Getting old in Russia is harder than dying
Natalia Chernova, Novaya Gazeta, 27.05.2009
Being born and dying in Russia was the main topic of the first review of the UN Human Development Report published in Novaya Gazeta (No. 48 of 13.05.09). However, according to experts, it is still more difficult to grow old in Russia. Moreover, in the coming decades, living the rest of your life with dignity will become an unsolvable task for the vast majority of compatriots. Total silence by the authorities of the problems of an aging country is a bad style. Very soon, according to forecasts – in the next decade, it is this sore point, and not the crisis destabilization of the economy, that will become the main headache for the authorities.
According to demographers' forecasts, potential pensioners of the next 20 years have lost the battle for retirement. The current rules for the appointment and indexation of pensions will lead to the fact that by 2020 it will amount to 18% of the salary (now it is 25%). To literally feel the "charm" of this figure, it is worth performing simple arithmetic operations. It turns out that a salary of 25 thousand rubles will turn into a pension of 4.5 thousand. A lower salary, of course, will take the overwhelming number of Russian pensioners beyond the subsistence minimum. For highly paid workers, the pension will not reach even 10% of wages. (For comparison: in developed countries, the potential pension does not fall below 40% of the salary.)
What Russia will get as a result in 10-15 years, the same demographic forecasts clearly draw. The balance of political forces will shift towards pensioners. The results of the 2020 elections will be determined by them as the majority of voters. There is no doubt that this electorate will be protesting. The old people's revolt – senseless and merciless – will become the main fragment of the political landscape. The fatality of this prospect is almost inevitable, even if, which is hard to believe, the state will address this problem immediately.
Demographers say that in order to keep the country from collapse, the capitalization of the pension system is necessary. The logic of experts is as follows: if we do not take care of ways to increase pensions now, the growing pressure from pensioners will begin to push the authorities to make populist decisions. For example, an increase in the single social tax rate will lead to the destabilization of the economy. Another option is to increase the recommended retirement age, which in the projected version will reach 65 years by 2030. On the one hand, it gives a chance to raise the pension to those who will reach the specified age in the workplace, on the other hand, it deprives those who decide to retire earlier of this increase. One can imagine from what last forces the vast majority of pensioners will pull the strap just in order not to be on the verge of poverty.
Speaking about the capitalization of the pension system, experts suggest that this is possible, but with a caveat – "with the combination of political will, economic resources and intellectual power." Six months of the country's life in crisis have left no illusions about this.
Single and family pensioners, if we evaluate the social and economic risks, are "two big differences". Growing old alone is not only a Russian "know-how", the whole aging world is faced with the growing "emancipation" of old people who prefer to live independently. However, in developed countries, lonely and independent old age has long ceased to be the most tragic ending of life. The system of social support in various forms works quite effectively. And in Russian realities, even now (and it will be even worse), a lonely old age is doomed to state indifference and poverty.
The portrait of a lonely Russian pensioner is as follows. One in three lives alone; one in five is widowed; more than half are divorced; 14% have never had permanent partners; a sixth have no children. Loneliness increases with age – by the age of 75-80, more than half of all pensioners become lonely.
The lonely Russian old age has a female face: 86% are women. In many ways, this is a consequence of the catastrophic gap in the life expectancy of men and women. And yet: having become single, elderly women, due to numerical superiority, as a rule, cannot find a new partner. By the age of 70, more than three-quarters of women are not married, and for men this figure does not reach even a third. The condition of single pensioners is much worse than that of family ones. In older ages, 42% have a disability. Naturally, even basic self-care becomes a big problem for the elderly. But only 3% of them used the help of social workers, nurses or carers. And they also suffer a lot from loneliness – they are twice as likely to feel fear, feel rejected, cry.
Demographers' conclusion: "The country urgently needs to rebuild the system of social relations for the care of the elderly." Given that there is no money in Russia (and it is not expected in the foreseeable future) for an elementary increase in pensions, this recommendation looks absolutely utopian. At the same time, experts state that in an aging society, social spending will only increase. Presumably, they can reach 8-10% of GDP. Russia will not pull this cargo.
Spending money on health is much more profitable than saving on it. The axiom, worked out by the entire civilized world, stubbornly does not take root in Russia. And neither on a public nor on a private scale.
Per capita health care costs in 2005 amounted to $561 in Russia. This is about the level of European countries in the mid-70s. Moreover, over the past 30 years, healthcare costs "there" have been growing rapidly. In Sweden, Denmark, the Netherlands, the growth was tenfold, in Portugal per capita spending increased 40 times. By definition, there could not have been such growth in Russia, but if we take into account inflationary processes, it turns out that in principle there was practically no such growth.
The system of compulsory medical insurance, which was supposed to improve the situation in healthcare, actually led to discrimination against patients. The territorial model of financing turned out to be the fact that the amount of money that each territory spends on its patient differs significantly. And in some regions of the Federation, this difference reaches 10-15 times. It is even more paradoxical that there is no dependence on the level of costs per patient and the morbidity of the population in each individual region. Experts are sure that the system of payment for services in the CHI, which depends on how many tests the doctor prescribes to the patient and how expensive they will be, and not on how quickly he recovers, leads to the fact that it is unprofitable to treat a single hospital well and quickly: funding will be reduced.
At the same time, in the coming years, the burden on healthcare, given the aging of the population, will only increase. According to calculations, by 2025, the volume of polyclinic care will grow by an average of 10%, inpatient care – by 13%, and emergency care – by 25%.
And again, demographers are forced to state: the opinion of professionals by officials who make up long-term concepts and national projects is persistently ignored.
For example, in the national project "Health" priority was given to the prevention of infectious and hereditary diseases. And the analysis of the structure of mortality was not taken into account. In Russia, at an early age, people most often die from diseases of the circulatory system and from external causes, which, according to the cost of treatment, take away more than half of all health care costs, and it is obvious that it is necessary to invest first of all here.
In addition, it is absolutely silent that the country is inevitably aging. In the long-term concepts, there is not a word about the increasing relevance of the development of gerontology, cardiology, oncology, medical and social care. Maintaining the health of an aging nation is too much of a luxury for a country where there is not enough money even to fight tuberculosis.
The experts' conclusion sounds like a verdict: "In order for healthcare to become effective, it is necessary to increase funding at least twice and more rational use of funds." The recommendation is as accurate as it is meaningless.
The report on human development in Russia was created by a group of experts based on research in recent years. That is, in pre-crisis times, although for Russia such a definition looks conditional. The picture of the "start", if the state was going to respond to demographic challenges with political decisions, was drawn clearly and in detail. It is clear that now everything is not as bad as scientists claim – everything is much worse. The question of whether the nation will survive in the proposed circumstances is not worth it. Of course, he will survive. The issue of losses is much more significant.
The expected answer does not cause optimism.
Portal "Eternal youth" http://vechnayamolodost.ru/27.05.2009