Tag Archives: healthcare

European Commission: “The state of health in the EU: Hungary”

A few days ago the European Commission released a 16-page summary of healthcare in Hungary. As I was gazing at the innumerable graphs in the pamphlet, what struck me was that in most cases Hungary was close to the bottom, together with Lithuania, Bulgaria, and Romania, just as was the case yesterday when I was looking at Hungarian 15-year-olds’ PISA scores. Yes, economic well-being, the level of educational attainment, and health correlate strongly.

The pamphlet is chock full of information, so I have to be selective. Although, according to Zoltán Ónodi-Szűcs, undersecretary in charge of healthcare, good basic healthcare “first and foremost is not a question of money,” I consider it significant that Hungary spends half the European Union average on healthcare. I’m also convinced that the fact that a Hungarian’s contribution to his own medical expenses is almost 30%, double the European Union average, considerably impacts the poor health statistics in Hungary. Only 56% of Hungarians consider themselves to be in good health.

Life expectancy in Hungary is almost five years lower than the EU average–75.7 as opposed to 80.6. Hungary is at the bottom, along with Romania, Latvia, Bulgaria, and Lithuania. As could be expected, there is a huge difference between the highly educated and the less educated strata of society when it comes to life expectancy. Economic inequality is also an important factor. Ever since 2007 economic and social inequality has been growing in Hungary. At the moment 35% of Hungarians live in poverty, and within that group 19% experience extreme hardship and occasional or regular hunger. The EU average for these two metrics is 17% and 10%.

Naturally, not all of the miseries of Hungarian health can be chalked up to a lack of money and poverty. According to several independent assessments, 40% of all illnesses are connected in one way or the other to unhealthy lifestyles. Hungary ranks fourth highest in the European Union when it comes to unhealthy lifestyles, right after, guess, Romania, Bulgarian, and Latvia. What are the main risk factors? Diet, smoking, alcohol consumption, and lack of exercise. According to this survey, 26% of adults smoke, the third highest in the European Union. Every third man and every fifth woman is a regular smoker. The number of smokers among people with little education is twice that of university graduates. What is truly upsetting is that 20% of 15-year-olds are regular smokers. The EU average is 14%.

Twenty-one percent of all Hungarians are described as “nagyivók” (big drinkers). It is hard to tell whether this is a euphemism for alcoholism. I read elsewhere that the number of alcoholics might be close to one million, which would be roughly 10% of the population. Apparently in the last 17 years alcohol consumption has been slowly decreasing, but it’s still about 10% higher than the EU average of 10.9 liters per adult. Drinking also starts early. Forty percent of 15-year-olds reported that they had been drunk at least twice in their lives. This figure is the second highest, after Denmark.

As for obesity, the numbers are up year after year. In 2000 only 18% of Hungarian adults were overweight, but by 2014 it was 21%. Again, Hungary is leading the way, along with Malta and Latvia. As we know from other countries, the United States for example, obesity is greatest among the poor. In Hungary 25% of those belonging to the lowest economic strata are overweight, while only one-sixth of the better-off are.

Exercising on an “adult playground” in District XIII / Source: Magyar Nemzet / Photo: Balázs Székelyhidi

The section on mortality statistics is not exactly heartwarming. The greatest killer of women is cardiovascular disease. In 2014, 35,000 women died as a result of heart problems, which was 55% of all deaths that year. Men actually fared better: only 47% of all male deaths could be attributed to cardiovascular disease. These numbers are double the EU averages. According to estimates, the reasons for these high numbers are smoking, obesity, and, yes, inadequate medical care. Cancer is the second greatest killer, accounting for 23% of female and 29% of male deaths. Every third Hungarian has high blood pressure and every twentieth has asthma.

Perhaps the saddest part of the study is the performance of Hungarian healthcare. Hungary is again one of the leaders, alongside Bulgaria, Latvia, Lithuania, and Romania, in the number of preventable deaths, which is double the European average. The Hungarian healthcare system loses 192.3 women and 361.3 men per 100,000 due to preventable deaths. The European Union average is 97.5 and 158.2 respectively. One reason for the high numbers is “the deficiency of acute medical care.” Fifteen percent of heart attack patients die within 30 days after being admitted to a hospital, the third highest in the European Union. There are also “questions concerning the quality of medical care of cancer patients.” Relatively few people go for screening for lung and breast cancer, which might be due in part to the endless waiting lists and the hours of waiting even if one has an appointment. I was told that the Hungarian system simply can’t cope with regular physicals and most preventive medicine. It cannot even keep up with those who are seriously ill.

The report card is not pretty, and Magyar Idők decided that the best thing was to forget about it. Writing an article on it would only confuse the Hungarian people.

November 24, 2017

Viktor Orbán is losing his cool

Trump’s uncontrolled outbursts seem to be contagious. While in the past Viktor Orbán showed considerable restraint when giving interviews or answering opposition members of parliament, in the last couple of weeks he has given vent to his frustration and anger.

Friday, during his regular morning radio interview, he lashed out against the European Commission, repeating himself, calling the legal opinion released by the European Commission an object of derision, a document that one cannot discuss without laughing. If Hungary accepted this document, it would become the laughing stock of Europe. He went on and on. Then yesterday, he accused Ákos Hadházy (LMP), who has spent years fighting the endemic corruption of the Orbán regime, of corruption himself. Pressured by the European Commission and by Hadházy’s dogged pursuit of his government’s systemic corruption, Orbán no longer seems capable of exercising self-control.

I have been following Ákos Hadházy’s political career ever since he first appeared on the national scene. He reported on a local corruption case in Szekszárd, a small town, where he was a Fidesz member of the city council. Since then, Hadházy, now co-chair of LMP, has focused on uncovering corruption cases. Just the other day, he said in an interview that he had held more than 80 “corruption infos.” Once a week he stands in front of the cameras and reports on yet another horrendous case. Each of these cases involves millions if not billions of forints. Hadházy estimates that in the last seven years the “Fidesz clientele” stole about three trillion forints of the subsidies Hungary received from the European Union. In his assessment, all work performed is at least 30% overpriced.

Lately, Hadházy has been working on two cases, both involving healthcare. The first one was a program that was supposed to set up “mentor houses” for premature babies and their parents in Szeged, Kecskemét, and Gyula. A foundation was established for the purpose, called “I Arrived Early Foundation,” which received 1.2 billion forints from the European Union. Since it was such a large project, Hadházy asked for details. It turned out that less than half of the money was allocated to the program itself. The rest was designated for the maintenance of the foundation. Money was spent on most likely overpriced rentals, legal advice, laptops, telephones, several printers, and very high salaries for the “coordinators,” while the 40 mentors received only about 50,000 forints a month.

It turned out that two other very similar projects received about half the amount that “I Arrived Early Foundation” got, and they managed quite well. Mind you, they didn’t pay 50 million forints for “legal advice.” In fact, they got along just fine without it. While a methodology study cost the “I Arrived Early Foundation” 50 million, the other foundation managed to get one for 8 million.

Hadházy stirred up a hornet’s nest by investigating this particular foundation. János Lázár’s wife is one of the board members of the foundation, and Hadházy suspected that the unusually generous financial support given to the foundation was not entirely independent of Mrs. Lázár’s presence there. Soon after the “corruption info” in which Hadházy announced the foundation’s suspicious expenditures, he found himself in the crosshairs of Zoltán Balog’s ministry, which awarded the money to the foundation, and the Office of the Prime Minister, headed by János Lázár. Nándor Csepreghy, Lázár’s deputy, assisted by the government paper, Magyar Idők, led the attack. Magyar Idők published several articles accusing Hadházy of being a heartless man who compared these premature babies to newborn puppies. Hadházy, who is a vet in private life, did in fact compare the weights of some of these babies to newborn puppies, and he was quite accurate. A newborn puppy is about 500 grams, just like the smallest premature baby. Csepreghy, in defense of his boss, called Hadházy an “ignorant scoundrel.” Lázár at one point offered his wife’s retirement from the foundation, but as far as I know nothing of the sort happened. Naturally, the foundation explained away all of its expenses.

The second case was even more clear cut. The National Healthcare Services Center (Állami Egészségügyi Ellátó Központ/ÁEEK) issued a tender for several ventilators. General Electric and three Hungarian firms submitted bids. The Hungarian firms were actually just wholesalers, and their bids were a great deal higher than General Electric’s. The three Hungarian firms offered to sell the ventilators for a price between 1.7 and 1.9 billion forints as opposed to GE’s offer of 1 billion forints. ÁEEK tailored the tender in such a way that only one bidder could win the tender. Predictably, GE lost the bid, but the company decided not to take the decision lying down. The American firm turned to the Public Procurement Authority (Közbeszerzési Döntőbizottság), which ruled in GE’s favor. ÁEEK had to pay 50 million forints. Bence Rétvári, undersecretary in the ministry of human resources, subsequently denied that the procurement was rigged.

Ákos Hadházy addressing Viktor Orbán in Parliament / Source: ATV

The GE affair was the topic of Ákos Hadházy’s weekly corruption info. János Lázár seemed to agree with Hadházy that those who were involved in the case must be investigated. So, emboldened by Lázár’s reaction, Hadházy brought up the case in parliament yesterday when Viktor Orbán by house rules had to be present and was obliged to answer questions. Hadházy asked the prime minister who was right: János Lázár or Bence Rétvári. Orbán flew off the handle. He accused Hadházy of lobbying for GE. “A representative stands up in the Hungarian Parliament lobbying for a company. How much money did you receive for this? How dare you? How dare you lobby for a company in the Hungarian Parliament during an ongoing public procurement? Especially, on behalf of a foreign company. Now, I have been sitting here for many years, but I have not seen a case more corrupt than this, shame on you!” He also ordered an “investigation” of Hadházy right on the spot.

Hadházy doesn’t seem to be intimidated. He will sue Orbán for slander. Otherwise, he wrote a defiant note on his Facebook page in which he pointed out that Orbán, with his outburst, “kicked a three-meter self-goal” by calling attention to the fact that they want to steal billions from the “dying hospitals.” He said that Orbán’s claim of “an ongoing public procurement” is a lie since the Public Procurement Authority already closed the case. Otherwise, he is looking for the day when Orbán will have to apologize to him. Well, in his place I wouldn’t hold my breath.

October 10, 2017

A first: Nine opposition parties agree on long-range healthcare priorities

Today was an extraordinary day, one that few people believed would ever come to pass. All nine opposition parties, including Jobbik, signed onto a “national healthcare minimum,” a document that outlines the basic steps that must be taken to salvage the sinking ship of Hungarian healthcare. Fidesz was also invited to the discussions that preceded the final act of approval, but the government party refused to participate.

How did this project come into being? The description of the process might be educational for crafting future agreements in fields that shouldn’t fall victim to party politics.

First, I should say a few words about the man, Gyula Kincses, without whom this healthcare minimum project couldn’t have taken place. Kincses was an ear-nose-throat specialist who eventually moved over to healthcare management and politics. He began his political career as an MDF member of parliament (1990-1994), but he was always more interested in healthcare management. It didn’t matter which party was in power, they all relied on his advice and expertise–from Viktor Orbán (1998-2002) through all subsequent governments–that is, up until 2010. He reached the pinnacle of his career during the Gyurcsány administration when he served as undersecretary of health.

By now Kincses is retired, but he is still extremely active. In the last five years he has been writing a blog called Asztalfiók (Desk drawer) in which he analyzes various aspects of healthcare. He is regularly asked to comment on health issues by Hír TV and ATV. As far as I know, he has not been asked for advice by this government.

Gyula Kincses

On June 14, 2017, the Friedrich-Ebert-Stiftung and Political Capital held a conference titled “Can Healthcare be cured?” where, in addition to healthcare professionals, representatives of several opposition parties were invited to participate. Tímea Szabó (Párbeszéd), László György Lukács (Jobbik), Ákos Hadházy (LMP), Imre László (DK), and László Szakács (MSZP) were among the speakers. Naturally, Fidesz was also invited, but they ignored the event. At this conference Jobbik’s Lukács was the only person to stress the “necessity of a consensus among the representatives of political life, which would elevate the issue of healthcare over and above the usual political skirmishes.” This suggestion moved Gyula Kincses, who was in the audience, to ask Lukács whether he would sponsor such a resolution.

The Hungarian media didn’t waste much time on this conference. The only article I found appeared on Jobbik’s internet news site Alfahír, which makes sense since it was a Jobbik politician who accepted the challenge of getting all the parties involved in working out a national minimum. A month later, on July 28, Népszava reported that the representatives of nine parties with measurable support (DK, Együtt, Jobbik, LMP, Kétfarkú Kutya, MSZP, MoMa, Momentum, and Párbeszéd) had gathered to try to identify the most basic elements necessary for a coherent healthcare policy that could be sustained over time. One of the problems Hungary, like most countries, faces is that when a new administration comes into power it brings with it politicians with new ideas who immediately dismantle everything the previous administration had accomplished. An agreement on healthcare—or, for that matter, on education—over the long run would eliminate this extremely destructive practice. Surprisingly, it turned out that the parties actually agreed on many of the elements Kincses found important. By the end of July Kincses was greatly encouraged by the level of cooperation he had received. Kincses gave an interview to Egyenes beszéd (ATV) in which he stressed that Fidesz would be a welcome member of the team, but the government party was steadfastly refusing to participate. However, he said, they are still waiting.

Although Kincses didn’t brag about it, by that time the document was more or less ready. By early August the final text was sent to the participating parties for discussion and for a final word of acceptance or rejection. At that time Alfahír still expressed its doubts whether all the parties would accept the final text. Well, today we at last found out that Kincses accomplished the close-to-impossible task. All nine parties decided to support the nine basic elements of the document.

The Hungarian media can occasionally be more than irritating. None of the articles covering this story lists all nine points, but I managed to find that the parties committed themselves to spending at least 9.4% of the Hungarian GDP (EU average) on healthcare. Currently the figure is only 7.1%. Of this, the state pays 4.8%, while the rest is paid by individuals. Out of every 100 forints spent on healthcare, 40 forints are paid by Hungarian citizens, which is much higher than in other EU countries. The plan would lower that figure to 30%. Everyone who is insured would receive the same quality care, though private insurers could offer additional services. The document includes a promise of graduated, substantial salary raises for healthcare workers over the next five years and the restoration of the old “social security system,” which was abolished by the Orbán government and replaced with a system financed by taxation.

The first party to sign was Jobbik, followed by DK. By now only a few haven’t yet gotten around to signing the document.

Magyar Idők has been silent about this whole project. In the past few months the government media has reported nothing about the discussions concerning long-term healthcare plans. It was only Pesti Srácok which today sarcastically announced that “the great opposition cuddling materialized; of course, Jobbik is among them.” Otherwise, the paper summarized the document accurately.

This is a first step but, I think, an important one. I hope there will be others to follow. They might inspire the electorate to realize that, after all, these parties can agree on issues which are important to them.

September 20, 2017

Hungarians’ changing priorities; shifts in the left-of-center media

Changing opinions on political issues 

Yesterday I saw a Hír TV news segment that I found intriguing. A woman reporter with a cameraman behind her stopped passersby wanting to know what the “man in the street” thinks about current affairs. This is the umpteenth time that I have encountered such an exercise. The result was always disappointing. Eight or nine people out of ten simply refused to answer any of the questions while the other(s) proclaimed their loyalty to Viktor Orbán, who has created a wonderful, prosperous country. To my great surprise this encounter turned out differently. Everybody was willing to speak, and there was only one woman out of about ten who was enthusiastic about Viktor Orbán on account of his defense of the country against the “migrants.”

The reporter wanted to know what people think are the most urgent tasks and problems Hungarians face today. The answers were practically uniform: healthcare and education. A couple of people mentioned low wages and inflation, especially food prices. When people didn’t cite migration as a problem, the journalist asked them about the topic. With the exception of one person, they all claimed that the danger of migration is not in the forefront of their concerns. There are no migrants in Hungary, and migrants show little inclination to settle there anyway.

One of those dissatisfied citizens

At first I thought I may simply have seen an atypical, or skewed, news segment. But then, a few hours later, I found an article in 24.hu reporting that “Hungarians worry more about poverty and healthcare than migration.” It summarized the findings of two international organizations, Eurobarometer and the conservative International Republican Institute. Both indicated that migration is not uppermost in Hungarians’ minds. The International Republican Institute’s findings are especially interesting because the respondents were not faced with a set of prepared options. Here poverty and the lack of social equality (28%) were people’s main concerns, followed by corruption (15%), unemployment (13%), healthcare (12%), and “migration” (4%).

But in that case, why did the Orbán government launch a new campaign against the “Soros Plan”? Knowing the careful political calculations of Fidesz, we must assume that the questions in the new “national consultation” will be slanted in such a way that it will speak to the concerns of the majority of Hungarians. There are signs that in the present Fidesz vocabulary the “Soros Plan” is actually just another name for the European Union. In this case, the main thrust of this new campaign will again be anti-EU. But it has to be structured so that it doesn’t cause the kind of adverse reaction that the “Stop Brussels” campaign did.

Changes in the left-of center media

Those of you who are able to watch Hungarian-language television must be aware of the slow transformation of ATV, which until about two years ago was the only independent TV station. At that time Lajos Simicska, Viktor Orbán’s old high school friend and the financial brain behind Fidesz, turned against Orbán, allegedly because of his pro-Russian orientation. This put an end to the pro-government stance of Simicska’s Magyar Nemzet and Hír TV. At about the same time, major changes began to be introduced at ATV, which is owned by the fundamentalist Assembly of Faith. It is hard to tell whether these changes were made in order to boost viewership or for political reasons, but there are fewer programs for people who are interested in political news. Reporters were hired from TV2, a commercial station that caters to a different audience from the one that ATV had attracted earlier. Also, two important reporters, Olga Kálmán and Antónia Mészáros, left the station. Kálmán joined Hír TV and Mészáros left the profession altogether. In addition, several reporters simply disappeared from the screen. The new crew was, at least in my opinion, not worth watching.

The final straw was the replacement of Kálmán and Mészáros with Zsuzsa Demcsák, who began her career as a fashion model but later spent years at TV2, a commercial station recently bought by Andy Vajna, most likely as a proxy for the Hungarian government. After the change of ownership, reporters started leaving TV2, including Demcsák in April. ATV jumped at what the management considered to be an opportunity and hired her. The arrangement was that Demcsák and Egon Rónai would rotate being anchor of “Egyenes beszéd” on a weekly basis. Demcsák’s first week on the job was dreadful. The woman was simply out of her depth. The following week she showed off her incompetence on ATV Start, an early morning political program. Then came Friday morning when she was, I’m afraid, quite drunk while interviewing Tibor Szanyi, MSZP’s European parliamentary member. She was suspended, awaiting the results of an internal investigation, but I’m almost certain that we are not going to see her on ATV again.

On the other hand, Hír TV came out with several new programs. This morning I watched two of them. The first was “Elmúlt 8 év” (The past eight years) with Györgyi Szöllősi, who is a good reporter. The other was “180 fok” (180 degrees) with Sándor Csintalan, a somewhat controversial character who started off as an MSZP politician and at one point was in the Fidesz camp. He is now a committed foe of Orbán. The program is in part a call-in show and and in part a series of interviews. The first guests were Miklós Haraszti, who is no stranger to the readers of Hungarian Spectrum, and the head of Iránytű (Compass), a polling company allegedly close to Jobbik. I encountered Iránytű’s director before and found his views moderate and balanced. And I loved the screen behind Csintalan, showing an idyllic countryside with a charming peasant house when suddenly Orbán’s infamous choo-choo train goes across. The train appears every five minutes or so. I laughed every time. I think I will also check out another new program called “Magyar Exodus,” which will be mostly filmed abroad, with Hungarian emigrants.

Unfortunately, these two cable channels reach very few people, but their existence is still vitally important. One can only hope that ATV will find its bearings soon because otherwise it can close up shop.

September 17, 2017

Is Zoltán Balog emotionally unfit to oversee the ministry of human resources?

It’s hard to pick the least sympathetic minister in Viktor Orbán’s cabinet, but Zoltán Balog, the former Calvinist minister, is definitely somewhere at the top of the list. Admittedly, my acquaintance with Calvinist ministers is limited, but I imagine that a good minister should be a compassionate human being who is ready to listen to the joys and sorrows of others. Someone who can offer solace. Someone who knows the meaning of empathy. Someone whose love of his fellow human beings is discernible in all his actions and words. Although I have never met him in person, when I think of a man who is the embodiment of the ideal clergyman it is Gábor Iványi who comes to mind, the Methodist minister whose church has been the victim of Viktor Orbán’s inexplicable hatred.

On the other hand, Orbán became very fond of Zoltán Balog, who joined the still liberal Fidesz party in 1991 as an adviser on church-related matters. In his student days and even later, Balog was highly critical of the conservative Hungarian Reformed Church and, in turn, the church hierarchy believed he should probably not become one of them. First, he was expelled from the Hungarian Reformed College of Debrecen and later from the Debrecen University of Reformed Theology. Although for a while he worked as a practicing minister, soon enough, after 1990, he drifted toward a political career. In 1993 and 1994 Viktor Orbán was refashioning the liberal Fidesz into a Christian Democratic party and was in need of people, Catholics as well as Protestants, who knew something about Christian churches.

By the time Viktor Orbán became prime minister in 1998 and Balog his chief adviser, Balog had abandoned his earlier liberal, even radical, ideas about relations between church and state and about a thorough revamping of the Hungarian Reformed Church. As time went by, he became more and more conservative, even radical in some ways. He was one of the first Fidesz critics of “politically correct” speech. He fought any legal restriction of “hate speech” and made some unfortunate remarks about the situation of the Roma when he claimed that the greatest danger the Gypsies face is not racism but hopelessness. Some of his earlier liberal friends didn’t know what to make of his sudden metamorphosis. One thing is sure. Balog today is one of the greatest apologists of the regime Viktor Orbán has built since 2010.

These are the bare facts of Balog’s transformation from Protestant minister to super minister of “human resources,” the person who is supposed to oversee education, health, sports, culture, churches, and family and youth. One would think that a former Protestant minister would be well suited to manage such human endeavors, yet over the years it became evident that Balog is singularly unfit for the job. Almost every time he opens his mouth he insults somebody or at least presents himself as an uncaring person.

Balog’s “mishaps” are too numerous to recount here, but I recommend my post from 2013 on the Hungarian Reformed Church Charity’s brilliant move of collecting 40 kids who live in poverty for a luxury dinner in the Budapest Hilton Hotel. They were served goose consomé with vegetables and rotini, chicken breast with a mushroom sauce prepared with Calvados, vegetable lasagna, broccoli, and rice. The dessert was yogurt strawberry cake. All this for kids who like pizza, hamburgers, and gyros. But then came the Reverend Balog’s speech in which explained that perhaps these children, when they have a job or “perhaps even go to college, who knows,” will be able to afford to eat in a restaurant like this. Or perhaps they will be able to visit Paris or Cluj/Kolozsvár. It was an incredible performance.

Since this incident, there were many others that demonstrated Balog’s insensitivity. For example, a couple of months ago at a gathering to celebrate the Day of the Ambulance Service he gave a speech at a breakfast meeting held in a relatively expensive restaurant in Budapest. It is a well-known fact that the members of the ambulance service receive shamelessly low salaries. Balog began his speech by cracking a “joke” about his audience whose members “eat breakfast here every day.” No one laughed.

More serious was when Balog and the newly appointed chief of the National Ambulance Service gave a press conference about the dreadful accident involving Hungarian high school students, 16 of whom burned to death in the bus near Verona. Balog introduced the new director by saying that “Gábor Csató just took over the leadership of the organization and it was a real baptism by fire, if one can say such a thing.” I guess one can, but one shouldn’t.

Balog made headlines a couple of days ago when he gave an interview on ATV’s Egyenes beszéd (Straight Talk). He explained that Hungarian healthcare is not as bad as one would think after reading the Hungarian media, which entertains the public with fake news which in turn has a negative effect on healthcare itself. The conversation turned to the case of a little girl who was being operated on but since the Országos Kardiológiai Intézet (National Institute of Cardiology) doesn’t have a CT machine she had to be transported to another hospital in the middle of the operation. Balog saw no problem with this situation. At least there is another hospital to which she could be transported. Instead of talking about the lack of CT and MRI machines, the media should concentrate on the higher salaries doctors are getting thanks to the government. He seemed to be totally unsympathetic to the little girl’s plight, who died a few hours after she was transported to the other hospital.

Most likely the trip to another hospital was not the cause of the girl’s death, but people nonetheless felt that Balog’s reaction, as usual, was inappropriate to the occasion. HVG pointed out that there are two possibilities. First, Balog may have been unaware of the death of the patient about whom many articles had been written lately. Or, second, he knew about it and yet showed no sympathy or emotion. In the former case, he is not fit to be a cabinet minister, and in the latter, he is unfit to be a clergyman.

July 13, 2017

Teaching Hungarian doctors to say hello

On June 2 several newspapers reported that a pregnant woman, after leaving the Ferenc Jahn Hospital in Budapest and while waiting for a taxi, collapsed in an epileptic seizure. The taxi driver had the good sense to hold her head to prevent her from injuring herself on the hard pavement. With the help of a passer-by he phoned the ambulance service. The dispatcher wouldn’t send an ambulance and instead suggested going to the hospital for help. But the door was locked and no amount of knocking or honking the car’s horn elicited a response. It took several more calls before the woman’s physician appeared at the door with a nurse. The taxi driver rightly pointed out that the problem is not only the state of Hungarian healthcare but also the attitude of doctors to their patients. I should add that this incident occurred at the same hospital where for several days no one noticed that there was a dead body in a restroom that served visitors to the neonatal unit.

I don’t know what our taxi driver would have thought if he had listened to a conversation between György Bolgár of Klub Rádió and a physician a day after the incident. The illustrious colleague explained to Bolgár why the hospital did what it was supposed to do. Just because the woman collapsed in front of the hospital, the institution had no obligation to accept her. He illustrated the case with the following example. Can anyone whose BMW breaks down in front of a BMW factory expect his car to be fixed right there just because the trouble occurred in front of the plant? People in a hospital have no time for such unexpected incidents. Who can go out? A doctor who is with another patient? Or a nurse who has to look after 40 patients? Yes, the taxi driver could only phone the ambulance service. Soon enough another physician, a woman this time, phoned in. She kept repeating, robot-like, that “there are rules,” and the rules say one must turn to the ambulance service in such cases. Period.

Where it all happened

And what was the reaction of the hospital administration once the story got out? The statement the hospital issued revealed that the security guard inside was fully aware of what was going on in front of the entrance. In fact, he was taking notes. “Everybody knows,” the hospital said, that between 11:00 p.m. and 4:00 a.m. the main entrance to the hospital is closed. One must use the entrance to the emergency department. As for the incident itself, “it is unfortunate that an epileptic seizure may occur at any time in the case of an epileptic patient.” The hospital administration conducted “a thorough investigation” and found that everybody followed the expected protocol. I should add that the emergency entrance is almost a whole kilometer away from where the incident occurred.

Only a few days after this incident the Állami Egészségügyi Ellátó Központ (ÁEEK), or National Healthcare Services Center, published a so-called performance evaluation, covering the 2013-2015 period. It is an extremely detailed manual of more than 1,000 pages on every possible aspect of the Hungarian healthcare system. Those who are not quite ready to wade through the incredible amount of information should at least read the summary (összefoglaló), which is depressing enough. Within the European Union, Hungary, together with countries like Bulgaria, Romania, Latvia, and Lithuania, is at the very bottom, whether as measured by mortality rate, life expectancy, or number of healthy years. There are incredible regional differences. For example, in Central Hungary, which includes Budapest, men live 6.6 years and women 8.4 years longer than their fellow citizens in Northern Hungary. The correlation between educational attainment and health is a well-known fact, which has a large literature. A man with a grade 8 education will die 12 years earlier than a man with a college degree. In the case of women, the difference is 5.6 years.

But what made the greatest impression on those who read about the study in the media was the notion of “avoidable deaths” which, according to the study, in 2014 was 26% or 32,000 deaths. Fourteen percent of these “avoidable deaths” could have been prevented by timely and appropriate care while 12% of them could have been prevented by better public health practices. Half of those who died before the age of 65 could have been saved if people were more health conscious. With these statistics Hungary ranks 26th of the 28 member states.

In addition to this massive study, Political Capital together with the Friedrich-Ebert-Stiftung organized a conference, “Can healthcare be cured?” Attila Juhász of Political Capital published a short, 30-page study with the same title which he summarized at the conference. Zsófia Kollányi, assistant professor of health policy and economy, mostly talked about Hungarians’ ever worsening health and societal conditions. She gave a few intriguing examples of the depth of the problem. For example, Swedish men live 9 years longer than Hungarian men, but the “real drama” is that if we compare college-educated Swedish and Hungarian men the difference is only five years. On the other hand, if we compare Swedish and Hungarian men with elementary educations the difference is 12 years. So, a greater emphasis on education would also most likely improve Hungary’s health statistics. However, the Orbán regime’s educational policy is moving in exactly the opposite direction.

After Fidesz won the election in 2010, one of the first moves of the Orbán government was to abolish a recently established independent organization that dealt with patients’ complaints. I’m sure that this was at the request of the medical profession, which in those days at least was a strong supporter of Fidesz. This independent watchdog organization was not exactly the favorite of physicians. Márton Asbóth, the lawyer in charge of health issues at TASZ, told the audience that every year 3,000 people turn to the Hungarian Civil Liberties Union with their complaints. So, there would be a great need for the resurrection of such an organization.

Finally, as György Leitner of the Primus Magán Egészségügyi Szolgáltatók Egyesülete (Association of Prime Private Healthcare Providers) said, “Hungarian doctors must be taught to greet people and shake hands.” Andrea Mezei of the Emberibb Egészségügyért Közhasznú Alapítvány (Foundation for More Humane Healthcare) also complained about the attitude of Hungarian doctors toward their patients. According to her experiences, “a cashier at the checkout counter is able to greet the shoppers, but in the doctor-patient relation this is often not true.” Healthcare facilities are like “islands” out of touch with Hungarian society at large. Her foundation tries “to bring normalcy into hospitals” by organizing training for doctors and nurses. They are not welcome in every hospital, and in fact in one hospital the nurses petitioned the hospital administration to prevent them from organizing such training. Leitner, representing the private healthcare providers, seconded Mezei’s observations by saying that not only is money missing from healthcare but also the positive attitude that adds to the satisfaction of the patients.

Which takes us back to the Ferenc Jahn Hospital’s attitude toward the woman with the epileptic seizure and the doctor who compared a hospital to a BMW plant.

June 16, 2017

The past seven years: Hungary in numbers, 2010-2016

Máté Veres, research associate of Gazdaságkutató Zrt., published this study in Új Egyenlőség at the beginning of the year. The article was translated by “Observer,” who added the following notes:

This article offers a set of indicators to reveal the state of the Hungarian economy and society. We think, however, that the situation is somewhat worse than Veres’s assessment because there are additional detrimental factors not discussed here, e.g.:

  • The very low investment rate as a percentage of GDP
  • The budget deficit hidden in subsystems down to individual units like hospitals or schools districts
  • The consumption boost by the remitted earnings from abroad, which are to decline in time
  • The poor ratings of the Hungarian places of higher education, the outdated, retrograde education model and policies, the very low number of people with IT or foreign language knowledge, etc.  

Analyses of these points will eventually be presented in another article. I’m grateful for the work and care “Observer” took in translating this important article for us.

♦ ♦ ♦

Analyzing the results of the second Orbán government [and third as from 2014] after seven years of freedom fight and other kinds of struggle and hundreds of millions of euros from the EU spent, it’s time to draw a picture of how the Hungarian economy and society are doing compared to 2010 in the light of the latest figures available.

After [the election victory in] 2010 the government benches have been widely using the already well known “past eight years” phrase. It was used by Fidesz and the Christian Democratic politicians as their favored counter-argument when the opposition tried to challenge government actions. The performance of the governments between 2002 and 2010 in many areas could have been criticized (as we did in our analyses), but in general the “last eight years” argument has always been a simplistic communication tool, often used to bypass substantive discussions. In our evaluation of the Fidesz government performance we now follow a different path and instead of summary political statements we shall stay with the facts and figures to show what the “past seven years” were like.

Seven years are already a sufficient horizon for an evaluation of the government’s achievements. For this purpose, however, in addition to showing the changes in numbers, we need to find explanations for the results, and therefore – where possible – to compare the results with those of our regional competitors as well. So now we’ll consider some areas of key importance to the future of the country.

UNEMPLOYMENT

It was 10.3% in 2010 and only 5% in 2016, according to the KHS (Central Statistics Office-CSO), or 6.8%, according to Eurostat.

Apparently the situation has improved, but it is worth adding that the [2008 world financial] crisis played a major role in the exceptionally weak 2010 numbers, while the much better 2016 numbers include both those working abroad and those fostered workers vegetating on subsistence wages (USD 180/month).

The same factors underlay the Eurostat numbers showing a miraculous growth of employment in Hungary (59.9% in 2010 and 68.9% in 2015). According to official figures we caught up with the EU average, but without those working abroad and the fostered workers we just caught up with the eastern [EU] member states. In any case, there is an improvement, primarily due to the EU-funded, labor-intensive construction projects.

HUMAN DEVELOPMENT

2010 – 36th place, in 2016 – 44th

Human development is an indicator introduced by the UNO, a concept of human well-being wider than the GDP indicator. It is generated by averaging three numerical indicators: life expectancy, education and standard of living (GDP Purchasing Power Parity per capita). In this area we not only managed to fall significantly behind, but all our V4 [Poland, Czech Republic, Slovakia and Hungary] regional competitors overtook us, while Poland was still behind us in 2010.

HOUSEHOLD DEBT

EUR 7,844 mil in 2010, 5,683 mil in 2016

A clear success can be booked in this area. The composition of the debt is just as important as its size, as the crisis taught a large part of the Hungarian middle class. Until 2010 the household debt of the Hungarian population grew at a rate remarkable even by regional standards, and in foreign currency, which was mainly due to the bad interest rate policy of the Hungarian Central Bank (HCB) and to the lack of regulation. The central bank’s interest rate policy between 2001 and 2007 encouraged the population to borrow in foreign currency.

PUBLIC DEBT

In 2010 the PD was HUF 20,420 billion or 78.8% of GDP. Seven years later, in 2016 it was 25,393 billion or 75.5% of GDP.

This figure has fluctuated during the second Orbán government. It had been over 80% GDP too, but at the end of the year ‘with hundreds of tricks’ – the best known being the seizure of the pension finds – they always managed a decrease from the previous year [the government publishes and uses only a single figure – that of Dec. 30th). There is a lot of uncertainty as to whether the government can sustain the downward trend, given the scale of the debt, but if it manages to keep the balance of payments at zero, the government can eventually claim a clear victory on this front.

TAXES ON LABOR

In 2010 the total was 54.1%; in 2016, 49.0% There is a sizable literature on the issue. The differentiated and on average higher taxes on labor and/or profit are not at all problematic, if they are used by the state to provide high-quality, accessible to all, health, education and other services. This is evidenced year after year by the results of the economic systems of Sweden, Norway, Denmark and Finland, known as the “Nordic model”, since the above-mentioned countries have figured at the top of the lists in competitiveness, innovation and the environment for decades. However, in Hungary things are developing in a direction exactly opposite to the Nordic Model. This question is also interesting because the Fidesz government proclaimed itself to be the government of tax cuts.

Social security expenses in the European Union, 2014

It is clear that if we look at the overall situation, the taxes on labor have decreased. Although it’s worth adding that in international comparison while in 2010 we had the second largest burden rate in the OECD, by now we managed to move up only by two places, occupying fourth place from the bottom. This small success is mainly due to the introduction of a flat personal income tax and its rate reduction to 16%.

However, it’s worth mentioning that the replacement of the progressive tax system used until then by a flat tax rate opened a HUF 444 billion hole in the yearly budget and benefited only the richest. In addition, never has labor in Hungary been burdened by such a wide variety of taxes as today. Actually the situation here is the worst in the region. Meanwhile the government promised a massive tax burden reduction in the medium term and a single-digit company tax. There has been a long-standing debate about the need for a significant reduction of the tax burden with regard to the competitiveness of the economy.

In any case, despite the 2010 promise, we surely didn’t get any closer to the “beer mat-sized tax return” [as V. Orbán half-jokingly promised in opposition]. However, with the new flat and extremely low 9% company tax rate, another 2010 slogan – “we shall fight the offshore knights” – now seems to have morphed into “join the offshore knights’ race.” Similar to the effect of the flat-rate personal income tax, now once again the richest (and the big companies) will do really well as not the Hungarians, but the multinationals, such as General Electric (GE), already did under a special agreement with the government.

GDP GROWTH

Between 2004 and 2010 the growth amounted to 9.9% or in absolute terms USD 114.2 billion to 129.4 billion (a 15.2 billion difference). Between 2010 and 2015, in the same length of time, the Orbán government boosted the GDP from USD 129.4 billion to 138.8 billion (a 9.4 billion difference). The right side of politics clearly underperformed. These numbers, however, may be deceptive because much depends on external factors. But if you just look at our competitors in the region, save for the Czechs and Bulgarians almost all Eastern European member states, even Romania, performed better.

PUBLIC TRANSPORT

The [public transport] ticket price in Budapest in 2010 was 320 Ft., in 2016 – 350. The ticket prices in the region were as follows in 2016. Sofia – 158 Ft., Bucharest – 90 Ft., Warsaw – 240 Ft., Prague – 275 Ft. So the situation remains unchanged, we are the most expensive.

FREEWAY CONSTRUCTION COST

During the Gyurcsány government overpricing [in public projects] gained notoriety, but there are still no authoritative studies regarding its extent. Interestingly, according to Zsuzsanna Németh, Minister of Development 2010-2014, the Hungarian freeway construction cost per kilometer had decreased steadily during the Gyurcsány government, and in 2010 was 1.8 billion Ft. on average. Compared to this, according to the same Ministry led by Zsuzsanna Németh, the freeway construction unit cost had increased to 2.3 billion per kilometers in 2013. But there were also sections where the costs reached almost 4 billion forints.

BIG MAC INDEX

[Or how many minutes you have to work for a Big Mac]

Crisis or not, the change here is clearly positive: in 2009 – 59 min., in 2015 only 44 min. That said, we still haven’t overtaken anyone in the region, we are on par with Bucharest. It is also important to point out that the Big Mac index focuses on cities, and while Budapest is clearly catching up, the country is dropping behind compared to the other EU Member States. And this worsening trend continued during the past seven years just as before.

BUDAPEST (CENTRAL HUNGARY) GDP PPP / CAPITA compared to EU average

In 2010 144%, in 2014 143% where 100% means the EU average

Only Budapest is above the EU average, the second best county – Győr-Moson-Sopron stands at only 77%. In the light of the foregoing it is worthwhile showing also how the best performing Hungarian regions – where the situation in this area has worsened since 2010 – compare to our V4 competitors. In 2014 in the same category Prague was stood at 173%, Bratislava 187%, Warsaw 197%. Notably in the case of Budapest, Pest County is also part of the region.

GDP per capita by purchasing power parity, 2015

IMPORTED FOODS SHARE

In 2010 24.5%, in 2015 22%

The more food is produced by local, domestic producers the better, both environmentally and economically. According to a relatively recent Corvinus University study, positive, if modest changes have taken place in this area.

THE REAL VALUE OF PENSIONS
It is so far growing in the second Orbán government period, due in part to last year’s persistently low inflation, the third year in a row, and, on the other hand, partially due to the inflation-indexation of pensions introduced by the Gyurcsány government and which during the Fidesz government was often surpassed through the use of small tricks.

MATERNITY LEAVE

In 2008 the gross benefit was HUF 28,500, in 2016 just as much. In international comparison, this is dramatically low.

PRIMARY SCHOOL TEACHER GROSS ANNUAL WAGES

In 2009 it was USD 9,500, in 2015 – 9,149.

The biggest change in the area of earnings in the past period, as mentioned before, was the flat personal income tax, which benefitted primarily the affluent. At first glance the above seems even a decrease, but due to the significantly weakened forint exchange rate in the period the balance is rather a positive one. This fact doesn’t make for any exuberant joy because according to the OECD data, admittedly in need of updating, the approx. USD 9,500 earnings (just as a few years ago) was sufficient only for the last place among the EU member countries.

PEOPLE LIVING IN EXTREME POVERTY

In 2010 – 3 million, in 2016 – 3.6-3.8 million

In addition to this terribly high number, perhaps it is most important to note that after nearly a quarter of a century, in 2011 the CSO stopped publishing any figures about exactly how many people live below the poverty line. (The Policy Agenda think tank, however, has calculated that by 2015 the number has grown to 41.5%. See our article on all of this.)

Actual Individual Consumption in the European Union, 2014

Furthermore, the CSO had calculated that at least 87,351 Ft. monthly net earnings were required (in 2014) for living at a subsistence level. In comparison the net minimum wage in 2016 was still 73,815 Ft. In the first case it seems there was finally a move forward. Thanks to the tenacious struggle of the trade unions in 2018 the minimum wage will reach the subsistence level of around 90,000 Ft. However, thanks to the far higher 35% tax burden, in net terms the minimum wage is still light years behind that of our competitors in the region regarding the increases carried out between 2008 and 2016. In addition, Hungary has the highest proportion (72.2%) across the EU of households that wouldn’t be able to pay any unexpected expense.

HOSPITAL BEDS NUMBER

In 2009 – 70,971, in 2014 – 66,000

The population has been declining steadily since 2010, but we surely aren’t so many fewer. Actually there are more elderly. Therefore we need more, not fewer beds.

HEALTHCARE

Not only compared to 2010, but in fact never has any government since 1990 spent so little on healthcare, as a percentage of GDP, as in the past several years. And this is not only a basic requirement for a more successful functioning of the economy but also a factor that could have improved significantly the overall mood of the whole country. Recent research has shown that the overall satisfaction level in a country is not best raised by increasing the earnings of the inhabitants but by spending relatively larger amounts on problems of well-being. There is also a demand for it. According to the 2016 European Social Survey the Hungarian society is in a terrible state compared to the other European countries: in Hungary people consume the smallest quantities of fruits and vegetables, Hungarian women are moving the least, compared to the Hungarian men only Lithuanians smoke more, compared to the Hungarian men only more Czechs are overweight, Hungarian women are the most overweight, we have the largest proportion of men in poor or a very poor state of health, compared to the Hungarian women only the Spanish women are in a worse state of health, among the Hungarian men are the most showing signs of depression, and the Hungarian population, both men and women, is most affected by cancer. After that, perhaps it’s not surprising that we visit doctors most frequently among OECD countries.

EDUCATION

Similar to the health care case, counting from 1990 we have never spent so little of the GDP in this sector as during the Orbán government. Yet the word education could safely be replaced by “future,” since it is basically influenced by the country’s medium and long-term competitiveness. We are rank penultimate in Europe [in spending], so such investment here would bring the biggest return among the OECD countries. The results are visible: we are sixth from the bottom in the OECD in the number of researchers employed in the country; there haven’t been so few studying in higher education in the last seventeen years. We spent the least for developing computer skills, and our students have the largest number of school hours for non-essential knowledge (e.g., ethics [compulsory alternative to religion], etc.) as opposed to essential ones (e.g. reading, writing, literature, mathematics, natural sciences, second or other language). In view of the above, the recently published PISA results, which understandably caused an outrage, probably represent only the tip of the iceberg.

One of the few positive steps in the past few years is that those who cannot find work are, finally, offered free training, but the training offered by the National [Vocational] Training Register (Országos képzési jegyzék) is unlikely to boost the highest added value production areas. In addition, the participants’ livelihood is not guaranteed during the course; hence the training can only be used by jobseekers with a better financial cushion or those enjoying a patronage. Improving job qualifications is needed to raise our incredibly low average salary, which already inhibits economic growth.

CORRUPTION PERCEPTIONS INDEX

In 2009 – 46th place, in 2015 – 50th place

Even the people in Saudi Arabia, Botswana, Qatar and four-fifths of our region feel their governments are less corrupt.

ENVIRONMENTAL PROTECTION

No previous government has shown less interest in this area. The Orbán government’s response to the day-by-day worsening problem of global warming was to abolish the Environment Ministry and to do nothing about the few concrete promises it made before the election – including the creation of a green bank. In the meantime, they managed to earn the glory of the “tree-felling government” title, since probably no one has cut down so many trees as they have done in the last seven years in Budapest, and they have plans for more. Moreover, we are perhaps the only country in the world to impose taxes on solar panels while indebting Hungary by a loan equal to at least 10% of GDPif not more – for the sake of a twentieth-century technology for [Russian nuclear reactor blocks] Paks 2, which, in the bargain, will surely never produce a return.

Meanwhile, despite all the flag waving and freedom fighting the external exposure of the Hungarian economy has not been reduced at all. And here it is not primarily the foreign currency denominated debt segment that counts most, nor the export-import volume, which reached 200% of GDP, but the fact that less than half of the exported added value is created in Hungary. In other words, more than 50% of the added value produced in Hungary is by foreign-owned companies, which is unique in the European Union. It is no surprise that of the EU money arriving here for business development – after the government has carved off its significant slice – almost 70% is awarded to multinationals.

Such a level of foreign investor influence is extraordinary even by regional standards, although in Eastern Europe we are all rowing in the same boat, i.e. in what the literature calls a dependent market economy. That is, our economies are wholly dependent on Western investments. This is particularly true for the car manufacturing brought to Hungary, because it accounts for more than 20% of Hungarian exports, and this situation hasn’t changed since the year 2000. Meanwhile a leading Fidesz politician says that nothing can be done because “Hungary is a determined country, where it’s impossible to pursue other economic policies.” But it was precisely the Orbán regime which showed that it is. Over the last fifty years countries such as South Korea, Taiwan and Singapore went through economic development with substantial state assistance, which took them to where we are heading today. Big companies like Samsung, LG and Hyundai were heavily subsidized by the state, which in return set certain export expectations, so these companies were forced to continue spending on innovation. While it is a widespread view that the international rules made impossible this type of government intervention, we can see that the Orbán regime can support their oligarchs without any sanctions. The problem is that instead of innovation the regime expects only political loyalty. Despite its references to them as a model, none of the East Asian models’ components has been employed.

In light of the above it is not surprising that there have never been so many who wanted to emigrate from the country. Meanwhile the middle class is eroding and the differences in wealth between the richest and the poorest are increasing.

There is money available though, since up to now the government has spent HUF 300 billion on state companies and a further HUF 100 billion on its own (i.e. our) soccer pet. Overall, we spend four times more on this prime minister’s mania than on road maintenance, while the number of spectators is steadily declining. There are other outlays that went wrong too – the György Matolcsy-led National Bank has had HUF 250 billion pumped into dubious foundations or spent for the purchase of art objects. In addition, another HUF 850 million was sunk into the Felcsút narrow gauge railway, never to produce any return, and HUF 6.7 billion credit was extended to Andy Vajna for the purchase of TV2. Speaking of Andy Vajna, it is worth highlighting the greatest of all items, in regard to which the government didn’t do anything, namely the offshore [knights racket]. Moreover, Hungary is actually moving in this direction. Even in the face of the couple of years old study finding that the almost unfathomable amount of USD 247 billion of untaxed income has left the country in past decades. In the course of this offshore racket we have suffered the second largest losses in Europe.

WHAT FOLLOWS FROM ALL THIS?

Looking at the numbers the government could demonstrate quite serious achievements compared to 2010, primarily in the area of balancing the ​​budget and public debt. The GDP growth rate could have been included but for the fact that this growth was due mainly to the accelerated EU investments and not to a better performance of the domestic economy. In fact our productivity has been stagnant since 2008.

On the other hand, the social inequalities have increased dramatically during these seven years. It is unlikely that these short-term favorable macro-economic data can be sustained in the long term, mainly because the Hungarian society’s human capital indicators have significantly deteriorated as a result of the dramatic underfunding of the public subsystems (healthcare, education, social policy, public transport). That is, the economic growth is due to a great extent to the EU investment funds and the short-term budgetary balance to huge austerity measures. Both are unsustainable.

February 19, 2017