Red Medicine: Socialized Health in Soviet Russia
MUCH of the effectiveness of the medicohygiene provisions in any community depends on the quality of its general administrative control; and we must, therefore, at this point give a brief and elementary sketch of governmental administration. The arrangements in the U.S.S.R. differ in so many respects from western democracy as to raise the doubt whether its government is democratic in character; though if we have regard to the exceptionally high proportion of Russia's population, men and women, who take an active part in the discussion and in details in the decision of administrative matters, the claim to be democratic must be recognized.
It is necessary to bear in mind that in Russia the distinction between public and private business has ceased, as has also much of the distinction between employer and employed. As the Soviet State controls almost the entire economic life in Russia, its national budget is scarcely comparable with that of capitalistic countries.
One thing is fairly certain: what has been done in the governmental control of agriculture and industry could scarcely have been accomplished under representative democratic government of the ordinary type, and certainly not in Russia with its enormous backward and illiterate population. It has been done by a government which is not directly representative in the usual western sense of the word. It is true that each governmental proposal has been the subject of active public discussion; and that such discussion, in respect of matters of local government, is especially active; but once governmental decisions are made, further agitation which appears to be directed against general communal policy is impolitic and even dangerous. The police successfully stamp out attems of this kind, and imprisonment or banishment or death has not seldom been the penalty for such "counterrevolutionary" efforts.
The U.S.S.R. comprises seven federated republics, which in their turn include fifteen autonomous Soviet Socialist Republics, one Socialist Soviet Republic founded by special treaty, seventeen autonomous regions, and thirteen national districts.
Each of these republics has its own separate government, and in theory at least is free to sever its connection from the Union. Nevertheless, in these republics there is remarkable uniformity in general policy. The difference between Russia Proper, White Russia, the Transcaucasian Republic, and the Ukraine was seen in our visits to be chiefly geographical, notwithstanding different languages, for the social and medical arrangements were similar.
The definition of Russia's position contained in the Guide-Book to the Soviet Union may be taken as our starting point:
The U.S.S.R. is so far the only state that is based not on bourgeois principles of private property, but on the principles of the socialist commonwealth; it is distinguished in its very nature from all other states in the world.
Supreme authority under the Soviet Constitution is vested in the All-Union Soviet Congress. As stated in Section II, Paragraph 9 of the Soviet Constitution)
The Congress of Soviets of the U.S.S.R. shall be composed of representatives of City Soviets and Soviets of Urban settlements on the basis of 1 deputy for each 25,000 electors, and of representatives of Provincial and District Soviet Congresses on the basis of 1 deputy for each 125,000 inhabitants. (The Constitution of the Union of Soviet Socialist Republics. Washington, D. C., Soviet Union Information Bureau, 1929.)
Regular meetings of the Congress are held once in two years ; the delegates having their traveling and other expenses paid by the Government. These delegates elect the Tsik, or All-Union Central Executive Committee, which is still a large body. It meets three times a year; and its members elect (1) the Presidium of the Tsik; (2) the Council of People's Commissars, or Soviet Cabinet; and (3) the Council of Labor and Defense, or Sto.
All these three separate bodies are concerned ingovernment, promulgating laws, making decrees, and making ordinances, which sometimes overlap and possibly conflict. Any confusion arising from the triple organization is unified by the coordinating action of the Communist Party, while laws, decrees, and ordinances are formally ratified at long intervals by the All-Union Soviet Congress. In its daily work the central Government is guided largely by the Council of People's Commissars. These are State Ministers who sit in the Sovnarkom, or Cabinet. Each Commissar has his own staff, which assists him in the administration of his Department, or Commissariat.
The method of popular representation may be given in Sidney Webb's words (Current History, February, 1933):
Instead of one representative system exercising all power, the U.S.S.R. has several parallel hierarchies having substantially a common form. Instead of the millions of citizens casting anonymous mass votes, in huge geographical constituencies, for the supreme legislature and executive, the citizens of the U.S.S.R. vote only in small groups of fellowworkers or village neighbors for one of themselves whom they know personally, and they delegate the rest of their power through indirect election... .
If in Western Europe and America democracy is often hastily summed up as universal suffrage with a free press, in the U.S.S.R. it might equally be summed up as universal participation in public business in the midst of incessant oral discussion.
For local government most voters vote where they work along with their coworkers; while in villages they vote along with other villagers who, like them, are mostly agriculturists. All persons over eighteen take part in the election, irrespective of sex, religion, race, or nationality. The electors number over 70 millions for the whole country, and it is significant that they have power to recall any elected person summarily and replace him by another.
In the United States important officers, including the President and the chief State officials, are elected by direct plebiscite of the people. This is not done in Britain. In Soviet Russia the local governing body, whether local or national, appoints administrative officials through its executive committee. This method may be less liable to abuse or corruption than direct election by popular vote.
But the government of the U.S.S.R is not carried on solely by the hierarchy just considered. An important part in practical government is also taken by: (a) manufacturing artels and collective farms, on the side of production, (b) the trade unions, which guard the conditions of work, and (c) the Consumers' Cooperative Organization, which regulates conditions of sale and purchase of consumers' supplies.
By the first named of these, systematization of production is facilitated, while the consumers' cooperatives organize distribution.
Consumers' cooperatives are very strong in Russia. In 1931 they had 72 million members enrolled in 45,764 separate cooperative societies (Webb), and often it is only through them that the needs of workers can be provided.
In capitalist countries trade unions art an instrument of defense and, when needed, of revolt against the unbalanced control of employers of labor. They typify the antagonism between capital and labor which hereafter must inevitably be reduced or abolished if capitalism is to continue indefinitely.
In capitalist countries the organization of trade unions is chiefly according to craft. In Soviet Russia each trade union represents everyone employed in a particular class of establishment, whether he or she be artisan, clerk, cook, waiter, cleaner, manager, or doctor. Thus there are doctors in each of the 46 trade unions of the U.S.S.R. Membership may begin at the age of sixteen.
Trade unions have an important place in local and industrial administration. They have some 12 million members (more than double the total in any other country), while the Communist Party, which exercises so much control in organized Russian life, has fewer than 3 million members. Trade unions have internal autonomy in their activities, but are very strongly influenced in their decisions by members of the Communist Party. Strikes are almost eliminated. Wage conflicts sometimes occur in a factory, and the Shop or Factory Committee deals with these. This Committee consists of twentyfive or more employees; its main duty is to promote increased production, but it deals also with problems of insurance and rents of workers' rooms.
According to Chamberlin Lenin's contention was that the trade unions "should function as schools of communists," and this they do. They run the 4,000 or more workers' clubs now found in Russia. Each of these clubs is the cultural centre of the factory, doing important work in education and recreation.
It should be added that each considerable factory has its "Red Corner," where notices are posted and where there may be discussions during intervals of work. Before the World War, trade unions were persecuted; but immediately after the war many of the factories came under their control. In this task the unions naturally failed, and a system of skilled management was introduced. But in later developments they remain the centre of labor organization, and with the extension of State management, they have become in substance a division of official activity, though organized by the workers themselves. The possession of a trade union card is prized. It entitles the holder to special privileges, including free insurance and the first claim for a vacant post. Through it manual workers are given a certain preference for admission to universities and in promotion in the State services, and they receive special lowpriced tickets for entertainments.
The Soviet organization of local and central government, the producers' and consumers' organizations, and the trade unions do not exhaust the list of bodies actively concerned in the government of the U.S.S.R. There is behind and beyond all these the Communist Party.
This has been described by Sidney Webb as an "extraordinary companionship," the "Keeper of the Nation's Conscience," reminding one of some religious orders, and as constituting "almost exactly what Auguste Comte designated a century ago as the spiritual power in the State.(In Current History, February, 1933.)
Webb regards it as misleading to describe the Communist Party as a political party in the western conceion of this word. Of this "Party" Stalin is the General Secretary. He acts through the central Committees which function around him.
The supreme position of the Party is indicated in the jocular remark, often heard in Moscow, that the main difference between the Party system in Western Europe and in Russia is that in the U.S.S.R. only one thing is possible: one party is in power and all the rest are in prison.
The Communist Party has become the instrument of a central dictatorship. Membership of the Party has always been limited to a minority of the population. According to Chamberlin it comprised 2,300,000 members and candidates in April, 1931. This, we are informed, corresponds to about two per cent of the adult population of the U.S.S.R. Priests, merchants, traders, and some others are definitely excluded, and every year some two per cent of its members are eliminated from the membership of the Party by local voting centrally controlled.
A third general "purge" of the Party was announced by the Central Committee on December 11, 1932; the first purge was in 1921, when the New Economic Policy was introduced (see page 81), and at that time one third of the members were expelled. Pravda, the Government's official newspaper, declared that the new purge must be thorough and merciless, and that only loyal Communists who placed the Party's interests above everything would be allowed to retain their membership.
The Communist Party is closely linked up with the Union of Communist Youths (Comsomols) and to a still larger number of younger Octobrists and Pioneers (see page 171). From the Comsomols recruits to the Party are commonly elected.
It will be seen that the Communist Party is a "highly selected, strictly disciplined, and very exclusive companionship" (Webb). Its members exercise, as such, no legal power; but in view of the methods of their selection, it is not surprising that they "hold nearly all the key positions in administration and industry," and that nearly everywhere they control the industrial and general government of the country.
The Soviet Government is served by a highly efficient and much feared police force, the All-Union State Political Department, commonly called the OGPU, or the "Gay-Pay-Oo" (see page 25). This force is described as "at least as watchful and active as the Tsarist secret police." It must never be criticized.
It deals with a wide range of "counterrevolutionary offenses"; it has sweeping powers of arrest and punishment, and according to Chamberlin, the number of people in prison or exile for political offenses must be very large.(1)
In one department of its work it often acts alike as police, judge, and executioner, after a quasitrial which is private.
In Stalin's words,
the punitive organ of the Soviet power . . . represents something like a military-political tribunal, constituted to protect the revolution against the assaults of the counter-revolutionary bourgeoisie and its agents.
This despotic power of the police force has become fully developed during the last ten years. The Soviet State's intolerance of any organization of political opposition necessitates the "vesting in the police of the powers of summary judgment in all cases which can be construed as political." It would appear that in Russia, the more it changes, the more it retains some at least of the characteristics of Tsarist administration.
Sidney Webb in his enlightening and authoritative studies of Russian Communism published in Current History, while highly appreciative of its methods in other respects, makes the following comment on Freedom under Soviet Rule (Current History, January, 1933):
None of the foregoing cases, however, represents the kind of repression by the Soviet Government that is most seriously complained of. That government is a dominant and intolerant autocrat in intellectual matters. In whatever it considers to be its own sphere, it suffers no rival influence to exist. . . . And this repression is exercised ruthlessly on great personages and humble folk alike, with widespread spying and delation; often, it is said, even today, without open trial . . . leading to severe sentences of imprisonment or punitive relegation to places where existence is but prolonged agony or even to secret execution. . . . How much truth there is in this matter, so far as the present practice of the Soviet Government is concerned, no man can say .. . such things have happened in past years.
In the background of Russia's governmental system stands a great army, with modern equipment, well trained, and with a high morale. Wherever we went, even in children's kindergartens, the question "Are you ready?" elicited the immediate response, "We are ready for labor and defense," which may be regarded as the national slogan.
After their experience of the World War, of foreign invasions after that war, and of the years of civil warfare which followed, it is not surprising that "war mentality" should persist in an exaggerated form. It is fostered and increased by Russia's continuing belief that all capitalistic countries must necessarily desire, at the earliest possible moment, to destroy the Russian Communist regime. An example of how this stimulation is effected has been cited in Chapter II in the account of our voyage down the Volga, when we were sent under cover while passing beneath a long bridge. In fact, this happened two or three times. We learned that the people feared bomb outrages. Thus the war mentality continues and the Soviets live, as we are made to realize, in fear of attack by some other country. This has a double effect; it keeps the people's enthusiasm at fever heat, and it helps them to bear the privations involved in the hectic haste with which vast schemes of industrialization and mechanization are being carried through.
In the effort to make themselves "safe," a large, powerful, and wellequipped army has been formed. During the operation of the Five Year Plan the Government has increased the stress on military preparation.
The fear is genuine and persistent. We were struck with the militaristic characteristics displayed in the regular activities of the Youth Movement.
The army itself is a class organization, the "deprived classes" being excluded from it. More than half the officers and about an eighth of the rank and file are members of the Communist Party (Sidney Webb). Each soldier during his military training receives a general education, in which the Communist philosophy takes a prominent place. This fact is not stated as a criticism; for education in governmental principles might well figure more prominently in all countries.
In this connection there arises the muchdiscussed question of Soviet propaganda in foreign countries. When the Bolsheviks seized power in November, 1917, the leaders looked upon the Russian Revolution as a part of a world revolution. Neither Lenin nor any of the other leaders considered it possible that an isolated
socialist state could exist in the midst of a capitalist world. It was, therefore, part of the policy of the Soviets not only to meet the invading armies, but also to undermine their Governments and thus initiate international communism. The Comintern was organized to undertake foreign propaganda, and subsidies were sometimes given to strikers in foreign countries and to Communist Parties of other nations to support agitation. This attitude of the Soviet Government has changed materially, as shown in the official text of the Nonaggression Pact of 1931. This stated among other things that
1. The contracting parties once more solemnly affirm the principle of the peaceful coexistence of countries irrespective of their social, political and economic systems, proclaimed by the International Economic Conference of 1927.
2. In accordance with paragraph 1, the contracting parties undertake not to apply any discrimination whatsoever in their relations with each other, and regard the adoion in any of their countries of a special regime directed against one or several countries subscribing to this protocol as incompatible with its principles.
The apparent change in policy is expressed in the following remarks by Louis Fischer. He says (2)
The Bolsheviks are today supremely introspective and concentrated more than ever before on the gigantic task of building up a modern industrialized Russia with a higher standard of living for all... .
Since 1927 Stalin has developed a foreign policy based on the principle of coexistence of different economic systems. If we ... fear Communism, then we must set our own house in order and relieve distress.
Summing up our discussion of government in the U.S.S.R., we may say that there are admirable points in the organization of Soviet administration. Its dictatorship was regarded as a necessary emergency measure in what is claimed to be an essential transition to Communism. Meanwhile the strongly centralized system of government is ingeniously combined with voluminous oral discussion, in minute detail, of every item of industrial or social local work. Probably the workers generally take a more detailed part in discussing points of local policy than the workers of any other country. This is compatible with rigid limitation of any criticism which can be regarded as "counter-revolutionary"; and to secure this limitation every activity of the State is closely supervised by a Party constituting a small minority of the nation, thus securing the "dictatorship of the proletariat," the Marxian and Leninist device for preventing relapse to capitalism and to the recurrent wars which it is part of their doctrine to regard as inevitable in capitalist imperialism. Lenin taught that during the period of this dictatorshipand the present position in Russia embodies his teaching in an extreme formrigid discipline is necessary; and for this purpose is needed a highly centralized government, which in his words (quoted in Chamberlin's Soviet Russia) is "quasimilitary in its severity ... guided by a group of comrades at the centre, enjoying the confidence of the rankandfile members, endowed with authority and possessing wide executive powers."
(1) According to newspaper articles published in June, 1933, about 100,000 political prisoners were to be released.
(2) Fischer, Louis, "Why Recognize Russia?" Address before the National Republican Club, New York, February 25, 1933.