On August 2, Qian XX and Zhang X reported to the Chairman: In accordance with the Chairman’s instructions of June 26, the Ministry of Health has conducted an inspection; they requested further guidance from the Chairman.

The Chairman said: “I have already said all that needed to be said. What are your plans?”

Answer: (omitted; the report proceeded to outline plans for training part-time health workers for rural production teams.)

The Chairman asked: “How long will the training last?”

Answer: About half a month.

The Chairman replied: “Half a month seems rather short, doesn’t it?”

Answer: “Their primary focus will be learning acupuncture, treatment of common ailments, and certain preventive measures. After the training, we also intend to take them into the field to provide hands-on experience.”

The Chairman inquired: “Field supervision is very important. How long will that continue?”

Answer: “Urban medical teams could remain in the countryside to provide ongoing guidance for three to four months.”

The Chairman remarked: “That sounds reasonable—three to four months should be sufficient to master treatment for a dozen or so diseases.”

(When the discussion turned to establishing semi-agricultural, semi-educational training classes)

The Chairman asked: “How would such a program be structured?”

Answer: “We propose to suspend studies during peak farming seasons and intensify learning during the off-seasons.”

The Chairman followed up: “Over what period?”

Answer: “Two or three years.”

The Chairman commented: “Two years means one year of formal study; three years means a year and a half. That approach is sound.”

(We then reported on the inspection carried out pursuant to the Chairman’s instructions.)

The Chairman asked: “How many health-care professionals are currently available?”

Answer: (omitted)

The Chairman observed: “This is no small contingent!”

Answer: (omitted)

The Chairman continued: “You have deployed so much manpower and allocated substantial funds to serve such a limited population.”

(We further reported that a medical education conference was being held to discuss the Chairman and Premier’s directives regarding the establishment of three-year health schools aimed at training doctors for rural areas.)

The Chairman remarked: “Higher education typically requires five years of study. The appropriateness of such a lengthy program merits careful consideration.”

(We explained that we were adopting a dual-track strategy: establishing three-year programs, primarily in rural areas, and recruiting students locally.) The Chairman asked: “What kind of students would be recruited?” Answer: “Mostly high school graduates.” The Chairman pressed: “Would junior high school graduates suffice?” Answer: “There are still quite a number of high school graduates in rural areas.” The Chairman persisted: “Couldn’t you recruit junior high school students as well? Wouldn’t it be possible to draw some from urban areas too?” Answer: “We do recruit a small number from cities, but our main target remains rural students.”

(As the conversation shifted to the relationship between a physician’s political consciousness and technical competence) The Chairman emphasized: “This is crucial. Physicians must possess strong political integrity. It would be entirely adequate to recruit politically reliable junior high school graduates.”

(We then addressed urban issues.) The Chairman questioned: “Are you providing satisfactory services to urban residents?”

(At the time, we did not fully grasp the significance of this remark and responded somewhat vaguely: “Our services are indeed inadequate, and public expectations are continually rising.”) The Chairman probed further: “Why are expectations rising?” Answer: “Take Beijing as an example: ×× ten thousand cadres receive government-funded medical care, while ×× ten thousand workers are covered by labor insurance, plus their dependents.” The Chairman pointed out: “Workers are not masters; they are the very people whose welfare we are called upon to serve.”

(We went on to explain that workplace medical services were poorly organized, leading workers to seek treatment directly at hospitals.) The Chairman asked: “Why not establish part-time health personnel in factories? Small enterprises could appoint health attendants, while larger ones could set up infirmaries.” Answer: “Unofficial health workers lack the authority to issue sick leave certificates. Employees wishing to take time off must still go to a hospital to obtain a doctor’s certification.” The Chairman remarked: “This touches upon matters of labor insurance and deserves thorough deliberation.”

(We next reported on efforts to organize urban medical staff to work in rural areas, with one-third rotating annually.) The Chairman inquired: “How would this rotation be arranged? And how long would each assignment last?” Answer: “Through a rotating schedule. Even after these rotations, the workload in urban healthcare facilities would remain considerable. We propose that students in higher medical institutions begin working while continuing their studies after completing their third year. Similarly, nursing students would engage in both practical work and academic learning.” The Chairman stated: “Merely memorizing textbook knowledge is insufficient.” He then asked: “Have you considered the possibility of war? If so, how?” Answer: (omitted) The Chairman continued: “If hostilities were to break out, could everyone still seek treatment at Beijing Hospital? This scenario must be factored into our planning. Given the highly specialized nature of your current system, what would happen in wartime?”

He emphasized: “In wartime, it would certainly not be feasible to rely solely on specialists. How could we manage if internal medicine experts were unable to perform surgery?”

(When the discussion turned to maintaining a dedicated cadre focused on cutting-edge research) The Chairman asked: “Do researchers involved in scientific advancement also see patients?” Answer: “Some do; others do not.” The Chairman followed up: “Which group does not treat patients?” Answer: “Those engaged in fundamental disciplines—such as physiology, pharmacology, and biochemistry—who conduct theoretical research without clinical practice.” The Chairman asserted: “Theory must always be grounded in practical application!” He added: “We should certainly continue to pursue advancements in science.”

(As the conversation touched upon the need for Party committees at all levels to assume greater responsibility for health-care work) The Chairman declared: “That is entirely correct. Party committees operate under collective leadership and oversee all aspects of work. The health-care sector exists to serve the people, so naturally it falls within the purview of Party committees. At the same time, Party committees should actively study and guide health-care policy.” (We then sought the Chairman’s guidance on the issue of remuneration for rural health workers. According to Article 60 of the People’s Commune Regulations, subsidies in the form of work points may not exceed two percent. While commune members had agreed to grant such subsidies to health workers, Article 60 itself contained no specific provision on this matter.)

The Chairman replied: “There is nothing wrong with doing good deeds for the masses. The farmers will undoubtedly approve. Now that cadres are participating in manual labor, the two-percent limit is often not even utilized—in some places, only one percent is used. Work points pose no obstacle; the farmers will support this measure.”

(We subsequently requested the Chairman’s approval to convene a national conference on rural health care later this year, with participation expected from provincial and municipal leaders.)

The Chairman approved: “Very well.”

(When the discussion turned to pharmaceuticals)

The Chairman stated: “Drug prices ought to be reduced.”

He added: “Family planning services in Tianjin are provided free of charge. It appears that although the state bears the cost, the overall economic benefits outweigh the expenditure. Investing a modest sum to safeguard productive capacity is indeed worthwhile. Those who cannot afford medication should not be compelled to pay.”

He further advised: “Following the implementation of rural health initiatives, steps should be taken to promote family planning.”

(Finally, we asked the Chairman whether he had any additional instructions.)

The Chairman replied: “No further instructions. Proceed according to what you have outlined.”