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The Sick Used to Die

January 11, 2006

As more and more Chinese attain standards of living and wealth that approach what has been known as middle-class in the developed world, they are discovering a "luxury" not previously known to them: chronic disabling illness.

I remember when such matters first came to my awareness at the tender age of twelve, on a family visit to Canada. I remarked to my father, a man who understood and cherished free markets and freedom itself, on how healthy all the Canadians looked. Handicapped parking places hadn't yet been invented, but it looked as though they wouldn't have been needed in Canada anyway.

My father's reply shocked my young ears: "The sick people are all dead, son."

I asked him how he knew this and, of course, he had to admit that he didn't as a matter of specific cases, but he laid out for me the widespread political rationing of medical care that is an inevitable fact wherever medicine is socialized, and explained that the paucity of lame or sickly people was likely the result of serious diseases running their course more rapidly in these conditions than they seem to in other developed countries where medicine is not (or is less) socialized. He recalled seeing a similar situation in Nazi Germany, where Hitler simply didn't put up with chronic illness in his people, nor any other form of disability for that matter.

The chronically ill are becoming evident — and vocal — in China as they never did under the good old days of communism. Drugs and treatments from abroad are present in China that were literally unheard-of during the Cultural Revolution. They are present but, like hundred-foot yachts and doctoral degrees, not necessarily available to just anyone who has "gotta have one of those." And what is available is expensive — quite ruinously so for those suffering intractable diseases whose progress is rendered even slower by the very treatments that are ruining them financially.

Financial ruination itself is a novelty in China that people in market economies everywhere have long taken as the inescapable handmaiden of prosperity. Wealth in China was, not so long ago, political capital such as that painstakingly accumulated over many years by Hu Cunxi of Shanghai, lately brought down, his doctor says, with stomach cancer and an inpatient in a Shanghai hospital. An article on the front page of the Wall Street Journal for December 30, 2005 describes how, as a faithful member of the Communist Party, Mr. Hu laid up his trove of collectivist security and then, when his world started turning capitalist, even purchased private medical insurance.

Between his and his wife's concurrent lung cancer, Mr. Hu has long since exhausted what little insurance applied to the exotic and chancy nostrums proffered by the hospital with its state-of-the-art pharmacopoeia and equipment and, like the father of communism himself, lies dying in a room adjacent to the room in which his wife lies dying. Unlike Karl Marx, he is furious that, unable to pay for them, he is denied the chemo- and radiotherapies that Marx's doctor was in no position to prescribe — or charge for — in 1883. He is dying, he feels, of capitalism. Next door, his wife may have the risible but understandable impression that capitalism causes cancer.

In a sense, since the incidence and deadliness of infectious diseases such as tuberculosis have plummeted with improving living standards, capitalism has increased the incidence of cancer, both by enabling people to survive long enough to succumb to it and by inventing — and then withholding from the impecunious — "cures" for it.

Mr. Hu may have been less infuriated to have died more promptly of communism, in which case no doctor attending him would have mentioned cancer, nor perhaps known or cared that he had a condition that they had no means of treating in any case. Mr. Hu would have been told he had a cold, given some pills, and sent home to never bother the doctors again. And indeed, he might have died of a cold or other infectious illness before ever contracting this peculiarly capitalistic disease of cancer.

The effrontery of Chinese doctors in demanding payment — in advance and in cash — is chronicled on the front page of the Wall Street Journal with notable frequency, as though the practice were unusual under rapidly advancing market conditions. Both the article about Mr. Hu and another on December 5, under the byline of Staff Reporter Andrew Browne, cite international authorities anticipating "social unrest" in a country already seething with riots and demonstrations occasioned by land appropriations and ecological catastrophes. One is confronted with the image of bread riots of yore being supplanted by … medicine riots, with tanks in Tiananmen Square being pelted with crutches and full ostomy bags and surgeons being burnt in effigy.

Browne, in a powerful reprise of muckrakers such as Upton (The Jungle) Sinclair, compares the Chinese medical morass invidiously with paragons such as the United States:

The practices of hospitals and doctors are only lightly regulated by Beijing, and there is little self-regulation. China lacks the kind of medical professional associations that set ethical standards, hear complaints and punish wrongdoers in the U.S. and other countries.

No doubt, Browne favors situations like that at the University of Medicine and Dentistry of New Jersey where, according to an article in the New York/Region section of the New York Times for December 30, 2005, the first-ever federal takeover of a state university was occasioned by the hospital and its doctors charging Medicaid for treatments for which they also collected full payment from patients or their insurers, a practice said to have been rampant there at least since 2001. Could it be that American doctors are aping their Chinese colleagues? Or, even more fancifully, might we hope that the Chinese government could learn from the gross errors of the United States and Canadian governments, not to mention its very own self?

Alas, it seems that ignorance continues to be a renewable resource, as Browne reports plans for a Great Leap Backward:

Chinese government officials have acknowledged that health care has become such a financial burden to people, even to those with insurance, that it threatens social stability. President Hu Jintao has pledged to increase government health spending.

 Egalitarianism as a Revolt Against Nature and Other Essays When Equality Means Death: $15

Not content to be the next Upton Sinclair, Browne would also fill in for Hillary Clinton and actually diagnose the ills of the Chinese government's health initiatives:

When Chinese authorities decided on the national insurance plan, they failed to recognize an inherent design flaw: …

The diagnosis, of course, continues with specifics, but they're of no account whatever. The design of a national insurance plan — any design — is the flaw. Even though he's unlikely to figure it out in what's left of his life, Mr. Hu will demonstrate this. Will the millions of Chinese who are healthy today figure it out? If they do, it will be without the help of Andrew Browne and the Wall Street Journal.


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