Scattered Sand. Hsiao-Hung Pai

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      On two mu of land per person – a third of an acre – he and his dad farmed wheat and sweet corn, for sale and their own subsistence. In total, they brought in 6,000–7,000 yuan (£545–630, $952–1,111) a year –enough to feed and clothe themselves but not much else. His dad had tried to look for other work nearby in order to improve their income, but there wasn’t much industry around Fuxing. They saw that the sons of many families had left for work outside the village.

      In 2004, his uncle developed heart disease and could no longer work on the land, and so could not afford the frequent checkups and treatment. He had no wife or children to support him. No medical insurance was available to peasants. Peng’s father tried to shoulder his brother’s medical costs – more than 1,000 yuan per month – taking a job transporting timber into town in his horse cart, but the extra income was hardly enough. He was too old to leave the village, and so after two years, Peng, then seventeen, volunteered to go work in the city, and became the main breadwinner in his family.

      ‘The ruling clique doesn’t care that most peasants aren’t insured for basic medical care,’ Peng concluded.

      From 1952 to 1982, health care institutions in China were funded by the state, with communes providing free health care to all. The Cooperative Medical System established health centres in villages staffed by ‘barefoot doctors’, medical practitioners with basic training. These health services were poor in quality, but at least available, and during this period infant mortality fell from 200 to 34 per 1,000 live births, and life expectancy increased from about thirty-five to sixty-eight years. Infectious diseases were controlled.

      When the communes were abolished in 1982, the system was dismantled, and peasants instantly became uninsured. Health care was privatized and decentralized, as the central government drastically reduced its funding for social services. Between 1978 and 1999, the government’s share of funding for national health care fell from 32 percent to 15 percent. Now doctors are paid according to a performance-oriented system, in which bonuses are granted according to the amount of money doctors generate for their hospitals from drugs and tests. Sales of expensive drugs – the chief source of income for China’s hospitals – have boomed. In 2007, the total revenue of public hospitals in China was 375.4 billion yuan; 200 billion were from drug sales, compared with 28.5 billion yuan in government funds – just 7.6 percent of total hospital revenues.

      The result is that health care is no longer accessible to most Chinese. Local authorities in the interior provinces and rural regions in particular have been unable to properly fund health care. In 1999, only 7 percent of rural residents and 3 percent of residents in the interior had health insurance, compared with 49 percent of urban residents.1 In 2006, according to the Ministry of Health, fewer than 10 percent of rural residents were insured, compared with 50 percent of urban residents. It was also reported that 87 percent of rural residents paid for all of their health care. Experimental initiatives, like the New Rural Health Cooperatives (NRHC), launched in 2003 in 300 counties, have largely failed. NRHC offered limited health insurance to peasants: 30 yuan per person per year – 10 yuan each contributed by the participant and central and local governments – proved insufficient to cover participants’ medical costs. Even in 2006, when the central and local authorities both increased their contributions to 20 yuan per year, the 50 yuan total per peasant covered only 25 to 35 percent of yearly health care costs in rural areas. Many peasants, too, suspect that the usual rampant corruption plays a part – that local authorities are skimming the funds.

      Recent health reforms have brought new problems. In 2010, as part of the national plan to promote domestic consumption, the government put forward guidelines for health care reform, along with an investment of $124 billion, 40 percent of which would come from the central government and the rest from local ones. The thinking was that if health care were improved, people would not have to save so much for medical costs and would spend more on consumer goods. However, the government never announced how the money would be allocated. The reform itself consisted of two parts: increasing funding for medications and medical equipment, and improving medical insurance coverage. The government planned to raise funds for the rural cooperatives to $18 per person in 2011, although at the time of writing there had been no release of information on how and where that would be done. Moreover, this was not a universal reform: Only sixteen cities (six each in central, western, and eastern China) were chosen to pilot it, with 5,000 township hospitals targeted for upgrading. InMedica, a medical research company, predicted that in China’s largely privatized health care system, the biggest winners in this reform would be medical equipment suppliers like Mindray, Beijing Wandong and Yuyue Medical. Private hospitals, too, including private foreign hospitals, would be favoured by the scheme. The rationale was that opening the door to foreign investment in health care would ease the burden of public health care, since middle-class patients would be more inclined to use foreign hospitals.

      Peng’s first security job in Shenyang paid 1,300 yuan (£118, $206) per month. He sent two thirds of this money home, and kept the rest for his living expenses. He was able to pay rent, and spent very little on food – a few yuan a day. The best meal he made himself was two eggs fried with tomatoes, and he cooked this only occasionally. He had no other expenses – no transport costs, because he walked to work. He was guarding a local three-star hotel. There were three other guards working with him, who also came from nearby villages. Many of the hotel’s guests came from the southern provinces; others came from abroad. He had wondered about them and why they came to a place like Shenyang, a city he found dull and depressing. His job was not easy; hardest to bear was his supervisor’s daily bullying – shouting and name-calling – and one day he talked back. Two weeks later, he was dismissed without notice. Since then, he’d been back at the labour market, looking for work, but had found only a temporary job as a labourer on a building site not far from the market. The pay rate was two-thirds that of the security job, and the work only lasted two days.

      The month before I met him at Lu Gardens, he’d found another security job, at a local brewery. The ad, like many listed at the labour market, had given no information about fixed wages. Such ads say only ‘good starting wage’ or ‘guaranteed good wage for the experienced.’ Peng took the job because he had no other option. When the first paycheck came, 1,000 yuan (£90, $158) for the same work he had performed at the hotel for 1,300, he asked for a raise and was immediately fired. His bosses said they couldn’t pay more, because of the global economic crisis – and they knew that they could find a replacement immediately.

      ‘Bosses can do anything they like,’ Peng said. ‘Heaven is high above and the emperor is far away. They don’t care about breaking the rules, precisely because the rules are not enforced.

      ‘In Shenyang, no one is on your side in these kinds of situations,’ he continued. ‘Arbitration is unfair and slow and always in the interest of the businesses. If worse things happen and you get injured, you can’t afford the costs to take the company to People’s Court. A Shenyang builder fell on a building site and lost his leg. He didn’t sue the company because he couldn’t afford to. Who cared about him? He’s one of us – from the countryside.’

      Now Peng came to Lu Garden every day. He got up at around 6 a.m. along with his roommates. They usually cooked porridge for breakfast and ate it with pickled vegetables. Peng never had much appetite that early in the morning, so he’d leave the flat and walk alone to Lu Garden, through the quiet alleyways and streets. He enjoyed it; it was the most tranquil part of his day. When he arrived, a crowd of job seekers was already there, well ahead of him, all eagerly waiting to see that day’s new opportunities. He would push himself to the front and scan the ads on the walls, taking notes, and then call up each number and ask for an interview. If he saw no suitable ads, he would walk around the market and chat with fellow job seekers. Sometimes he would sit on the floor in a corner and rest, before getting up again to look for more incoming ads. He would also walk around seeking potential employers – sometimes they would come down to look for individual workers to do a casual job, just for the day.

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