Universal health care is great — except in Russia. Here’s why.

The benefits of universal healthcare are so well known that they hardly warrant repeating. Lower administrative costs, a focus on preventative coverage, removal of the profit motive in keeping human beings alive, higher efficiency, and lower costs to the patient are just a few of them.

This said, there is a reason that nobody is voting to move their countries toward the American system of healthcare; it’s not as good as the French/British/Canadian/Australian/Singaporean/etc model.

There is one national health system that America’s goofy model is better than, however. Russia has a national healthcare system that shows you how not to do it.

Its real horrorshow droogs.

From a purely statistical standpoint, the Russian healthcare system needs work. The Bloomberg Healthcare Efficiency Rankings place Russia at 53rd out of the 56 countries measured. America sits at 54th. They spend $524 per-capita on healthcare, which is one-eighteenth what the U.S. spends but is more in line with a developing country than an industrialized one. While in theory, every citizen has health care out of a public fund, in practice everybody is required to have private insurance.

The Russian life expectancy has increased to 71 years, but that value can vary dramatically by region, with many provinces having a life expectancy of under 65 years for men. While the number of specialists is relatively high, especially around Moscow and St. Petersburg, the number of general practitioners is low and is shockingly low in rural areas. Seventeen thousand five hundred towns and villages have no local medical services at all. Lines are long, and bribes are common to assure treatment.

These statistics are all a bit dry though, and nightmare stories about the conditions in Russian hospitals can provide much-needed illustration.

An Icelandic woman told the world her experience of going to a rural Russian hospital with heartburn. After being given a shot in the bum without warning, enduring a filthy, bloody bathroom, and a bed with soiled sheets her Russian speaking husband had to prevent the doctors from engaging in surgery to “make sure that the internal organs” were “in order.” She was able to get out and go to a proper hospital later.

Some doctors reportedly show up to work while drunk and even try to work on patients while plastered. One woman related a story where snockered doctors kept screwing up an IV until her husbands’ arm was swollen. Her attempts to reason with the doctor went nowhere.

Perhaps she should be glad they couldn’t get it right, since a woman died in a Russian hospital when they somehow put formaldehyde in her IV. At least she got to the hospital, in an interview with France 24 a woman explains how she had to give directions to an ambulance that had to come in from out of town and got lost on route. The extra time cost the life of her daughter.

Even Russian government officials understand their medical services are than stellar. Pavel Astakhov, the former commissioner of children’s rights, took his wife to France to give birth to their child rather than endure a Russian hospital. He explained to the press, “I was concerned about my wife and future child, I couldn’t take the risk.”

He isn’t paranoid, the Russian maternal mortality rate is double that of the United States and triple that of France. Given the pro-natal policies Russia has implemented to help increase their falling birthrate, this is quite unsettling.

Why is it like that?

There are many reasons for the wretched condition of Russian healthcare. The primary cause of the current troubles is massive funding cutbacks made in 2014 in response to an economic downturn. Before the recession, the healthcare system had been improving from the shock of the collapse of the USSR, with life expediencies passing Soviet levels in 2006.

Cost-cutting measures have inflicted havoc on small communities, where services were cut the most. Some towns now lack ambulance service. The time it takes for one to arrive from the next city over is often too long for those in need. This would be less of a problem if the hospitals in the other towns were adequately funded, but they aren’t. The result is poor infrastructure where it exists and none in other places. Soviet era equipment often goes without replacement or repair.

Culture is also a factor. Many doctors in Russia were trained during the days of the USSR and are not up to date on new procedures and guidelines since professional development isn’t as valued as it is in America. This, in turn, lends to a different attitude toward medicine and patient care than would otherwise be expected.

For example, many Russian doctors won’t allow families to visit sick patients despite declarations from the government stating that kin have the right to visit their loved ones in the hospital. While prohibiting visits to the ill might have made sense in the Gulag archipelago, today it is an arbitrary rule that keeps people from seeing their family members; even when they are dying.

In one case, for instance, a woman was forced to draw a gun on a doctor who wouldn’t let her see her dying five-year-old otherwise.

What can we learn from this?

In a sentence: how not to manage a national health care program. More specifically, we can look at the decay of the Russian system since 2014 for insights as to what can cause a system that was on the up and up to suddenly go down in flames.

This isn’t to say America’s healthcare system is without its own nightmarish stories, but the drastic funding cutbacks in Russia has had a wide-randing impact — many doctors in the provinces are making poverty line wages. This, in turn, could explain their lack of professionalism and why they drink on the job. No system that pays so poorly can expect quality staff to sign on, particularly if the position requires living in Siberia.

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Attempts to make the system more efficient have led to hospital closures in isolated areas that leave patients hours away from the nearest, still underfunded, medical facilities.

Given the crisis that rural America is currently facing with closing hospitals and long drives to quality medical care, this lesson has a clear application in this country. Any universal healthcare system implemented in the United States will have to take steps to assure access in all areas of the country and not merely in large population centers.

Secondly, the failures of the Russian healthcare system should remind us that any system is only as good as the people running it. The improving performance up until the recession suggests that the Russian system has the potential to function adequately, but that the political will to give the Russians quality healthcare doesn’t exist. While President Vladimir Putin recently promised to increase funding as part of his most recent “reelection” campaign, the results have yet to be seen.

Universal healthcare is great, practically, morally, and financially speaking. However, there is a wrong way to do it. The conditions in Russian hospitals demonstrate how a great idea can be poorly implemented. The failures of universal healthcare in Russia can be a learning experience for the United States as it looks for ways to improve its healthcare system.