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Income inequality is surging, and there are few countries where it is rising faster than the United States. The distance between rich and poor is greater in America than nearly all other developed countries, making the US a leader in a trend that economists warn has dire consequences. GlobalPost sets out on a reporting journey to get at the ‘ground truth’ of inequality through the lenses of education, race, immigration, health care, government, labor and natural resources. The hope is to hold a mirror up to the US to see how it compares to countries around the world.
When citizens become patients, the country's growing economic divide is painfully evident.
Irina, an elegant 70-year-old pensioner with a shock of white hair, sporting modest makeup and a smart black coat, cut a peculiar figure behind the wheel of a taxi on Moscow’s snowy roads this month.
A widow, Irina says that cab fares are the only way she can make enough money to get treatment for her daughter. She brushes away tears with apparent embarrassment as she explains that her divorced 33-year-old daughter, a German-Russian translator, has advanced leukemia and urgently requires a blood transfusion to replace platelets in her blood stream.
“I am not getting out of this car until I have 5000 rubles,” Irina says. “That’s what it costs for a donor for a single day. They say that if she doesn’t get this blood, it will be too late and the illness will become irreversible. This is quite literally a matter of life and death.”
Sisters of Mercy and a nurse look after patients at Saint Alexei Hospital in Moscow.
Irina gets a monthly pension of 13,000 rubles as a former civil servant who retired from the Foreign Ministry a decade ago. She says she has no one to turn to for help.
“If anyone tries to tell me that we have good medical health care, what can I say? It is bad. Where can I get 5,000 rubles in a day? Tell me — where?”
She declines to give her surname or be photographed out of apparent shame for herself and her daughter. “I’m not healthy either," she says. "I am disabled and I have problems with my lungs. And I’m driving I’m earning money. I’m ashamed. I’m so unbelievably ashamed. When you see a woman of my age driving a taxi… it is shame. Pure shame.”
"I really wish care wasn’t so expensive," says Lyubov Mitichkina, a Sister of Mercy and senior nurse at Saint Alexei. “The vulnerable section of society really need the government’s help as they can only receive free care to a very limited extent.”
Queues and corruption
Alexander Saversky, head of the Patients' Rights Protection League, said the health care system is increasingly focused on paid treatment. He says that state hospitals offer paid services in parallel with free services, which he claims makes it profitable for doctors to pressure patients into paying for treatment.
“We have queues because the top doctors want to earn more money and create queues so that for patients get to treatment they have to pay money,” said Saversky.
He explained that the health care system has not recovered from the lows of the turbulent 1990s that followed the Soviet collapse. He pointed to the World Health Organization’s 2000 report that ranked Russia in 130th. He said Russia’s system had deteriorated faster than its post Soviet neighbors Kazakhstan and Belarus, which ranked 64th and 72nd respectively.
Research from the ROMIR center found last year that 65 percent of Russians paid for medical services and 20 percent of patients made informal payments to doctors. One estimate put these shadow patients at $5.5 billion last year.
Natalya Bondarenko of the Levada Center said that every year there is a larger portion of Russians who say the health care situation is worsening. In 2012, polls showed it was a bigger national bugbear than corruption, one of the main drivers of the last year of street protests against President Vladimir Putin.
"It is a larger concern than the problem of corruption and improvement of the police force. That's a pretty significant indicator,” said Bondarenko.
Fewer Russians who can afford to go private, risk going to state-funded services, according to Elena Prikhodova, 44, the executive director of a fund that allocates health cover for personnel at JSC Medicina.
“Free health care in Russia doesn’t exist,” says Prikhodova. “The range of medicines that are available for free are probably not enough. You need more. If you want to be healthy, then you have to pay.”
Pirkhodova holds medical insurance at JSC Medicina, an award-winning private clinic in the elite Mayakovskaya district of Moscow established in 1990.
A first-time consultation with the doctor costs between $80 and $100.
A Maserati is parked outside and a harp player strums in the foyer as receptionists guide patients through spacious, wood-paneled corridors. These lead into immaculate clinics with state-of-the-art equipment.
Elena Prikhodova lies down for a check-up on her leg, which she bruised badly, at JSC Medicina. Located in the center of Moscow, JSC Medicina is one of the most prestigious hospitals in Russia.
Prikhodova says she recently injured her leg when she slipped while making her children’s beds at home. She says she was rapidly seen by a doctor, X-rayed quickly and received top-class treatment. She squeezed in a subsequent check-up during her lunch break.
“Of course,” she says, “a main problem is avoiding long queues.”
The clinic has a bustling commercial marketing department, which did not allow GlobalPost to interview patients apart from Prikhodova.
It forwarded kitschy promotional images of expansive hotel-style recovery rooms featuring planted patients relaxing in large quilted beds beside faux antique telephones. Its clientele are top managers, cultural figures and politicians, as well as middle managers.
“Haggling” for health
The Sisters of Mercy operate a nightly bus of volunteers who reach out to the homeless with shelter, food and treatment during Moscow’s bitter winters. It also helps poor families raise funds for expensive medical care.
Without such charity financing, there is every chance wheelchair-bound 12-year old Dasha Smirnova would not have survived 2012. She was born with cerebral palsy and her mother Polina was told that she would die unless she received risky corrective surgery on her spinal cord.
But Russia’s top state institute for this surgery declined to perform the operation, leaving what looked like only one option — to use inexperienced surgeons in Moscow.
“I asked them whether they had ever done the operation and they openly admitted that they had only done it twice over a matter of years. Dasha is my only child – I decided to try different options.”
Polina Smirnova, 37, is not poor by any stretch in terms of property and income, She owns a 9-floor apartment which she inherited from the mass post-Soviet housing privatization and she earns 40,000 rubles a month ($1,320) as an assistant at a jewelry company.
But, she says, the operation, wheelchair, medicine and rehabilitation for her daughter far surpass her insurance coverage.
Smirnova applied to various charity support schemes and raised 1.6 million rubles through the Sisters of Mercy, which allowed her to fly Dasha to Germany for the operation. It also afforded her a German-made wheelchair.
Polina knows how lucky she has been to find charity help. Every year thousands of children are handed over to orphanages as parents see health complications such as cerebral palsy as an insurmountable challenge.
“The state does not pay for medicine for disabled children. So I have to buy medicine,” said Polina, adding that up to $200 a month goes to stocking up on a pages-long shopping list of medicines. She says she feels abandoned by the state.
Saversky of the Patients' Rights Protection League sums up the health care landscape for Muscovites:
“The patient is constantly haggling,” he says. “Do you want the pills that work or do you want the ones that could maim you? Do you want the prosthetic limb that becomes rusty or do you want the one that will last your whole life? The system is always bearing down on the patient.”