If you are thinking of traveling to Beijing, China for the 2008 Summer Olympics, consider what it might cost if you have a major medical emergency. To understand what is going on in China, and the United States for that matter, let’s step back a couple of thousand years and examine what happened during the Han Dynasty.
In 141 B.C.E., more than two thousand years ago, a new Han emperor came to sit on the Dragon Throne. His name was Wudi. He ruled for fifty-four years. Wudi believed that all people should have the right to buy certain commodities and not be priced out of the market. He implemented government monopolies in certain critical areas like salt, alcohol and iron. Prices were controlled so anyone from a peasant to the most powerful war lord paid the same low price. The profit margin was tight and the merchants did not like that. Emperor Wudi believed that commodities that were essential to survival should not be included in the free market system because many of the people might not be able to buy what they needed.
After his death, a great debate known as the “Debate on Salt and Iron” took place. The end result was Wudi’s government monopolies were abolished. The poor could no longer afford many essential commodities. The rich grew wealthier. Soon after that, the Han Dynasty entered a period of stagnation sort of like what is taking place in America today where more than forty million Americans live without healthcare; the national debt has soared to more than ten trillion dollars, and families are losing their homes in huge numbers due to variable rate, limited term mortgages with balloon payments that can send you into orbit.
China loves most things American. All you have to do is visit China to see for yourself. McDonalds and Domino’s Pizza are considered gourmet restaurants. American clothing styles are the craze. Buick vans manufactured in China by General Motors seem to dominate the high end middle-class auto-market. Also, China appears to be using the United States as a model for medical care. The result being, like America, millions without medical care because of high costs.
After the Communists won China in 1949, health care greatly improved. Prior to that time, the life expectancy of the Chinese people was thirty-five years. By 2001, it was almost seventy-two years. The focus in China, then and now. is on putting prevention first which means to plan your lifestyle around healthy habits. That’s why early in the morning you can find many older Chinese outside exercising using the graceful, poetic movements of Tai Chi to insure health and longevity.
Of course, not everyone practices healthy habits since more than three hundred million Chinese smoke American cigarettes and obesity is a growing epidemic in China like it is in the United States. How could obesity not be a problem since the Chinese are having a love affair with American fast food?
Prior to the reintroduction of a free market economy in China, there were three basic areas of medical care during Mao’s time. The first and best medical care was provided to the proletarian working class, meaning workers and peasants. These people were provided free medical care even if most of it was substandard. My wife told me that Mao started a program called ‘bare-foot doctors’. This program was the backbone of rural health care in China. This meant that anyone could become a doctor. Mao told the people that if you wanted to be a doctor, you didn’t need to go to medical school. All you had to do was have the motivation to provide medical care to needy people and the government would support you and provide training like from a film. Imagine an illiterate peasant operating on a stomach tumor with acupuncture and a sharp knife with only a little medical training from an illustrated pamphlet or a film that may or may not have covered everything a medical doctor learns in the United States before she is allowed to practice medicine.
The second class of medical care went to people such as teachers, clerks and secretaries. These people were considered ‘friends’ of the working class, the proletariat. The only difference was that these ‘friends’ had to pay to get medical treatment. It was possible to face bankruptcy from one hospital stay even after everyone in the family donated their entire savings to help save a loved relation like a grandmother or grandfather.
The third class were termed enemies of the proletariat like former shop-owners, landlords and denounced intellectuals (like liberal arts professors). These people were denied treatment altogether.
Today, the system that was put into place by Mao no longer exists. Doctors and nurses are trained properly the same as in the Untied States. Since Mao’s death, in one of the greatest policy reversals of modern times, China dissolved medical care in its rural communities (gone were the bare-foot doctors), privatized vast areas of the economy and shifted public health resources toward the cities.
Their economic role model seems to have been President Ronald Reagan. During Reagan’s years in the White House, the U.S. saw a steep rise in the for-profit sector in medicine, in particular the for-profit hospital chains. Other Republican presidents like the first George Bush continued this push toward a for-profit, free market approach to health care. The results, like what is happening in China today, means that there is no room for the poor and uninsured and uninsurable to afford health care beyond what is considered basic like blood pressure tests and taking your temperature along with a bit of advice or a prescription that may or may not help. Many Americans don’t even get that much medical care so in that one way, China will be better than the United States.
Although China’s government has promised that by 2010, basic medical and health care will cover all rural residents, if someone becomes seriously ill and can’t afford medical care, he is out of luck. Under this basic medical system, subscribers are funded at a level of fifty yuan per person (twenty yuan from the central government, twenty from the local government and ten from the individual). For many peasants in rural areas this could mean as much as ten percent or more of their income would have go toward basic health care insurance. Many can’t afford that cost let alone the cost of health care for a serious health challenge. However, the rural people do not have a choice. The government forces everyone to pay his share.
Since the best doctors live in the major cities, the best equipped hospitals are in the cities too. If a peasant living in the countryside becomes seriously ill, he may have to travel a long distance through rugged terrain on foot or be carried by family and/or friends to seek needed care— if he has the money.
Medical care in China is all about money just like the United States. If you have money, you can buy the same medical care that exists in America. Money opens hospital doors and pays the rent for the surgeon’s scalpel. For most tourists, medical care costs less due to the yuan exchange rate of almost seven yuan for one American dollar. However, if a tourist doesn’t have access to easy money (credit or savings), she could be denied care equal to the best in the world.
It is also good to know that a Chinese hospital will pay more attention to foreign patients, because China wants to look good to outsiders. In China, most hospitals do not provide food. Family or friends bring food on a daily basis or the patient may starve. One summer while my wife was in China and I was here in the United States, she fell ill and ended up in a local Shanghai hospital. Since my wife was born in Shanghai (she is an American citizen), it was obvious that she would need a friend or family member to support her personal needs. I was several thousand miles away. There was a two week wait to be granted a visa.
A couple of phone calls later to a close friend living on America’s east coast brought one of my wife’s former grade school friends to her bedside. This old friend was someone that still lived in China. Food and personal care were taken care of on a daily basis after that by this old friend and her family. Someone was always by my wife’s side, and I could sleep easier. Just thinking of this incident is enough to bring tears to my eyes. It is possible that a foreign patient may actually be fed by the hospital, but the hospital can’t be counted on. If you plan to travel to China and do not have friends of family over there, plan for the unexpected ahead of time.
Also, when it comes to drugs, the government has factories in every province that manufactures drugs at a low cost. This is one commodity where the prices are controlled. For example, a bottle of antibiotics in the U.S. that costs $80 would cost $14 in China. That cost is still out of reach for many rural peasants living off only a hundred or more dollars a year (six or seven hundred yuan). Drugs are not part of basic care.
Basic care also does not include a stay in a hospital. A stay in a hospital in China would cost about $100 a night but in America more than a $1000. One hundred dollars is equal to the yearly earnings of hundreds of millions of Chinese.
If you want the best care money can buy, meaning the “American Standard”, it can cost you the same as you would have to pay in the United States. It is obvious that China is learning fast from America regarding the free market economic model and is ignoring the rest of the world’s attempt to cover everyone’s medical needs. In this way, America and China are walking hand-in-hand (except for drug costs).
A few years ago, some friends of ours accompanied us on a trip to China. The husband, a fellow teacher, ate something that made him violently ill. He suffered from a river of diarrhea and vomited endlessly. We checked him into a local Shanghai hospital where he stayed an entire day with an intravenous drip so he would stay hydrated. The costs at that time for all of the care he received including seeing a doctor (more than once) and having a nurse nearby at all times was a total of fifty American dollars.
In contrast, his wife overheard a conversation (our daughter translated) where a peasant woman did not have the money to pay to have a benign brain tumor removed that was going to keep growing until it killed her. The cost was only one hundred American dollars for this surgery. My friends were kind enough to pay for the surgery but not everyone in China will have someone like my American born friends to pay for this kind of medical care. By the way, this surgery would have cost more than twenty thousand dollars in the United States.
If you are going to travel to China as a tourist to see the country and possibly visit the 2008 Olympics in Beijing this August, make sure you have the money to pay for any medical emergency that comes up. Also, realize if you travel outside of the major cities, there may not be a hospital close enough to treat you if a major medical emergency happens. In China, cash is king. Maybe Emperor Wudi of the Han Dynasty had the right idea when he decided that certain necessary commodities and services should not be part of the private economic sector.
by Lloyd Lofthouse
author of “My Splendid Concubine”