zemstvo physicians, who prized the zem-stvo’s autonomy and were hostile to any expansion of central government control, opposed the creation of such a ministry. The revolutions of 1917 occurred before the Rein Commission’s plans could be implemented. See also: FELDSHER; HEALTH CARE SERVICES, SOVIET
BIBLIOGRAPHY
Alexander, John T. (1980). Bubonic Plague in Early Modern Russia: Public Health and Urban Disaster. Baltimore and London: Johns Hopkins University Press. Conroy, Mary Schaeffer. (1994). In Health and in Sickness: Pharmacy, Pharmacists, and the Pharmaceutical Industry in Late Imperial, Early Soviet Russia. Boulder, CO: East European Monographs. Frieden, Nancy. (1981). Russian Physicians in an Era of Reform and Revolution, 1856-1905. Princeton, NJ: Princeton University Press. Hutchinson John F. (1990). Politics and Public Health in Revolutionary Russia, 1890-1918. Baltimore: Johns Hopkins University Press. McGrew, Roderick E. (1965). Russia and the Cholera, 1823-1832. Madison: University of Wisconsin Press. Ramer, Samuel C. (1982). “The Zemstvo and Public Health.” In The Zemstvo in Russia: An Experiment in
Local Self-Government, ed. Terence Emmons and Wayne S. Vucinich. Cambridge, UK: Cambridge University Press. Solomon, Susan, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloom- ington: Indiana University Press.
SAMUEL C. RAMER
Soviet socialized medicine consisted of a complex of measures designed to provide free medical care to the entire population, at the time of service, at the expense of society. The Soviet Union was the first country in the world to grant every citizen a constitutional right to medical care. This commitment was one of the few brighter (and redeeming) aspects of an otherwise bleak totalitarian system and often held as an example to emulate by other nations. The promise of universal, free (though not necessarily equal) care was held as the fulfillment of an age-long dream of providing care to those who needed it regardless of their station in life and ability to pay. It thus promised to eliminate the commercial aspects of the medical encounter that, in the eyes of many, had turned the physician into a businessman concerned primarily with his income and his willingness to treat only those who were affluent.
In the first decade of the Soviet regime, the official ideology held that illness and premature mortality were the products of a faulty socioeconomic system (i.e., capitalism) and that the establishment of a socialist society (eventually to become communist) would gradually eliminate most of the social causes of disease and early deaths by creating improved conditions (better nutrition, decent standard of living, good working conditions, housing, and prevention). This approach was set aside when Stalin took power at the end of the 1920s. He launched a program of forced draft industrialization and militarization at the expense of the standard of living, with an emphasis on medical and clinical or remedial approach, rather than prevention, to maintain and repair the working and fighting capacity of the population. The number of health personnel and hospital beds increased substantially, though their quality was relatively poor, except for the elites.
Soviet socialized medicine was essentially a public and state enterprise. It was the state that provided the care. It was not an insurance system, nor a mix of public and private activities, nor was it a charitable or religious enterprise. The state assumed complete control of the financing of medical care. Soviet socialized medicine became highly centralized and bureaucratized, with the Health Ministry USSR standing at the apex of the medical pyramid. Physicians and other health personnel became state salaried employees. The state also financed and managed medical education, all health facilities from clinics to hospitals to rest homes, medical research, the production of pharmaceuticals, and medical technology. The system thus depended entirely on budgetary allocations as line items in the budget. More often than not, the health care system suffered from low priority and was financed on what came to be known as the residual principle. After all other needs had been met, whatever was left would go to health care. Most physicians (the majority of whom were women) were poorly paid compared to other occupations, and many medical facilities were short of funds to purchase equipment and supplies or to maintain them.
Access to care was stratified according to occupation, rank, and location. Nevertheless the population, by and large, looked upon the principle of socialized medicine as one of the more positive achievements of the Soviet regime and welfare system, and held to the belief that everyone was entitled to free care. Their major complaint was with the implementation of that principle. Soviet socialized medicine could be characterized as having a noble purpose, but with inadequate resources, flawed execution, and ending in mixed results. See also: FELDSHER; HEALTHCARE SERVICES, IMPERIAL
BIBLIOGRAPHY
Field, Mark G. (1957). Doctor and Patient in Soviet Russia. Cambridge, MA: Harvard University Press. Field, Mark G. (1967). Soviet Socialized Medicine: An Introduction. New York: The Free Press. Field, Mark G., and Twigg, Judyth L., eds. (2000). Russia’s Torn Safety Nets: Health and Social Welfare During the Transition. New York: St. Martin’s Press. Ryan, Michael. (1981). Doctors and the State in the Soviet Union. New York: St. Martin’s Press. Sigerist, Henry E. (1947). Medicine and Health in the Soviet Union. New York: Citadel Press. Solomon, Susan Gross, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloomington: Indiana University Press.
(1770-1831), leading nineteenth-century philosopher.
Georg Wilhem Friedrich Hegel was one of the most influential idealist philosophers of the nineteenth century. In German philosophical thought, Hegel was rivaled in his own times perhaps only by Immanuel Kant.
Hegel developed a sweeping spectrum of thought embracing metaphysics, epistemology, logic, historiography, science, art, politics, and society. One branch of his philosophy after his death was reworked and fashioned into an “algebra of revolution,” as developed by Karl Marx and Friedrich Engels, Russian Marxists and socialists, and later by Vladimir I. Lenin, the founder of Bolshevism. Georg Wilhelm Friedrich Hegel influenced the writings of Karl Marx. © BETTMANN/CORBIS
For Hegel, reality, which progresses dynamically through a process, or phases, of thesis, antithesis, and synthesis-his triadic concept of logic, inspired by the philosophy of Heraclitus-is essentially spiritual. Ultimate, determinant reality, according to Hegel, is the absolute World Spirit (Weltgeist). This spirit acts in triadic, dialectical fashion universally throughout world history. For Hegel, the state was the principal embodiment, or bearer, of this process.
Because of its occasional obscurity and complexity, Hegelianism as a social and political philosophy soon split into various, contrasting branches. The primary ones were the extremes widely known as Right and Left Hegelianism. There was also a middle, or moderate, form of Hegelian-ism that in some ways influenced English, Italian, American, and other branches of late-nineteenth-century idealism and pragmatism.
Right (or Old) Hegelianism regarded reality more or less passively, as indubitably rational. Whatever is real is rational, as seen in the status quo. Spirit, it alleged, develops on a grand, world scale via the inexorable, dialectical processes of history. Wherever this process leads must be logical since spirit is absolute and triadically law-bound. In the milieu of contrasting European politics of the nineteenth century, Right Hegelianism translated into reactionary endorsement of restorationism (restoring the old order following the French Revolution and the Napoleonic Wars) or support for monarchist legitimacy.
By contrast, however, Left (or Young) Hegelian-ism, which influenced a number of thinkers, including Marx and Engels together with Russian Marxists and socialists, stressed the idea of grasping and understanding, even wielding, this law-bound process. It sought thereby to manipulate reality, above all, via society, politics, and the state. For revolutionaries, the revolutionary movement became such a handle, or weapon.
Hegel had taught that there was an ultimate reality and that it was spiritual. However, when the young, materialist-minded Marx, under the influence of such philosophers as Feuerbach, absorbed Hegel, he “turned Hegel upside down,” to use his collaborator Friedrich Engels’s apt phrase. While retaining Hegelian logic and the historical process of the triadic dialectic, Marx, later Engels, and still later Lenin, saw the process in purely nonspiritual, materialistic, historical, and socioeconomic terms. This became the ideology, or science, of historical materialism
