"That's all very well, but how many family doctors would you need? It simply doesn't fit into the system of...free universal health service."
"It'll fit into a universal national health service, but it won't fit into a free health service," said Oreshchenkov, rumbling on and clinging confidently to his point.
"But it's our greatest achievement, the fact that it's a free service."
"Is this in fact such a great achievement? What does 'free' mean? The doctors don't work for nothing, you know. It only means they get paid out of the national budget and the budget is supported by patients. It isn't free treatment, it's depersonalized treatment. If the patient kept the money that pays for his treatments, he would have turned the ten roubles he has to spend at the doctor's over and over in his hands. He could go to the doctor five times over if he really needed to."
"But he wouldn't be able to afford it?"
"He would say, 'To hell with the new drapes and spare pair of shoes. What's the use of them if I'm not healthy?' Is it any better as things are now? You would be ready to pay goodness knows how much for a decent reception at the doctor's but there's no one to go to get it. They all have their schedules and their quotas, and so it's 'Next patient, please.' As for the clinics that do charge fees, the turnover's even faster than the others. Why do people go there? Because they want a chit or certificate or sick leave or an invalid's pension card. The doctor's job is to catch the malingerers; patients and doctors are like enemies. Do you call that medicine? Or take actual drugs and medicine, for instance. In the twenties all medicines were free. Do you remember?"
"Is that right? Yes, I think they were. One forgets."
"You'd really forgotten had you? They were all free of charge, but we had to give it up. Do you know why?"
"I suppose it must have been too expensive for the government," said Dontsova with an effort, closing her eyes for a short while.
"It wasn't only that, it was also that it was extremely wasteful. The patient was bound to grab all the drugs he could since they cost him nothing and as a result he threw half of them away. Of course I'm not saying all treatments should be paid for by the patient. It's the primary treatment that ought to be."
As the number of PCP's needed is a current issue as well, I thought it apropos.
It is also a proposal that is not even on our health-care map: that the patient pays for primary care and medicines, but hospital and specialist services are paid for by the government.