The other day I wrote about Viktor Orbán's predicament as far as Hungarian doctors are concerned because they were instrumental in helping Orbán to the pinnacle of his career by their fierce opposition to healthcare reform. I pointed that the Hungarian Medical Association and the leaders of hospitals didn't even wait for the second round of voting; they already presented their demands to the new government. Although for political reasons Fidesz in opposition was opposed to any reform, the party leaders know full well that pouring more money into healthcare without enacting structural changes is a waste of money.
Lajos Molnár's book is full of interesting tidbits about the first Orbán government's plans as far as healthcare reforms were concerned. The upshot is that in many ways the Fidesz plans were much more radical than what later, in opposition, they refused to support. When Molnár became minister of health he found all sorts of documents in the ministry which reveal the extent of these proposed changes.
Molnár quotes István Stumpf's book entitled Végjáték (Endgame, 2008) in which the former minister states that the Orbán government "was unable the realize its ambitious plans." The reason? Stumpf is silent on that score. Viktor Orbán's first choice for minister of health was Árpád Gógl who did practically nothing for two years while his successor, István Mikola, "made some changes but he didn't have anough time." Gógl prior to his appointment as minister of health was–of all things–president of the Hungarian Medical Association! So it is not surprising that he wasn't eager to introduce any change that would be opposed by the medical establishment. His successor, István Mikola, although he talked a lot, in the end achieved little. Molnár's conclusion is that the first Orbán government didn't dare to go against the medical establishment.
Within Fidesz there was a group of people that labored diligently to come up with a workable reform. One can read details of the Fidesz reform plans in the 1998 party program, which were very similar to the ones Lajos Molnár tried to introduce. The reforms envisaged by the Fidesz politicians included a reduction in the number of hospitals. There are over 100 hospitals in the country when according to most experts only 50 would do just fine. Moreover, some of these hospitals offer inferior services, which might explain some of the shortcomings of Hungarian medicine. However, Fidesz politicians knew that such a move would meet with incredible resistance from the medical establishment. So they didn't even try to implement it. Another plan was a restriction in the free choice of specialists. As it stands now patients pick their own doctors, a privilege that requires slipping some money under the table. The Orbán government wanted to put an end to this by saying that anyone who wanted to have her own obstetrician or surgeon would have to cough up "part or all of the cost." I might mention here that Molnár's plans included only a 30% surcharge in the event that the patient insists on his own doctor.
The first Orbán government was originally planning to introduce co-pay "for the benefit of private insurers." It was a far cry from the 300 Ft ($1.50) co-payment introduced by the Gyurcsány government that would have benefited the doctors and the hospitals. The Orbán government was thinking of a universal basic medical package with a minimum insurance premium; any additional services would be covered only by taking out additional insurance. So, in brief, all those reforms that Lajos Molnár tried to introduce had already been contemplated by the first Orbán government. However, in opposition for political reasons Fidesz fought against every structural change and stood by the medical establishment. In fact, only a couple of months ago Orbán wrote a letter to the directors of hospitals telling them that the time was not far off when the savior was coming and their sufferings would be over.
How will Viktor Orbán tell these people so full of expectations that reforms are necessary whether they like it or not and that there is no more money to throw into a bottomless pit? Especially since he himself knows that things cannot remain as they are. I really wouldn't like to be in his shoes. It was easy to oppose everything. It will be much more difficult to cool the expectations that he himself raised so high.