Molotov Cocktails and Health Care Reform
The struggle for the future of public health care in Hungary has entered a new phase
On Monday the Hungarian parliament will vote on legislation that will privatize public health care. In essence, it will put in the hands of a few corporations some 1.5 trillion HUF (approximately 8 billion dollars) annually. Naturally this money isn't all profit; the corporations involved will have to provide some sort of medical services for the 10 million inhabitants involved. Yet as the Health Minister noted, if corporations can provide the same or better quality services than the state and can make a profit from it, why not?
The reason why not is very simple: corporations are in it for the money. Their first priority is to make a handsome profit, not provide excellent health care. If the opposite were true, than any money leftover or saved would not be taken out of the health care sector but reinvested in terms of more hospital beds (which the government drastically cut), equipment, personnel, higher wages, etc. In fact, nothing would be leftover as profit. This in turn, would not interest a corporation; a corporation exists to make money, not provide philanthropic support.
As a result, the apprehension among most Hungarians is that the quality of service will decline further if public health care is privatized. Akin to the US, which is often adopted as a model for post communist development by the countries of Central and Eastern Europe, regional health maintenance organizations (HMOs) will be established in Hungary to take over the role of the State. Because of the profit-oriented nature of the enterprise, however, the fear is that HMOs will deliberately neglect or even kill off their unprofitable patients.
Despite verbal guarantees by the government to the contrary, there is nothing to prevent abuse by HMOs looking to fatten their bottom line. Not only this, since an HMO controls only the financial aspect of providing care and not the medical aspect, it can easily insulate itself from malpractice lawsuits. At the same time, it's able to exert pressure upon the providers it has contracts with to meet certain financial criteria. These criteria, in turn, influence the decisions of health care providers, often to the determinant of patients.
Over the past year, the government itself has already begun to introduce such a practice by attempting to force doctors to prescribe the cheapest drugs available, notwithstanding the fact that both the patient and doctor may see some benefit in other, more expensive ones. In fact, if a doctor issues too many prescriptions, this is also carefully scrutinized. If it is found that a doctor is prescribing too many drugs or what is being prescribed is too expensive, the doctor is given a hefty fine.
While it may appear that the government is doing this in order to provide patients with the cheapest medications possible and to not have doctors prescribe medication needlessly, there is actually an ulterior motive to all of this. The government tries to bring down the costs of public health care by reducing the amount it pays for subsidising more expensive - yet potentially more effective - medication, regardless of the benefit it may have on a patient.
Ultimately, the main reason the government is giving over its responsibilities for public health care to corporations is because it feels that the State is a bad manager and that corporations are better at such things. This line of reasoning, which has been used consistently by the neo-liberalist left in Hungary since the fall of communism to justify privatising anything and everything it can, is clearly faulty. The case of Enron in the US and the recent financial crisis to hit the likes of Citibank is proof enough that not all corporations are good at business; they may be good at lying, cheating, and erecting a facade, but very few are good at actually running an honest business.
Likewise, not all governments are bad at managing enterprises. If this were so, then French and German companies owned by the governments of these respective countries would not have bought privatised Hungarian assets. Not only this, if there is a problem with the way a government is running things this doesn't mean there is a need to throw the baby out with the bathwater; if a government is unable to manage an enterprise, then the members of the government should be changed in the same way that at a major corporation the CEO and other heads are changed if the shareholders feel that the company isn't performing well.
For its part, the government declared that it's not withdrawing completely from involvement in public health care. To allay fears of corporate abuse, it noted that it will maintain a supervisory role over the new system. Yet if the government is giving up its role in maintaining public health care because it's not a good administrator, then how can it expect to be able to properly supervise and co-ordinate this same system which is then split among several players? In many ways, such a role takes much more of an organisational effort than running a centralised system itself.
Not only this, but the government argument that the quality of service will be guaranteed by market forces as different HMOs compete for patients reflects contempt and cynicism toward what health care is all about. People are not simply commodities that are bought, sold, or traded in a marketplace. Treating people as such not only robs individuals of their dignity, but is also an affront to basic human and civil rights.
Bunker Mentality
The framework which would privatise public health was already passed in parliament once toward the end of last year. The ruling Socialists, together with its junior coalition partner the Free Democrats, have just enough votes to ensure that the legislation is passed. However, the President vetoed the bill and it was returned to parliament. After a few minor changes, the bill will now be voted on Monday. If it passes, which it is expected to, then the President will be forced to sign it.
Public opposition to the bill, on the other hand, is enormous. A referendum which seeks to nullify the legislation has been proposed, and already over 400,000 signatures have been collected (200,000 signatures are required for the referendum to be held). Thus, even if the bill passes it's not certain that it will last.
Given the mounting public discontent over the issue, a campaign of fear and intimidation has been launched by the authorities. This campaign is not much different than to what was done a year and a half ago, when the prime minister admitted in a speech that he and his party had lied day and night in order to seek re-election (Politics of deception). Already the parliament has been cordoned off by a fence and demonstrations in front of parliament have been banned. Anti-government demonstrations are planned, nonetheless, in various parts of the city and as close to the parliament as possible.
Tensions were raised a notch as at the end of last week when the homes of five Socialist MPs were hit with Molotov cocktails. No-one was hurt but there was some damage to some of the homes. Later, a group claiming to be The Hungarian Arrow National Liberation Army claimed responsibility for the attacks. Some Socialist MPs also received letters containing white powder; the powder turned out to be harmless. As a result of all this, coupled the rising level of public discontent, the Hungarian security forces have been put on high alert. The attacks, meanwhile, have been labelled as acts of terrorism.
Many are sceptical, however, about all this. Political violence in Hungary is minimal and if it does occur it only happens during general elections. Conversely, for the past few years whenever the government has been faced with rising public discontent, the threat of violence seems to come out of the woodwork. Bomb threats, telephone threats against certain individuals, even the shots at the main police headquarters have all been used to conjure up an atmosphere of fear and trepidation.
The purpose of this fear and trepidation is to divide the public politically between left and right, with the former fearing a possible revolution and even a fascist takeover. Along these lines, approval of the status quo is grudgingly elicited along with the passive acceptance of a heavy-handed police presence.
Incidentally, the fear of a fascist takeover was further reinforced this past weekend when neo-Nazi skinheads demonstrated at Heroes Square to mark the anniversary of when toward the end of the Second World War an army contingent had tried to break out of Budapest which was then encircled by Soviet troops. This commemoration is usually held by a small group of right-wing extremists called Blood and Honour. The commemoration is usually small and takes place near the Buda castle where the soldiers were encircled. Until now it has always been a low-key affair. This year, however, the demonstration was allowed with no problem and police protected the neo-Nazis from a large group of anti-fascist protesters. What was ironic about the whole situation was that most of the skinheads weren't even Hungarian, but had come from Switzerland, the UK, Germany, and elsewhere from Europe.
What has made a lot of people sceptical about this heightened state of affairs is the way that the Socialist Party had immediately sought political gain from what happened. It seemed that everyone knew their lines: those who had their homes attacked with Molotov cocktails immediately vowed to vote for the government measure without ever betraying a quiver in their voice; similarly, the head of the parliamentary faction quite naturally talked about the threat to democracy that Hungary faced because of such actions. As a result of the seeming casual response to otherwise shocking events, coupled with the fact that previous such attacks and incidents have never been solved (with the investigation quickly slipping from view), many are of the belief that the Molotov cocktails and white powder were all staged events.
Yet even if these events weren't staged and that The Hungarian Arrow National Liberation Army actually does exist, many feel that the government is to blame. People have been pushed to the limit, and in desperation some feel there is no other way in which they can express their discontent. Democratic institutions don't appear to work and with knowledge of how other democracies function, the contempt which the present government appears to show toward its own citizens is too hard to take for some. They feel powerless, and actions such as sending a letter with white powder or throwing a Molotov cocktail end up being the only way they can think of to address this sense of helplessness. At the other end of the scale is suicide.
Given the present heightened state of affairs in Hungary, the question remains as to why would all this be necessary if the government has the majority to pass the bill a second time in parliament anyway. The fact of the matter is passage of the bill is no guarantee of its success. Already the government is being called to account in a referendum a month from now that seeks to scrap various user fees in the health and education sectors (the visit fee and hospital fees along with tuition fees). Indeed, some speculate that the present atmosphere of fear and trepidation isn't geared for what will happen on Monday but for the referendum which will take place in March, as well as the referendum against the privatisation of public health care which is expected to be held sometime in the near future. Indubitably, the battle has just begun.