Opinion & Commentary
A rotting core: the other side of China’s miracle
Ask many Chinese parents (like mine) anywhere in the world what they wanted their kids to be when they grow up and the chances are that they will say a ‘doctor’ – the medical kind of course rather than the less practical PhD.
You would think that China posed no exception to this rule. However, in a report to a Chinese parliamentary advisory body last week, Qiu Guixing from the elite Beijing-based Peking Union Medical College Hospital cited a wide ranging survey indicating that 78 percent of Chinese doctors did not want their children to study medicine.
No, it wasn’t higher pay or better benefits that doctors wanted. It was that being a doctor is becoming an increasingly dangerous profession. In the first ten months of 2006 (the latest figures available) 5519 Chinese doctors were bashed by angry patients, compared with 3735 in 2004 and 2600 in 2002.
At the heart of the problem is China’s failing welfare and social system. From a base (albeit an extremely low one) of being the most equal society just a generation ago, it has now become the most unequal society in Asia. China’s ‘economic miracle’ benefits a rising middle class and other Party insiders of about 150 million people – no mean feat – but over a billion are being left behind and about half of these have seen their net disposable incomes stagnate or decline over the past decade.
Poor or non-existent access to basic healthcare is just one tragic sign of these problems. Bashing doctors is a very unconstructive way to deal with their frustrations, but it is the only outlet many Chinese feel they have.
The violence and social unrest overwhelmingly occurs in rural China in a country with one of the worse urban-rural divides in the world. But violence is not just perpetrated against doctors – far from it. In the latest figures official available, there were 87,000 instances of social unrest (defined as 15 or more people) in 2006, up from just a few thousand in 2000.
This brings us to the Party’s announcement last week of a 30 percent rise in rural social spending, including a hefty increase for rural medical services and insurance. The increased spend was largely applauded by senior policy makers in Beijing – and so it should.
But we should also prepare for disappointment.
The government is preparing to spend a record US$79 billion on China’s 700 million farmers. About $19 billion will be spent on direct subsidies, $43 billion used to improve production capabilities, and $17.5 billion on education, culture and health.
The proposed spend is about one sixth of the total budget. In raw figures, $79 billion sound like a huge number but let’s put it in context and see what the likely impact will be.
China is largely a decentralized political and bureaucratic system. Local governments account for about three quarters of public expenditure, and even monies spent by the central government is largely administered by local authorities.
In theory, local authorities should be better placed to efficiently allocate public resources.
But China is decentralizing without building institutions that encourage public accountability. Judicial and administrative independence is too much a matter of personal courage and integrity rather than an institutional requirement. Under China’s one Party system, local authorities are left to plunder public resources and are rarely ever prosecuted. Why would they be when courts and tribunals are themselves in league with officialdom?
As a result, the level of corruption and misuse of public money is hard to believe. Fleets of cars for local officials alone cost over US$42 billion each year. Overseas trips and other entertainment costs (which the Chinese call ‘banquets’) incurred by local officials amount to over US$70 billion each year. According to a 2005 China National Audit Agency report, local officials misappropriated about 10 percent of the entire budget each year and the figures were rising. Finally, as a further blow to China’s rural poor, local taxes and fees amount to between 20-40 percent of net income, even though the law states that such ‘peasant burdens’ cannot exceed 5 percent.
And these are the same local officials that will be largely called upon to administer the ‘record’ $17.5 billion that will be spent on education, culture, and health in rural China.
To address the rising discontent with local officials, the central leadership instituted ‘open’ elections at the village level that allowed independent candidates to run. This is the lowest tier of government in China but many believed it was a start. However, the formation of political parties independent of the Chinese Communist Party (CCP) was still banned.
Given the overwhelming resources of the CCP whose candidates enjoy the full machinery of the state behind them, outright intimidation and even violence against independent candidates is the norm. Besides, even when independents are elected, the law still states that the village Party official constitutes the ‘core leadership’ of that village.
Some of the money will get to the people it was intended for but we can be sure that a significant part of it will not. Giving billions of dollars to unaccountable officials is a recipe for corruption and misappropriation.
Should doctors in China tell their children it is safe to take up medicine? Maybe they should wait.
Dr John Lee is a Visiting Fellow at the Centre for Independent Studies, his book Will China Fail? was published by CIS last year.
