Health care, public dialogue, capitalism in Hungary

If everything goes well, next Tuesday the Hungarian parliament will vote in the affirmative on the endlessly discussed changes in health care. There are still a few media doomsayers, but a rational observer pretty well knows that, although there are a few not too clever people in the Hungarian parliament, who among them would willingly commit political suicide? Because there is no question that if the health care legislation fails, it would mark a crisis of confidence in the government.

In the past few days I’ve heard more and more complaints from the "ordinary people" that they still don’t understand what these changes are all about. In turn, the politicians apologize profusely that they "were unable to communicate properly." It is their fault that the majority of the people still don’t understand how this system will work. Another complaint is that there was no "dialogue" between the decision makers and the public and/or the "profession." The third complaint is that the time allotted for the preparation of the bill was insufficient. Exaggerated and often false statements are made by members of the opposition that "in other countries, like the United States and the United Kingdom, similar changes were made slowly, in fifteen years." It doesn’t matter how much I search my memory for such a change in either the USA or in England, I can’t think of any. Oh, yes, I remember Hillary Clinton’s proposed health care reforms that succeeded only in tarnishing her name. Massachusetts has recently made an effort. But I don’t know of anything else (save the Medicare prescription drug benefit)–especially not the kind of paradigm-shifting change that this government is attempting. After all, an old socialist remnant, functioning less and less well, must be scrapped and transformed into a system that better serves the population.

Here’s an example of the second complaint in a different context: the other day I heard a three- or four-way conversation about stricter fines and punishments for people who commit traffic violations. Until now the fines were ridiculously low and the point system, introduced a few years ago, so ineffectual that practically no one lost his driver’s license for repeated offenses. One of the participants, an "expert," was outraged: how can they change the fines tenfold without a "public dialogue?" Who can’t anyone imagine the result of such a public dialogue? No rational human being would want to pay $70 instead of $7. Case closed!

It seems that Hungarians are torn about the notion of representative democracy where we, the people, conduct our affairs via elected officials. Many feel more comfortable with the town meeting model, where for "town" they substitute "country." That is, every change should first be debated in a country-wide forum–that is, a "public dialogue." While in a small New England town people can reach consensus, in a country the size of Hungary nothing would ever get accomplished. This is actually what’s happening of late in Hungary.

Despite the complaints, the Ministry of Health under the new minister, Lajos Molnár, has in fact encouraged dialogue. The ministry published a "green book" (available via their home page). They invited the profession and the public to discuss the suggested changes; apparently they received thousands of e-mails. Innumerable meetings took place between the ministry’s officials and the heads of hospitals, the Hungarian Medical Association, different organizations of specialists and health professionals. Yet if you ask any of these people they will tell you that they had no opportunity to discuss anything. Or rather, they had the opportunity but no one ever listened to them. The officials of the ministry insist that there was ample opportunity to discuss the reforms and that they incorporated many of the suggestions they received. One thing is sure: the "profession" is afraid of the changes and opposes them.

I also suspect that most people who complain about the lack of information are the ones who usually pay little attention to public affairs in general. We all know about the public’s woeful ignorance of the world around them. Some people don’t even know the prime minister’s name.

But even those who try to understand the health care reforms have an uphill battle. The opposition politicians did their very best to frighten the population about the dire consequences of the reforms. The propaganda of the opposition began even before the elections when they claimed that in the new system people would have to pay thousands of dollars for the simplest operations. When it became obvious that this was false, the next move was an appeal to the stratification of society (that is, the rich versus the rest of us): the rich will get everything while we’ll get the minimum. Another scare tactic was that private insurers would be able to pick and choose and sometims even reject people. They would pick the young and healthy and leave the old and sick behind. As a result of this scare campaign, the government has been constantly on the defensive. They have had to repeat over and over that none of the above is true and that, according to their plans, the service will be better at no greater cost to the consumer.

The final, very potent argument against the reforms is the presence of private insurers and the infusion of private capital into the system. Hungarians are convinced that a capitalist will want to see a return on his capital, and where will this come from? According to their way of thinking, it can only come from inferior service to the customers, the patients. The patient will not get his blood pressure measured because the capitalist wants to make a profit on him. The ministry is desperately trying to explain that the health care system today is so wasteful that billions will be saved by private insurers checking on what’s going on in hospitals and doctors’ offices. According to estimates right now, about 10% of the total amount spent on health care is wasted. This last fear is a hangover from the Kádár regime: deep-seated distrust of private business fueled by populist propaganda from the political leaders of the Fidesz.

Put it this way, I will be very happy when this whole thing is finally over.