healthcare

Viktor Orbán and the Fidesz parliamentary delegation show the way

After spending quite a bit of time on foreign affairs, we have to return to domestic policies because soon enough parliament will reconvene, and the Fidesz and KDNP caucuses are preparing for the new session. Members of the caucuses get together, normally at some resort, and are sequestered for a few days. Their agenda is to set the tone of politics for the next five or six months. This time the Fidesz caucus met at the Balneo Wellness Hotel near Mezőkövesd, the center of an area known for its distinctive folk embroidery. Obviously, there is no shortage of funds in the Fidesz coffers. The caucus has 115 members, and several ministers and undersecretaries also attend these retreats.

Balneo Wellness Hotel

Balneo Wellness Hotel

I find these gatherings amusing, especially when I hear from Antal Rogán, the whip of the caucus, “we request and authorize the government” to do this or that. Naturally, the situation is the reverse, Viktor Orbán tells Antal Rogán what he expects them to do. If they come up with an idea of their own, which doesn’t happen too often, Orbán usually decides against it. Or if they want information from the prime minister, they don’t always get it. This time, for example, apparently the MPs wanted to know more about the visits of Angela Merkel and Vladimir Putin, but they heard nothing about either. It also seems they were hoping to hear more about the deal between the government and the RTL Group. They should have known better. When Viktor Orbán loses a fight, he doesn’t like to talk about it. Or, if an encounter, like the one with Merkel, is not exactly a success, he changes the subject.

So, let’s see what Viktor Orbán actually wanted to talk about. His greatest concern seems to be the immigration of “economic refugees.” In the last two years their numbers have grown substantially, and recently they’ve spiked. While last year 42,000 requests for immigrant status were received, this year, just in January, 14,000 such requests were filed. Orbán’s solution to the problem is draconian. He wants “to bolt the door to Hungary” to all “economic immigrants because we don’t need any of them.” Hungarian economic emigrants leave in droves while Hungary is bolted tight to anyone coming from “another culture.” He will not wait for the European Union, which is far too slow. Hungary will act on its own. I wonder how they will deport all those people who are currently in Hungary and what will they do with those who are on their way. An Irish proverb says “Never bolt the door with a boiled carrot.” What will the Hungarians use?

The government must have realized that the so-called school reform initiated by the second Orbán government was a failure. All schools were nationalized except for a few private schools and were put under one huge umbrella organization that turned out to be totally incapable of supervising about 120,000 employees and thousands of schools. We don’t know how the government is planning to undo the chaos created by Rózsa Hoffmann (KDNP), but it looks as if another “reform” is underway. Every time I hear of a new school reform I just shudder. So far the government hasn’t talked to educational experts or teachers’ unions, and it hasn’t spelled out the details of its plan. It has simply resurrected an old idea of Zoltán Pokorny, former minister of education in the first Orbán government (1998-2002), to extend the eight grades of compulsory education by one year. Apparently, it was inspired by the “Polish model,” which introduced a ninth year of elementary education–along with an entirely new educational philosophy. It seems, however, that Viktor Orbán doesn’t like the idea, so most likely it will be dropped.

Another concern of Viktor Orbán is the state of Hungarian healthcare, which is rapidly deteriorating instead of improving. Orbán seems to be frustrated. At the meeting he complained that 500 billion extra forints had been sunk into healthcare and yet the hospitals are still in the red. Their current debt is 70 billion forints, which must be paid out of the central budget. Their suppliers, mostly Hungarian middle-size companies, are also hurting. For the time being, the newly appointed undersecretary will remain, but I have feeling that his days are numbered. The government’s solution is simple: forbid the hospitals from accumulating any new debts. If a hospital director doesn’t follow this order he will be fired. It is hard to fathom how such a strategy will help the situation. By the way, there’s an apparent contradiction worth mentioning here. On the one hand, the government wants to reduce the number of hospitals and most likely cut back on the number of employees, while on the other hand Antal Rogán “requested and authorized” the government to make money available for a brand new hospital in Budapest. It turns out that money for this new hospital will come from the European Union while maintaining the existing hospitals must come from Hungarian government resources.

Although the Hungarian media is full of the news that Viktor Orbán had to give in to the demands of RTL Klub without the television station toning down its news coverage of government corruption, we learned today that “Fidesz authorized the government to negotiate further with Brussels” concerning the advertising levy. What can that mean exactly? Well, nothing good, I fear. Viktor Orbán will take his sweet time thinking about the deal between János Lázár and the top management of the RTL Group. Moreover, Orbán made it clear that the amount of money he was hoping to get from the advertising levies cannot be reduced as a result of the compromise with RTL Klub. So, we can all use our imaginations trying to figure out what Viktor Orbán has in mind when he talks about further negotiations with Brussels.

If I properly interpret the leaks from the meeting of the Fidesz delegation, Orbán will not back down on government supervision of non-governmental organizations. In his opinion the Hungarian government is entitled to know what kinds of foreign subsidies are given to Hungarian civic groups. So, I assume the harassment of these groups will continue. So will the “national freedom fight.” Rogán revealed that “the Hungarian people expect that the government will always stand for the national interests” and that as a result of the government’s policies “national self-esteem” has grown during the last five years. Orbán also has no intention of changing his “independent” foreign policy because “Hungary has become a strong country” thanks to his leadership. He repeated that cheap gas means inexpensive utility prices, which he considers critical to his political longevity. Only Putin can give him what he needs. What Orbán will give in return is as yet unknown.

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Fast track hospital care for “VIP” patients

Who doesn’t remember the infamous story of the referendum of March 2008 proposed by Fidesz that was approved by the Constitutional Court in October 2007? The questions were formulated in such a way that only a fool would answer “yes.” Like: “Do you want to pay 300 forints (then $1.50) when visiting a doctor?” Of course, most people answered “no.” Not surprisingly, the referendum was a colossal defeat for the Gyurcsány government and a great triumph for Fidesz. And all this over a 300 forint co-pay when patients regularly put thousands into the pockets of attending physicians.

Just as Fidesz changed its mind on charging tuition in institutions of higher learning, it also changed its mind on allowing hospitals to charge extra under certain circumstances. For example, for an additional fee the patient now has the privilege of choosing his own doctor. And today almost all hospitals offer “luxury” rooms for those who are willing to pay for them. These luxury rooms, by the way, are the norm in hospitals in most western European countries and in North America. They are simply single or double rooms that they have their own bathrooms. In certain hospitals you can even order food à la carte. There is at least one hospital in Budapest where 25% of the rooms fall into the “luxury” category. Initially the management wasn’t sure whether the investment would pay for itself, but it turned out to be a great success. More and more people are willing to pay extra for better hospital accommodations.

A few days ago Népszabadság reported on a new phenomenon. As of a few weeks ago, patients at the Uzsoki Street Hospital can pay not just for extra “luxury” rooms but  also for their entire medical procedure. Half of that money will go to the doctors, surgical support staff, nurses, and physical therapists. The members of the support staff work with these private patients as independent contractors. Their work in the private section of the hospital is carefully separated from their activities as employees of the hospital. Or at least this is what we hear from management.

VIP section

What are the benefits of this arrangement for the patients? First of all, there are no endless waiting lists. I don’t always understand the ins and outs of the Hungarian healthcare system. For me, one of the mysteries of the system is that hospitals can perform only a limited number of procedures even if they have the capacity, in terms of both personnel and equipment, for more. Thus, their capacity is not fully utilized. I assume that the Hungarian healthcare strategists have an explanation for this odd practice, and perhaps it is my fault that I can’t grasp its true goal. But one thing is sure. As a result, in some hospitals one has to wait two or three years for certain procedures. The waiting lists are especially long for knee and hip replacements. If, however, you are ready to pay 1.2-1.7 million forints (approximately 5,000 euros) you can have your operation, and the physical therapy that follows the procedure, within a couple of weeks. These private patients, by the way, forfeit their right to health insurance when they sign the contract with the hospital.

It seems that this arrangement is not yet available in most of the hospitals in provincial cities. There hospital administrators claim that they have neither the extra personnel nor the funds to provide care for both paying and nonpaying patients. In brief, patients in Budapest can receive more timely care than those outside of the capital. I try to explain to my Budapest friends how bad the situation is in the provincial hospitals. A few weeks ago one of my relatives (and he himself was a doctor) had an operation in Pécs and had to wait five solid weeks for the biopsy result. The tumor turned out to be benign, but imagine worrying yourself sick for such a long time over whether you have cancer or not.

Other Budapest hospital administrators would be only too happy to follow the example of the Uzsoki Street Hospital. They think that it is time to speak “honestly” about the problems of the healthcare system that no longer can provide the same high-quality care to all insured patients.

Right now the situation is totally chaotic. According to Népszabadság, in a Budapest hospital the doctors performed a pulmonary biopsy on a patient using a local instead of general anesthesia because the poor man didn’t have the extra money the hospital demands to put a patient completely under. Apparently, the man went through incredible agony. The same anesthesia rule holds true for colonoscopies. The very idea sends shivers down my spine.  The price for general anesthsia  is 35,000 forints for the first thirty minutes. Only a little over 100 euros, yet in Hungary even this amount is too high for many patients. Moreover, the pulmonary biopsy patient rightly pointed out that he was never told when he was paying his health insurance that certain procedures would be performed only for cold hard cash.

I don’t know how long the Orbán government can postpone a thorough reform of the entire healthcare system.

The first draft of a “party program” of the Hungarian democratic opposition. Part II

Yesterday when I left off I was talking about the opposition’s concern over the very low Hungarian birthrate, which is resulting in a steadily aging population. At the moment the Orbán government is discussing a scheme by which every woman over the age of 18 who gives birth to her first child would receive a sizable amount of money–the most often heard figure is 300,000 forints–in addition to a flexible scheduling of the subsidies already given to women after childbirth. Most people don’t think that this scheme would make families rush to have children given the current economic situation. As I mentioned, the democratic opposition doesn’t have any better ideas on the subject except that they want to put an end to the current unfair distinction between legally married and unmarried couples who have children. In addition, they promise to put an end to child hunger.

Naturally, they pay a great deal of attention to the welfare of the large population over the age of 65. They promise not only to raise pensions to match the rate of inflation; they also plan to reintroduce a “premium” that would be indexed to economic growth. They make a renewed promise of free public transportation to everyone over the age of 65. They would also again allow pensioners to work while drawing their pensions and would allow people to work beyond the retirement age. Out of these promises the only one I object to is free public transportation for everybody over the age of 65. I think that forcible retirement is untenable in a democratic society and that in certain professions it is outright injurious to the public interest. I am thinking of judges and university professors, for example.

The next topic of the provisional party program is healthcare, and I must say that it is one of the weakest points of the program. Here we have only vague generalities. I understand, however, from a television interview that the hospitals would remain in state hands and that the new government would stick with a single centralized state insurance system. Only yesterday I was listening to an interview with Erzsébet Pusztai (earlier MDF, now a member of Lajos Bokros’s conservative party) who was won over to the idea of privatizing healthcare. What does she mean by that? Basically, that doctors would be the owners of their own practices. Having doctors as state employees guarantees failure, she contends. I tend to agree with her. Therefore I don’t expect any great positive change in the quality of Hungarian healthcare as a result of a change of government. In the first place there is no money to raise salaries and, even if they did, the problem lies not only with low salaries but with attitudes.

The MSZP and Együtt 2014-PM negotiating team / MTI, Photo Lajos Soós

The MSZP and Együtt 2014-PM negotiating teams / MTI, Photo Lajos Soós

Naturally, the democratic opposition wants to put an end to the Kulturkampf introduced by the Orbán government and they make all sorts of promises of state subsidies to make culture readily available. As for the state of the media and the media law, which they surely want to change, they said nothing about MTV, MR, and Duna TV. I’m afraid that these organizations would need a complete change of personnel; otherwise the new government will end up with a far-right state media of low quality.

The Internet wasn’t left off the list either. They promise to pay special attention to making broadband available everywhere in the country and to encourage Internet usage and computer literacy.

These two parties at least don’t want to take away the voting rights of the new Hungarian citizens from Romania, Ukraine, and Serbia. The reason I didn’t include Slovakia here is that Slovakia introduced legislation that forbids dual citizenship and therefore there were very few people who applied for Hungarian citizenship and, if they did, it was in secret. I personally wouldn’t support that right and from what I read on the subject a lot of people would vote along with me on that issue. The document does make special mention of the democratic forces’ opposition “to the use of  the Hungarian minorities in the neighboring countries as instruments of Hungarian political parties,” but as long as voting rights are ensured there is no way of preventing party politics from spilling over the borders. On that issue, I’m with Ferenc Gyurcsány’s Demokratikus Koalíció.

Finally, the democratic opposition pledges its support of European values and Euro-Atlantic cooperation. They realize the changing nature of the European Union, but Hungarian national interests must be protected in cooperation with and not against the European Union. Hungary wants to be a partner in the building of a stronger and better European Union.

* * *

Commentators, on the whole, responded positively to the beneficial effects of the joint declarations and the parties’ willingness to work together. Most of them think that once the first step toward an electoral alliance is taken the number of undecided voters will drop and support for the opposition will increase.

In addition to this document the opposition came out with another one that deals with the nomination of MP candidates. I will spend some time on that document in the future, but until then suffice it to say that this particular document pretty well ensures that there will be a single common party list, which is an absolute prerequisite for any success against Fidesz at the next election.

Breaking News: Sándor Csányi, CEO of OTP, the largest Hungarian bank and the premier holder of Forex mortgages, dumped almost 2 million shares yesterday, allegedly to invest in his other businesses. OTP stock has been under pressure recently as a result of rumors about a new government scheme to help the approximately 100,000 people who are currently incapable of repaying their Forex loans. This generous assistance would come at the expense of the banks. Since details of the plan are unavailable, we don’t know how large a haircut the banks would have to take, but the hit might be substantial. I guess that Csányi, who by the way has been a big supporter of the prime minister, decided to bail while he still had some equity left. In the wake of his mega-sale (and I assume that sooner or later we’ll find out who was on the other side of that block trade–again, rumors are flying), OTP stock lost about 9% today.