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Decomposition of medicine: bureaucrats become millionaires, doctors become poor

Catastrophic processes take place in Russian medicine, which in the end will completely destroy it.

The class stratification of nomenclature and plebs in science, education and medicine began not 5, but 15-20 years ago. In the 90s, the directors of research institutes and university rectors realized that they were landlords of profitable real estate and their incomes no longer depended on their main activity. In the zero years, they learned to earn money on paid expert examinations of the world pharmacy and protect the “commercial segment”. Nowadays, they have known the joy of distribution and state security, which began to be distributed in the right hands. As a result, they became at the same income level with top officials and middle-class businessmen. But unlike them, they also gained administrative and political weight.

The catastrophic events taking place recently on the medical front, according to the Moscow blogger Gleb Kuznetsov, serves as proof that the stratification of society inevitably leads to its decomposition:

“Today, the staff of the next medical institution in our vast country threatened with dismissal if they did not finally begin to pay overtime work under the law. This time in Perm. At the Oncology Center, doctors made a schedule of their dismissals, "so as not to jeopardize the lives of patients." The ministry accused them of violating "ethics and deontology", and the commission sent completely sided with the administration. There is nothing unexpected.

But I caught myself thinking that we were missing one very important and seemingly lying logic of the conflict in the Cancer Center, and in Tagil some time ago, and in Perm today, and according to my sensations – everywhere else. Really everywhere.

This is class logic. The joke is that healthcare administrators and the doctors they administer suddenly began to belong to different social classes. Here we see doctors on YouTube records showing salary receipts with amounts of several tens of thousands of rubles.

And here we look at the declarations of their dear bosses. A hectare in Greece with a house, an apartment with a minor son in the same place. Amounts of many millions of rubles of official income and a suddenly arising payment of 70-100 million from the head or his wife. (I myself was surprised, but it turns out that once every few years many heads of budgetary organizations turn out to be the happy owner of a legally declared million euros with a hook).

The heads of institutes, doctors, professors, people who have never been anywhere, except in the civil service, are official dollar millionaires. An official from the Ministry of Health, who heads the commission to investigate the innumerable crimes of oncologists, declares 11 million for 2018. She is the head of the department, her whole life in the civil service. It is unlikely that the so-called "civilized world" is a country where the head of the department – the official is not low, but not high, the ink soul – has 150 thousand euros per year. Moreover, with our 13% tax, which on high incomes acts very beneficially in comparison with Europe and its progressive taxation.

Interestingly, the explosive increase in the cost of administering healthcare and the social sphere began around 2014-2015. And for 3-4 years, the regular income of administrators (I do not take 70-100 million accordion legalizations) increased two or more times. Those people who showed RAV4 in 2013 today have a Mercedes fleet without changing the name of their position.

So we have come to what we have come to. At a table against each other — in Moscow, Tagil, Perm, and so on — are not sitting colleagues, not people doing one thing, but the most class enemies in the hardcore Marxist sense. The dialogue between the Director of the Center and Professor Mentkevich is not a debate about the future of the profession and their general medical institution, it is a dialogue between the Manchester manufacturer and the trade union leader in 1920. So far, the trade unionist, however. While talking about working conditions and remuneration for it, and not making political demands.

The income gap between specialists and administrators is not just bad for the state of healthcare and the social sphere in general. The budget oligarchy, which grew on two pillars – the ability to independently manage salaries within their institutions and access to public procurement – begins to create political risks, as we see on the same Tagil.

The convenient explanatory structure – "pension reform has undermined the confidence of state employees in the authorities" – does not explain anything and only obscures the understanding. The issue is not reform, but the fact that income inequality is reproducing at an accelerating pace at the level of decisions of heads of budget organizations.

And the solution to the question can only be political. It is necessary to revise the principles of salary allocation in budgetary institutions, limiting the appetites of superiors and its clientele and giving specialists access to increase income.

The atmosphere needs to be healed quickly and whenever possible publicly sharply! ”

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