[A big long post right off the bat today making an allegory about the Chinese medical industry, after all the news lately about the government cracking down on medical corruption and investigating hospitals for taking kickbacks. I thought all of this was super interesting.]
An askreddit question: “Do hospitals exist to save lives or make money?”
The top-voted reply is, “I’ve seen a Minister of Health talk about community kitchens, and it instantly explained why China’s healthcare is in such a crisis.
If you want to look this up yourself, it’s a story from Miao Xinbo, former Guangdong State Ministry of Health’s Deputy Minister. He told us a story about community kitchens in rural villages. This article doesn’t mention a word about hospitals and medical reform, but if you patiently read through it, then you’d understand why there are so many patient-doctor conflicts in China.
The story starts:
There’s a restaurants in Pottery Town, where they only charge one cent per meal. I worked for years in this restaurant and witnessed many magical stories. I’m going to tell them to you today. I’m sure you’d find it interesting.
Charity Kitchen:
This restaurant was built in the late 70s as the cafeteria for the production team. [This was back when China was trying to be communist, so the production team is the government organised team where everyone would go to find employment, get assigned to do whatever needed to be done around the village, in return for “labour points”, that could be exchanged into ration tickets. Back in the day, you weren’t allowed to have your own kitchen at home, but everyone ate at the community kitchen.] It was mostly funded with money from the production team, and villagers only needed to pay a cent per meal for as much as they could eat. Of course, the meals provided were super simple too, just carrots, cabbages, and bread.
The production team leader used to tell us, “The cafeteria is a charity project. It’s meant to primarily serve the community. The cafeteria workers have a holy duty to feed the hungry.” And we always believed in those teachings. Some villagers can’t even afford a cent, so we’d let them come in and eat for free. Sometimes, beggars would come through, and we’d let them into the kitchen to eat whatever they want. And the production team would just eat the cost for it. As a result, the cafeteria always had a great reputation. Due to the white chef’s coats we always wore, some people even called us “angels in white” [a term that’s often used to call doctors and healthcare workers in China.]
When the 80s rolled around, the cafeteria became managed by the town mayorship. Although the cost of making every meal by this point had risen to 50 cents, the town mayorship always gave the cafeteria a big enough budget that the villagers could still enjoy their meals for a single cent. And the workers in the cafeteria always fulfilled their holy duties of feeding the hungry.
2. The Genius Mayor
In the start of the 90s, the mayor says, “The mayorship’s current offices are too small and cramped. We need to build a bigger office building. All the local government workers unanimously agreed. The mayor’s BIL who was responsible for infrastructure building, and his cousin who was responsible for logistics, were even more enthusiastic for the suggestion. The town mayorship had a lot of sub-departments, there’s the Plowing Department, the Seeding Department, the Irrigation Department, the Harvest Department, the Scavenging Department, the Ranching Department, the Feed Department, the Slaughter Department, the Pork-Selling Department, etc, etc. If everyone got 400 square metres of office space, then they needed at least an 80-floor high skyscraper. But where’s the money going to come from?
The village held meetings for three days and three nights, until the genius mayor came up with a genius idea: rename the cafeteria as the “Pottery Town Restaurant” and make it commercialised. The town mayorship will only fund 40% of the restaurant’s budget, and make the restaurant be responsible for the other 60% of profits. Basically, start charging the villagers who ate there. That way, it can not only lessen the burden on the town budget, but they could fund the skyscraper with this restaurant.
The town mayorship’s accountant ran the number and said, “Right now, each meal costs an average of 3 RMB to make. If the government subsidises 1.2 RMB of it, then the restaurant only has to raise the cost of meals from one cent to 1.8 RMB to cover the difference. I can get that arranged as soon as the meeting’s over.”
The mayor glared at the account and yelled, “Are you insane!? The villagers are upset enough about rising prices. If the town mayorship announced that meals are going to increase in cost 180 times, they would start rioting!”
The account asked, “Then what are we supposed to do? If we don’t increase meal prices, how’s the cafeteria supposed to come up with any money?”
The mayor smiled and said, “Just you watch.”
3. Fund the cafeteria with utensils.
The next day, the Pottery Town Mayorship posted an official noticed named, “Fund the Cafeteria with Utensils”. The notice announced in order to solve the budget shortfall in public cafeterias, they’re now permitting the cafeteria to charge each customer a “utensil fee”. The utensil fee will be used to cover the lack of income from meals.
From that point on, whenever the villagers came to eat at the cafeteria, aside from the cent for their meal, they’d have to pay 1 to 5 RMB for their utensils. The era where you could eat to your heart’s content for a cent is gone forever. The villagers discussed among themselves, “The town mayorship controlled the food prices from rising. They’re thinking of us! The cafeteria’s getting around it by charging us for our utensils. What greedy bastards!”
Throughout the 90s, Pottery Town’s economy took off. Economic growth was skyrocketing. The town mayorship slowly bought 18 Mercedes, 18 GAC Hondas, 18 Volkswagon Passats. The mayor got himself two mistresses. And he went his son across the river to America Town to go to school. If other villager faced some kind of natural disaster, the town mayorship would even generously donate. The government worker’s salaries went up every year too.
Of course, the villager had no idea that the ratio of the budget used to fund the cafeteria was decreasing every year. By 1998, only 10% of the budget was being spent on the cafeteria, and even that 10% wasn’t always paid on time. Sometimes, they received no money from the mayorship at all. At this moment, the Pottery Town Restaurant was still supposedly a “charitable organisation”. But in reality, it wasn’t any different from any private restaurant responsible for its own income and expenses.
During this time, the town mayorship also realised that continuing with one cent meals wasn’t really realistic, so they’ve raised the prices a couple of times. By 1998, each meal cost 2 RMB. But in exchange, the quality of the meals had increased too, and the cost of making them had went up accordingly. Each meal cost 5 RMB to 20 RMB to make. The money they charged people for the meal and the utensil fee combined still wasn’t enough to even cover the costs. The cafeteria was out of options, and was forced to purchase a bunch of high-end utensils so they could justify raising the “utensil fee”, to make up for the losses they were taking on the meals. In addition, the cafeteria started importing high end ingredients like South African Abalone and Australian lobsters and Kobe beef, that they could charge for separately outside of the 2 RMB base price. These meals could be sold for hundreds of RMB. Not only could they satisfy the demands of wealthier customers, but it helped fill the deficit in their income.
4. The Four Problems.
In 2000, the town mayorship’s accountant was ordered to investigate the cafeteria, and discovered several problems that he reported to the mayor.
First: As costs rose and the menu was updated, every meal cost 10 to 30 RMB to make. But the mayorship’s rules meant that the cafeteria could still only charge 2 RMB per meal. Even if you added in the income from the utensil fee and the small amount of high-end meals sold, the cafeteria was losing money every year. If this continued, sooner or later, the cafeteria would have to shut its doors. If the cafeteria shut its doors, the villagers would have nowhere to eat, and they’d all be mad at the town mayorship. How can they prevent the cafeteria from closing?
Second: As the villager’s demand for food rises, the amount of work that had to be done in the cafeteria has increased several fold. But the cafeteria never got permission to hire more workers. As a result, the existing workers in the cafeteria are being forced to work overtime on a long-term, regular basis. They start work at 3AM and often don’t get off of work until 11PM. Whenever they get customers coming for late snacks, they’d have to force themselves to work even later to cover those needs. This increased need for labour isn’t being solved by hiring more workers, but by forcing existing workers to work unpaid overtime, to give up on their holidays, to sacrifice their individual rights. The cafeteria’s workers are all mad at this. How do we solve this?
Third: In the last two decades, the entire food industry has changed drastically. In the modern day, food has become a highly-skilled industry. If someone wants to become a chef or a waitress, they need to first get into a top university that requires high marks, and finish a 5 year Bachelor’s Degree. Then, some of them would study for another 3 years in a Master’s Degree. The Head Chef, chef, and maitre’d positions only hired Doctorates. Before new hires could start working for real, they often have to get through a long, agonising, extremely low-paid internship period and rotations, everything from cleaning vegetables, washing dishes, scrubbing floors, serving food. After they do get hired full-time, they still need to spend the rest of their life continuing to study, keeping up with the latest advancements in the food field, in order to succeed at their jobs. The customers have incredibly high standards for their meals’ taste, colour, shape, temperature, nutritional level, cleanliness, portion size, service attitude, etc, etc. The cafeteria workers have to follow a set of incredibly complicated and strict industry standards and provide incredibly detailed, careful work. If they screw up even a little, they could end up getting sued or even going to prison. As a result, the cafeteria workers are under an enormous amount of pressure to perform an incredibly difficult job. At this point, cafeteria workers are putting a lot more into their work than most other workers in other industries. But they’re not actually paid much at all. Cafeteria workers are very upset about this. How do we solve it?
Fourth: The villagers are paying extremely heavy taxes, and yet they’re no longer enjoying their subsidies of “one cent food”. Not only do they have to spend 2 RMB on every meal, but they have to spend several times that on utensils. If they want to eat abalone or lobster, it would even cost hundreds or thousands. As a result, the villagers often complained about how expensive it was to eat. The cafeteria’s workers, kitchen, tables, and even utensils are highly sought after resources, and during peak hours, villagers who came to eat often couldn’t get a table. And it’s very slow for them to get their food. As a result, the villagers often complained about how hard it was to get food. If the villagers ever discovered that all of these problems were the result of the town mayorship reducing how much they’re giving the cafeteria as its budget, they’d surely blame the town mayorship. How can they hide this from the villagers?
The mayor listened to all four of these problems and didn’t say anything. He just smoked with his eyes narrowed. The accountant didn’t dare to say anything either, and just waited silently for the mayor. After he was done with the whole pack, the mayor turned his head and asked the accountant, “Say, do you think the cafeteria workers are people or gods?”
The accountant had no idea what the mayor was driving at, and could only answer honestly, “Of…of course they’re people, not gods. Why?”
The mayor nodded, and said, “Great! So long as they’re people and not gods, then this problem is easy.”
Clearly, the mayor already had a plan in mind!
5. Shooting four birds with one stone
The next day, the account returned from the cafeteria, excited about his investigations. He reported to the mayor, “I’ve found it! I’ve found it!”
The mayor told him, “Don’t be in such a hurry. Sit down and tell it to me slowly.”
The accountant sat down, caught his breath, and continued, “I’ve carefully went though all the cafeteria’s financial reports, and finally discovered, that when they were purchasing abalone, they took 1000 RMB in kickbacks from the supplier. 500 of that was used in purchasing a sterile locker, 100 for maintaining the stoves, 100 for changing the lightbulbs and faucets, they gave all the chefs a 30 RMB raise, and paid the waitresses the wages that didn’t get paid last month, about 5 to 10 RMB roughly.”
After he heard the report, the mayor grinned mischievously, “Great! I knew they were people and not gods!”
The accountant didn’t get it, and asked the mayor, “What do you mean by that?”
The mayor said, “They’re not gods, so they couldn’t possibly make rice and flower and meat and veggies appear magically. Nor could they get water, electricity, or natural gas. Or tables, chairs, bowls, and chopsticks. If they weren’t getting a budget from us, then they had to use other means to keep the cafeteria running. They’re not Gods, so they can’t live like religious ascetics, to continue burning their life in return for no pay. So they would resort to other means to make up their income.”
The accountant awkwardly asked, “So…should we officially start an investigation and put a stop to all this activity?”
The mayor announced right away, “Of course not! I need them to keep using these other means.”
The accountant was confused and asked, “Why?”
The mayor sighed and said, “You’ve been with me for years, why do you still not get such a simple question? The four problems you brought up yesterday—the cafeteria isn’t making enough money to cover its expenses, the workers are overworked, and they’re underpaid, and the villagers find it expensive and difficult to get food. What’s the reason for all these problems?”
The accountant answered without thinking, “I know. The reason the cafeteria can’t make enough money to cover its expenses is because the village isn’t giving them enough of a budget, but we’re also not allowing them to raise their prices. The cafeteria workers are overworked because we’re not letting them hire enough people, and they don’t have money to hire unofficial workers. They’re underpaid because we’ve set the standard pay too low. The villagers find it expensive to eat food because the cafeteria is forced to charge them a lot of money since we’re not giving them enough subsidies. Compared to eating their fill for a cent, the villagers naturally feel the current food prices are insane. They find it hard to get food because the cafeteria doesn’t have enough production capability and workers, because we didn’t give them enough of a budget or allotment of personnel.”
The mayor said, “That’s right. You’re not an accountant for nothing. So, who’s responsible for these four problems/“
The accountant opened his mouth to answer, and swallowed his words back again.
The mayor raised his voice, “Tell me, who’s responsible for it!?”
The accountant stared at the mayor terrified, and stammer out, “It’s…it’s the town mayorship’s responsibility?”
The mayor snorted, then laughed coldly, and finally kindly told the accountant, “You’re right. But I’m going to make the whole village believe that this is the fault of the cafeteria workers.”
The accountant asked, confused, “How are you going to make them believe you?”
The mayor said, “I’m going to let the cafeteria take kickbacks and accept bribes. The town mayorship is going to hold a big movement against kickbacks, but in fact, we’re going to encourage the cafeteria to get kickbacks from suppliers.
The mayor continued, “Kickbacks are great. First, they provide the cafeteria with a source of income, and makes up for the deficit created by their low prices and lack of funding. It’ll keep the cafeteria running and hide the fact that they haven’t been given enough of a budget to begin with. Second, the kickbacks can be used to pay the workers and make them forget how hard their work is and keep being salarymen, and keep working that overtime. Thirdly, the villagers would obviously identify kickbacks and corrupt was evil, and thus will learn to hate the cafeteria. They’ll be paying all their attention to cafeteria workers, and venting all their frustrations at them, and they won’t have time to think about the town mayorship. And at the same time, if we occasionally, irregularly make a couple of arrests for kickbacks, then the villagers would even love and support us for fighting corruption. This way, all four problems you talked about yesterday will solve itself, and it won’t cost the town mayorship a cent!”
The accountant’s jaw was on the floor, and it took him a while to gather his wits about him. He remarked, “Mayor! You’re really a genius! You’re killing four birds with one stone!”
6. Make the villagers fight the cafeteria.
It was a sunny and bright day. In the Pottery Town Office Building, 44th floor, no.4444 conference room, the “Pottery Town Promotional Project” is holding a meeting. The mayor is leading the meeting himself, with the Head of Radio and Head of Slogans and Head of Billboards and Security Team Leader all attending.
The mayor announced that when it comes to promotions about the cafeteria in the future, they need to be careful to mix up certain concept.
First: You need to confuse the concepts of “passively avoiding loss” and “actively seeking profits”. If the cafeteria wasn’t taking kickbacks or charging sky-high utensil fees, or selling high-end meals aimed at rich people, they cannot continue their operation on just the 2 RMB they charge for food and subsidies from the government. If the chefs and waitresses in the cafeteria didn’t recommend high-end utensils and meals to their customers, they cannot get paid, and they’ll eventually lose their jobs. The cafeteria can’t just let it self get shut down, and the workers aren’t going to accept getting laid off. So they’re simply doing what they must to avoid losses and maintain normal operations. But through the town’s promotions, they have to make the villagers believe that the cafeteria is actively seeking profits, using their professional skills to benefit themselves and becoming millionaires. This is how to invoke the villagers to hate the cafeteria workers.
Second: You need to confuse the concept of “reasonable income” and “massive wealth”. Based on the difficulty, skill requirement, risk, amount of work, and care required of the job, the reasonable amount of income for a cafeteria worker should be around 1000 RMB. But right now, even with the kickbacks, most workers are only getting paid 600 RMB. You must use promotions to erase the special requirements of this job, and compare it to the low wages villagers are making from their low-diploma, low-skill, low-difficulty, low-risk, low work hours jobs. Use the villager’s natural jealousy towards people who make more, to make them think that getting paid 600 is a massive salary that the cafeteria workers are getting, in order to invoke the villagers to hate the cafeteria workers.
Third: You need to confuse the concept of “corrupt leaders” and “normal workers”. In the cafeteria, there are some leaders who are using kickbacks to get massive wealth of several thousand dollars every month, but that’s less than 1% of people. 99% of normal workers are taking a low wage, and yet being forced to work overtime in backbreaking labour, sacrificing themselves for the community. You must use promotions to make villagers believe that all cafeteria workers are getting a massive income from kickbacks, they’re all extremely wealthy, they all have eight houses and ten cars and a hundred mistresses, in order to invoke the villagers to hate the cafeteria workers.
Four: You need to confuse the concept of “a reasonably high bill” and a “unreasonably high bill”. Some high-end meals were supposed to cost a lot of money. But when it comes to promotions, you must erase the meal’s inherent values and tastiness and nutrition, and instead emphasise the high number at the end of the meal, and make the villagers believe the cafeteria is taking advantage of them, in order to invoke the villagers to hate the cafeteria workers.
The mayor finally concludes, “Cafeteria workers are all ordinary people. They’re going to have all the flaws of an ordinary person. You need to dig deep and blow up small issues, and make individual cases feel like industry standard, make trivial matters a big deal. Make the villagers believe that all cafeteria workers are corrupt murderers who care nothing for them. Whenever the villagers get into conflict with the cafeteria, you need to run a ton of reports covering the incident from the villager’s point of view. You need to use very colourful language to paint a picture of the pain the villager suffered, how hungry they were, their fights to a meal, how helpless they are against the cafeteria. And never let the cafeteria have a chance to tell their side of the story. Before an investigation even starts, you need to make the cafeteria worker look guilty by default. You need to always be on the side of the villager. You need to use our monopoly over the media to make the cafeteria hated and despised. And once we’ve made the cafeteria an obvious bad guy, even the normal work they go about every day feeding the poor will be suspected to be some form of corruption and embezzlement. The villagers won’t listen to any of their justifications, and their good intentions will be taken to be sinister. As soon as they open their mouth, the villagers think they’re just covering up for themselves. The fact that most of them are working overtime, doing backbreaking labour, sacrificing themselves will all be ignored. The villagers will believe that all their problems are caused by cafeteria workers.
From that point on, news reports blaming cafeterias and cafeteria workers have never stopped. And it would even reach a climax every couple of years.
7. A 2000 RMB bread.
One day in 2008, a villager came to the cafeteria to eat some bread. He took a bite and complained, “There’s no flavour in this at all. Give me some fish in chilli oil.” The waitress brought him his order, and the villager took a bite and complained, “It’s too spicy! I can’t eat this at all! Bring me the menu.” The waitress brought over the menu, and he ordered a 1200 RMB lobster and a 1000 RMB bottle of moutai. After he was done having his fill, he called the waitress over for the bill, and it came out to 2235 RMB total. The villager jumped up, “What the fuck!? How much are you charging me!? Are you fucking insane!?”
The next day, the Pottery Town Newspaper came out with a headline news, which announced in big, extra-bold characters, “Eating a single piece of bread cost 2200 RMB!” In the report itself, it said, “Villager Zhang went to the cafeteria seeking just to have a piece of bread. But when he got the bill, he was charged an astronomical 2200 RMB! When Zhang questioned the cafeteria on their pricing, the cafeteria manager even dared to claim that they were charging perfectly reasonable and legal amounts and there wasn’t been a mistake.”
When the villagers saw this news, they were all furious, and all accused the cafeteria of exploiting them.”
[This story might be an allegory, but a lot of the numbers used in it are actually based on reality. For example, in actuality, it is in fact only about 10% of the CCP’s budget is being spent on healthcare. And doctors are in fact shockingly underpaid in China. They make an average of roughly 90K a year. I know that in the nearest bigger city to my hometown (which is still a small city by China’s standards), surgeons are only paid about 5K a month.]
This seems...incendiary? Very interesting reframing.
Yow.
But on a trivial tangent, is "Pottery Town" vs. "America Town" a direct translation? Is "china" = "pottery" a current code for evading censors?