provides medical services either directly at government-run hospitals and clinics, or indirectly, by being the only insurer and reimburser for all such services), then the coronavirus pandemic would be so much easier on all of us.

With Medicare for All (M4A in Twitter lingo) it is supposed we would have all the supplies we need, thousands of spare doctors would be on standby, hospital beds would be available for all the incoming patients, millions of functioning test kits would be ready and waiting, and all the vaccines would be developed and distributed the day before the pandemic hit. Twitter is full of such blather.

Examples of socialized medicine from across the Atlantic illustrate the absurdity of such claims.

Considering Italy, Spain, France, or the UK (all countries with some facsimiles of M4A), it is entirely unobvious that the Euro-M4A is responding any better than the American system. There are plenty of horror stories of incompetence, mismanagement, bureaucratic bungling and shortages of everything at all levels of the Euro-M4A.

I’m neither a doctor nor an expert on European socialized medicine. I do speak and read Russian fluently, however. My intention here is to offer a brief current summary of the Wuhan coronavirus pandemic in Russia.

Russia, too, has its Medicare for All. Though there are some private clinics and private doctors for those who can afford them (though, of course, the truly wealthy jet off to Switzerland for treatment), the vast majority of the health care is government-provided or a version of single-payer, and virtually all hospitals are government-owned and government-run.

In other words, were Bernie Sanders to look at Russia’s healthcare system, he would nod his balding head with approval, recognizing his dream of M4A there. And Russia’s M4A has everything you expect of socialized medicine—shortages of supplies and testing, overworked doctors, long lines, overcrowding, rationing, corruption, government lies and cover-ups, and fraudulent and unbelievable statistics.

Russian Healthcare Meets the Pandemic

Even before the pandemic, Russia’s health care system was under extreme stress. The country has roughly half the number of hospitals it had in 2000. The number of hospital beds for handling infectious diseases is 30 percent less than it was 15 years ago—even though the number of cases is up by 12 percent. Budgets are miserly, service poor.

For all you M4A lovers out there (and Russia is unquestionably an M4A example), here are some sobering statistics: of all buildings where medical services are performed, 14 percent are structurally unsafe, 30 percent have no water supply, 52 percent have no hot water, 41 percent have no central heating, 35 percent have no connection to the sewage system, and 32 percent have no telephone service. 

Again, this was before the pandemic.

Thousands of photos on the Internet show the provincial medical facilities themselves—decrepit buildings, crumbling walls, leaky roofs, dirty beds, filthy toilets. Outside of Moscow and a few large cities, hospitals often lack basic equipment that would be standard in any Western hospital. Pay for doctors and nurses puts them at poverty level. Due to overt and covert drug import restrictions, and onerous certification requirements (along with the associated graft), Western pharmaceutical companies have mostly abandoned Russia.

Russia’s own pharmaceutical industry is failing to fill the gap, despite the government’s policy of import substitution and protectionism. Early this year, Russia began to experience an oncological collapse—hospitals were running out of imported drugs for cancer patients, while local equivalents were ineffective or toxic.

The situation is particularly desperate for children with rare diseases—Russian TV routinely shows fundraising appeals to help buy medicine for this or that child. The Health Ministry tells doctors to find Russian equivalents—notwithstanding all the evidence that they either do not work or have brutally toxic side effects. The government, however, always finds money for more important things—like fireworks on April 4 in honor of the 75th anniversary of the 1945 liberation of Bratislava, Czechoslovakia by Soviet troops.

The first two cases of the Wuhan virus appeared in the Russian Far East on January 31—the same day President Trump stopped air travel between China and the United States. Russia then followed the familiar trajectory—denial that the virus is a problem, assurances of government preparedness, minimizing the impact as just another flu, denial that there is an epidemic going on, dragging its feet in imposing quarantine measures, and so on.

As the Wuhan virus spread through Russia, doctors, nurses and EMTs began sounding the alarm—not only were they unprepared for dealing with the infection itself, but they were lacking basic personal protection equipment. Masks were in short supply. Gloves, hand sanitizer and respirators were virtually non-existent. (Sound familiar? China, with its M4A, had similar problems early on.) Only one lab in Novosibirsk was “certified” to test for the virus. (Sound familiar?) Disposable gowns were almost unheard of—and where available, were re-used many times after washing. Even elite Moscow hospitals had severe shortages.

To this day, nobody knows exactly how many ventilators there are in Russia. Leaked documents, to give just one example, show that the Tomsk region in Siberia (population over 500,000) has no ventilators at all. Zero. Next time you hear New York politicians complain, remember that number—zero.

Other regions (rough equivalents of a U.S. state) have no test tubes for storing coronavirus test samples, while yet others have no supplies of masks and goggles at all—and none are expected for months. Still others have no protective gowns. Some labs have no lab supplies. Doctors and nurses are forced to make their own masks.

If all this sounds like you’ve seen it all recently on TV here, just remember: this is not an aberration—all countries are in the same boat, but with Medicare for All, the usual bureaucratic incompetence, corner cutting, and corruption is multiplied by government secrecy and fear of bringing bad news up the chain, to exact a price far greater than the profit motive can exact.

Stories abound of hospitals throughout Russia that served as coronavirus breeding grounds, and are now under quarantine. Local and regional authorities spent weeks denying problems and reassuring higher ups that everything was ready for the epidemic.

Meanwhile, doctors and nurses in hospital after hospital, all over Russia, were unknowingly infecting patients, and patients were infecting doctors and nurses who were desperately short of protective gear. The diagnosis, for weeks, remained the same—pneumonia. No Wuhan virus epidemic here!

Denial Meets Inefficiency

While the Russian government slowly began ratcheting up travel restrictions, there was little evidence that the government was mobilizing the Russian industry to produce the key supplies—PPE, ventilators, test kits, hospital equipment. As of Friday, there were only scattershot mentions of this or that ministry doing something ad hoc.

It is difficult to deal with a crisis when you keep denying that there is a crisis.

Statistics coming out of Russia show all the classic sins of socialized medicine coupled with the Russian government’s traditional penchant for lying. Coronavirus is bad news—and Vladimir Putin does not want bad news on TV.

All over Russia, doctors began noticing a spike in the number of respiratory infections and “atypical pneumonias” in January and February, and some even going back to December. Since testing was rarely available, in March (and even today its availability is problematic), pneumonia usually remained the diagnosis.

As an example, in Crimea (population 2 million), the regional health minister revealed on April 4 there were 1,500 people in hospitals with respiratory infections. These, of course, are people whose symptoms are severe enough to be admitted (and for whom a bed could be found). How many others have symptoms but haven’t been admitted? Twice that number? Three times? How many of their relatives and friends have these 1,500 cases infected? If anyone in Russia knows, they are not saying.

Extrapolating to all of Russia based on this one anecdotal example works out to something like 200,000-500,000 cases—but this is just a very tenuous guess, if that—nobody really knows. It could be 100,000, or 1 million. With asymptomatic, not-yet-symptomatic and mild cases, it might be 2 million. Or perhaps not. Except that in the Russian M4A health system, if you don’t diagnose the Wuhan virus, then, there is no Wuhan virus.

Officially, the first case in Moscow was confirmed on March 2. Before that—officially—all the coronavirus cases could be counted on the fingers of one hand. All the way until March 14, the daily number of new cases in Moscow—the epicenter of the pandemic in Russia, due to its large population and its transportation and economic centrality—was in the single digits, sometimes in the low single digits. On March 15, the government reported no new coronavirus cases in Moscow at all.

Given the contagiousness of the Wuhan virus, such a trajectory is simply impossible.

A problem became evident early on: the polymerase chain reaction (PCR) test available in Russia was 100 times less sensitive than corresponding Western tests. This meant that the tests were showing a huge number of false negatives. (If this sounds familiar, it should. Many Western countries, including the United States, Britain, Spain, and the Netherlands, had similar problems—tests that were unreliable or that didn’t work—proving yet again that bureaucratic bungling knows no borders.)

By the end of March, Russia claimed to have performed 200,000 tests and identified about 1,000 cases of infection. This, again, is impossible—that many tests should have revealed somewhere around 20,000-40,000 cases. Either the tests were defective, or they were testing the wrong people, or they were lying about the results.

It is also wildly inconsistent with the official figure of 215,514 suspected cases on April 1—and given the realities of Russia’s health care system, one has to assume that each patient has symptoms that give rise to such suspicions. If the government admits to 215,514 suspected cases, the real number is surely many times that. But the truth would have been bad news, and Vladimir Putin was not ready for that sort of bad news.

A chart from here, where I replace Russian-language notations with English, shows the following dynamic based on official figures:

This chart has one clear message: the situation is under control. There is no explosive growth in coronavirus victims, no doubling every 2 days, no daily exponential increase in cases, no uncontrollable wildfire of infections. Yes, the virus has arrived, but things are well in hand.

If this chart were true, then Russia would be the only country on Earth with such a dynamic. Countries with urban populations showed the number of infections in the initial phase exploding—yet all was mostly quiet on the coronavirus front in Russia. Russia reported only about 6,300 cumulative cases on April 6. On April 7 (five weeks after the first reported cases), it reported 1,154 new cases, breaking the psychological 1,000 mark—but still grossly inconsistent with the 215,514 suspected cases a week earlier. On April 9, about 1,500 new cases were reported. On April 10 (10 days later), 1,800 new cases.

In other words, the official numbers are disconnected from reality.

Can Russians Feel the Rain if Putin Denies It?

Note also how concentrated the infection is in Moscow in the chart above—the rest of Russia (the blue minus the red) is almost an afterthought.

While there is little doubt that Moscow has a viral pandemic, so does St. Petersburg, another large city of 5 million. (The city’s hospitals are overflowing and approaching a coronavirus collapse—virtually all hospitals, and almost all the hospital beds in the city, with a small handful of exceptions, have been repurposed into quarantined COVID wards, pneumonia wards or suspected COVID wards—at a time, when the government has not yet fully acknowledged that there is an epidemic in the city.)

In the Far East, prior to closure of the border, there was routine cross-border travel with China. In November, there were a dozen flights a day to Wuhan alone—when “patient zero” supposedly appeared in Wuhan. Except that he wasn’t patient zero, he was just the first identified patient. It is impossible to believe that months after this, in large cities in southern Siberia and the Far East, the number of cases is in the single digits. Any realistic testing would surely reveal many thousands, if not tens of thousands.

At the same time, Russia still has some shreds of a free press. It is thus unlikely that there are truckloads of coronavirus corpses being buried or cremated in secret. The government might like to do just that, but it probably can’t (yet). Official statistics showed daily coronavirus deaths in the single digits until April 8—a laughably small number. Still, while the government can disguise hundreds of coronavirus deaths as the flu or pneumonia, it probably can’t hide thousands. Probably.

More bad news is coming soon. Russian prisons are not the healthiest of places in the best of times. There are reports of prisons filled with infected inmates, with new arrivals (coughing or not) being placed in cells with other prisoners (coughing or not).  In Russia, the idea of isolating infected prisoners from uninfected ones is unworthy of discussion. The idea of arresting fewer people than usual, or releasing those accused (or even convicted) of minor offenses is a non-starter as a matter of principle. Testing prisoners for coronavirus, when even patients in hospitals have to wait for days, is a complete fantasy.

There are news reports of prisons where everyone in a cell (six-10 people) is now coughing. And so is everyone in the next cell. The guards are starting to come down with infections as well. Prison doctors, who can only prescribe Amoxicillin (an antibiotic of no discernible value against the coronavirus), are also coming down with “pneumonia.” The coronavirus is on the verge of a second break out into the general population, this time from the prisons.

Retirement homes are not as developed in Russia as in the West, since far fewer Russians can afford them, but they do exist. It is impossible to believe that mass infections are not taking place there.

And Putin? While Western presidents and prime ministers went on TV daily in March, explaining what they are doing in the face of the pandemic, Putin became invisible. Not until March 25 did he finally go on TV.

Putin’s bland, emotionless address had one overarching message: things are under control. Putin explained nothing about the current state of the epidemic, or what, specifically, the government was planning to do. Russia has $550 billion in hard currency and gold reserves in its rainy day funds—but Putin doesn’t think it’s raining.

He tossed out a few crumbs, and decreed that everyone should take a week off (at their employer’s expense)—a sort of quarantine, but not exactly—many went to barbecues, giving the virus more opportunities to spread. Thankfully, he postponed the procedurally dubious April 22 “plebiscite” on amending the constitution to extend his rule until 2036.

In his second TV address on April 2, his only substantive measure was to extend the “vacation” until April 30. (Moscow itself was on a functional lockdown by late March.) Putin refuses to call the restrictions a “quarantine” or an “emergency.” The Russian government had no plans to help the tens of thousands of small businesses that are facing imminent bankruptcy. If you’re not a personal friend of Putin, you’re on your own.

Perhaps sensing that, notwithstanding the plaudits from his sycophants, his TV appearances were becoming an irritant to a frightened and increasingly desperate population, on April 8 Putin offered a few more crumbs: 80,000 rubles a month extra (about $1,000) for doctors who work with coronavirus patients, about $600 extra for nurses, and $300 for assistants and orderlies. (These amounts might seem unimpressive to many Americans, but in many provinces, that’s triple or quadruple what many doctors make.)

A few more crumbs were tossed out to families with children, the newly unemployed, pensioners, and companies that do not lay off people. Still, it was difficult to match the extent of Russia’s accelerating economic contraction (and the plentiful reserves available to deal with it) to the half-measures and miserly amounts being talked about—a few billion dollars at most, instead of tens or hundreds of billions.

Conspiracy theorists have a ready explanation for all of this. Since the virus kills mostly older people, this is a good thing, from the perspective of the Russian state—less need to spend on the elderly. The Russian economy, fundamentally, is an oil and gas export economy, so small businesses dying out is not a problem for the roughly 100 Russian dollar billionaires—with nowhere else to go, their labor force will only be cheaper.

When the government becomes intertwined with the health industry until it is impossible to tell where government ends and medicine begins, all medical decisions inevitably become political decisions. In Russian Medicare for All, the medical logic of every decision is often subordinated to higher political needs of the ruling class. Russia illustrates the classic failure of Medicare for All in dealing with pandemics. Yet this is just the sort of system that Vermont socialist Bernie Sanders and Representative Alexandria Ocasio-Cortez (D-N.Y.) would love to foist upon America. Are we ready for such an abomination?