Kai Ryssdal: For all the attention that the cost of the health care reform law has gotten, economists still haven't been able to put a specific dollar amount on the thing. That's in part because it's so hard to estimate the costs of disease. There's the cost of medical care,loss of productivity, intangibles that are far harder to measure. It's one thing to try to figure those costs when you're talking about individual illnesses. It's entirely another when you apply those costs across an entire economy.
Our health care correspondent Gregory Warner has the last of his series from Russia on the battle between health policy and health care.
Gregory Warner: Picture yourself standing on a metro station platform in Moscow, just waiting for your train. Look around and you're bound to see two posters. One shows a smiling mother balancing triplets on her lap. It's urging women to have more babies. The other shows a cigarette ripped in half. It's telling you not to smoke. Those two omnipresent posters reflect two sides of one looming fear: that if Russia does nothing to increase its birth rate and lower its death rate, its population could fall by 30 million -- 20 percent in the next 40 years.
OK, we can actually leave the station now. Let's head above ground to a tiny office at the Institute for Economic Forecasting in Moscow. Professor Boris Prokhorov is 83, 20 years over the average life expectancy for the Russian man. And old enough to remember when statistics was a dangerous profession. You could get arrested for publishing the results of a bad wheat harvest.
Boris Prokhorov: Concurrentnaya zanimat nashenia.
Today he says he's free to publish whatever he wants. Though his research into children's health hasn't made him a favorite with government funders. He reaches into his coat closet -- it doubles as a library -- and he pulls out his latest book.
Warner: I see a graph that's going from 1996 to 2004, and it's increasing, and that's...
Prokhorov: Deti pa rostof.
Warner: The increase in children's diseases
Prokhorov: Natchet vot...
Tuberculosis, cerebral palsy, alcoholism in teens -- an assortment of conditions and disorders on the rise since the 1990s. And while the picture's improved somewhat in the last few years along with the Russian economy, a 15-year-old boy in Russia still has a shorter life expectancy than a boy in Haiti.
That's not just bad for Russians, it's bad for Russia's economic prospects. International investors use certain health statistics -- like infant mortality and life expectancy -- to gauge a country's economic future. So to deal with these troubling statistics, the Russian government announced a plan to build 23 neonatal centers across the country with state-of-the-art Western technology.
One of those neonatal centers is being built here, in the ancient city of Yaroslavl, a four-hour train ride north of Moscow. The center hasn't opened yet when I arrive -- the federal program has been racked with delays -- so I stopped in to one of the city's maternity wards.
I meet the director, Irina Dmitrievna, a vigorous woman, nearly six-feet tall with a blond bouffant. She leads me to the premie ward. There's an incubator and a tiny baby inside.
Irina Dmitrievna: Su davkhodit innovi technology.
The future neonatal center, she says, will have much better technology.
Dmitrievna: They're aimed at obtaining a healthy person who will go on take an active role in the life of our city and our government.
She might have added "our military," as well. The military is worried about finding enough healthy soldiers to guard the borders. The Ministry of Defense is reportedly planning to tag newborn boys and track their health as they grow.
Andrei Demin is a physician and a public-health advocate in Moscow. He tells whoever in the government will listen...
Andrei Demin: You should not be preoccupied with high technologies. Please look at how people are doing in everyday life. Forty-eight percent of pregnant women do not stop smoking during the pregnancy.
Meaning almost half of women smokers keep smoking when they get pregnant. And Russia has more smokers than any other country. Some of the cheapest cigarettes too -- down to 52 cents a pack.
Demin: The main thing that we are suggesting is to increase prices.
Actually this January the government did increase prices a little bit. Last year the cheapest pack was 35 cents.
Yuri: I think it's a violation of human rights!
Yuri is a law student in Moscow. His brand of smokes used to be 60 rubles -- about 2 bucks 10 cents. Now it's a whopping $2.50.
Yuri: This is just profiteering by the companies and by the government.
Yuri is in the minority. Polls say most Russians support some kind of price increase, but how much?
Yuri: The more pressure people suffer, with higher taxes, higher prices on cigarettes and alcohol, will make people rise in protest.
They rose in protest in 1985 when Gorbachev raised the price of vodka, a move that increased life expectancy to the highest it's ever been in Russia -- and sparked widespread resentment that some say helped bring down the Soviet Union.
Andrei Demin says that tobacco lobbyists warn the government not to raise prices.
Demin: They often site you see there would be riots, and please remember, more than 70 percent of men in some age groups are dependent on tobacco. Tobacco is like bread, this is what they say. It's like bread. They need it every day!
Just in the last month, Russian officials made back-to-back announcements The government is increasing its budget for hi-tech medical equipment for the nation's hospitals by $160 million next year. And it's considering raising the price of cigarettes up to five times. It's an unspecified date in the future. Meanwhile, each year some 400,000 Russians die from smoking-related causes. And another 500,000 early deaths come from drinking.
Demin: Our government is at the crossroads. If they do nothing with alcohol and tobacco then the demographic problems would increase.
For the sake of its economic future, he says, Russia needs to convince people to live healthier. But for the sake of political stability, its rulers have to be convinced that those people, denied their opiates, won't chuck them out of office.
In Moscow, I'm Gregory Warner for Marketplace.
Ryssdal: You can hear all five stories in our series and read Gregory's reporter's notebook -- just click here.
“I think the best compliment I can give is not to say how much your programs have taught me (a ton), but how much Marketplace has motivated me to go out and teach myself.” – Michael in Arlington, VABEFORE YOU GO