By Renfrey Clarke
MOSCOW — As of mid-May, some 2.5 million health workers in three-quarters of the administrative regions of Russia were either on strike or had taken part in protest actions. Doctors, nurses and ambulance crews were demanding big pay rises, and an end to the government's strategy of starving the public health system of funds in order to force its privatisation.
Meanwhile, teachers were on strike in at least seven major cities. Education workers in more than 50 regions had declared their readiness to take part in coordinated stoppages from May 22.
On May 12, leaders of the health and education unions had been presented with a statement from the Russian government which amounted to a slap in the face. No increase in basic pay rates was foreseen, though there would be some changes to bonus systems and minor concessions to particularly disadvantaged groups of workers.
News of the government's position brought an angry response from a rally of 10,000 health workers in central Moscow the same evening. "Treat Yeltsin in a local polyclinic!", ran a popular slogan.
As it campaigns to reduce spending and win the favour of the International Monetary Fund, the Russian government has slashed the national health budget. In the first quarter of 1992, Izvestia reported on April 29, Russian government allocations for health care were no more than about half the levels required.
Hospitals and clinics have regressed to medieval conditions. Few medicines are available. Surgical wards are often completely without anaesthetics, and when urgent surgery is required, patients can only be dosed with a bottle of vodka. Razor blades are at times employed for lack of scalpels.
Only 20% of the ambulances in Moscow are considered to be in good repair.
The wages of health staff in April averaged 774 roubles per month, and even a senior doctor in a public hospital made only about 1200 roubles. The Moscow City Statistical Committee put the "subsistence minimum" income in the Russian capital in March at 2755 roubles per month. The minimum necessary spending on food alone was calculated at 1197 roubles.
It is, however, possible to get quality health care in Russia, from properly fed doctors. All you need is upwards of 1000 roubles a day. The elite medical institutes which once treated high-placed officials of the Communist Party regime have now been privatised as joint-stock firms catering on a user-pays basis to Russia's new rich.
The Yeltsin government projects that in coming years, the bulk of
medical services in Russia will be provided on a privatised basis. Free health care will remain only for pensioners and a few other especially underprivileged groups. The bulk of the population will have to subscribe to health insurance schemes, and legislation covering these schemes is being rushed into effect.
However, the incomes of a large majority of Russians are now below the subsistence minimum level. In polls, around 40% of respondents report that they are seriously threatened by hunger. For scores of millions of Russians, paying significant sums for health insurance is simply impossible.
The barbarity of Yeltsin's plans has spurred health workers to go well beyond wage-related issues in formulating their demands. As well as demanding big rises in pay rates, a resolution adopted by a Moscow conference of health workers on April 9 also called for the restoration of proper funding for all health institutions, and for an end to the handing over of health service assets to commercial operators.
The plight of teachers in the era of "economic reform" has many parallels with that of health workers. Both groups are made up overwhelmingly of women, performing work that traditionally has been badly compensated. Education spending has not suffered such drastic cuts as the health budget, but wage levels are much the same; in April, when the average industrial wage was 2600 roubles per month, teachers were averaging 700. Buildings in the education sphere, as in the health sector, are frequently handed over to commercial users.
Teacher militancy has been on the boil for months, with hard-fought local struggles. In the Kuzbass, Siberia's main heavy industrial region, teacher strikes brought classes to a halt throughout much of April.
In Moscow, a demonstration by thousands of teachers on April 22 blocked traffic for an hour on one of the city's main streets. On May 5, a conference of Moscow teachers threatened a city-wide indefinite strike from May 22, as part of the proposed national campaign of action.
"We consider the solving of economic problems at the expense of education, health care and culture to be criminal", the teachers stated in a press release. The demands around which Moscow teachers are now organising include pay rises of as much as 500%, adequate funding for education, fixed prices for school meals, and a ban on the transfer to private firms of buildings designated for educational purposes.
The teachers' disillusionment with the Yeltsin government is, if anything, even keener than that of the health workers. This is largely because of a promise, made by Yeltsin in July last year and still unfulfilled, that teachers' pay would be increased to match the average levels in industry.
Yeltsin has reportedly taken a close interest in the handling of the teachers' and health workers' protests, and appears to have
decided personally that the workers' major demands would be met with blanket refusals. Unlike other groups such as coal miners and steel workers, the health and education strikers have little economic muscle. Their chance of winning their demands therefore depends heavily on the political impact of their struggles.
Of critical importance will be the strikers' readiness to mobilise their supporters in large demonstrations to defend education and health care. The strike leaders have already shown a willingness to move in this direction, and they have broad public backing. An opinion poll reported in Moscow News on May 10 showed that 53% of Russians supported the health workers' strike, while only 25% opposed it.
Even at their current stage, the struggles by health workers and teachers represent the most serious political challenge Yeltsin has faced in 11 months as president. Fundamental weaknesses of the government's neo-liberal strategies are being exposed.
In attacking health and education spending, Yeltsin is convincing millions of formerly sympathetic Russians that his policies have a thoroughly anti-popular essence. His onslaught against public spending is alienating a social layer that in the past has formed one of his key political strongholds — the liberal, westward-looking intelligentsia, of which doctors and teachers are important parts.
So far, industrial workers have responded to Yeltsin's attacks with confusion and passivity. Time lost in strikes during the first quarter of 1992 was only half that in the corresponding period of last year. The industrial workers, however, have still in most cases been able to eat; key sections of the intelligentsia have been forced by starvation wages into an uncharacteristic militancy. People who, a few months back, were followers of Margaret Thatcher are now learning the vicious realities of class society.