The way forward in the Polish doctors and nurses strike

By Marius Heuser

19 July 2007

The weeks-long strikes and protests by Polish doctors and nurses are threatening to end in defeat. Although protesting nurses have recently undertaken increasingly desperate measures, including a hunger strike, the right-wing Law and Justice Party government led by Prime Minister Jaroslaw Kaczynski has refused to make any concessions. The response by the nurses’ own trade union has been to break off all demonstrations and dismantle the protest camp set up in front of the government offices in Warsaw.

For four weeks hundreds of nurses and care personnel manned the protest camp demanding pay rises. Doctors, who have taken strike action over the last nine weeks, have announced they will continue their action but have now been left increasingly isolated by the abandonment of the struggle by the nurses union.

Hospital personnel have been demanding improvements to the run-down Polish health system and a substantial wage increase. A Polish nurse with 30 years service earns less than 300 euros a month, while young doctors earn slightly more and most take home around 340 euros. These are wage levels, which make any sort a decent standard of living for an individual in Poland—not to speak a family—impossible. As a result thousands of qualified doctors and nurses have emigrated to England, Sweden or other European Union states, where they can earn substantially more.

Following protests in the health service last year the Kaczynski government agreed a general 30 percent wage increase for health workers. The money, however, was awarded to hospital management, which often used it for the renovation of run-down facilities or the repayment of debts rather than supplementing wages.

The crisis within the healthcare system is symptomatic of the economic situation in the entire country nearly 20 years since the restoration of capitalism. While a narrow elite has access to the very best medical care and private hospitals, the overwhelming majority of the population is dependent on one of the worst health systems in Europe. At barely 4 percent of GNP, Poland spends less money on healthcare than any other nation in the European Union.

It is usual practice for patients to wait months for treatment—even in the case of life-threatening diseases—because of the lack of hospital beds. This situation has led to a system whereby patients are forced to pay large bribes in order to move up waiting lists. The physical survival of many patients is directly bound up with the size of their wallets.

This state of affairs is the product of the ruthless implementation of the free market in Poland over the last two decades. Up until the collapse of the Stalinist system in 1989, the Polish constitution of 1952 guaranteed every worker the right to comprehensive and free medical treatment—even though in practice it became increasingly difficult for workers lacking connections to the bureaucracy to realise their entitlements.

The restoration of capitalism, which transferred nationalised state property into the possession of the new elite, resulted in a series of devastating cuts in health service. At the same time additional funding reductions were made to trim the country’s budget for entry into the European Union. Brussels not only demanded the break-up of the country’s agricultural and mining industry, but cuts in the national budget. The ratio of hospital beds per 1,000 inhabitants subsequently decreased from 6.7 in 1980 to 4.6 in 2002. In one year alone—1991—nearly 100 hospitals and health centres, i.e., 2,500 hospital beds, were slashed.

In 1999 the conservative government of Election Action Solidarity (AWS) replaced the former, dilapidated state guaranteed healthcare system with a regionally organized obligatory insurance, requiring every citizen to contribute 7.5 percent of his income, irrespective of income level. This meant hospitals were no longer financed directly by the state, but through health insurance companies. The result was a drastic supply crisis and a further decline in wages and numbers of personnel.

In 2001 the post-Stalinist Democratic Left Alliance (SLD) government replaced the regional funds by a National Health Fund (NFZ), which basically operated on the same system and only served to deepen the crisis. Hospitals were treated as if they were private companies, which had to negotiate a certain percentage of private treatment in order to subsidise treatment for the rest of the population. The way in which the meagre funds were distributed was then left to the discretion of the hospital management. This represented a major step towards the privatisation of the health system. At the same time, the number of private hospitals shot up. Speaking on behalf of a private health company, Medicover, Bartosz Maciejewski boasted that his company already had 280,000 customers and the number was increasing.

The latest protests by doctors and nurses are not only directed at improving their miserable wages, but also reflect their alarm at the state of the health system. Individuals motivated by the desire to care and heal have been forced to look on as increasing obstacles are put in the way of their work.

This also explains the high level of solidarity within the population for the medical personnel. According to one poll, 75 percent of the population support the demands of the doctors and nurses. Nurses at the protest camp reported complete strangers coming to bring them food and beverages. When the police moved in to forcibly break up a protest by nurses, thousands of miners and railway workers spontaneously travelled to Warsaw to protect the nurses against police brutality.

The government led by Kaczynski is very conscious of the significance of the protests as an expression of the fundamental contradiction between the demands of workers and the reality of modern capitalism in Poland. After seeking to appease workers one year ago with a 30 percent wage increase, the government is now going on the offensive. It has stated that the doctors’ demands would cost 2.7 billion euros and exceed the budget limit laid down by the EU. Prime Minister Kaczynski explained that any concession by the government would “massively undermine the confidence of other European Union states in the country.”

The prime minister even went so far as to claim that the strikers were “being manipulated by foreign forces.” In hysterical religious tones, Kaczynski warned against “the devil’s work” and his party colleague Tadeusz Cymanski went further in a later interview, saying the government was in “a struggle against evil, the powers of darkness.”

The rhetoric of the Kaczynski brothers cannot hide their utter cynicism. When it suits their own interests they are prepared to play the nationalist, anti-EU card, but when it comes to the doctors’ wages they solidarise with the EU and its budget limitations.

In line with its “struggle against evil” the government sent in police to brutally break up a completely peaceful demonstration by nurses. “You treated us like criminals ... like hooligans in a stadium” was the reaction of the president of the Polish Nurses Union, Izabella Szczepaniak. Several injured women had to be treated in hospital while Kaczynski and his health minister Religa have made clear that they regard the protests by nurses and doctors to be illegal and the deployment of police entirely justified.

During the last two years the government has been preparing for precisely such a confrontation with workers. The Kaczynski brothers (twin brother Lech is president) have filled strategic posts in the entire state apparatus with their own supporters. They have brought the national media under their direct control and created an institution—the Central Anti-corruption Office (CBA)—which is directly subordinate to the prime minister and unites the police with Polish intelligence agencies. Recently the CBA accused the right-wing populist and head of the Kaczynski’s coalition partner Samoobrona (Self-Defense), Andrzej Lepper, of corruption and thereby sought to put pressure on his organisation. Lepper had sought to correct the plunging levels of support for his party by expressing some sympathy for the striking hospital personnel.

Flanked by a deliberate campaign of misinformation in the press against the strikers, the government is planning further attacks on the health system by forcing through privatisation. Jaroslaw Kaczynski has already announced plans for a national referendum on the question of the privatisation of the hospitals and stated that the question must be discussed, otherwise public finances would be bankrupted by the workers’ wage demands. “That would be absolutely irresponsible,” he concluded.

Upon taking over his post two years ago the Polish Health Minister Zbigniew Religa, (an independent with close links to the neo-liberal opposition party Citizen’s Platform—PO) declared his main priority was the setting up of a private health insurance system. While promising increased funding for hospitals, the reality of his two years in office has been merely to legalize the practice of bribery for medical treatment. Those with enough money to insure themselves privately receive premium medical care, while the rest of the population must wait patiently on a list for the chance of a place in an overcrowded ward under miserable conditions.

The latest plans by the Kaczynskis for the complete privatisation of the hospitals mean an inevitable further deterioration of healthcare for the majority of the population, of whom 12.8 percent subsist on an income of 100 euros per month or less.

The trade unions have neither the means nor the intention of opposing the frontal attack made by the government. From the very beginning they sought to demobilise health workers by presenting their struggle as purely of an economic nature. The vice-chairman of the National Doctors’ Trade Union (OZZL), Tomasz Underman, stressed on several occasions that its protests should under no circumstances be considered a political strike. The OZZL has even declared that it is in principle not opposed to the privatisation of hospitals.

The doctors’ union reacted in a conciliatory fashion to the government’s refusal to contemplate wage increases and its declaration that the strikes were illegal. At the same time the public were told that President Lech Kaczynski was simply not informed about the situation in the hospitals and would probably support the demands of the health workers in future. Now the nurses union has suspended its protests without any palpable results.

To the extent that trade union leaders play down the attacks being carried out by the government and suppress the political questions involved in the strike—in particular the restructuring of the health service—they are consciously creating the conditions for the defeat of the strike. Even if they achieve a wage increase of few percentage points—an event which would be presented by the trade union as a “success”—this would merely represent hush money aimed at paving the road to complete privatisation with catastrophic consequences both for the majority of health workers and the population at large.

The conciliatory stance of the trade unions has already led some health sector workers to attempt to break out of the bureaucratic straitjacket. In a protest carried out without the sanction of the OZZL, 200 doctors at a large Warsaw hospital occupied a street adjoining their place of work. The leader of the hospital’s strike committee, Maciej Jedrzejowski, explained later that the action had been an expression of despair and frustration on the part of doctors.

While such militant actions outside of the organizational control of the trade unions are to be welcomed, they are insufficient to combat the combined forces of the Polish government, state and media, which requires a political struggle by the working class. At the same time, the Kaczynski government is very weak, having been voted into power by a small majority of the electorate and only retains power through the continuous shifting of seats and positions within its shaky coalition of right-wing parties. Opinion polls demonstrate that the former limited support for the government is sinking even further.

This government is only held in power by the complete lack of any effective opposition. Millions of workers have only contempt for the Kaczynskis, but still recall with dread the policies and rule of the party which held the reins of power longest following capitalist restoration—the post-Stalinist SLD.

Any effective movement against the government must draw a balance of capitalist restoration—including the role played by the Solidarity movement in preparing for such a restoration—and its political helpers over the past two decades, in particular the SLD and the Polish trade union bureaucracy. Polish health workers must develop their own broad political movement, turning to other sections of workers including miners, teachers and railway workers. At the same time, they should strive to establish links with their European and international colleagues on the basis of a struggle to repulse all attempts at privatisation in order to defend what remains of the Polish health and welfare system on the basis of a genuine socialist program.