It seems to me that the following four points represent the most characteristic features of the Soviet health system: (1) Medical service is free and therefore available to all. (2)The prevention of disease is in the foreground of all health activities. (3) All health activities are directed by central bodies, the People’s Commissariats of Health, with the result that (4) health can be planned on a large scale. . . .
The socialist state . . . declar[ed] that the people’s health is . . . essential for the welfare of a nation. If a society is to function successfully, it requires healthy members. Besides, health is one of the goods of life to which man has a right. Wherever this concept prevails, the logical consequence is to make all measures for the protection and restoration of health accessible to all, free of charge. Medicine . . . becomes a public function of the state. . . .
On November 13, 1917 five days after the Revolution, the Soviet government issued the following decree:
The Russian proletariat has placed on its banners ‘Full Social Insurance for Wage Workers’ as well as for the city and village poor. The tsarist government of landowners and capitalists . . . failed to satisfy the demands of the workers in this respect.
The Workers’ and Peasants’ Government . . . announces to the working class of Russia and to the city and village poor that it will immediately prepare decrees on social insurance in accordance with the ideas of the workers.
Insurance for all wage workers without exception, as well as for the city and village poor.
Insurance to cover all forms of disability, such as illness, injury, invalidism, old age, maternity, widowhood, orphanage, as well as unemployment.
The total cost of the insurance to be borne by the employer.
Full compensation in case of disability or unemployment.
The insured to have full control of the insurance institutions. . . .
There can be no doubt that the Soviet system of social insurance is infinitely superior to any insurance system in capitalist countries. The costs are what they should be, part of the cost of production. The benefits are infinitely greater than under any other insurance scheme. The worker is guaranteed complete medical service, he is given social security. He is entitled to it because, after all, he is creating the values that make such a scheme possible. . . .
Another very characteristic feature of Soviet medicine is that it has done away with the traditional distinction between preventive and curative medicine. As a matter of fact the entire system is built upon the idea of prevention. Prophylaxis is in the foreground of all medical considerations. This is expressed in the programme of the Communist Party: ‘The Communist Party of the Soviet Union will base its public health policy on a comprehensive series of health and sanitary measures aiming to prevent the development of disease,’ and the statute of 1921 regulating the activities of the Russian Commissariat of Health made that body ‘responsible for all matters involving the people’s health, and for the establishment of all regulations promoting it, with the aim of improving the health standards of the nation, and of abolishing all conditions prejudicial to health.’ . . .
The general idea is to supervise the human being medically, in a discrete and unobtrusive way, from the moment of conception to the moment of death. Medical workers and medical institutions are placed wherever anyone, in the course of his life, is exposed to dangers. Medical supervision begins with the pregnant woman and the woman in childbirth, proceeds to the infant, the pre-school and school child, the adolescent, and finally the man and woman at work.
This is an entirely new medical attitude. It is the result of the new social order and of its underlying philosophy. It is socialist medicine. Soviet society is a collective society without classes, in which all members tend toward one common goal. It is like one great organism, harmoniously built. If one member suffers, this affects and harms the whole organism which obviously will protect itself against all such occurrences. Medical service becomes a function of the collective. And this is what counts. . . .
But more than this: all government agencies are allies. They all work toward the same end. There is no mystical goal to attain, there are no nationalistic or imperialistic programmes to fulfill. The state has but one purpose: to promote the welfare of the people, of all the people, without distinction; to raise the material and cultural standard of the population; to liberate man from the bonds of poverty, of ignorance and disease. This and only this justifies the existence of the state.
In such a state the health programme is one part of the great programme of the nation. The physician is the specialist who knows about disease, and he works toward the fulfillment of the general plan side by side with the other civil servants. . . .
In June 1918 the People’s Commissariat of Health was established. For the first time in the history of medicine a central body was directing the entire health work of a nation. The first People’s Commissar of Health was Nikolai Alexandrovich Semashko, a close friend of Lenin. Born in 1874 he had led the life of the revolutionaries, had been arrested and exiled, had emigrated in 1907, had lived and worked in Geneva and Paris with Lenin, preparing himself for the coming tasks. He returned to Russia after the February Revolution and was instrumental in the creation of the new Commissariat at the head of which he remained for twelve years.
The task was gigantic. The entire public health service had to be reorganized along new lines. The whole nation had to be mobilized to fight the devastating epidemics. Workers’ Committees to combat epidemics were created in the cities and larger villages as early as 1918. Their task was to inspect lodgings and public institutions, to teach people cleanliness, to distribute soap, to fight the louse. The Party, the Trade Unions, Women’s Organizations, and Youth’s Organizations, all these groups joined in the struggle against disease. It was a fight not only for health but for socialism as well. As Lenin once said in 1919: ‘either socialism will defeat the louse, or the louse will defeat socialism.’ Socialism was victorious and it was due to the combined efforts of the whole working population fighting under the leadership of the Commissariat of Health. . . .
In spite of the adverse conditions of the early years, the systematically planned work of the Commissariat began on the very first day and the foundations of socialist medicine were laid in the stormy years of the Civil War. . . . A network of medical stations was created giving medical service to mother and child and to the working population in town and country. The sanatoriums and health resorts, once the privilege of the wealthy few, were turned over to the people. . . .
The Commissariat of Health controlled in the beginning the health work of the entire territory that stood under Soviet jurisdiction. During and after the Civil War national Soviet republics were created and on December 30, 1922 the first All-Union Congress of Soviets proclaimed the establishment of the Soviet Union. The Constitution ratified in 1923 established Health Commissariats in all the constituent republics. . . .
In capitalist countries the health work is necessarily haphazard. The various health departments obviously have their programmes and state or private health organizations may decide to start a campaign to fight a definite group of diseases. But these efforts are not co-ordinated and there is as much difference between a capitalist and Soviet health programme as there is between a capitalist and Soviet budget. Besides, curative medicine escapes control and, therefore, cannot be planned. In the Soviet Union 5-year plans and yearly plans are established. The entire work of the nation is planned and the health plan is one part of the general plan. . . . When I was in Russia in 1936, the third Five-Year Plan was just being prepared, and wherever I went I found the people busily engaged in working on their plan.
The plans are discussed not only among the specialists, that is the medical workers, but also in the factories and farms, among the working population at large. It is the health of the people that is concerned and it is obvious that no health plan can be carried out without their active co-operation. Therefore, it is only logical that their voice should be heard. . . .
The Soviet Union was the first country that ever attempted to socialize medicine, the first that ever considered the protection of all the people’s health a public function of the state. Much remains to be accomplished in the public health field, and no one knows it better than do the men who are responsible for the work. I, too, am well aware of present deficiencies in Soviet medicine. There is still a serious shortage of physicians, of all categories of medical personnel, and of medical facilities, particularly in rural districts. There are still poor institutions, poorly equipped and poorly managed. In Russia, as elsewhere, you may find bureaucrats and fools and people who like to take the way of least resistance. But these shortcomings are seen and admitted freely. They are discussed openly and means and ways are sought to overcome them—not at some uncertain time in the future, but at a definite date according to plan. . . .
Nobody can deny that Soviet medicine, in the short period of twenty years and under most trying circumstances, has stood the test and has created powerful measures for the protection of the people’s health. It has demonstrated that socialism works in the medical field too, and that it works well, even now, in the early beginnings of the socialist state. It is a system that is full of promise for the future—for a very near future. . . .
I have come to the conclusion that what is being done in the Soviet Union to-day is the beginning of a new period in the history of medicine. All that has been achieved so far in five thousand years of medical history, represents but a first epoch: the period of curative medicine. Now a new era, the period of preventive medicine, has begun in the Soviet Union.