This is the first in a four-part series of articles providing a snapshot of modern life in China ahead of October 1, 2009, the 60th anniversary of the founding of the People’s Republic of China. It was published September 20, 2009 in the Insight section of the Idaho State Journal.
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Zhongshan, Tonglu County, Zhejiang, China — In a old wooden home hidden behind Zhongshan’s main street is a place where Ye Xianna, my husband’s 76-year-old grandmother, is quietly putting her trust in Jesus — to protect her against illness.
After sitting with for nearly four hours in the rows of turquoise-colored pews that felt like tiny park benches — witnessing speaking in tongues, singing hymns in Chinese, and preaching on the virtues of Christianity — it was one of the congregation who spoke the most important reason why Ye, like many others in the church, was present that morning.
A senior man in a tan-striped polo shirt and oversized brown pants, with squinty eyes, stubble and a mostly toothless smile, stepped behind the turquoise podium with a blood-red plastic cross attached to it, and began addressing the room.
He was speaking in the local dialect of Tonglu — one of the thousands of dialects in China that sounds different from the country’s official Mandarin Chinese — so I couldn’t understand his words, at first. “What is he saying?” I asked Ye, sitting next to me in the pew in a flowered blouse and pants, with her wiry, shoulder-length gray hair tied into two pigtails.
Ye, whose local dialect is better than her Mandarin Chinese, explained it to me as simply as she could: “His arm used to hurt. Then he believed in Jesus, and it stopped hurting.”
Her simple words spoke a powerful idea: that Jesus heals, literally.
And for many churchgoing senior citizens in China’s countryside, like Ye, it’s the one thing they can count on in the face of a rural healthcare system that is still far from ideal.
One family, two systems
Yu Huimin, my 61-year-old father-in-law, enjoys a health insurance policy that covers approximately 90 percent of his expenses. If only his policy included his 55-year-old wife, Jin Genxiu.
It might seem inconceivable that spouses cannot share a policy in China. But the reason is simple: the policy in Tonglu County where my in-laws live, and in many other parts of China, is tied to your legal status.
In China, there are two different legal designations for citizens: peasant, the status for Jin (and the majority of countryside residents), and city resident, the status for Yu. How can it be that my father-in-law, who was born and raised in the countryside, is not considered a peasant? Because the system allows for peasants to change their status through things such as college admission, investment or, in his case, work. Since he worked for a public school in Zhongshan, his status was eventually upgraded from peasant to city resident.
Given the limitations of peasant health insurance, he is a fortunate man. Jin’s policy will reimburse expenses based on how much money is spent — from 10 percent of expenses at the low end, up to 65 percent of expenses for treatment costing 20,000 RMB (about $3,000) or more. That rate decreases when she visits hospitals outside of Zhongshan, such as in the county seat, or the provincial capital. And, in any given year, her reimbursement cannot exceed 50,000 RMB (about $7,300).
Still, peasant health insurance is a symbol of progress in China’s countryside. Before the New Rural Cooperative Medical Scheme in 2003, health insurance was one thing peasants had to do without, instead relying on family savings, luck, and, for those like Ye, Jesus. Now, peasants just pay an affordable 40 RMB (about $6) per year to access a basic policy. It’s not full coverage, but it’s a start.
And China is eager to turn that start into something more. Just this summer, the Chinese government announced a plan to reform the rural health insurance system, with the goal of providing full universal access to healthcare by 2020. But for now, peasants in Tonglu County have to face the reality of coverage that is, well, catastrophic — especially when it divides a household.
Nutritional swindle
Yu’s comprehensive coverage may be enviable, but it’s no protection against vitamins and supplements that are really a scam.
When I saw the young salesman with an unctuous smile walk into the foyer one morning, I knew something wasn’t right — because my mother-in-law chased him right out of the house. “The nutritional supplements door-to-door salesman,” she remarked, after I inquired about the man. But at lunchtime, I realized that man was much more than a mid-morning annoyance: my father-in-law had bought over 10,000 RMB (approximately $1,500) worth of nucleic acid supplements from him, all sold with dubious health claims.
Nucleic acids as a supplement? It seemed to go against the very logic of nature. After all, I was a biology major in college. I knew nucleic acids as DNA and RNA, the building blocks of life that store and transmit genetic information. Nowhere did my textbooks describe their ability “boost immunity”, “combat fatigue”, and “reduce aging”. But that is exactly what Zhen’ao, the company behind this product, promises to customers.
Zhen’ao is simply giving consumers something too good to pass up — a cure-all in a pill. The claims may sound vague and suspect, but this is a country where popular, effective Chinese remedies are marketed, for example, to “boost your blood” or “lower fire”. Meanwhile, Zhen’ao backs everything up with an aggressive marketing campaign that includes free, all-expenses-paid vacations jammed with informercial sessions and slick take-home collateral loaded with photographs and professional testimonials that never even hint at the deception within. Since people in the countryside generally have no home Internet access or local libraries, there’s no easy way to prove Zhen’ao is wrong.
And if my father-in-law is any evidence, it works. Once we began questioning the value of nucleic acids, there he was, staunchly defending Zhen’ao while standing next to a glossy, color Zhen’ao calendar hanging behind our family’s kitchen wall, decorated with photos of Olympic gold medal diver Guo Jingjing. “See,†said Yu, wearing loose navy pants belted to fit his figure and a light-blue button-down shirt, “these Olympic athletes take nucleic acids.” He spoke of a Nobel-prize winning scientist who developed the product, support from the government, and promotion on China Central Television, the BBC of China. He even pointed to his salt-and-pepper buzz cut and claimed nucleic acids had turned his hair from gray to black.
But there’s one place that the truth about Zhen’ao cannot hide. A Google search on “Zhen’ao nucleic acid” yielded results with the words “scam” and “caution” on the first page. That’s how Yu finally saw the reality: that nucleic acids are unnecessary, ineffective, and even harmful (the latter comes from reports of joint pains that disappeared after users stopped taking Zhen’ao nucleic acids). As for Zhen’ao’s marketing claims, nothing was true — not even the part about the Nobel-prize-winning scientist.
He promised to stop taking Zhen’ao nucleic acids, and has replaced them with a multivitamin for seniors from a reputable Chinese company. But the Zhen’ao color calendar still remains, hanging behind the kitchen wall — a reminder of an expensive lesson in health care products.
Private hopes and hurdles
Still, there is hope in the private health sector in China for rural residents, and it may just save lives. Including the life of Peng Qiulan, my husband’s 55-year-old aunt.
Peng discovered she had uterine cancer, thanks to a private clinic in Tonglu County offering free physical exams.
Generally, it’s a win-win proposal. Free care helps the clinics, which normally reject health insurance, to recruit new patients. And peasants like Peng, who may skip exams to save money, have an incentive to seek preventative care without fearing cost.
Of course, the private clinic’s business strategy is to eventually treat people who come in for physical exams. But not Peng. That’s because uterine cancer is outside their expertise. Peng was eventually referred to Shanghai’s Fudan University Cancer Center, but still had to rely on her son to pay for treatment. Her peasant health insurance only covered 45 percent of the total cost, which was 23,000 RMB (about $3,400). Nevertheless, she is relatively fortunate — some catch their cancer too late, or cannot even afford treatment at hospitals in major cities like Shanghai.
We could see the exhaustion in Peng’s eyes when we visited her home that cloudy afternoon, less than a day before I was to board a plane returning to the US. Yet, this tired woman in flowery pajama bottoms insisted on rising from her bed and walking all the way downstairs, despite having returned just days from Shanghai. Like any good Chinese host, she offered us tea, fruit and snacks, and pressed us to stay longer than the 10 minutes we had. But still, it was good to see her at home. You could feel the hope in that room — a hope that she would survive, in spite of an imperfect healthcare system.
Is this an attempt at steering the current debate in America? You seem to support socialized, communist medicine: shared policy between husbands and wives? equal benefits for both rural and urban residents? It is a slippery slop, you know. Health care is not a right, the government is taking over everything.
I’m just kidding.
Thanks for the detailed first-hand accounts. But it does seem a bit anecdotal. It might be better if you could cite some statistics and surveys to back up your general claims (e.g. rural health insurance is inadequate). And I don’t think it would hurt your journalistic impartiality by pointing out some interesting facts, such as that China does not leave a sixth of its citizenry uninsured.
Those fake nutritional suppliments are bad, but probably not as bad as blind faith in some invisible man, “the opiate of the people”. And it is certainly not as bad as real opium that was once advertised in a similar way, and pushed upon uneducated Chinese by western colonial and commercial interests. Maybe the correct way of doing this business in the 21st century is to rebrand Zhen’ao as “Zhen’aomycin”, “Zhen’aophine” or “Zhen’aovill”, pass some “scientific” clinical trials at some Zhen’ao sponsered labs, get it approved by some FDA-like bureaucracy, and put up ads that states “side-effects may include joint pain, diarrhea, dizziness,….., and blah, blah, blah, ask your doctor about Zhen’aomycin.”
Big pharmaceuticals are the same everywhere. Their aim is to make profits, not to save people. The most profitable approach, therefore, is to focus not on cures or effective prevention, but on treatment, and the more costly, unnecessary and prolonged, the better.
If there is one thing about health care on which I can entirely agree with the conservatives in the US, it would be that health care is a privilage and luxury. In the long run, we all die. It is a matter of fact, the inevitable end of life. Nobody has any inalienable right to health and life. And the world will always move on regardless of individual human deaths, or even completely human extinction. Evolution occurs. Differential survivorship and differential reproduction happen, all the time, whether you like it or not. Nature cares not about rights, individuals, equality, or senescence, because they are all evolutionarily insignificant. Some deaths may have happened for the “common good”. Or perhaps there is no good versus bad. Mother Nature must be a nihilist.
Thanks for the comment, Roadblock.
I appreciate your suggestion on adding statistics. With this piece, I wanted it to be more anecdotal — seen through my own experiences in China, and the experiences of my family members. It’s not intended to be an academic report, just give people a feel for the situation in the countryside. That said, my husband provided a lot of input and help on this piece and I can tell you that data on rural health insurance is not easy to come by. Even the data I did collect from my family members required several phone calls.
However, my main emphasis in this piece is the inherent inequities in health insurance in the countryside. From your comment above, it seems that you don’t think this is an issue.
You mention that “health care is a privilage and luxury. In the long run, we all die. It is a matter of fact, the inevitable end of life. Nobody has any inalienable right to health and life.” Yes, we all die, but I’m not sure that is a good reason why health care should be a privilege and luxury. Should we then argue that, since fires are inevitable, there should be no fire fighters — or that because crime is inevitable in society, we should have no police? That fire fighting and police protection are luxuries, and we should just grab a gun and pail of water, and live in the wild, wild west all over again?
You also say that “Some deaths may have happened for the “common good”.” Who decides that a death is for the common good? This thinking is a slippery slope which leads to a society where humanity is lost — where there is less compassion for those who suffer and die. And when that suffering and dying happens because those people did not get the health care that would have been available — had they had more money, better insurance, etc. — it is a failure of society that should never be labeled as something “for the common good”.
Sorry about my blatant cynicism. But I think it would make a good antidote to a lot of the irrational wishful thinking that so constantly goes around the subject of health and death.
I have never said that we should abolish health care altogether, or that we must not provide it to more people. I only maintain that it is not a universal, inalienable right, that it comes at a huge cost, and that it does not necessarily have to cover everybody equally (and in practice, it cannot).
Besides, there is a fundamental difference between fire or crime and death. Fire and crime are preventable and avoidable, at least on an indiviual basis. A person may live his/her entire life without ever getting cought in a fire. In fact, that is what happens to most people in their lives. But death is an absolute certainty for everybody. A well-organized society can cut crime rate significantly. But it can never stop death. Everybody still has to die.
This is also why I believe the very concept of health insurance or life insurance is inherently doubtful. Insurance is, or should be, intended for catastrophic eventualities which are unlikely to happen, hard to predict, but whose consequences are unbearable: Fire, flood, rare diseases, earthquakes, plane crash etc. It is a way for you to bet against the insurance company to hedge against those unlikely yet catastrophic senarios. Now the risk of getting sick and die is 100% for everyone. So strickly speaking, it is not a risk, but a certainty. How can one bet on the inevitable? Insurance is certainly not the way to go. Moreover, your lifespan is directly causally linked to your own behavior: Lack of exercise, unbalanced diet, reckless attitude, and unhealthy life style in general can all compromise your health. The basis of insurance is distorted, when you have such causal power over the events that your insurance supposedly covers. Therefore, health insurance is not real insurance. It is incompatible with the essence of insurance.
In my opinion, the only rational way to deal with such inevitables as illness and death is to understand them, anticipate them, and to prepare for them, not by feeding money to insurance companies, but by saving money on your own, setting aside resource, and making wills. It is impossible by definition to avoid or prevent the inevitable. And there is usually little point in delaying it. So I am not against euthanization. I also find religious people, who pray not to die, and oppose euthanization, to be quite funny. Isn’t it the case that they can’t wait to join their creator in heaven? To be fair, I must admit that I am always more concerned about those “seriosly and consistently religious” nut-jobs who are eager to go to heaven with 72 virgins.
As to the comment on “common good”, I think people too often buy into rosy, comforting nonsense like “Every human life is invaluable in and of itself” and so on. I am confident, for example, that, in hindsight, few would object to a bloody, premature death of Hitler on the front line of WWI, if we could unwind the tape of history. Realistically, and on a large scale, it was the plague that undermined the foundation of the old Christian theocracy, broke down the feudalistic mode of property ownership and production in Europe, and in effect brought about the the Renaissance. Without it, Europe might still be in the dark ages today. My point is that death is not necessarily a bad thing. Like with many other natural phenomena, it is us humans who imposed our moral views and value judgements on deaths, and interpreted them as bad. But this is all very subjective, self-regarding, and anthropocentric, and lacks rational basis.
Roadblock,
You are right that death is inevitable. Nobody would argue that there is something wrong with an elderly individual passing away in their late 70s, 80s or 90s — for the most part, many of these deaths are because the body has aged to the point where that person cannot survive any longer.
Yet, you are missing one point — death is a problem when it hits people at a younger age, when they still have families to care for. Dieing when you are, say, in your 30s or 40s is not a certainty, yet it happens. And when it happens due to illnesses that could have been completely prevented by medical treatment that is commonly available, it is, again, a travesty. This is why we have term life insurance policies. If a husband or wife should die while they are still within child-rearing years, and have a family to care for, they need monetary support to make sure that they can get through those years ahead. Now, once your children have left the home and are independent, and as you get older, yes, life insurance becomes less meaningful. But not while you’re young and having to provide for your family.
The fact that we all cannot have access to good health insurance policies means trouble for those who are younger and within child-raising years. Because even with the best of intentions, stuff happens — including illness that has nothing to do with your diet or exercise or reckless life choices (my mother, who wore sun screen her entire life, died at 47 from an advanced melanoma that no one caught until it was too late — and she took very good care of herself on diet/exercise). Some people even are getting sick because of pollution in the area (think, the kids with high levels of lead in their blood in Shaanxi Province). No one ever has full “causal power” over illness, despite what you believe.
You also say:
Studies have shown that those in poverty — especially in the US — tend to be the most obese, because the cheapest foods (think processed) are also the worse for your health. Should we yell at them to get off their fat butts and start working out, and buying better foods? These people are just trying to survive and pay the bills. Sometimes they live in neighborhoods where, if they would go out to run, they might be afraid of getting shot. Note this quote from the article I linked to above:
In your desire to put all of the blame on the individual, you fail to recognize the barriers that individual faces. And you fail to acknowledge the inequities.
Also, you need to recognize that covering all individuals lowers the overall costs to the system. If people, even those with less-than-perfect diet and exercise, actually had access to preventative health care — you know, regular physical exams, screenings (things people might skip because they don’t have the money) — they would catch problems earlier and be able to treat them at a lower cost. Rather than, say, going to the emergency room when it becomes a crisis and then leaving the hospital with yet another huge unpaid emergency room bill.
As for the idea that every human life is invaluable in and of itself, I am not here to decide what lives are more valuable than others, nor would I ever enter into any debate about whether a plague was a good idea. I do believe, however, that every human life deserves basic compassion. Even prisoners and people on death row get health care services here in the US. Compassion is not nonsense — it is about being selfless, about caring for others, about being good neighbors. I don’t know about you, but I’d rather live in a world of “good neighbors” who look out for each other, rather than people who think that every life is a dime a dozen and stand on the street corner watching a person die slowly after being hit by a taxi — when that person could have been saved by a 911 call and a little compassion and concern.
I’m afraid you and I are just going to have to agree to disagree on this.
” I do believe, however, that every human life deserves basic compassion. Even prisoners and people on death row get health care services here in the US.”
I agree totally. To let someone die or suffer on economic grounds is horrible. A Chinese friend of mine explained to me about the difference in health care service in America (New York) and in China (Beijing). He said that if you need emergency hospital care in USA you will get if, even if you are uninsured. No hospital will let you die. But this happens from time to time in China. If you need emergency health care here you have to pay, otherwise they wont treat you. In fact they need a deposit before they treat you.
In fact some people die because they can´t even afford a simple treatment. We see this on Cctv (Chinese tv) all the time. Sick people tell their story and some other people collect money so they can get treatment.
Coming from a country that has universal health care for all I feel horrified of some of these stories. To hear that some people die because they can´t afford a simple visit to the doctor is very, very sad. When you see them it is often to late. Something that could have saved there life at an early stage can´t be treated now.
Outside of Beijing’s biggest hospitals you often see poor people sleeping, they might have some relative in the hospital. They are to poor to stay at a hotel so they sleep outside on madrases they cary with them. Winter and summer you see them there. I think about my easy, lazy life , so rich in comparison and I feel shameful. I admire the strength of these Chinese, but they deserve better. My heart breaks every-time I see a very old person among them, especially wintertime.
But there are people who try to do something about this: like the Chinese Christian female dentist who treats patients in her little hospital that she pays by herself. the cost? What they can afford. If they are old, sick or poor it´s free. I felt very moved by this when I heard here story. I talked to some of her patients and some said they had never been to a doctor.
You can´t help being moved by such compassion whatever your views are on religion. Coming from the worlds most secular country I have never seen something like this before, you Americans see this all the time of course? I admire her.
Jocelyn: you write very good articles! Keep up the good work!
Hi Jocelyn,
I am sorry to hear about your mother. As I have mentioned before, rare diseases should be covered by insurance. I have nothing against insuring unpredictable, rare, and protentially lethal or disabling conditions. But if someone has the misfortune to carry a genetic disposition to develope a deadly condition at a reletively young age, and if s/he knows about it, or should know about it from early on, then it is a sightly different and more complicated story. It is certainly a sad unfortunate situation. But tragedy happens in life from time to time.
I think the senario, where “we all cannot have access to good health insurance policies” as you put it, is extreme and not a fact. The reality is that most of the prudent, discerning and responsible individuals in a society can, should and do get decent health care.
The case of children harmed by pollution is a totally unrelated matter. Those pollution victims ought to file class action suits against the polluters, who ought to compensate for the damages they caused themselves. But the society at large should not get penalized for the irresponsible and illegal acts of few bad apples. In fact, arguments could be made that the society has been victimized by pollution as well. And that is often why some polluters are criminally prosecuted.
I do not claim that people have “full causal power” over their health. That is a gross oversimplification. There is a large body of philosophical literature on causality, determinism/indeterminism, moral responsibility, blameworthiness, legal obligation and so on and so forth. I don’t want to give a tiresome lecture about my philosophical positions on these issues. But please let me say this: I definitely do not think people have, or can possibly hold, “full causal power” over their health. In fact, I do not even think that any agent has any “full causal power” over anything. Although causation is a crucial, necessary condition for responsibility, responsibility does not require “full causal power.”. Often times, people who are quite removed on a causal chain from an incident are still held responsible for it (think about negligence cases).
If the less-privileged are suffering from bad health, because of poverty and the consequent unhealth life style, how is good health care going to solve the root of this problem? You would have to solve poverty first. So that is a different issue.
You may wish to set a bare minimum for every member of the society that includes rights to health care and so forth. But the reality is that it is just way too expensive. The welfare state is never sustainable in the long run, even for the wealthiest, most productive nations. There has been many crises in rich European welfare countries (for example, in Michael’s country, Sweden in 1992). And even after widespread welfare reforms in many welfare countries in the 1990s, they still cannot escape the debt spiral. Given the current economic condition of Europe, I expect to see collapses of welfare systems across Europe in the next decade or two. It is already happening in Iceland and Ireland. In the US, Medicare and social security are already broke, which is the real reason behind the proposal of Obamacare. But even when Medicare was looking fine, the funds were run like a giant Ponzi scheme. (This is no exaggeration. Look up the details if you will. It may scare you.) If the US couldn’t cover all its citizens during the boom years, how can it possibly achieve it now?
But there is something more basic and important. I know it is unpopular and politically incorrect, but the truth is there is always going to be stratification in a human society. There will always be helpless cases that are bound to fail no matter what, because as I said, evolution by natural selection just happens everywhere. You can never stop it, unless you are willing to take it over, and to substitute some artificial selection for it, such as family planning, ostracism, and eugenic programs, to ensure some minimum quality standard for entering the society. But to the PC crowd, any vaguest allusion to such artificial process is just far too abhorrent. Yet, on the other hand, they simply cannot admit the existence of Darwinian natural selection among humans, even as it carries on in its powerful but inconspicuous way. So I suppose the high-minded people will just keep playing with their lofty ideas, wishing for the unattainable egalitarian utopia, and keep getting disappointed.
Compassion is a euphemism for pity in my mind. It is a lovely concept, and a noble feeling. But it amounts to nothing but kin selection in scientific terms. Arguments that appeal to emotion rather rationality are moving and touching. But one cannot take them seriously. I, too, prefer good neighbors. But I would want them to be reasonable rather than emotional. Mindlessness is always more dangerous than heartlessness, because history made up of episodes of the heartless defeating the mindless.
Jesus Loves you Roadblock!
Sorry to disappoint you, but I am an atheist.
Hi Jocelyn,
Wow, great blog post. I have a friend in Shanghai that visits the US about once a year for business. Whenever he comes to Seattle, he always stocks up on vitamins and supplements from GNC and Whole Foods. Amazingly, I always wonder why he can’t just buy these same dubious elixirs in China as that is where most of them come from anyway. It must be the distance vs quality curve phenomenon.
.-= Mark Anderson´s last blog ..Providing health insurance for your college graduate =-.
Hi Mark, glad you enjoyed this post. You know, you can actually find some very high-quality vitamins in China, though they are a little different than what’s available here. Multivitamins are probably more advanced over in the US, in terms of having a lot of nutrition packed in one formula. When I was in China and bought vitamins there, it was a lot harder to find one vitamin that had just about everything you needed for nutrition. Still, they sell a LOT in China now — from basic multivitamins to fish oil to even CoEnzyme Q10 (the best ones, I’ve found, are at Watson’s in China).
I can’t tell why bing sent me to your blog but I should probably I have been overall interested by the comments you have patched together. How much time did it take to start getting this many people coming to your blog pages? I am pretty new to this.
You post informative articles. thanks!