Poland’s health care workers’ strike: new challenges and old problems

The Doctor’s Strike and the Nurses’ Occupation

Poland is entering the sixth week of a very serious doctors’ strike. Thousands of doctors around the country have been protesting the state of the health care system and one of its main problems: low wages for health care professionals and long working hours, usually compounded by the fact that most people work extra shifts to make ends meet. Many doctors also have handed in their notice as a direct action, saying they’d rather quit than work under these conditions.

The strike was called by some doctors and did not relate to all health care workers, which irritated some other members of the medical profession, most particularly nurses, who also wanted to take action. In former strike actions, it has typically, for whatever reason, been nurses, not doctors who have taken part in and organized more radical direct actions, and this time the same happened. About one month into the strike, the nurses organized a mass demonstration to Warsaw and started a protest action that is finally breathing some life into the struggle.

On June 19, despite heavy rain, about 20,000 health care workers marched in Warsaw. Towards the end of the march, four nurses demanded to see the Prime Minister and ended up occupying one of the offices of his building. They have been there since that day, despite threats made by the government. Other nurses, demanded a meeting with the Prime Minister, who wanted nothing to do with this strike except to strongly criticize the workers; they have refused to leave from outside the PM’s office. They declared that they would stay there all night if they had to. They have been there 5 days already.

On the first day of the protest, the nurses occupied the street but come morning, the police brutally removed them from the street onto the sidewalk. Two women were hospitalized in the action, one suffering a heart attack. The Prime Minister later claimed that the nurses were committing a crime and the only reason they weren’t completely removed is “because they are women.” He claimed that “if they had been men, they would have been removed a long time ago”. Having been cleared from the street, the nurses set up a camp across from the PM’s office on the street in front of a city park.

The nurses have widespread public sympathy, but that doesn’t mean that masses of people have joined their action. Still, people not only from the political scene have arrived with food or words of support for the strikers. Their demands are thought to be reasonable: pay rises, better working conditions and a rise in the amount of the GNP spent on healthcare from the current 3.7% to 6%.

The Situation in the Health Care Industry

The health care system in Poland is in deep crisis for many reasons. The amount of the GNP spent on health care is on the bottom of the list of OECD countries and is kept low as a policy of forcing the system into the ground as a way to introduce privatization. The system is also rife with corruption.

Salaries for doctors and nurses are notoriously low. There are no standard salaries, and what one earns often depends on numerous factors, but all too often, health care workers earn about half of the national average wage, often around 250-300 euros a month. Some workers get by only because they work extra shifts but in many cases, this overtime is not voluntary; the health care system is the victim of a brain drain with many of Poland’s professionals having gone abroad in search of a better living. In many hospitals, people have to work more and more – even up to 80 hours a week – just to keep the hospital operating.

The state, which usually pretends to want to maintain the health care system, in fact does everything possible to push towards privatization. Many hospitals are charged with “poor management” and then debt collectors are sent to them. The government has been encouraging and enpowering these debt collectors to go to hospitals and repossess equipment and even to evict them. While it is true that some hospitals are in deep debt or are seriously mismanaged, the government’s stance has done nothing to help them. In place after place, the government has closed down hospitals and clinics, overloading those that remain. Private hospitals have been moving into some of the hospitals abandoned by the state.

The Politics of Privatization

In fact, the state’s strategy has been a brilliant way to spread support of privatization. Although the quality of health care ranges dramatically from place to place, many people in fact depend solely on privatized health care already.

In some areas, there is simply no public health care readily available. For example, last year during an emergency situation, we found out that there were no clinics working on the east side of Warsaw on the weekend! In a city of well-over two million people, no public clinic was available within a reasonable distance on the weekend. More typical is that people who go to clinics find that they have to wait on some unreasonably long lines. A trip to a clinic may mean that you have to take even a whole day off work to wait in a line. Yet other times you need treatment and are told “but we don’t have this equipment or medicine”or that there is a great line. People are sometimes asked to provide their own medicines or, more often, to pay the hospital to purchase the equipment. It is also “understood” that if you want to avoid waiting in a long line for some procedure, some doctor can serve you privately – at a price. Recent figures show that the state allocates far too little money per person during their stay as well, except for politicians who are allowed to use special hospitals.

With the system in such a state, many people in fact have either bought themselves private insurance with a private medical provider or get this as a work benefit. These people, who are in fact perhaps the bulk of those with above-average paying jobs, also pay for the state system through mandatory contributions, and tend to complain that, although they pay, they are not able to make use of the system because it’s just too bad. Thus, although most people want to see free health care for the poor, there are segments of society that see privatization as something cost-effective for them as individuals. Add to this the constant neoliberal consensus spread through the media and politicians and you have a lot of people thinking that privatization is the only option for the system.
Among those that fight for privatization is the doctor’s union OZZL which called the strike. Although many of the doctors in it have a different idea, and although in the past year they have modified their politics slightly to be more “social”, the OZZL is advised by right-wing think tanks which have developed a program of health care reform for them. The main idea behind this program is that privatized health care will work better. Recently this union has proposed giving all citizens “health care vouchers” in equal amounts which they could spend chosing their own service providers.

Anarchists have unfortunately not always been able to come to some consensus on how to treat this issue. The movement in Poland was heavily influenced by libertarians who dominated anarchist ideology in the 80s and 90s and thus you find those that like vouchers. On the other hand, some anarchists recently follow in the statist ideology of the leftist “social state” and rather uncritically support the state institutions. In the past, there have been many long discussions on the health care system inspired by some articles written by those who want to tackle the issue from an anarchist perspective.

It has been my long-standing opinion that neither the state-run system nor the privatized one is the solution. Few people can support the idea of pumping more money into the state-run system when they are aware that a certain portion of it is misappropriated by bureacrats – but this does not mean that privatization is the answer in a society where the capitalist health care system threatens to create layers of society which can afford some health care, leaving others to fend for themselves. Some soft version of anarchist ideas can be promoted in the here and now as a solution.

The Union of Polish Syndicalists (ZSP) have taken the first steps towards a dialog on this issue. In a statement in support of the nurse’s strike, we ask what can be done to overcome this impasse where the government runs things badly and bureaucrats are interested in their own profit and capitalists run things for the own profit, and badly at that. We maintain that part of the problem is that people do not control public spending directly and, if they did, they probably would chose to devote funds to social needs rather than buying F16s or giving sweetheart contracts to some politicians’ families. Medicine should be “socialized” in the meaning that society should have direct control over it together with health care workers. ZSP proposes that the health care system come under direct popular control immediately. It also calls for other industries which are involved in labour conflicts, for example teachers who also recently had some warning strike action, to join forces together. Finally ZSP calls for the general society, all of whom are effected by this issue, to show more support for the nurses.

The Outlook for the Protests

Unfortunately, the outlook does not seem to be very optimistic. Years of right-wing media and intellectual dominance have ensured that there are many proponents of privatization in society. Many ordinary people also do not identify with doctors. For some, they are seen as an arrogant class of corrupt profiteers determined to improve their material condition at the cost of poor people who cannot afford too many bribes. The media, especially during the doctors’ strike, is filled with stories about “rich doctors” who live in villas. They quite deliberately stir up class envy, even though journalists on average aspire more towards the richer class of people than the poor and if privatization of the health care industry really becomes more widespread, you’ll find increasingly more profiteers from the industry living in villas that would make those few doctors’ houses really seem quite modest. Surely the owners of private clinics and pharmaceutical companys already live in luxury and some are on the list of the richest people in the country but there’s no big campaign against them in the media.

Besides the media campaign against “rich doctors”, the authorities decided to make a few spectacular arrests for corruption. A chiropractor for example, was arrested for signing people’s sick leave papers, apparently taking bribes to fake a few things. No doubt such things exist but it is being sickeningly used by the government in their campaign against doctors. It might seem strange for people from other countries, but the current government is mired in populist rhetoric against “educated elites” which they use to manipulate the poor. Doctors and nurses are under fire and presented as some evil group of greedy bastards and even criminals that the government cannot negotiate with because they constitute some sort of anti-social element.

In one of the PM’s favourite type of manipulation, he suggested that he might want to hold a “referendum”. The current government is quite fond of holding referenda on questions they think they can win as they are confident they can ask questions which will guarantee that the people choose their ideas. (This didn’t work for them in the past however when they held a local referendum on the Rospuda Valley bypass, sure that 99% of the local people supported government plans. It turned out that only a small group of supporters voted for it.)

The PM proposes that people are asked whether or not they want their taxes raised to pay for the doctors’ and nurses’ pay rises. He claims that “people need to be told the truth” – that there is “no way to pay people more without raising taxes”.

Such actions of the PM need to be strongly criticized as it’s a gross manipulation to claim to ask the people to decide, yet not to ask them whether they want to spend money on other things, for example the Polish military missions in Iraq or Afganistan, which most people are against.

Right now, the outlook does not look too bright because society is very passive and neither the doctors nor the nurses have been able to mobilize people, despite the fact that most people support at least the demands for pay rises and more of the GNP spent on health care as reasonable, especially in light of the fact that the economy, we are told, is always “growing” and “booming”. The doctors, one has to say, organized an extremely weak protest: they rarely were seen on the streets or in the media and normally their union leader did all the talking. There were no “real faces” for the people to see, nor do people get a sense of determination to fight, despite the fact that in reality, many are very determined. The PR for the struggle was absolutely abyssmal. The nurses on the other hand are much more visible for the average person, camped out on the streets of Warsaw. Only now with the nurses’ action does anybody from the public actually have the opportunity to go and show any sign of support. And, quite sadly, for some people, only now that the nurses are camped out do they realize that we are in the midst of a very serious strike. Amazingly, the widescale doctors’ strike made little impact on society.

One of the worst case scenarios would be some sort of compromise made by the Tri-Partite Commission, which I fear might actually be the outcome of this. Solidarity and OPZZ, which sit in this commission, are long-time supporters of privatization, as of course are the business institutions which sit on this commission. Some doctors who have given in their notice (and, in some cities this concerns whole hospitals), may be hired back as contract workers at slightly higher rates, or may try to work in the private sector. It is very likely that some hospitals may hire back some people but make cutbacks elsewhere to compensate. They may, for example, liquidate “unprofitable” wards; already in some cities they are discussing this. In the worst case, in one city they decided that one hospital doesn’t need OB-GYN services because there are two other hospitals in the city that have them, so they’ll just liquidate those services at the hospital where the doctor’s decided to give notice. Of course it turns out that there aren’t enough gyneacologists now in that city and such cuts will only force even more people to seek private services. The most likely outcome of negotiations through the Tri-Partite Commission is probably going to be further attempts to divide the doctors by giving in to some of them and deciding to phase in more privatization.

Laure Akai