in Esperanto
Chapter 5: SKETCH OF COMMUNIST SOCIETY -- WELFARE
6.1. Community-centered medical system
Along with the pension anxiety, the medical crisis that worsens access to medical care symbolizes the fluctuations of the capitalist welfare state. Medical shortages are a common cause of concern for countries with a high public burden of medical expenses. On the other hand, in underdeveloped countries with poor public finances, it is impossible to spread public medical care in the first place, and the absence of medical care is the norm.
Putting aside various technical factors, medical difficulties and lack of medical care are fundamentally medical finances, or in other words, money problems. The only way to recover from the medical difficulties is to keep low-income and poor people away from medical care by raising the patient burden rate of public medical care (in other words, shifting to self-pay medical care) and increasing medical insurance premiums. As such, it becomes equivalent to no medical care.
In contrast, a communist society freed from the destabilizing factor of financial resources would provide a more efficient and fair medical system. Various systems are conceivable for communist medical care. For example:
First of all, the front line of regional medical care, which is the pillar of medical care, will be handled not by the commune, but by the regional area, which is a wider intermediate municipality, so as not to place an excessive burden on the commune. At this level, in addition to operating public hospitals that serve as regional medical bases, public clinics will also be opened in depopulated areas.
On the other hand, conventional private hospitals and clinics will also conduct medical care under public supervision as registered medical institutions at the regional level. However, the qualifications of practitioners and the oversight of the quality of care in private hospitals will be more stringent.
In the field of emergency care, it is also possible to set up emergency departments with well-staffed staff at all base hospitals in the region, without worrying about financial resources, and are capable of accurate triage.
On the other hand, more advanced treatment for specific diseases and treatment and research for intractable diseases that cannot be handled by ordinary hospitals are the role of specialized hospitals in provincial areas, quasi-zones, or zones.
6.2. Planned allocation of doctors
On the other hand, communism should greatly solve the problem of the uneven distribution of doctors, which is both the cause and the result of the lack of medical care. This is because in communist medicine, the planned placement of doctors is a very natural measure.
In other words, excluding specific specialists with particularly advanced knowledge and skills, general physicians are first registered for each provincial area, and then, in order to avoid excess or deficiency, they will be placed in each hospital in a well-balanced manner according to the medical needs of each regional area.
In principle, physicians in private hospitals and practitioners who are approved with extremely rigorous qualifications will also be part-time or part-time regional medical public servants, and will be included in regional physician placement plans as necessary. In a communist society, private hospitals and practitioners are no longer profitable businesses, but become volunteers. Therefore, the difference from public hospitals and clinics will become relative, and their public character will become clearer and more sophisticated.
6.3. Role of Public Health Centers and Pharmacies
In a communist society where the monetary economy is abolished, it is impossible for any medical institution (including private hospitals and clinics) to bear the burden of medical expenses on patients. As a result, there will be no need for a subsidy system such as public medical insurance. If this is the case, conservative Americans who dislike the public medical insurance system will surely be delighted.
This free supply principle is the same as for all other goods and services. However, if such a "medical paradise" is realized, there may be concerns that hospitals may be overwhelmed with patients.
In that regard, in communist medical care, public health centers provide comprehensive preventive services from the perspective of disease prevention, such as initial diagnosis through health consultations and advice on lifestyle habits. It will serve as a bulwark to prevent hospitals from flooding with mildly ill patients.
In addition, pharmacies will also function as drug therapy stations, not drug supermarkets like those under capitalism, but facilities for certain diagnoses and prescriptions for mild cases. This will be achieved by reestablishing pharmacists as pharmacy experts independent of physicians.
6.4. Scientific and fair pharmaceuticals
Here I would like to touch on the issue of drug development, which is inseparably linked to the medical system. It is a well-known global phenomenon that drug development is held in the hands of huge pharmaceutical capital under a capitalist economy. What is happening as a result?
One is the control of medical care by pharmaceutical capital. In other words, they are forcing treatment with new drugs on the medical community through human experiments called clinical trials.
Originally, drug clinical trials should be conducted neutrally, scientifically, and humanely, but in reality, medical scientists who receive research funding from pharmaceutical capital cooperate in a substantial way. As such, the conclusions are often even manipulated in favor of pharmaceutical capital. Even worse, it goes as far as putting the cart before the horse, creating a new disease name for new drug development.
As a result, even well-meaning general doctors who are unaware of the circumstances will prescribe drugs of dubious efficacy or even harmful drugs. Even if serious drug hazards arise from that, the pharmaceutical capital will not take legal responsibility easily.
In contrast, under communism, as mentioned in Chapter 2, pharmaceuticals are handled collectively by the Pharmaceutical Organization, one of the production business organizations, which are socially owned enterprises, and are managed separately from the general economic plan. Clinical trials are conducted in a scientifically rigorous and humane manner by a testing institution that is completely independent of the business organization. In addition, a drug monitoring agency will be established to check side effects of all drugs and have strong regulatory authority, such as discontinuing manufacturing.
Eventually, the pharmaceutical industry would be integrated at the global level, and world-class pharmaceuticals and drug distribution – free of charge, of course – would be controlled under the oversight of specialized agencies such as today's World Health Organization (WHO). By doing so, we will see a solution to the problem that low-cost distribution of AIDS treatment drugs in less developed countries such as African countries suffering from the AIDS epidemic is hindered by the patent barrier of pharmaceutical capital.
