January 28, 2011
Who Needs a Sputnik Moment?By Ion Mihai Pacepa
Never in my worst nightmares did I expect to hear the president of the United States give voice to a dream of building "our generation's Sputnik moment." For the privilege of becoming an American citizen some 32 years ago, I paid with two death sentences, both levied on me by one of those Soviet bloc countries that spawned the Sputnik era and later collapsed under its own weight. From my vantage point, ObamaCare now looms over us with disturbing reminders of the Soviet bloc's Sputnik-era health care system.
Last November, an overwhelming majority of Americans rebelled against ObamaCare, fearing that it would generate an outrageously expensive and ineffective bureaucracy which would destroy the excellent health care that we have proudly enjoyed until now. Our wealthy country thrives on a capitalist economy, and we are accustomed to measuring things in terms of cost and the quality of the product we get for our money. But this greatest nation on earth, where "We, the People" have always been masters of our own lives, has never experienced a Sputnik-style society, and therefore most Americans have trouble predicting the long-term consequences of a health care system run by a Sputnik-era bureaucracy. I've been there, and I know what would happen -- the future would be scientific stagnation and human degradation.
After I was propelled to the top of the bureaucratic ladder in the Soviet bloc, I saw with my own eyes how replacing a country's free-market health care with Sputnik-era bureaucracy drastically reduced the ability of my native Romania and the rest of the Soviet bloc countries to generate scientific progress. During the Sputnik era, the Soviet empire wielded an enormous medical and pharmaceutical bureaucracy, but it was never able to take legitimate credit for any of the 20th century's main medical inventions. Lacking the vitality nurtured by private ownership, individual incentive and free-market competition, that rigid and over-centralized health care community proved inherently incapable of generating any progress on its own.
The Nobel Prize for medicine tells the whole story in a nutshell. During the last century, the United States' free-market medical care system was rewarded with 72 Nobel prizes. The Soviet Union's socialized medical system got none. Zero. Zip. (Tsarist Russia did get one Nobel Prize for medicine in 1904, for Pavlov's conditional reflex theory.) To make up for its scientific impotence, the Kremlin ordered the bloc intelligence community -- of which I was a part -- to steal the West's medical and pharmaceutical technologies, to dress them up in indigenous clothes, and to present those clones as Soviet bloc creations.
Twenty-two years of my other life were spent supervising Romania's slice of the Soviet bloc scientific and technological espionage effort, and I know how difficult it was for even those stolen technologies to elbow their way through all the bureaucratic layers of government that had to approve their birth. A complete project for a penicillin factory stolen from West Germany in the late 1950s, when I was chief of Romania's intelligence station there, took well over ten years before the bureaucrats granted approval for it to be used to build a "Romanian" penicillin factory (in the town of Iasi).
Bureaucracy, like cancer, is a disease where a formerly useful entity spins out of control and transforms itself into a tumor that eventually kills its host. There is no better way to visualize the long-time disaster -- and yes, tragedy -- that a Sputnik-style health care system could generate than to watch the movie The Death of Mr. Lazarescu. This 2007 Romanian film, which won more than twenty international prizes, was inspired by the heartbreaking true story of Constantin Nica, a retired Romanian engineer who had the misfortune of growing old in a country that still maintained a nightmarish government health care bureaucracy -- even twenty years after its last Communist dictator was gunned down by his own people.
The movie's script follows the fictional Mr. Lazarescu, who has become gravely ill, as a Romanian government ambulance shuttles him from one government-owned hospital to the next. At the first three hospitals, although the doctors determine that he does need surgery, the government bureaucracy refuses to take him in because he is too old and does not have enough money to bribe the hospital personnel. Mr. Lazarescu stubbornly refuses to give up, but at the fourth hospital, the evil bureaucrats win -- he dies after a delayed and botched surgery. (The real Mr. Nica was in fact dumped onto a park bench and left there to die.) Mr. Lazarescu's real enemy was not his illness, but the uncaring and authoritarian attitude so deeply ingrained in bureaucratic practice. The whole movie is so realistic that even The New York Times -- a strong supporter of government-run health care -- had to admit that the movie "absorbs you into its world" .
I hope that all members of the 112th Congress will have a chance to watch The Death of Mr. Lazarescu. Romania, of course, need not be seen as the standard for how a government-run health care system would play out in the huge democracy we enjoy in the United States, but its example does give food for thought. In 2010, when the 111th Congress rammed through our new health care law, I felt as if I were watching how, years ago, Romania's Communist nomenklatura nationalized that country's private health care system. In both cases, the laws were approved in secret by politicians who did not really understand what was in them, but the bureaucrats' instinct for self-preservation did alert them to the fact that the new health care system would be bad for their own health. In both countries, the politicians declared "every man for himself" and scrambled for cover under exemptions for themselves.
All the U.S. congressmen who mindlessly approved the 2,000-plus pages of the Patient Protection and Affordable Care Act exempted themselves from its provisions. Romania's nomenklatura did not enjoy the luxury of that simple solution, but they did build four medical centers that did not fall under the new health care law's provisions, and they designated them to serve only the Communist Party and government nomenklatura. In the mid-1970s, I myself built such a medical center for the nomenklatura of Romania's foreign intelligence service, the DIE. That new medical center, which was hidden away in a forest just outside of Bucharest, displayed no name (so as to conceal it from the eyes of the common "plebeians") and was, of course, exempted from Romania's health care laws. The "idiots," as Romania's President Nicolae Ceausescu used to call the country's 22 million non-nomenklatura citizens, had to deal with a decrepit health care system managed by underpaid government bureaucrats, where personal contacts and bribes were the key to getting any decent medical care. The difference between Romania and the rest of the Soviet bloc lay, really, only in the amount and currency of the baksheesh. Throughout the Soviet empire, everyone knew that he had to "stimulate the bureaucracy" in order to get medical care. Everyone who needed surgery was aware that the first thing he had to do was to find out the size of bribe that would be acceptable to the bureaucrats who could approve him for that particular surgery.
People in the United States are not used to baksheesh, but if our health care system is in the future run by bureaucrats, the country will soon get the hang of it. It might not start out as the blatant kind of bribes found in the former Soviet bloc, but bribery is sure to soon become the rule in one way or another. In France, for instance, the government bureaucracy recently introduced a €1 franchise on every medical consultation, described as a contribution au remboursement de la dette sociale (contribution to the repayment of the social debt). That was followed by an €18 franchise on "costly" medical procedures. Now the French patients are learning that if they discretely slip an envelope with cash into the pocket of the doctor's white lab coat hanging in his office, they'll get more "attention." And a little extra attention may be vital in a such a government-run health care system, where doctors are obliged by law to see sixty to seventy patients a day.
It is said that there's nothing certain for us but death and taxes. Bureaucracies are generated by tax money, and, as taxes, they never go away. In 1989, the Soviet bloc collapsed in the same way as its government-run economy did. The huge bureaucracy running the health care system survived, however, hiding under a new name -- just as the Soviet KGB itself did. Now the U.N.'s World Health Organization calls that Marxist health care a "Semashko" health care. Nikolay Semashko was a Russian Communist who became the people's commissar of Public Health in 1918, and he fathered the Soviet health care system. In the year 2000, a European Union report on Romania's Semashko "Health Care Systems in Transition" admitted that this system was still devastating that country, whose infant mortality rate (20.5 per 1,000 in 1998) was among the highest in Europe and whose death rate in 1998 was 70% higher than the EU average .
In 2008, the world's leading general medical journal, The Lancet, reported that Russia's current Semashko health care system was still being run by a huge government bureaucracy, that each doctor and nurse still had "his or her little tax," and that "they all prefer cash in envelopes, of course." Nurses took 50 rubles (U.S. $2) to empty a bedpan and 200 rubles ($8) to give an enema. Operations started at 300 rubles, but "the sky's the limit" . The Lancet also noted that "there is a large gap between Russia and other G8 countries in terms of health outcomes. Life expectancy at birth is 66 years for Russians; 16 years less than for people in Japan and 14 years less than the European Union average."
A good many members of the 111th U.S. Congress seem to have forgotten that the United States spent 44 years of Cold War to free the people of the Soviet bloc from Marx's ruinous "utopia," in which people were to be rewarded simply according to their perceived needs. That Congress voted to replace our outstanding health care system with a nightmarish Sputnik-era bureaucracy, delightfully illustrated by the incredibly complicated Rube-Goldberg diagram published by the U.S. Congress itself . The new leaders of the 112th House of Representatives are determined to replace that terrifyingly bureaucratic health care law with one based on our traditional free-market system, but for that, they need the help of the White House.
I hope that President Obama will come down to earth from his "Sputnik moment." We have infinitely more reasons to turn for inspiration to our historical ally, Great Britain, than to turn to Russia. A couple of days ago, British prime minister David Cameron announced that his coalition government had finally decided to get rid of the "command-and-control bureaucracy" running the country's health care system by "giving control over management to family practitioners rather than bureaucrats." Cameron said that the reform would cut red tape, improve treatment, and reduce Britain's huge deficit. It would also create a health care system that would be "part of Britain, part of Britishness ". In other words, no more Semashko health care.
The United States has a well-deserved reputation for providing excellent health care. Saudi Arabia's King Abdullah, who can afford to seek medical care anywhere on earth, just had another checkup at the Mayo Clinic in Rochester, Minnesota. Italy's Prime Minister Berlusconi and Newfoundland's Premier Danny Williams had heart surgery in the United States. Canadians claim to love their socialized health care, but when they get really sick, they come here for treatment. The U.S. health care system can, and should, be continuously improved. This unique land of opportunity can, without a doubt, find acceptable ways to provide health care to every American who wants it. But let's do it the American way, not the Sputnik or Semashko way. And let's do it in the daylight as a unified national effort, not secretly at midnight as a Democratic Party conspiracy.
Lt. Gen. Ion Mihai Pacepa was head of Romania's Presidential House, the equivalent in this country of being White House Chief of Staff and Director of the CIA, the FBI, and the Department of Homeland Security. In 1989, Ceausescu was executed at the end of a trial whose main accusations came out of Pacepa's book Red Horizons (Regnery Publishing, Washington DC, 1987), republished in 27 countries.
 "Romania: Health Care Systems in Transition," European Observatory on Health Care Systems, 2000, p. 4.
 Helen Womack, "Russia's next president needs to tackle health care reforms," The Lancet, Volume 371, Issue 9614, Pages 711-714, March 1, 2008.