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by Liang Jing The medical reform program, having been “long-awaited” for three years, has finally come into the world. Had it not been introduced, China's power holders know, they would have been unable to face the common people or the world at large. Why has the medical reform program had such a difficult delivery? The power-holders might well be charged with incompetence, or indifference to people’s suffering. Had it been advanced earlier, however, wouldn’t it have been more to their political advantage? What were the problems causing the decision-makers to drag things out so long? A mainstream explanation in China’s media is that the difficulties with the medical reform program were due to stalemate in government and struggles over departmental interests and power. Wen Jiabao is unwilling to accept this explanation because it implies dereliction of duty and incompetence on his part. “Most difficult and most important, I think, is the reform of public hospitals. Because this reform involves a lot of hospitals in urban and rural areas, we lack experience, and need pilot projects” has been his line. [1] Wen’s explanation is disingenuous. Two issues in China's medical reform have never made sense to me. First, given that officials know so little about medical reform and place their departmental interests and power struggles above the public interest, why not learn from the majority of countries and establish an independent reform body, employing reputable experts, directly responsible to the decision-makers, to design the medical reform program? Second, why not hasten to get rid of the seriously defective “growing medicine by sale of drugs.” Delay has been so long that the defects have in the past three years become even more rampant, not only wasting resources, but also forcing more "good girls to become whores." More doctors have come to rely more recklessly on “big prescriptions”, unneeded examinations and operations to make a living. The public health care system is China's national disgrace; not only is it the most inequitable in the world, but also the most wasteful, because the interests of doctors have been driven into complete opposition to the interests of the community. Without overcoming their scruples and writing big prescriptions, or unnecessarily examining and operating on their patients, they couldn’t survive. This issue came to light years ago and its great harm is very clear. Why then can’t it be solved? The economic logic of solving the problem is uncomplicated, namely separating medicine from drug prescription, so that doctors get a reasonable level of income directly from their service charges, without forcing patients to take medicine, or have unnecessary tests and surgery. Why must China’s rulers pull doctors down into a quagmire of moral failure? I realize now that the logic of pulling doctors down into such a quagmire is the same as for teachers—an inherent survival need of the legitimacy-deficient CPC regime. The difficulty of medical reform, as the CPC leaders intuitively recognize, is that separating medicine from drug prescription requires hospitals to be self-governed, and medical staff asked to raise their moral discipline and self-respect. Once highly public institutions like health care and education gain autonomy however, and professionals gain a solid foundation of personal independence and dignity, it will subvert the concepts of governance of today’s China, exacerbating the regime's crisis of legitimacy. Why do I say this? What is the structure of governance China now? As some Chinese intellectuals have begun to realize, the present system of governance in China is a rare one in human history, different from traditional absolute monarchy, but also from modern strong totalitarian dictatorships like those of Hitler or Stalin, though similar to that of the Brezhnev era; one which consciously safeguards the interests of the CPC’s bureaucratic system. To make matters worse, China's system, in which only the servile can rise, is incapable of producing a Mikhail Gorbachev. Believers in the philosophy of servility are good at taking advantage of what is base in human nature; it’s a big problem they them should be running the country, but still more serious is to systematically. Post-Tiananmen China completed precisely this transformation. In absolute monarchies, the emperor at least is not a lackey, but acts on the motive of his dynasty ruling the land. While employing lackeys it cannot wholly depend on them, lest the society completely go to pieces. Only by understanding this can one understand how ancient China could maintain official, scholarly and medical ethics much higher than those of today. In terms of China's experience over the past two decades, the reach and social destructiveness of governing by promoting the servile has been unprecedented. The evil trend in this governance system, which is difficult to stop, drags everyone down with it. People have long been aware of the moral disaster taking place in China, and hence have predicted on the basis of historical experience that China will soon collapse, but such predictions have failed, not only has China failed to break down because of its moral collapse, it has indeed “risen.” Where did these prophets get it wrong? They underestimated the ability of governing by promoting servility to co-opt everyone in serving their own interests, at the expense of the weak, of future generations and of the environment. Now, having seen this point, some intellectuals believe that China is entering a long-term darkness. I’m not so pessimistic, but am unclear where lies the moral fulcrum to support the Chinese people in rising and reversing these evil trends. [1] “Wen Jiabao: yigai zui nan zui zhongyao de shi gongli yiyuan gaige” [ Wen Jiabao: the most difficult and most important medical reform is of public hospitals], Xinhua wang, 23 March 2009 [ “温家宝：医改最难最重要的是公立医院改革”， 新华网，2009年3月 23日 (http://topic.rbc.cn/09zt/jdxyg/glyy/200903/t20090319_1171596.htm). Translated by David Kelly China Research Centre University of Technology SydneyLiang Jing © Copyright 2009 by Boxun News Top of Page |
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