WARSAW — Don’t call it socialism, but Poland’s new right-wing government is looking left as it revamps its health care system.

The Law and Justice (PiS) government says it will put a halt to planned privatization of the public health system, and move toward a model more like the U.K.'s.

PiS, which came to power after elections in October 2015, has been causing alarm in Brussels for its rightward shift and push for state control of the media and the country's highest constitutional court. But on health care, the direction the government is taking is more nuanced — universal health care mixed with socially conservative views on some areas like in-vitro fertilization.

“Poland doesn’t like the word socialism very much, but what we are proposing is a Poland simply based on solidarity,” Health Minister Konstanty Radziwiłł said in an interview with POLITICO. “I don’t like the word ‘market’ when used for health."

The PiS move follows similar efforts by Viktor Orbán’s Fidesz government in Hungary and Robert Fico’s Smer party in Slovakia.

The former Civic Platform (PO) government talked up big changes in the health sector, including plans to convert many publicly-run hospitals into private companies.

“But in practice PO did very little and had few ideas. People want and still expect their public services for free, and only 16 percent of the hospitals are private,” said Piotr Arak, an analyst at Polityka Insight, a think tank in Warsaw.

From Bismarck to Beveridge

The proposed PiS changes in effect would move Poland from a so-called Bismarckian insurance system to what is known as a Beveridge system similar to that in the U.K., Gavin Rae, a lecturer at Warsaw’s Koźmiński University, said.

German Chancellor Otto von Bismarck’s social health insurance plans, unveiled in 1883, brought in compulsory funding by employers and employees. That made health care a ‘right’ connected with labor status and not aimed at universal coverage.

British social reformer William Beveridge, meanwhile, helped set up the National Health Service in the U.K. in 1948, based on funding from general government revenues and covering the entire population. This was a shift from health coverage as a right of labor to "health as a human right" or health coverage as a constitutional or legal right.

“Poland doesn’t like the word socialism very much, but what we are proposing is a Poland simply based on solidarity” — Konstanty Radziwiłł, health minister

“The Polish constitution states that all have the right to free health care, so if this reform were carried through it would be a case of the government actually meeting the requirements of the constitution rather than breaking it. So this should be welcomed by all, including the democratic opposition,” Rae said.

Radziwiłł noted the constitutional obligation as well, but said it doesn't necessarily mean all services will be free for all.

"This will bring the over 2 million people now not covered into the system, people on junk contracts [short-term contracts where the employer is not obliged to pay social insurance] for example," he said. "This is a question of social solidarity but also preventative long-term strategy.”

Window of power

Since winning a majority in parliament and the Senate in October, adding to its control of the presidency, PiS has a window to make major policy changes.

With the greater powers PiS has amassed in its first three months in office, most notably curtailing the powers of the Constitutional Tribunal, the government could push through many of its reforms without much opposition.

The most high-profile pledge of the PiS plan is to abolish the NFZ, Poland’s public fund responsible for paying for health care services and for reimbursement of medicines with the money received from mandatory health insurance contributions.

Recent polls suggest a majority of Poles are not happy with how the NFZ is working, so it is likely a winning issue politically.

Radziwiłł pledged during the campaign that the government will switch to a funding system similar to the U.K. where financing comes from the budget, raise health spending by 25 percent by 2020 and start monthly 500 złoty (€112) payments for second and subsequent children.

This will be covered by new taxes on bank assets and a planned tax on supermarkets. In addition, the minister said savings from reduced bureaucracy in the NFZ would fund some of the increase.

PiS failed to abolish the NFZ when last in power in 2005-2007. At that time big changes in hospital networks were planned, which was well received by experts, but PiS says it did not have enough time to implement the plan.

They also want all publicly financed hospitals to be non-profit oriented. The plan is to impose a cap of 49 percent on private co-ownership of public hospitals, through legislation now in the pipeline.

The minister would not, however, disclose when his party would fill in all the details on its campaign pledges.

New math?

Many analysts are skeptical and say the party will have to water down some or most of its election promises made in late 2015.

“What concerns me is that, of course everyone wants to get free health care, but who will pay for it?” said Brendan Melck, a life sciences analyst for IHS in London, noting the 2 million uninsured in Poland, out of its population of 38 million.

There is as yet no timetable for abolition of the NFZ, but Melck said 2018 was likely the earliest date it could go ahead. “The system has contracts signed for up to mid-2017, so it won’t happen soon. It is a huge diversion, and weirdly idealist,” Melck added.

PiS wants to raise the proportion of GDP spent on public health care from 4.7 percent to 6 percent.

PiS also says it wants to raise the proportion of GDP spent on public health care from the current level of around 4.7 percent to 6 percent. The average spending on health is about 6.5 percent among even not-so-wealthy neighboring countries, according to the Organization for Economic Co-operation and Development.

“This is a question of priorities and health services must be commensurate with people’s needs and demands. We will make savings in the system of checking if people have insurance, among other things,” the minister said.

This would keep the left within PiS happy, with more money from the finance ministry at the government’s disposal, but it would make the process more political, Melck said.

And health care is political in Poland: when they took power, PiS moved further right by, for example, scrapping subsidies for in-vitro fertilization.

The cost of increasing spending will be 30 billion złotys (€6.8 billion) a year, and will be spread over 4-5 years, Radziwiłł said.

But as ratings agencies continue to express caution about the country's new direction, borrowing costs rise and foreign investors look elsewhere, which could force PiS to revise its health plans.

The question is how they will reform it and when it would all be introduced. “And this is not made clear by the government,” Rae said.