Putin’s Health Care Disaster

Protests about medical reform may be the biggest political challenge the Russian president has to face right now.

Sergei Karpukhin/Reuters

MOSCOW—Several eye-catching items of bad news awaited Russian President Vladimir Putin on his precipitous return from the G-20 summit meeting in Australia earlier this month. The Moscow air was so dangerously polluted that the government recommended people with lung and heart diseases stay at home; somebody burned 14 luxury cars—Rolls Royces, Bentleys, Mercedes and Porches parked in Moscow—worth over $3 million in total; protestors marching along the river embankment in the capital brandished a banner reading "Yesterday Kiev, tomorrow Moscow"; the ruble is plunging and the country seems more isolated internationally than ever.

In the face of all that, Putin remains a paradigm of smug self-confidence whose approval ratings in the high 80s are roughly twice those of U.S. President Barack Obama. This is a man who knows his people and what the issues are that move them.

Which is why he may be worried now about an issue that has drawn little attention outside the country.

State employees, the foundation of Putin's political support, are planning protests against social reforms that will hit 40 Russian regions this week. A medical reform program that president Putin pushed as a priority when he returned to the Kremlin in 2012 has provoked the greatest fury. At street protests earlier this month, Moscow doctors claimed it was applied to them like some kinds of “secret military operation." Nobody was supposed to say anything, and only when a document was leaked did Muscovites learn the news that authorities would close over 20 hospitals and fire about 7,000 health-care professionals in the metropolitan area.

On Sunday at least 5,000 people marched in Moscow, some of them pulling a coffin on which they'd written, "I did not have room in the hospital." Other protesters have demonstrated with banners that read: "Did you close our hospital? Now open a cemetery" or "Do you make doctors work as nurses? Then bureaucrats should clean streets." Moscow officials insist that the hospitals listed for closure lacked professional services and often stayed half empty.

Putin has been mobilizing Russian law enforcement agencies to fight against so-called extremism in support of supposed “color revolutions” like those that brought democratic change or hopes of it to so many countries of Eastern Europe, most recently Ukraine. The Kremlin likes to portray these as sinister Western conspiracies. But the wave of protests in reaction to the closing of hospitals is something a majority of Russians respond to very much on their own steam, and there’s plenty of that.

Every visit to a hospital is an ordeal but for those who cannot pay for private care the experience is a horror show. Most Russians are accustomed to thinking that medical care can and should be free, as it was in the Soviet era, but they are no longer willing to accept care and facilities that have changed little since the 1950s.

On a recent visit to the gastroenterology ward of a hospital in St. Petersburg, a professional medic discovered that a fresh coat of paint had been put on the walls, but there were still only two toilets available for a ward full of patients with stomach and intestinal issues. “No professional management would allow this situation in a department where dozens of women suffer from gastro problems,” the medic told The Daily Beast. “On seeing the restrooms I decided that I could not stay at that hospital a single night.”

I recently visited a public ward for patients with prostate cancer in Moscow’s Hospital No. 50 by accident and was hit by waves of stench. The beds were crammed together, and a man in the middle of the room had spots of flesh on his body that obviously were rotting. He moaned constantly from the pain.

In the past few years Moscow has cut the number of district clinics from 402 down to 86; the new plan to close dozens of hospitals was something that not many Russians could understand, as, bad as they were, they did not see an alternative to the clinics.

On a recent afternoon, the head of the Social Inquiry Foundation, Maria Gaidar, received two elderly ladies in her Moscow office. The pensioners complained that authorities were closing their Khamovniki district clinic. Gaidar, formerly the vice governor of the Kirov Region, now educates people about how to deal with authorities. "Only pressure, only constant street protests, and written complaints,” are likely to work, she says. “Of course it almost never happens,” she adds, “but people should not give up.”

Social revolt is something president Putin clearly does not welcome now in the midst of the conflict with Ukraine, with the Russian economy already suffering from sanctions by the European Union and the United States as well as a massive drop in oil prices. So Putin has called for officials to think more and work harder on health reform. As Gaidar suggests, this is the rare case when public reaction has influenced authorities at all.

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Yan Vlasov, a ministry of health official, recently told a public gathering that Moscow city hall is to blame for the "thoughtless" reform that provoked the social fury. "Moscow's medical reform should be conducted in dialogue with the public," Vlasov said.

In fact, it looks like that angry dialogue is just beginning, and where it will lead is anybody’s guess.