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it’s 5 years though
by multi-tiered i think they mean accessibility to/affordability of different levels of treatment, complexity wise
to use a somewhat large country (brazil) with universal health care (public option called SUS) as an example: we have it on paper, but in practice we lack doctors and it’s really, really hard to execute it in “deep brazil” (mainly the countryside) - existing doctors don’t want to go there, there’s barely any useful infrastructure, etc
another issue is that, when it comes to specialized treatments and exams, where the technology is much more expensive, supply often doesn’t meet demand
to make things worse, these technologies also need technical training to be used, so sometimes we have the machines but no one who can properly and safely use them
now, this is for a somewhat large country with a rural population of 14%; imagine a massive country like china, with a rural population of 40% and vastly underdeveloped regions more to the center (as they had been focusing mostly on the coastal cities until recently)
and still they already have 95% coverage for basic treatment, so i guess they’re doing ok? i mean, my main point is that i wouldn’t criticize this without really knowing in detail what they’re doing wrong, because in my country we literally have universal health care in our constitution, but regardless of our printed words our actual conditions haven’t allowed us to make this a reality
This is all well and good but I think what we ignore here is that China had a system of universal healthcare before. It was dismantled, I think frankly quite haphazardly, and suddenly talk of that old system is dismissed out of hand as unachievable. And it was not a joke medical system either! It accomplished huge strides in infant care, women’s morality, basic health outcomes etc. All for free and entirely uncommodified. Whereas now the real issue is that for many people even if ‘access’ exists if is curtailed by hukou, employment status, quality of care in shitty public hospitals, doctors having extremely limited time to see patients, etc. There is a whole phenomenon of mobs beating doctors up because they prescribe medicine that is pushed by insurance sponsors (like the US lol). Saying that things will change slowly ignores how quickly the state was able to change things before, which in my opinion is just a matter of a vastly changed political economy.
this is why i mentioned basic healthcare
the system during the mao period managed to do that really well - this is doable, since whenever the material requirements are low enough you can change things through sheer force of will, as the barefoot doctors certainly did and got huge gains from it
but it wasn’t universal healthcare - or do you think the barefoot doctors had access to the latest chemotherapy medicines? radiotherapy machines? MRIs? respirators, ICUs, and so on
unless you believe traditional chinese medicine can take care of this stuff, which it obviously can’t, there are very real material limitations and ideals can only take us as far as they allow us to
my criticism to the reforms was shutting off free access to basic treatment in the short term, because this, as you said, could have easily been provided - but i haven’t read their justifications for it
You’d actually be surprised as to what level of care was conducted by the barefoot doctors. Also I might point out that there is nothing in the definition of universal healthcare that suggests you need to have the very advanced equipment (not sure how much of that was largely available in the 1950s anyway). Universal healthcare is simply a system where all citizens are guaranteed easy access to healthcare. FYI the Maoist regime didn’t care for ‘traditional Chinese medicine’ (a nonsense term btw) but it is actually being significantly more espoused TODAY and even by government sources.
The justification as for why basic treatment’s access was changed was because the nature of health care largely changed. It stopped being solely the purview of the state. Private actors were allowed in, provincial governments felt they could let budgets slide. You can say that ah they couldn’t have gotten better tech if not for this budgetary change but I mean most government run healthcare programs would disagree.
