by James Millar
HEALTH CARE SERVICES, SOVIET
Local Self-Government, ed. Terence Emmons and Wayne S. Vucinich. Cambridge, UK: Cambridge University Press. Solomon, Susan, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloom-ington: Indiana University Press.
SAMUEL C. RAMER
HEALTH CARE SERVICES, SOVIET
Soviet socialized medicine consisted of a complex of measures designed to provide free medical care to the entire population, at the time of service, at the expense of society. The Soviet Union was the first country in the world to grant every citizen a constitutional right to medical care. This commitment was one of the few brighter (and redeeming) aspects of an otherwise bleak totalitarian system and often held as an example to emulate by other nations. The promise of universal, free (though not necessarily equal) care was held as the fulfillment of an age-long dream of providing care to those who needed it regardless of their station in life and ability to pay. It thus promised to eliminate the commercial aspects of the medical encounter that, in the eyes of many, had turned the physician into a businessman concerned primarily with his income and his willingness to treat only those who were affluent.
In the first decade of the Soviet regime, the official ideology held that illness and premature mortality were the products of a faulty socioeconomic system (i.e., capitalism) and that the establishment of a socialist society (eventually to become communist) would gradually eliminate most of the social causes of disease and early deaths by creating improved conditions (better nutrition, decent standard of living, good working conditions, housing, and prevention). This approach was set aside when Stalin took power at the end of the 1920s. He launched a program of forced draft industrialization and militarization at the expense of the standard of living, with an emphasis on medical and clinical or remedial approach, rather than prevention, to maintain and repair the working and fighting capacity of the population. The number of health personnel and hospital beds increased substantially, though their quality was relatively poor, except for the elites.
Soviet socialized medicine was essentially a public and state enterprise. It was the state that provided the care. It was not an insurance system, nor a mix of public and private activities, nor was it a charitable or religious enterprise. The state assumed complete control of the financing of medical care. Soviet socialized medicine became highly centralized and bureaucratized, with the Health Ministry USSR standing at the apex of the medical pyramid. Physicians and other health personnel became state salaried employees. The state also financed and managed medical education, all health facilities from clinics to hospitals to rest homes, medical research, the production of pharmaceuticals, and medical technology. The system thus depended entirely on budgetary allocations as line items in the budget. More often than not, the health care system suffered from low priority and was financed on what came to be known as the residual principle. After all other needs had been met, whatever was left would go to health care. Most physicians (the majority of whom were women) were poorly paid compared to other occupations, and many medical facilities were short of funds to purchase equipment and supplies or to maintain them.
Access to care was stratified according to occupation, rank, and location. Nevertheless the population, by and large, looked upon the principle of socialized medicine as one of the more positive achievements of the Soviet regime and welfare system, and held to the belief that everyone was entitled to free care. Their major complaint was with the implementation of that principle. Soviet socialized medicine could be characterized as having a noble purpose, but with inadequate resources, flawed execution, and ending in mixed results. See also: FELDSHER; HEALTHCARE SERVICES, IMPERIAL
BIBLIOGRAPHY
Field, Mark G. (1957). Doctor and Patient in Soviet Russia. Cambridge, MA: Harvard University Press. Field, Mark G. (1967). Soviet Socialized Medicine: An Introduction. New York: The Free Press. Field, Mark G., and Twigg, Judyth L., eds. (2000). Russia’s Torn Safety Nets: Health and Social Welfare During the Transition. New York: St. Martin’s Press. Ryan, Michael. (1981). Doctors and the State in the Soviet Union. New York: St. Martin’s Press. Sigerist, Henry E. (1947). Medicine and Health in the Soviet Union. New York: Citadel Press. Solomon, Susan Gross, and Hutchinson, John F., eds. (1990). Health and Society in Revolutionary Russia. Bloomington: Indiana University Press.
MARK G. FIELD
HEGEL, GEORG WILHELM FRIEDRICH
HEGEL, GEORG WILHELM FRIEDRICH
(1770-1831), leading nineteenth-century philosopher.
Georg Wilhem Friedrich Hegel was one of the most influential idealist philosophers of the nineteenth century. In German philosophical thought, Hegel was rivaled in his own times perhaps only by Immanuel Kant.
Hegel developed a sweeping spectrum of thought embracing metaphysics, epistemology, logic, historiography, science, art, politics, and society. One branch of his philosophy after his death was reworked and fashioned into an “algebra of revolution,” as developed by Karl Marx and Friedrich Engels, Russian Marxists and socialists, and later by Vladimir I. Lenin, the founder of Bolshevism. Georg Wilhelm Friedrich Hegel influenced the writings of Karl Marx. © BETTMANN/CORBIS
For Hegel, reality, which progresses dynamically through a process, or phases, of thesis, antithesis, and synthesis-his triadic concept of logic, inspired by the philosophy of Heraclitus-is essentially spiritual. Ultimate, determinant reality, according to Hegel, is the absolute World Spirit (Weltgeist). This spirit acts in triadic, dialectical fashion universally throughout world history. For Hegel, the state was the principal embodiment, or bearer, of this process.
Because of its occasional obscurity and complexity, Hegelianism as a social and political philosophy soon split into various, contrasting branches. The primary ones were the extremes widely known as Right and Left Hegelianism. There was also a middle, or moderate, form of Hegelian-ism that in some ways influenced English, Italian, American, and other branches of late-nineteenth-century idealism and pragmatism.
Right (or Old) Hegelianism regarded reality more or less passively, as indubitably rational. Whatever is real is rational, as seen in the status quo. Spirit, it alleged, develops on a grand, world scale via the inexorable, dialectical processes of history. Wherever this process leads must be logical since spirit is absolute and triadically law-bound. In the milieu of contrasting European politics of the nineteenth century, Right Hegelianism translated into reactionary endorsement of restorationism (restoring the old order following the French Revolution and the Napoleonic Wars) or support for monarchist legitimacy.
By contrast, however, Left (or Young) Hegelian-ism, which influenced a number of thinkers, including Marx and Engels together with Russian Marxists and socialists, stressed the idea of grasping and understanding, even wielding, this law-bound process. It sought thereby to manipulate reality, above all, via society, politics, and the state. For revolutionaries, the revolutionary movement became such a handle, or weapon.
Hegel had taught that there was an ultimate reality and that it was spiritual. However, when the young, materialist-minded Marx, under the influence of such philosophers as Feuerbach, absorbed Hegel, he “turned Hegel upside down,” to use his collaborator Friedrich Engels’s apt phrase. While retaining Hegelian logic and the historical process of the triadic dialectic, Marx, later Engels, and still later Lenin, saw the process in purely nonspiritual, materialistic, historical, and socioeconomic terms. This became the ideology, or science, of historical materialism and dialectical materialism as embraced by the Russian Marxist George Plekhanov and, thence, by Lenin-but in an interpretation of the ideology different from Plekhanov’s.
HELSINKI ACCORDS
In the Marx-Engels-Lenin-Stalin interpretation of Left Hegelianism, historical change, the motor of history as determined by the forces and processes within the given social and economic system, is law-bound and strictly predictable. As presented in historical materialism, the history of societies develops universally by st
ages-namely, from slavery, to feudalism, to capitalism, and finally to socialism, whose final stage is full-fledged communism.
Each stage, except the merged last two (socialism/communism), contains the seeds of its own destruction (or “contradictions”) as the dialectical process of socioeconomic development spirals upward to the next historical stage. For instance, capitalism’s antithesis is seen in the seeds of its own destruction together with the anticipation of the new synthesis of socialism/communism. Such seeds, said the Marxists, are capitalism’s impoverishment of a majority of the exploited population, overproduction, unemployment, class struggle, economic collapse, and, inevitably, revolution.
Progressive elements of the former, capitalist order are then continued in new form in the final, socialist/communist phase. This assumes the form of industrialization, mass production, a just sociopolitical order (under a workers’ dictatorship of the proletariat). In this formulation the Marxists developed the theory of base and superstructure. The base is the economic system; the superstructure are such facets of society as government, laws, religion, literature, and the arts. The superstructure both reflects and rationalizes the base.
Ultimately, under the dictatorship of the proletariat, state power, as described in the Marxist Critique of the Gotha Program, gradually withers away. The society is thence led into the final epoch of communism. In this final stage, a virtual millennium, there are no classes, no socioeconomic inequality, no oppression, no state, no law, no division of labor, but instead pure equality, com-munality, and universal happiness. Ironically, in contrast to Marx’s formulation, the ultimate phase in Hegel’s own interpretation of the dialectic in history was the Prussian state.
In Lenin’s construction of Marxism, Hegelian-ism was given an extreme left interpretation. This is seen, among other places, in Lenin’s “Philosophical Notebooks.” In this work Lenin gives his own interpretation of Hegel. He indicates here and in other writings that absolute knowledge of the inevitable historical process is attainable-at least by those equipped to find it scientifically. The leaders of the impending proletarian revolution, Lenin says in his 1903 work, What Is to Be Done?, become a select circle of intellectuals whose philosophy (derived from Marx and Hegel) equips them to assume exclusive Communist Party leadership of the given country. Lenin could imagine that such knowledge might allow a nation’s (namely, Russia’s) socioeconomic development to skip intermediate socioeconomic phases, or at least shorten them. In this way, the Russian Bolsheviks could lead the masses to the socialist/communist stage of development all but directly. This could be accomplished by reducing or suppressing the phase of bourgeois capitalism. (This Leninist interepreta-tion of the dialectic has been criticized by other Marxists as running counter to Hegel’s, and Marx’s, own explanations of the dialectic.)
Thus, in Lenin’s interpretation of Hegel and Marx, the dictatorship of the proletariat becomes the leader and teacher of society, the single indoc-trinator whose absolute power (based on the people) saves the masses from the abuses of the contradictions of capitalist society, whether in rural or urban society, while guiding society to the final, communist phase. See also: DIALECTICAL MATERIALISM; ENGELS, FRIEDRICH; LENIN, VLADIMIR ILICH; MARXISM
BIBLIOGRAPHY
Gregor, A. James. (1995). “A Survey of Marxism.” In The Oxford Companion to Philosophy, ed. Ted Hon-derich. Oxford: Oxford University Press. Hegel, Georg Wilhem Friedrich. (1967). The Philosophy of Right. Oxford: Clarendon. Marx, Karl, and Engels, Friedrich. (1962). Selected Works. 2 vols. Moscow: Foreign Languages Pub. House. Possony, Stefan T. (1966). Lenin: The Compulsive Revolutionary. London: Allen amp; Unwin. Tucker, Robert C. (1972). Philosophy and Myth in Karl Marx, 2nd ed. Cambridge, UK: Cambridge University Press. Weeks, Albert L. (1968). The First Bolshevik: A Political Biography of Peter Tkachev. New York: New York University Press.
ALBERT L. WEEKS
HELSINKI ACCORDS
Signed at the Finnish capital of Helsinki on August 1, 1975, the Helsinki Accords were accepted by
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HERZEN, ALEXANDER IVANOVICH
thirty-five participating nations at the first Conference on Security and Cooperation in Europe. The conference included all of the nations of Europe (excluding Albania), as well as the Soviet Union, the United States, and Canada. The Helsinki Accords had two noteworthy features. First, Article I formally recognized the post-World War II borders of Europe, which included an unwritten acknowledgement of the Soviet Union’s control over the Baltic states of Estonia, Latvia, and Lithuania, which the USSR had annexed in 1940. Second, Article VII stated that “the participating States recognize the universal significance of human rights and fundamental freedoms.” This passage, in theory, held the Soviet Union responsible for the maintenance and protection of basic human rights within its borders.
Although the Soviet government was never serious about conforming to the human rights parameters defined by the Helsinki Accords, the national leadership under General Secretary Leonid I. Brezhnev believed that its signing of the document would improve the Soviet Union’s diplomatic position with the United States and other Western countries. Specifically, the state wished to foster the perception that it was as an equal player in the policy of d?tente, in which both superpowers sought to relax Cold War tensions. What the regime did not anticipate, however, was that those outside the Soviet Union, as well as many of the USSR’s own citizens, would take the Accords seriously. Soon after the Soviet delegation returned from Finland, a number of human rights watchdog groups emerged to monitor the USSR’s compliance with the Accords.
Among those organizations that arose after the signing of the accords was Helsinki Watch, founded in 1978 by a collection of Soviet dissidents including the notable physicist Andrei D. Sakharov and other human rights activists living outside the USSR. Helsinki Watch quickly became the best-known and most outspoken critic of Soviet human rights policies. This collection of activists and intellectuals later merged with similar organizations to form an association known as Human Rights Watch. Many members of both Helsinki Watch and Human Rights Watch who were Soviet citizens endured state persecution, including trial, arrest, and internal exile (e.g., Sakharov was exiled to the city of Gorky) from 1977 to 1980. Until the emergence of Mikhail S. Gorbachev as Soviet general secretary in 1985, independent monitoring of Soviet compliance with the accords from within the USSR remained difficult, although the dissidents of Helsinki Watch were never completely silenced. After the introduction of openness (glasnost) and restructuring (perestroika) under Gorbachev in the late 1980s, however, these individuals’ efforts received much acclaim at home and abroad. The efforts of Helsinki Watch and its successor organizations served notice in an era of strict social control that the Soviet Union was accountable for its human rights obligations as specified by the Helsinki Accords. See also: BREZHNEV, LEONID ILICH; D?TENTE; DISSIDENT MOVEMENT; HUMAN RIGHTS
BIBLIOGRAPHY
Civnet: A Website of Civitas International. (2003). “The Helsinki Accords.” «http://www.civnet.org/ resources/document/historic/helsinki.htm» Luxmoore, Jonathan. (1990). Helsinki Agreement: Dialogue or Discussion? New York: State Mutual Book and Periodical Service. Nogee, Joseph and Donaldson, Robert, eds. (1992) Soviet Foreign Policy since World War II, 4th ed. New York: Macmillan. Sakharov, Andrei D. (1978). Alarm and Hope. New York: Knopf.
CHRISTOPHER J. WARD
HERZEN, ALEXANDER IVANOVICH
(1812-1870), dissident political thinker and writer, founder of Russian populism.
Alexander Ivanovich Herzen was born in Moscow, the illegitimate son of a Russian aristocrat and his German-born mistress. His family name, derived from the German herz (“heart”), was given to him by his father. In 1825 Herzen was deeply affected by the Decembrist revolt that fueled his rejection of the Russian status quo. His early commitments were developed in the companionship he formed with a young relative, Nikolai Ogarev. In 1828 on the Vorobyevy Hills, they took a solemn oath of personal and political loyalty t
o each other.
While a student at Moscow University, Herzen became the center of gravity for a circle of critically-minded youth opposed to the existing social and moral order; in 1834 both Herzen and Ogarev were arrested for expressing their opinions in private. Herzen was exiled to Perm and later to Vyatka, where he worked as a clerk in the governor’s
HERZEN, ALEXANDER IVANOVICH
office. A surprise encounter with the future tsar Alexander Nikolayevich (later Alexander II) led to his transfer to the city of Vladimir. There he found work as a journalist, and later received permission to reside in St. Petersburg. This, however, was soon followed by another period of exile that lasted until 1842. Meanwhile, Herzen’s study and propagation of Hegelian philosophy became the cornerstone of his debates and intellectual alliances with radical Westernizers such as Vissarion Grigorievich Be-linsky, moderates such as Timofey Nikolayevich Granovsky, and the early Slavophiles. He established himself as a prolific writer on issues such as the perils of excess specialization of knowledge, the promises and defaults of utopian socialism exemplified by Robert Owen (1771-1858) and Charles Fourier (1772-1837), the libertarian anarchism of Pierre-Joseph Proudhon (1809-1865), and, most of all, the purportedly socialist promise of the Russian peasant commune. This latter subject became the centerpiece of his thought and worldview; as set forth in his key work, From the Other Shore (1847-1848, coinciding with the appearance of Marx’s Communist Manifesto), Herzen laid out the key arguments of Russian populism, arguing that the primordial collective morality of the commune must be preserved against the inroads of capitalism, and extolling Russia’s opportunity to overtake the West on the path of social progress toward a just and equitable organization of society, without having to pass through the capitalist stage. Populism, as envisioned by Herzen, was to become one of the two main currents of Russia’s revolutionary thought, alongside with Marxism. Each of these philosophical strains cross-fertilized and competed with the other.