There is a widespread view in the West that Russia’s aggressive actions in Ukraine and confrontational policies toward the United States and Europe are an attempt to revitalize aspects of its lost Soviet glory days. But if we look at some of the Kremlin’s domestic policy initiatives, we see a country struggling to become less “Soviet” in its actions and reform its decrepit institutions before it’s too late.

Many of the reforms now underway reflect Moscow’s long-overdue recognition that the Russian state simply cannot afford to maintain costly Soviet-designed structures, such as free higher education for all students or an oversized military based on mass mobilization. Though many of the current changes are forced by dire necessity rather than any grand progressive vision, they are reforms nonetheless. This in itself is a striking development. In general, Russians are ready to tolerate the loss of personal freedom, but they still cherish Soviet social benefits like free health care, and the Kremlin has always been afraid to tamper with them.

But now that President Vladimir Putin’s patriotic propaganda has managed to distract popular attention from dismal political and economic conditions, the reforms, haphazard though they might be, are going forward. The irony is that the leaders who have been trumpeting Soviet grandeur on the world stage are presiding over its retreat at home.

A case in point is health care. Today, a few years into the reforms launched when Mr. Putin returned to the presidency in the spring of 2012, the overall picture remains bleak. Moscow has been giving regional governments incentives to close inefficient, duplicative and deteriorating hospitals and health centers, trim the medical work force and improve efficiency in exchange for more funds for modern equipment, renovation and better pay for health workers.