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Россия может сделать ещё один шаг по снятию социальных обязательств с государства и перекладыванию их на плечи граждан. Соответствующие рекомендации содержатся в докладе Центра стратегических разработок (ЦСР) «Здравоохранение: необходимые ответы на вызовы времени».

 

Бесплатная медицина — не для граждан России

27 февраля 2018 г.

      Автор: Фоменко Виктория

Средства на лечение от рака, операции, паллиативную помощь, хосписы уже много лет собираются «всем миром». Почему бы и вовсе не перевести здравоохранение на народный донат?

Бесплатная медицина — не для граждан России

Фото: www.globallookpress.com

Мягко стелют

Формально детище ЦСР, руководимое бывшим министром финансов Алексеем Кудриным, отнюдь не выглядит манифестом либертарианства. Напротив, составители документа рассуждают о «динамике развития человеческого капитала», необходимости перенаправления усилий государства с военной сферы в образование и здравоохранение и, соответственно, удорожании средств и методов лечения различных заболеваний, о мировом опыте.

Некоторые фрагменты и вовсе смотрятся так, словно их писал нормальный человек.

Технологический прорыв в здравоохранении планируется совершить за счёт поддержки новых медицинских технологий, внедрения инновационных управленческих моделей и развития центров экспорта высокотехнологичных медицинских услуг, — говорится в докладе. — Для этого предлагается запустить госпрограммы по развитию биомедицины и поддержки стартап-проектов в индустрии здоровья (2018—2024 гг.), а также сделать массовой подготовку кадров по разработке и эксплуатации медицинской техники".

Казалось бы: адекватные мысли, высказываемые в рамках общих мировых трендов. Но ключевой момент доклада касается того, откуда следует брать деньги на всё вышеизложенное великолепие. Изложен он на сайте в следующем виде:

«Целесообразно провести апробацию в нескольких пилотных регионах новых механизмов финансирования, обеспечивающих развитие страховых принципов в системе ОМС».

Прямо скажем, не очень понятная фраза. Однако агентству РБК удалось получить полный текст доклада с конкретными «рецептами». И не только получить, но и поделиться ими с общественностью.

ОМС

Фото: Алексей Павлишак/ТАСС

Хотят жить — пусть платят

В непубличной части документа специалисты ЦСР перестают стесняться и напрямую предлагают правительству начать брать с россиян деньги за лечение.

В силу прогнозируемого исключительно быстрого обновления медицинских технологий государство вряд ли сможет сразу вслед за появлением всех наиболее значимых дорогостоящих инноваций обеспечивать их общедоступность на бесплатной основе", — убеждены они.

Поскольку небогатое нефтью, газом, золотом и алмазами российское государство платить за новые приборы и материалы не сможет (их производство внутри страны либералами не рассматривается по умолчанию), то на чудеса биотехнологий должны будут раскошеливаться рядовые граждане.

Реализовывать этот принцип предлагается через систему соплатежей, когда одну часть лечения оплачивает государство, другую — сам пациент, а третью — работодатели.

Необходимость перевода российской медицины на платно-страховую систему составители доклада аргументируют тем, что уже сейчас около 15% жителей платят за дополнительные медицинские услуги. «Если система софинансирования не будет выстроена официально, она останется «в тени»», — цитирует РБК текст доклада, который сами эксперты ЦСР предпочли не публиковать у себя на сайте.

Того, что 85% россиян номинально всё-таки за лечение не платят, составители документа предпочитают не замечать. «Угроза» же того, что деньги, которые граждане тратят на дополнительные анализы, останутся в тени, — это прямая и непосредственная апелляция к чиновничьей жадности, попытка спровоцировать власть на «синдром утки»: хватать и глотать всё, что проплывает мимо клюва, не разбирая, что это на самом деле, и стоит ли это есть.

медицина

Фото: www.globallookpress.com

Специалисты ЦСР полагают, что при реализации такой схемы для уверенного развития наукоёмких технологий и принципиального улучшения уровня здравоохранения государству будет достаточно повысить расходы на медицину с 3,2% ВВП, шедших на эти цели в 2016-м, до 5% ВВП — к 2035-му.

Переводя с «экспертного» на русский

Что же на самом деле означают рекомендации? Попробуем разобраться.

Прежде всего в глаза бросается мизерный рост расходов на медицину: всего два процентных пункта за 19 лет или чуть больше 0,1% ВВП в год. То есть кудринцы прозрачно намекают кабмину, что тратиться на здравоохранение госказне почти и не придётся. Всё случится само.

Второе, на что нельзя не обратить внимания, — это распределение ролей. ЦСР подмигивает коллегам-либералам из правительства и заявляет, что у государства якобы нет денег на развитие медицины. Ну ещё бы: ведь львиная доля средств уже утекла на ежегодную закупку американских долговых обязательств на миллиарды долларов. На развитие генной инженерии и производство медтехники остались жалкие крохи.

Между тем россияне — отнюдь не те люди, о которых можно сказать, что они «зажрались». Реальные доходы населения падают четвёртый год подряд, средняя российская зарплата дрейфует между уровнем относительно благополучных стран Африки и сильно неблагополучных стран Восточной Европы.

Особый цинизм ситуации заключается в том, что «бесплатная» российская медицина — в реальности ни разу не бесплатная. Все работающие россияне платят 5,1% от своих доходов в федеральный Фонд обязательного медицинского страхования (ФОМС). Но даже те, кто не имеет официальной работы, всё равно опосредованно оплачивают медицинскую помощь через косвенные налоги, идущие в региональные бюджеты.

Проблема российской медицины не в том, что население не платит, а в том, что деньги растаскивают.

Чтобы не быть голословными, приведём такой пример: на спасение частного банка «Открытие» уже потрачено 1,1 триллиона рублей. Это почти в два раза больше, чем совокупные расходы страны на здравоохранение в 2018 году: они составляют всего 685,5 миллиардов. О каком развитии наукоёмких отраслей хоть в медицине, хоть в любой другой сфере можно говорить при такой расстановке приоритетов?

Предложения ЦСР порочны в принципе: сколько бы государство ни собрало денег с граждан, они всё равно не будут потрачены на улучшение ситуации в стране, поскольку у ЦБ и финансовых элит на них другие планы.

медики

Фото: www.globallookpress.com

Трансплантация американской язвы

По сути, ЦСР предлагает взять и перенести на российскую почву американскую модель страховой медицины. Вообще, у США много всего можно позаимствовать: агрессивную внешнюю политику, сверхуспешную космическую программу, эффективное применение ЧВК. Но только, увы, не систему здравоохранения. Штаты — единственная из развитых стран, которая не гарантирует своим гражданам бесплатной медпомощи.

Экспертов из ЦСР не смущает тот факт, что американские элиты уже несколько лет как осознали пагубность такой практики и взяли курс на уход от неё. То, что это системное решение истеблишмента, а не взбрык отдельно взятого Барака Обамы, по прихоти своей учредившего ObamaCare (систему всеобщего обязательного страхования), показала попытка Дональда Трампа отменить её. В ответ против намерения президента-либертарианца в Конгрессе поднялись не только демократы, но и республиканцы.

Почему же американские политики, большинство из которых являются миллионерами и миллиардерами, решили отказаться от системы, позволявшей десятилетиями драть три шкуры с простых граждан? Ответ прост: такая система не только порождает нешуточное социальное напряжение, но и полностью несовместима с трендами на развитие человеческого капитала.

Понимают ли это составители доклада? Скорее всего, да. Но не исключено, что именно поэтому и лоббируют свой вариант.

Всё идет по плану

Надо понимать, что предложения кудринской команды — вовсе не новое слово в либеральной политике. Это ещё один шаг в деле ликвидации российской медицины.

Такая политика давно и последовательно проводится кабинетом министров и губернаторским корпусом. В ноябре 2017-го Счётная палата сообщила, что 84 российских региона сократили расходы на здравоохранение в среднем на 42,9%. При этом 20 из них свернули финансирование более чем в три раза, то есть медики получили всего по 30% от уровня 2016 года. Сократил расходы на медицину и федеральный бюджет — примерно на 20%. И это при том, что в прошлом году отмечался рост бюджетных доходов и уменьшение дефицита бюджетов всех уровней.

Согласны с этим трендом и условно оппозиционные либералы.

В октябре прошлого года «Высшая школа экономики» предложила ввести систему целевых сборов с населения на образование, медицину и инфраструктуру. В ВШЭ сочли, что россияне вполне могли бы отдавать 2-3% годовых доходов за пользование больницами, школами и дорогами. Проблема с этими инициативами ровно та же, что и с предложениями кудринской команды: они никак не решают проблему откачки ресурсов из страны.

В целом можно сказать, что у России есть выбор: остаться либеральным дискурсом в экономике или же попытаться сохранить медицину, а заодно и промышленность, образование, науку и население.

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121 комментарий на «Хотят жить — пусть платят: Адепты «кудриномики» о платной «бесплатной» медицине. Почему бы не перевести здравоохранение на народный донат? А что?»

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