Hungarian physicians will also own tobacconist shops

Can you imagine C. Everett Koop, surgeon general of the United States between 1982 and 1989, refusing to take a stand on the question of smoking? Something like that happened in Hungary the other day when István Éger, president of the Hungarian Medical Association, refused to take sides on the question of whether it is ethical for a physician to own a tobacconist shop or shops. He claimed that “the question is too controversial.” He explained that, after all, owning a tobacconist shop “doesn’t mean that the physician will be sitting at the cash register.”  So, according to the author of the article that appeared in Index, “the Hungarian Medical Association doesn’t consider it inappropriate for a physician to profit from selling a product that can have devastating effects on his patients’ health.” By way of explanation Éger said the following, which the reporter found incomprehensible. “A healthy lifestyle is an important part of everybody’s life and Hungary is a pioneer in limiting tobacco use. It would be best for everybody if there were no tobacconist shops at all, but since that is not the case, we don’t want to take sides.”

I will try to shed some light on what might be behind the very cautious, perhaps even cowardly stance of the Hungarian Medical Association. First of all, quite a few physicians and their relatives won twenty-year concessions for tobacconist shops. By now it is an open secret that local Fidesz politicians decided who would have the opportunity  to operate a National Tobacconist Shop. The decision was based primarily on whether the applicant was a Fidesz supporter. And the percentage of Fidesz supporters within the medical community is extraordinary high. I might point out that traditionally the medical profession has been attracted to the political right. One mustn’t forget that the idea of the notorious numerus clausus was hatched at the medical school of Budapest in 1920.

Some of the doctors who received permission to operate tobacconist shops are rather important political actors within the medical profession. Most likely they would have raised hell with Éger had he taken a stronger stand. As it is, Éger’s position at the moment is rather shaky.

And finally, my hunch is that far too many physicians still smoke. The huge debate about smoking that occurred in the U.S.  in the 1970s has not yet been settled in Hungary.

It is true that smoking has decreased somewhat among men in the last ten years or so, but the number of women smokers has risen by 1% every year. I might add here that getting reliable and detailed data on smoking in Hungary is rather difficult. One problem when it comes to comparing data, let’s say, between Hungary and the United States is that while the U.S. numbers refer to the population of 18 years and over, most Hungarian data I found talked about smokers age 15 and over! According to a fairly recent summary published by the National Public Health and Medical Officer Service (ÁNTSZ), since 2009 the number of male smokers under 65 decreased by 2% but among those over 65 it grew by 2%. In any case, the percentage of smokers in the 15+ population is very high. It is noteworthy that Hungary has the highest death rate due to lung cancer of any country in the world.

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I tried to find data on the percentage of smokers among Hungarian physicians, to no avail. In fact, no such data exist according to The Tobacco Atlas. But here are a few European statistics that are available. In France 34.6% of physicians smoke,  in Poland 76.8%, in Ukraine 33.1%, in Germany 27.5%. The number in the United States is 3.3% and in Canada  6.0%. Let’s assume, extrapolating from these figures, that perhaps a third of all Hungarian doctors smoke. This figure would match the smoking habits of Americans who didn’t even finish high school. And we know that normally there is a high correlation between educational attainment and smoking.

Naturally I find it appalling that Hungarian doctors can have a handsome second income stream selling tobacco products. One might counter that Hungarian doctors are very poorly paid and therefore one mustn’t be very surprised that they grabbed at this business opportunity. But I found at least two obstetricians among the recipients. Obstetrics is the most lucrative medical specialty in Hungary. A childbirth, theoretically free, usually costs $400-500. This money goes straight into the doctor’s pocket, hidden from the prying eyes of the tax man. If estimates are correct, the tobacco shops (which seem to be expanding in the direction of convenience stores) will be equally profitable if not more so. And, after all, business is business.

What will happen to Hungarian health care?

More and more people are convinced that Viktor Orbán has lost his sense of reality and as a result is making decisions that may have grave consequences for the country and even his own party’s popularity.

Just lately he underestimated student reaction to his hasty introduction of tuition fees and the lowering of the number of scholarships available. He insisted to the very end on the introduction of voter registration, although surely many people must have warned him that it might have serious international consequences.

His latest foray into unreality is the decision that public employees who due to their age are entitled to receive pensions must be discharged from their jobs beginning on January 31, continuously as the law specifies. This law affects a lot of people,  including all employees of elementary and middle schools, medical personnel, judges, prosecutors, and members of the armed forces. The only exceptions are college instructors and researchers employed by state financed colleges and universities. Anyone who wants to contest this ruling must make a request in writing; from the wording of the law that was published in Magyar Közlöny (no. 184; December 29, 2012) it sounds as if individual exceptions will be hard to come by.

Actually, the bill proposing this legislation was already voted on by the Hungarian Parliament on December 17, but it went pretty well unnoticed until Viktor Orbán met the so-called Council of Elderly Affairs. At the time I read the newspaper articles on this meeting, but most of the reporters concentrated on some silly expressions of Orbán, according to whom the Hungarian economy is like a wasp that has a big abdomen yet still can fly and, mixing metaphors, like a live fish that can swim upstream and the dead one that goes with the current. The articles said little about how Orbán replied to a question about the dire situation that might result from this decision in the medical profession.

The question came from Dr. László Iván (age 80), a Fidesz member of parliament who seems to be extremely fit both physically and mentally. Mind you, he doesn’t have to worry about the new law because politicians are exempt. We learned, for example, that Sándor Pintér, who was a policeman before he became a politician and who retired from the police force at the age of 48, now receives 150,000 forints in addition to the millions he makes as a minister. Today, thanks to new Orbán governmental policy, policemen and soldiers cannot retire early.

László Iván, a doctor and a university professor, was particularly interested in the medical profession. It is a well known fact that there is a serious shortage of physicians and that many practicing doctors are over the retirement age. He asked Orbán to extend the compulsory retirement age to 70 for doctors. Orbán eventually met Iván “halfway.” Doctors will still have to ask permission from the government to stay until the age of 70. They will not, however, be able to draw both their salaries and their pensions. He promised to raise their salaries to compensate for their financial loss. (Would they really be so naive as to believe this promise?)

I noted earlier that college teachers and researchers employed in institutes of higher learning are exempt, but it is not at all clear whether research institutes financed by the state directly or indirectly but not attached to a university are exempt. The Union of  Scientists and Innovators interpreted the law as applicable to, for example, research institutes attached to the Academy of Sciences. They considered the decapitation of the research institutes to be the death of Hungarian science. Can you imagine scientists and researchers being kicked out of their labs at the age of 62 and being forced to sit with their grandchildren on a bench on the playground? Lunacy!

The various medical organizations frantically ran to the undersecretary in charge of health care, Miklós Szócska, but he wasn’t moved. He announced that any fear of the collapse of Hungarian health care is baseless. “There is no danger to the functioning of  the public health system.” (Three years ago Szócska was the hope of the medical establishment, but since then physicians came to realize that their hope in Szócska and in Orbán was misplaced.) At the meeting everybody asked for a blanket exemption from the regulation for the entire medical profession. Orbán refused to budge. They will have to make individual requests, and by the grace of Viktor Orbán perhaps they can stay.

So, by January 31, up to 15,000 requests will have to be processed. The situation currently is as follows. There are 35,000 practicing physicians and a quarter of them have already passed retirement age while another 42% will have to retire within ten years. In addition, about 3,500 nurses will have to retire unless there is some kind of resolution to this impasse. Perhaps the physicians will gather their courage and, learning from the activism of the students, express their dissatisfaction in some more forceful way. One must add that last year almost 1,000 younger doctors left Hungary and 1,600 physicians and nurses indicated their desire to work abroad.

Young doctors on the move

The situation is a bit better in elementary and high schools, but even there 7,000 people will have to be discharged. In certain schools it might cause problems. I heard of a school where about half of the teaching staff is over 62. But at least here there is the hope that they will be required to leave only at the end of the school year.

All this doesn’t seem to phase Viktor Orbán. Alas, when everything depends on one man who can act without restraint this is what happens.