Irresponsibility, expressed by the popular Russian saying “They pretend they are paying us and we pretend we are working,” resulted in appalling quality of service, widespread corruption, and extensive loss of life. My friend, a famous neurosurgeon in today’s Russia, received a monthly salary of 150 rubles — one-third of the average bus driver’s salary. In order to receive minimal attention by doctors and nursing personnel, patients had to pay bribes. I even witnessed a case of a “nonpaying” patient who died trying to reach a lavatory at the end of the long corridor after brain surgery. Anesthesia was usually “not available” for abortions or minor ear, nose, throat, and skin surgeries. This was used as a means of extortion by unscrupulous medical bureaucrats.
“Slavery certainly ‘reduced costs’ of labor, ‘eliminated the waste’ of bargaining for wages, and avoided ‘unnecessary duplication and parallelism’.” To improve the statistics concerning the numbers of people dying within the system, patients were routinely shoved out the door before taking their last breath.