by multi-tiered i think they mean accessibility to/affordability of different levels of treatment, complexity wise
to use a somewhat large country (brazil) with universal health care (public option called SUS) as an example: we have it on paper, but in practice we lack doctors and it's really, really hard to execute it in "deep brazil" (mainly the countryside) - existing doctors don't want to go there, there's barely any useful infrastructure, etc
another issue is that, when it comes to specialized treatments and exams, where the technology is much more expensive, supply often doesn't meet demand
to make things worse, these technologies also need technical training to be used, so sometimes we have the machines but no one who can properly and safely use them
now, this is for a somewhat large country with a rural population of 14%; imagine a massive country like china, with a rural population of 40% and vastly underdeveloped regions more to the center (as they had been focusing mostly on the coastal cities until recently)
and still they already have 95% coverage for basic treatment, so i guess they're doing ok? i mean, my main point is that i wouldn't criticize this without really knowing in detail what they're doing wrong, because in my country we literally have universal health care in our constitution, but regardless of our printed words our actual conditions haven't allowed us to make this a reality
This is all well and good but I think what we ignore here is that China had a system of universal healthcare before. It was dismantled, I think frankly quite haphazardly, and suddenly talk of that old system is dismissed out of hand as unachievable. And it was not a joke medical system either! It accomplished huge strides in infant care, women's morality, basic health outcomes etc. All for free and entirely uncommodified. Whereas now the real issue is that for many people even if 'access' exists if is curtailed by hukou, employment status, quality of care in shitty public hospitals, doctors having extremely limited time to see patients, etc. There is a whole phenomenon of mobs beating doctors up because they prescribe medicine that is pushed by insurance sponsors (like the US lol). Saying that things will change slowly ignores how quickly the state was able to change things before, which in my opinion is just a matter of a vastly changed political economy.
the system during the mao period managed to do that really well - this is doable, since whenever the material requirements are low enough you can change things through sheer force of will, as the barefoot doctors certainly did and got huge gains from it
but it wasn't universal healthcare - or do you think the barefoot doctors had access to the latest chemotherapy medicines? radiotherapy machines? MRIs? respirators, ICUs, and so on
unless you believe traditional chinese medicine can take care of this stuff, which it obviously can't, there are very real material limitations and ideals can only take us as far as they allow us to
my criticism to the reforms was shutting off free access to basic treatment in the short term, because this, as you said, could have easily been provided - but i haven't read their justifications for it
You'd actually be surprised as to what level of care was conducted by the barefoot doctors. Also I might point out that there is nothing in the definition of universal healthcare that suggests you need to have the very advanced equipment (not sure how much of that was largely available in the 1950s anyway). Universal healthcare is simply a system where all citizens are guaranteed easy access to healthcare. FYI the Maoist regime didn't care for 'traditional Chinese medicine' (a nonsense term btw) but it is actually being significantly more espoused TODAY and even by government sources.
The justification as for why basic treatment's access was changed was because the nature of health care largely changed. It stopped being solely the purview of the state. Private actors were allowed in, provincial governments felt they could let budgets slide. You can say that ah they couldn't have gotten better tech if not for this budgetary change but I mean most government run healthcare programs would disagree.
Universal healthcare is simply a system where all citizens are guaranteed easy access to healthcare
i understand, but if you can't afford specialized treatment that means people won't have access to it
so how universal is that access, really?
traditional Chinese medicine’ (a nonsense term btw)
what do you mean by that? TCM has a very identifiable theoretical basis for each of its branches, i don't see the issue with the term
but it is actually being significantly more espoused TODAY and even by government sources.
this wasn't really my point, and i don't know how much more espoused it is today
but it's still far more incentivized by the government than i deem ideal, that's for sure. i don't know if they've just decided these practices are so deeply rooted in their culture that they're impossible to suppress, and that it was better to just cave in and regulate it instead, but it's a waste of resources that could be used for stuff that actually works
The justification as for why basic treatment’s access was changed was because the nature of health care largely changed. It stopped being solely the purview of the state. Private actors were allowed in, provincial governments felt they could let budgets slide. You can say that ah they couldn’t have gotten better tech if not for this budgetary change but I mean most government run healthcare programs would disagree.
this makes sense, do you have a source i could look at? especially for the effectiveness of government run healthcare programs
I mean the question about specialized treatment is a valid one but again I am not sure how valid it is in the face of the Maoist project being dead for 50 years. We cannot really definitively say that the latest advancements would not have been procured by the state later on, and again I am not sure that we can sya the state of the field today is one where every villager has access to an MRI machine. There are certain treatments one cannot get in the UK under free healthcare today, but you can get them in the US if you pay a shit ton of money. The UK still has 'universal' healthcare, though, as it can offer some treatment of the illness even if not the specific, best one. The US will give it to you if you are willing to pay a shit ton of money. I would wager we would both take the former.
TCM is a moniker that actually a lot of Sinologists really get irritated at. My apology if I did as well. We don't like it because it projects the idea of a single or even single continuum of traditional practices that were part of a body of scientific or pseudo-scientific knowledge in pre-modern China. But no such body existed. Much of the stuff was actually invented after the fact, many of the medicinal prescriptions were practiced by people that were very much at odds with each other, and the idea of medicine in say Qing-era China was radically different. TCM is very much an invented category for what is largely a set of practices that were made traditional, rather than really representing 'tradition'.
It is more 'espoused today' in the sense that, again, Maoist era officials hated the idea of anything 'traditional', invented or not, and strictly forbid 'superstitious' practices like qigong etc. Again there is nothing about these practices that are deeply rooted in a singular 'Chinese culture' because that singularity is actually a lot more hetereogenous than people give it or credit for, and a lot of these supposedly popular 'ancient' practices were only made popular after the fact.
If you want a good source on healthcare in China today vs the Maoist era, Martin Whyte has written a lot on this.
We cannot really definitively say that the latest advancements would not have been procured by the state later on
we can't definitively say anything regarding hypotheticals in general, right?
and it's also very hard to compare because, for instance, i could use your example to say "see, even the UK, one of the richest countries on earth, has been unable to provide certain specialized care for its citizens", but that leaves out the fact that they're a capitalist country, which implies different priorities for the government; or i could try to be more fair and mention how cuba, which has a similar per capita GDP and a socialist government still has trouble acquiring medicines and specialized equipments, but that in turn leaves out the embargo and how this relates to the fact that most of those are produced by american companies
but i think that would be pointless as i'm not arguing the current healthcare system is better: but that it has the potential of being such, whereas i don't see this being the case for the previous one
TCM is a moniker that actually a lot of Sinologists really get irritated at. My apology if I did as well.
it's cool, if you did i didn't notice it
i get what you mean about TCM. i'll try to be more specific next time
If you want a good source on healthcare in China today vs the Maoist era, Martin Whyte has written a lot on this.
Yes but I think the lack of definitiveness is what makes history so compelling to me! There were potentials for something different, and we cannot erase them. I guess ultimately my stance on this is that I do not genuinely believe that the CCP introducing market forces into healthcare was necessary for good health outcomes (in fact, there is also a lot of literature on how access to certain technologies such as MRIs also does not wholly necessitate better health outcomes). Whole other sectors of the economy (defense, energy) were shielded from marketization due to national interests. Why couldn't healthcare also have been shielded? Important to note that the UK may be a rich country but the NHS is breaking down because the Tory party doesn't want to fund it. China has the will to fund lots of infrastructure projects for example. Money could be found for an expansion of public healthcare as well, but Whyte argues the issue is that China's aging society plus the total lack of any welfare infrastructure means that the costs would be tremendous (along the lines of Japan, but without the benefit of Japan being an already wealthy society). That is a political economical deficiency that was caused, he argues, by the one child policy and also macroeconomic policy in the 80s and 90s that left poor provinces at the mercy of the market.
So while I agree that a one to one comparison of the healthcare systems of Maoist and post Mao China isn't the most helpful, I also don't share your optimism about the current model getting much better, simply because I do fundamentally believe that the sector could have been left decommodified to some degree or at least wholly state owned.
it's 5 years though
by multi-tiered i think they mean accessibility to/affordability of different levels of treatment, complexity wise
to use a somewhat large country (brazil) with universal health care (public option called SUS) as an example: we have it on paper, but in practice we lack doctors and it's really, really hard to execute it in "deep brazil" (mainly the countryside) - existing doctors don't want to go there, there's barely any useful infrastructure, etc
another issue is that, when it comes to specialized treatments and exams, where the technology is much more expensive, supply often doesn't meet demand
to make things worse, these technologies also need technical training to be used, so sometimes we have the machines but no one who can properly and safely use them
now, this is for a somewhat large country with a rural population of 14%; imagine a massive country like china, with a rural population of 40% and vastly underdeveloped regions more to the center (as they had been focusing mostly on the coastal cities until recently)
and still they already have 95% coverage for basic treatment, so i guess they're doing ok? i mean, my main point is that i wouldn't criticize this without really knowing in detail what they're doing wrong, because in my country we literally have universal health care in our constitution, but regardless of our printed words our actual conditions haven't allowed us to make this a reality
This is all well and good but I think what we ignore here is that China had a system of universal healthcare before. It was dismantled, I think frankly quite haphazardly, and suddenly talk of that old system is dismissed out of hand as unachievable. And it was not a joke medical system either! It accomplished huge strides in infant care, women's morality, basic health outcomes etc. All for free and entirely uncommodified. Whereas now the real issue is that for many people even if 'access' exists if is curtailed by hukou, employment status, quality of care in shitty public hospitals, doctors having extremely limited time to see patients, etc. There is a whole phenomenon of mobs beating doctors up because they prescribe medicine that is pushed by insurance sponsors (like the US lol). Saying that things will change slowly ignores how quickly the state was able to change things before, which in my opinion is just a matter of a vastly changed political economy.
this is why i mentioned basic healthcare
the system during the mao period managed to do that really well - this is doable, since whenever the material requirements are low enough you can change things through sheer force of will, as the barefoot doctors certainly did and got huge gains from it
but it wasn't universal healthcare - or do you think the barefoot doctors had access to the latest chemotherapy medicines? radiotherapy machines? MRIs? respirators, ICUs, and so on
unless you believe traditional chinese medicine can take care of this stuff, which it obviously can't, there are very real material limitations and ideals can only take us as far as they allow us to
my criticism to the reforms was shutting off free access to basic treatment in the short term, because this, as you said, could have easily been provided - but i haven't read their justifications for it
You'd actually be surprised as to what level of care was conducted by the barefoot doctors. Also I might point out that there is nothing in the definition of universal healthcare that suggests you need to have the very advanced equipment (not sure how much of that was largely available in the 1950s anyway). Universal healthcare is simply a system where all citizens are guaranteed easy access to healthcare. FYI the Maoist regime didn't care for 'traditional Chinese medicine' (a nonsense term btw) but it is actually being significantly more espoused TODAY and even by government sources.
The justification as for why basic treatment's access was changed was because the nature of health care largely changed. It stopped being solely the purview of the state. Private actors were allowed in, provincial governments felt they could let budgets slide. You can say that ah they couldn't have gotten better tech if not for this budgetary change but I mean most government run healthcare programs would disagree.
i understand, but if you can't afford specialized treatment that means people won't have access to it
so how universal is that access, really?
what do you mean by that? TCM has a very identifiable theoretical basis for each of its branches, i don't see the issue with the term
this wasn't really my point, and i don't know how much more espoused it is today
but it's still far more incentivized by the government than i deem ideal, that's for sure. i don't know if they've just decided these practices are so deeply rooted in their culture that they're impossible to suppress, and that it was better to just cave in and regulate it instead, but it's a waste of resources that could be used for stuff that actually works
this makes sense, do you have a source i could look at? especially for the effectiveness of government run healthcare programs
I mean the question about specialized treatment is a valid one but again I am not sure how valid it is in the face of the Maoist project being dead for 50 years. We cannot really definitively say that the latest advancements would not have been procured by the state later on, and again I am not sure that we can sya the state of the field today is one where every villager has access to an MRI machine. There are certain treatments one cannot get in the UK under free healthcare today, but you can get them in the US if you pay a shit ton of money. The UK still has 'universal' healthcare, though, as it can offer some treatment of the illness even if not the specific, best one. The US will give it to you if you are willing to pay a shit ton of money. I would wager we would both take the former.
TCM is a moniker that actually a lot of Sinologists really get irritated at. My apology if I did as well. We don't like it because it projects the idea of a single or even single continuum of traditional practices that were part of a body of scientific or pseudo-scientific knowledge in pre-modern China. But no such body existed. Much of the stuff was actually invented after the fact, many of the medicinal prescriptions were practiced by people that were very much at odds with each other, and the idea of medicine in say Qing-era China was radically different. TCM is very much an invented category for what is largely a set of practices that were made traditional, rather than really representing 'tradition'.
It is more 'espoused today' in the sense that, again, Maoist era officials hated the idea of anything 'traditional', invented or not, and strictly forbid 'superstitious' practices like qigong etc. Again there is nothing about these practices that are deeply rooted in a singular 'Chinese culture' because that singularity is actually a lot more hetereogenous than people give it or credit for, and a lot of these supposedly popular 'ancient' practices were only made popular after the fact.
If you want a good source on healthcare in China today vs the Maoist era, Martin Whyte has written a lot on this.
we can't definitively say anything regarding hypotheticals in general, right?
and it's also very hard to compare because, for instance, i could use your example to say "see, even the UK, one of the richest countries on earth, has been unable to provide certain specialized care for its citizens", but that leaves out the fact that they're a capitalist country, which implies different priorities for the government; or i could try to be more fair and mention how cuba, which has a similar per capita GDP and a socialist government still has trouble acquiring medicines and specialized equipments, but that in turn leaves out the embargo and how this relates to the fact that most of those are produced by american companies
but i think that would be pointless as i'm not arguing the current healthcare system is better: but that it has the potential of being such, whereas i don't see this being the case for the previous one
it's cool, if you did i didn't notice it
i get what you mean about TCM. i'll try to be more specific next time
right, putting it on the list
Yes but I think the lack of definitiveness is what makes history so compelling to me! There were potentials for something different, and we cannot erase them. I guess ultimately my stance on this is that I do not genuinely believe that the CCP introducing market forces into healthcare was necessary for good health outcomes (in fact, there is also a lot of literature on how access to certain technologies such as MRIs also does not wholly necessitate better health outcomes). Whole other sectors of the economy (defense, energy) were shielded from marketization due to national interests. Why couldn't healthcare also have been shielded? Important to note that the UK may be a rich country but the NHS is breaking down because the Tory party doesn't want to fund it. China has the will to fund lots of infrastructure projects for example. Money could be found for an expansion of public healthcare as well, but Whyte argues the issue is that China's aging society plus the total lack of any welfare infrastructure means that the costs would be tremendous (along the lines of Japan, but without the benefit of Japan being an already wealthy society). That is a political economical deficiency that was caused, he argues, by the one child policy and also macroeconomic policy in the 80s and 90s that left poor provinces at the mercy of the market.
So while I agree that a one to one comparison of the healthcare systems of Maoist and post Mao China isn't the most helpful, I also don't share your optimism about the current model getting much better, simply because I do fundamentally believe that the sector could have been left decommodified to some degree or at least wholly state owned.
Richest man in China got there off health care and bottled water. Massively hoarded wealth off of basic necessities.
But the exploration is well supervised or something.