collapsedsquid reblogged your post: collapsedsquid reblogged your…
You’re showing plots and data from the Great Leap Forward, I believe the point that Chomsky’s making is that it ended. Killing people was not effective in developing the country. Actually doing public health is.
I said “industrialization“ when I probably should have said “development,“ because it’s not industrial capacity they needed but medical infrastructure, but in all this you have to ask the question “Why was India unable to accomplish even this?“
Like @mitigatedchaos, I don’t think India is the relevant comparison. I think China is better compared to other centralized, authoritarian states in East Asia, like Taiwan and South Korea, rather than a decentralized, democratic state like India. But that comparison does suggest an answer to the question “Why was India unable to accomplish even this?”
Democratic, decentralized states have more trouble coordinating public resources and marshaling public effort. Amartya Sen, comparing India to China, thought that there was “no mystery in explaining these failures” in public health. It wasn’t because India didn’t have egalitarian goals. India’s National Congress was an admirably egalitarian and social democratic party, with a 1955 manifesto commitment to “planning with a view to establish a socialist society in which the principal means of productions are characterized by social ownership or control.” India didn’t fail because it didn’t have the right goals. India failed because it lacked the means.
Sen writes that India failed “because of the extraordinary neglect of these goals in choosing the directions of planning and public policy”. Sen describes the failures not as failures of substance – although he concedes that India should have focused on export promotion, agricultural development, and economic incentives rather than import-substitution, industrialization, and state-directed planning – but failures of will.
The picture is, however, quite different when it comes to means using failures. There is a surprising amount of tolerance of low performance precisely in those areas, vital to the living standard, that had grabbed the imagination of the nation at the time of Independence and that, in the ultimate analysis, give significance to planning efforts in transforming the quality of life of the masses. There is, in fact, remarkable complacency about India’s moderate record in removing escapable morbidity, avoidable mortality, and astonishingly low literacy rates.
I think this is just the mirror image of the virtues of a democratic and decentralized government, and the pluralism of Indian society, which Sen praised so fulsomely in the context of famine prevention. “No government in India – whether at the state level or at the center – can get away with ignoring threats of starvation and famine and failing to take counteracting measures,” but China could survive years without any change in policy.
But the pluralism that prevents the central government from ignoring threats of starvation – that supplies the powerful opposition pressure to change its policies – is the same pluralism that discourages it from expropriating private wealth, directing public wealth to national programs, prioritizing public health over the preferences of strong interest groups, or delivering the same public investments for decades without democratic control.
Sen says as much:
In China, where the driving force has come from inside the state and the party rather than from the opposition or from independent newspapers, the basic commitment of the political leadership – not unrelated to Marxist ideology – to eradicate hunger and deprivation has certainly proved to be a major asset in eliminating systematic penury, even though it was not able to prevent the big famine, when a confused and dogmatic political leadership was unable to cope with a failure they did not expect and could not explain. The advantages and disadvantages of the different forms of political arrangements and commitments in China and India provide rich material for social comparison and contrast.
China was a totalitarian country. Comprehensive planning meant the Communists were able to coerce individuals into professions for much less than it would cost them if they were free – “the relatively low wages paid to highly specialized medical personnel help keep total expenditures down” – allowing the planners to deliver as many personnel as they needed, at nominal cost.
There are only 2,458 people per (fully qualified Western) doctor in China, as compared with 9,900 in other low-income countries and about 4,310 in middle-income countries. The ratio of population to other medical personnel (including nurses and doctors of Chinese medicine) is even more favorable - 892 excluding barefoot doctors and 365 including them, as compared with 8,790 in other low-income countries and 1,860 in middle-income countries.
In part because the pay of most medical personnel is very low by international standards, this has been achieved at an estimated total annual cost of under $7 per capita, of which $4 is public expenditure. Almost two thirds of expenditures are for drugs. By the standards of low-income developing countries, the level of public expenditure is high - it compares with $2 in India and $1 in Indonesia.
You could do the same thing in an open society – Korea and Sri Lanka did, and without spending much – but it’s harder.
I think @mitigatedchaos is right to focus on homogeneity. It’s harder to deliver public goods when you’re a democratic, decentralized, and pluralistic society. It doesn’t mean you can’t do it – Sri Lanka and Kerala did – but it makes it harder to coordinate resources, especially when you’re facing strong incumbents.
China did away with all that. It did away with democracy, decentralization, and pluralism. It liquidated its incumbents. That made it easier for the Communists to pursue their plans to “eradicate hunger and deprivation,” but it also made the Communists liable to reproduce hunger and deprivation – both inadvertently and on purpose.
Look at that malnutrition table again:
Beijing children born after 1965 were half as malnourished as children raised in other cities, and twenty times less malnourished as children raised in the suburbs. (One wonders what happened in the countryside.) In poorer provinces, life expectancies were 10 to 13 years shorter than they were in Shanghai. Communism reinforced that urban bias.
So long as we’re comparing autocracies with autocracies, it’s pretty clear that Taiwan and South Korea have a better record than China – or Cambodia, Laos, and Vietnam – and China has a much better record after 1978 than it did beforehand, notwithstanding Sen’s amusing belief that perhaps Reform and Opening stopped China from achieving first-world living standards.
Taiwan and South Korea had the same insulation from democratic control that was proves such an “asset in eliminating systematic penury” through credible commitments, but they lacked the socialist platform that made China such a basket case. They didn’t liquidate the small farmers. They didn’t nationalize the land. They draft the peasants into work teams. They didn’t centralize food marketing. And they got by without famines. Not because they were democrats – they weren’t – but because they weren’t socialists.
Taiwan and South Korea also dramatically reduced mortality. They just didn’t kill tens of millions in the process.
Which was what that graph was about.
