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	Doctors and patients battle to resuscitate Russia’s dying healthcare system by Alexander Nurik, Georgy Borodyansky Equal Times, Open Democracy   Mar. 2016   Millions more Russians living in poverty as economic crisis bites. (AFP)   Russia’s recession-hit economy has propelled the country’s poverty rate to a nine-year high, state statistics showed, as the country struggles to cope with a crippling economic crisis.   An average of 19.2 million Russians – or 13.4% of the population – were living last year on less than 9,452 roubles ($139) a month, the minimum subsistence level determined by the Russian government in the fourth quarter.   This figure represents a 20% increase year-on-year, with an average 16.1 million people living below the poverty threshold in 2014.   More Russians have been slipping into poverty on the back of low oil prices that have battered the country’s energy-dependent economy and significantly diminished purchasing power. Western sanctions as result of the conflict in Ukraine have further constrained growth.   But 2015 poverty indicators are still lower than in 2000, when 29% of the population found itself below the poverty threshold, according to the official Government statistics.   Increasing poverty represents a setback for President Putin and the Russian Government, whose popularity had been fuelled by the economic growth that resulted from high oil prices in the first decade of his presidency. Though the benefits of growth were very unevenly distributed, and corruption was endemic.   Russia’s energy-reliant economy shrank by 3.7% in 2015 and is set to continue suffering this year. In September, the World Bank warned against a “troubling” increase in poverty in Russia resulting from a sharp drop in the income of the most vulnerable social groups including pensioners.   Prime Minister Dmitry Medvedev conceded in January that increasing poverty was “one of the most painful” consequences of the economic crisis. Real wages in the country shrank 6.9% last month in comparison to the same period last year.   October 2015   Doctors and patients battle to resuscitate Russia’s dying healthcare system, by Alexander Nurik. (Equal Times)   Russian authorities have said they will reverse a number of controversial cost-cutting measures following protests, work stoppages and even hunger strike action by beleaguered health care staff.   Numerous proposed hospital closures have been rescinded and authorities are promising to increase the amount paid out to some of the estimated 14,000 medical staff that will lose their jobs between 2015-2017 in Moscow alone as a result of “optimisation” measures.   But the government vows to continue what it describes as an attempt to modernise Russia’s Soviet-era health care system, while cutting costs and making it more accessible to ordinary people.   Healthcare in Russia is free under a compulsory medical insurance scheme but over the past five years, Russia’s healthcare system has been gutted by massive layoffs.   In Moscow alone, some 9,500 medical staff were made redundant in 2014. Nationwide, that figure is though to be around 90,000.   In terms of actual hospitals and clinics, according to the Moscow Times, between 2005 and 2013, “the number of health facilities in rural areas fell by 75 per cent from 8,249 to 2,085. That number includes a 95 per cent drop in the number of district hospitals, from 2.631 to only 124, and a 65 per cent decline in the number of local health clinics, from 7,404 to 2,561”.   Most worrying, these massive job cuts are thought to have had a devastating impact on mortality rates. According to the Auditing Chamber of Russia, 18,000 hospital deaths were linked to the cutbacks.   “The reform has only one aim – to destroy free health care,” says Simon Halperin, a neurologist who was actively involved in anti-reform protests in Moscow. “It is impossible to render a hospital inefficient based on how much money a bed brings to it. No professional doctor would think of such a criterion when taking decision to close the medical institution."   In the face of growing criticism, the Russian government has tried to defend its measures, noting that growing and ageing populations everywhere are resulting in ballooning health care costs worldwide.   But health care cutbacks across the country, and a suggestion from the Minister of Health Veronika Skvortsova to replace local staff with “Skype doctors” in regions where even mobile phones are scarce, have been backfiring.   In 2014, a broad public campaign against the collapse of the Russian health care system was launched by the Deystvie union, the Russian Confederation of Labour (KTR), the Pirogov doctors movement, the ‘Together for Decent Medicine’ protest group and other civil society organisations.   Thousands of doctors took to the streets of Moscow and 46 other cities across the country to protest over the closure of a number of hospitals, maternity centres and specialist departments.   For Boris Kravchenko, president of the KTR, these protests were the last-resort action of workers pushed to the brink, and will only stop when the authorities are ready to consult them on the tumultuous changes taking place.   "We demand consideration of all our requests, transparent public discussion of the strategy and content of the reform," Kravchenko said at the time. "Prior to the start of full-fledged discussions, we demand a freeze to the process of massive layoffs, a recall of the dismissal notices received by doctors, and the prevention of similar practices in other regions of Russia".   http://www.equaltimes.org/doctors-and-patients-battle-to#.ViMHCG6pUd8   Looking after yourself in Siberia, by Georgy Borodyansky.(Open Democracy)   The ‘rationalisation’ of medical and social services in rural Russia has compelled people to acquire new skills in order to survive, but life for the weakest is very hard – and very expensive.   Circumstance has forced the inhabitants of Kurganka, a village in Russia’s Omsk Region, to become their own medical service. They have worked out how to give one another injections, avoiding the need for a doctor’s’ prescription. For a prescription you have to go to Muromtsevo, the district centre, 50km away – an expensive exercise and risky as well; it never rains here but it pours, literally, and even if you get though the deluge there’s no guarantee a doctor will see you. The queue starts forming at 8am, and if you’re a bit late, tough! And the bus from the outlying villages only arrives after 9am.   ‘There have been so many times when I’ve arrived too late to get an appointment’, says pensioner Lyudmila Afinogenova, ‘and then you lose the whole day: the bus doesn’t go back until the evening. I gave up going there ages ago. I went just once last year with my granddaughters; the older one was starting school and the school health worker said all the children needed to have various jabs first. So off we went, taking her little two-month-old sister along as well. A friend agreed to drive us there and back, for 1,600 roubles [the average monthly pension is 10,000 roubles]. But when we got to the hospital they said we weren’t on their lists; according to their information, we’d moved out of the area. So we had to go home without the jabs.’   This February, medics from the Central District Hospital deigned to come to Kurganka to do the immunisations. The baby was then 15 months old, and it was the first time anyone from the medical profession had shown any interest in her.   Lyudmila herself has diabetes, for which she needs regular insulin injections. ‘If your blood pressure goes up to 220, you need insulin or you’ll die’, she says. ‘Mind you, if you do die that’s not so bad, but you might have a stroke instead and that’s such a pain for your family.’   Life without medics   Sometimes Lyudmila does her own injections, sometimes, family members do it for her. Many people in Kurganka and the other settlements in the area have learned this skill; after the First Aid station that served four villages closed down, medical services have turned into a cross between volunteering and small business. There’s no other way to earn any money here: back in the 80s the prize-winning local collective farm was never out of the newspapers, but by the mid-2000s agricultural activity was reduced to a cooperative with 200 head of cattle that is now in receivership. And even while it was running, employees were mostly paid in hay and firewood – cash only appeared on special occasions.   The Kurganka First Aid Station effectively closed down at the start of the 2000s, but it was still officially listed as a medical facility until 2009, when the Novaya Gazeta daily published an article exposing this anomaly. The mythical facility was resurrected soon afterwards, but not for long: the nurse practitioner appointed to run it went back home after a year and a half, without waiting for the 500,000 roubles he had been promised under the ‘Governor’s Medical Programme.’   ‘It was such a pity’, says pensioner Lyubov Znayeva. ‘Our Aleksandr was such a good nurse. He was kind and sensitive; you could turn to him any time – evenings, Sundays, he would always be ready to help.’   Lyubov is 77 and is registered disabled: she had a stroke 19 years ago and now she says she relies on injections to keep her heart and brain going. ‘We give them to each other – not for free, of course, but for a lot less than you’d pay if you went into Muromstsevo. I have an arrangement with a neighbour who used to work as a nursing assistant: she gives me 20 injections for 200 roubles.’   The residents of Kurganka can’t survive entirely on their own efforts, of course; they still need qualified medical help from time to time, not to mention emergency treatment. They tell me about how, three years ago, Maria Kuklina, a young woman of 36, had a heart attack. They phoned for an ambulance but were told there was none available: they would have to get her to the hospital in Muromtsevo themselves.   It took them two hours to find a car in the village, and they had gone only six kilometres when Maria’s heart stopped.   The rationalisation of rural life   In 2001 the Znamya Truda (Banner of Labour) newspaper wrote that the Muromtsevo district (with 24,000 inhabitants) contained four hospitals, six polyclinics and more than 40 village First Aid stations.   That was in the turbulent, poverty-stricken 90s. In the following period, when Russia was getting up off its knees, big changes took place in local healthcare; and, as I have now learned from Dmitry Shchekotov, a member of the district council who has a visual impairment himself, there are now only three hospitals, one polyclinic and ten village First Aid stations.   The district is no better, and no worse, off than the rest of the Omsk Region. In the neighbouring Sargatskoye district, for example, many villages have not only no First Aid station or school, but no water fit for washing and other household needs, let alone for drinking. The locals use water from a lake, at some risk to their health. Pyotr Plesovskikh, a farmer and social activist, told me that many villagers had had enough and that ‘it could all get out of control.’   Last October, 40 people from Novotroitskoye, where he lives, and the neighbouring village of Despozinovka blocked the local highway in protest, demanding repairs to the road along which their children have to travel to school. Some of the potholes, says Plesovskikh, are half a metre deep, and it takes the bus over two hours, and longer in bad weather, to cover 40km. So the children spend five to six hours a day shaking about in the bus, while their parents wait for them at home with their hearts in their mouths.   The protest could be described as successful: the regional highways department found one million roubles for repairs to the road, a small sum considering it had had no repairs for 20 years, but something at least – the most dangerous potholes were filled in with clay.   This is, however, the farmer points out, a temporary measure: ‘Come spring, we’ll be up to our ears in mud.’ However, he and three other organisers of the blockade were fined 30,000 roubles and given 50 hours of community service, but considered it was worth it.   Last year the Omsk Region website announced that in-patient facilities were to be closed at two rural hospitals in the Cherlaksky district. The nearest hospital beds would now be in the district centre, 57km away from one of the villages served.   Medical facilities are also being ‘rationalised’ in the area around Omsk, with in-patient services closed at a hospital serving seven residential areas, and also in Omsk itself; in February, the city’s Hospital No.2 closed its in-patient department, losing 200 beds.   None of this is the fault of the regional authorities: neighbouring regions, and those further afield, are facing the same cuts. In the Sverdlovsk Region, for example, the number of village First Aid stations has fallen from 248 to 177 in the space of four years, and in the Orenburg Region, 54 have closed down over two years.   All health, education, social services, and benefits in the Omsk region have been ‘rationalised’ since the beginning of the year. Free school meals, for example, are now available only to children in low-income families, those earning under 1.5 times the living wage; in some other regions it is only families with an income lower than the living wage whose children are entitled to a free school meal.   Meanwhile the ‘Social Assistance Standards’ for the elderly and disabled, also introduced on 1 January, have effectively reduced this assistance to nil. Previously, home care workers visited four clients a day; now their workload has doubled and they need to get round eight people in the same eight-hour shift. ‘There’s usually a 15-20 minute walk between clients’ houses in the villages’, says Dmitry Shchekotov, ‘and if you take that out of the hour, there’s not much time left for actual care. And the fees the old people now have to pay for the service are often beyond their means.’   The rise in social service charges over the last decade (until 2006 all these services were free) is a good indicator of the humanitarian concerns of the state. Even ignoring inflation, they have increased by several times and are now exorbitant; and now disabled people and war veterans have even lost their 50% discount on service charges.   * Georgy Borodyansky is an Omsk-based correspondent for Novaya Gazeta. Visit the related web page
	Australians are the biggest losers in the world when it comes to gambling by Tim Costello, James Panichi, Alex Mitchell Inside Story, Meanjin Australia   Aug. 2014   Will the Labor leader stand up to the greedy and powerful gambling lobby, by Tim Costello.   Australians are the biggest losers in the world when it comes to gambling, after the Singaporeans. We lose $961 each year, on average, per resident. Indeed Victorians squandered $2.3 billion on playing the pokies in the 10 months to May this year alone.   And that is just what we spend. We are losing out in other ways too.   The gambling industry is one of the most powerful and greediest lobby groups in Australia. It has already infiltrated and to a large extent tamed our federal politicians, and now it has declared war on the Victorian Napthine government, targeting 22 of its marginal seats in the November state election.   Napthine’s crime, committed late last year, was passing a 4.2 per cent tax increase for pokie venues with machines that take more than $32,000 per machine per year. There is no tax increase for venues whose machines take less than $32,000 per machine.   In having the temerity to attempt to claw back a little revenue to compensate for the vast social costs this unholy industry generates, the Premier has bought himself a powerful enemy.   The Victorian campaign is a replica of the powerful Clubs Australia 2011 federal campaign that nearly brought down the Gillard Labor government.   Community Clubs Victoria, the entity prosecuting the Victorian campaign, is making the extraordinary assertion that the clubs combined pour more than $300 million back into the community every year. This is breathtaking in its dishonesty.   Most of this is, in fact, normal business expenses – wages, capital works and equipment. And of the $60 million that may be charitable, most is devoted to special interests.   If we are forced to have to have pokies in our community, then the money they take can surely be used as state revenue to help fix our child protection system, fund vital mental health services or even clean up the harm pokies cause.   The damage caused by pokies in our community includes suicides, divorces, bankruptcy, lowered productivity and job loss, depression and anxiety, and crime (especially fraud). For every person with a gambling problem, the lives of several people will be harmed, including those of dependent children, spouses, anyone in their care, employers and work colleagues.   Many large pokie clubs are now indistinguishable from private business. Given the cost to both the state and the community of the social damage they do – 42 cents in every pokie dollar comes from an addict – they should be made to contribute as much as possible to the community.   I call on both major political parties to stand up to this greedy lobby and declare support for tax increases. A united, bipartisan stand would neutralise the wedge tactics that allow the pokie clubs to flex their muscles in our democracy and ultimately call the shots. At the same time, both parties should commit to further measures to rein in the damage pokies cause – for example, Labor and the Coalition should impose a limit of $1 per button push.   When the pokies devastate electorates, it is time for the Victorian Labor Party to put their people ahead of cynical electoral tactics and stop siding with this lobby.   In the long run, the Victorian government should wean itself off dependence on pokie losses to balance the budget, but not at the expense of handing more of the losses to the pokie barons.   Now is the time to fight back and insist on tax revenues that can support the community much more generously and genuinely.   * Tim Costello is chairman of the Australian Churches Gambling Taskforce and CEO of World Vision Australia   July 2013   The lobby group that got much more bang for its buck, by James Panichi.   Targeting marginal seats is nothing new in politics. But the gambling industry showed that it could also work for a lobby group facing a panicky government.   You will be familiar with the narrative. Lobbyists are quietly pulling all the strings in the political world. Deals are done behind closed doors, suspicious men in dark suits lurk in the corridors of power, and vested interests throw money at political parties to buy the influence they need to control what passes through parliament.   But what if that way of working is being turned on its head? What if those vested interests are out in the open now, using the methods pioneered by political parties to win their battles? Rather than waiting for political donations to trickle down and the lobbyists to bend the right ears, what if interest groups are setting up fully fledged political campaigns of their own and cutting out the middleman?   Public campaigns that bring together public relations and lobbying objectives have become the perfect tool in a political system with a chink in its armour. You don’t have to convince a majority of voters of your position, or even too sizeable a minority of voters. You’ve realised what the parties already know: to win certain kinds of fights you only have to convince a small group of people in marginal electorates.   Here’s how you do it. You pick off ten or fifteen swinging seats and scare the local MPs out of their wits. That’s all. You can give your lobbyists in Canberra the week off and simply allow the terror of the MPs to percolate through to the party room and the leader’s office. The marginal-seat politicians will be begging their government to end the pain.   Take the gambling industry’s well executed campaign in 2011 and 2012 against the slot-machine reforms advocated by Tasmanian independent MP Andrew Wilkie. Spearheaded by ClubsNSW, it dismantled the proposed legislation one piece at a time, watering down and postponing the few minor impositions that remained in place. In terms of legislative outcomes, it was a triumph.   But the clubs went further. Even though they were acting out of self-interest, they were able to win a public relations war that, on paper, they should have lost. They achieved this by choosing the pitch on which the entire game was to be played out; it was a narrative they owned from beginning to end. The substance of the problem-gambling issue that underpinned the reforms was all but ignored.   What we heard was a story of mums and dads concerned that government policy was about to end their way of life, and of pensioners at the local bowls club voicing fears that their days may be numbered. And in their corner was a community-based, not-for-profit organisation doing what it could for members’ rights and pleading for common sense to prevail.   It was a marginal-seats political campaign in all but fact. It was carried out at a bargain-basement price: the clubs and their backers spent a mere $3.5 million out of a $40 million war chest, much less than the mining industry spent tackling Labor’s super-profits tax. And it was time and money well spent, buying the industry the strategic know-how for future campaigns and a reputation so fierce it may scare off a generation of backbenchers.   When Tasmanian independent MP Andrew Wilkie made poker machine reform a condition of his support for the minority Labor government in the wake of the 2010 election, he could have been forgiven for thinking he was onto a winner. Polls showed between two-thirds and four-fifths of Australians supporting reform and the usually hard-nosed Productivity Commission had sounded the alarm over the high incidence of problem gamblers among poker machine users (they account for 40 per cent of pokie revenue). Two things had come together: a popular mood for change and an authoritative report pointing to a serious public health problem.   http://insidestory.org.au/the-lobby-group-that-got-much-more-bang-for-its-buck http://theconversation.com/coalition-problem-gambling-policy-putting-the-fox-in-charge-of-the-henhouse-17232   Lobbying for the Dark Side, by Alex Mitchell.   Con men, swindlers and cheaters pay bribes. Sophisticates hire lobbyists because lobbyists get better, more lasting results while only rarely landing in the slammer. — Michael Maiello   Former Prime Minister Kevin Rudd’s announcement in May 2010 of a super profits resource tax triggered the most ferocious lobbying campaign ever seen in Australia. Global giants Rio Tinto, BHP Billiton and Xstrata joined local mining houses in forming a multimillion-dollar slush fund to stop the tax becoming law.   They hired a string of lobbyists across the country with serious expertise in crafting campaigns on behalf of big business. Their principal job was to feed a stream of anti-tax ‘horror’ stories to handpicked newspaper columnists and radio shock jocks.   Lurid articles were planted, suggesting that overseas investment in Australia would dry up, tens of thousands of jobs would be lost and the mining boom, the saviour of the economy, would grind to a halt. The influence-pedlars had the unqualified support of Tony Abbott’s federal Opposition, so they concentrated on Labor MPs in marginal seats, particularly in Queensland and Western Australia, warning that they faced political oblivion if they supported the new tax.   They also supplied them with ‘independent’ polling showing that the measure was deeply unpopular in their electorates and suggested they do everything to halt its passage.   One Sydney-based lobbying firm doubled its staff and offered a twenty-hour information service to clients, sending them press briefings each morning on anti-tax comments made overnight by politicians and resources companies in Britain, South Africa, Canada and the United States. The lobbying machine provided a steady stream of ‘talking heads’ to the commercial television networks: the support of channels Seven, Nine and Ten was a foregone conclusion after the mining companies showered them with prime-time advertising vilifying the government’s tax plan as un-Australian and anti-Australian.   The no-tax campaigners included the Business Council of Australia, the Minerals Council of Australia, the federal Opposition and Rupert Murdoch’s News Limited newspapers. Liberal Party leader Tony Abbott helped to promote the panic with his claim that the tax was ‘a dagger aimed at the absolute heart of our economy’. The 2010 anti-tax campaign was new to Australian political life because it was organised and financed by the private corporate sector in the interests of its owners and investors. Such tactics are very familiar in the corporation-driven politics of the United States, where Washington lobbying is a US$3.3 billion industry employing 12,633 lobbyists. That’s about twenty-three lobbyists for every member of the House (435 members) and the Senate (100 members).   Selling the tax scheme to the Australian public should have been as easy as shifting meat pies to spectators at the MCG. It would add $9 billion to the budget bottom line, putting the economy into a generous surplus and making it the envy of comparable economies around the world. The overseas mining giants were pocketing an absolute fortune, while local mining entrepreneurs such as Gina Rinehart, Andrew Forrest, Clive Palmer and Nathan Tinkler packed the top end of the Business Review Weekly’s annual Rich List. From 1999 to 2009 the value of coal and iron ore exports rose almost sixfold from $12 billion to $69.4 billion, and it is expected to reach $100 billion by 2014.   Export sales have risen, on average, at a rate of 20 per cent per year, yet the lion’s share of the mining ‘boom’ went into the pockets and offshore accounts of the mining conglomerates, their directors, senior executives and institutional shareholders.   The nation’s finite mineral resources, owned by the Australian people through the Commonwealth Government, which awards mining leases, were being quarried and shipped to China and India to sustain their epic economic growth while Australians were not receiving a return that was either adequate or fair. Those who attempted to argue sensibly and rationally for a mining tax to underpin the nation’s long-term economic security were out-gunned by the mining industry and its high-powered lobbying campaign.   ABC TV reporter Andrew Fowler reported: ‘In the forty-one storey tower block that houses BHP Billiton’s headquarters in Melbourne, the company established a war room with a team of hired guns: pollsters and strategists. They planned a multimillion-dollar advertising campaign against the mining tax proposal. Other companies weighed in too with their own campaigns.’   http://meanjin.com.au/articles/post/lobbying-for-the-dark-side/
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