FROM BIALE MIASTECZKO TO THE BALLOT BOX, HEALTH

UNCLAS WARSAW 002185 SIPDIS SENSITIVE SIPDIS C O R R E C T E D COPY CAPTION E.O. 12958: N/A TAGS: ECON ELAB PGOV PL PREL TBIO SUBJECT: FROM BIALE MIASTECZKO TO THE BALLOT BOX, HEALTH CARE GETS POLITICAL REF: WARSAW 1757 ¶1. (SBU) SUMMARY: While leaders of the Doctors and Nurses Unions claim to have avoided the politicization of health care in the latest elections, the presiding Law and Justice (PiS) party used the threat of privatization of hospitals in a last minute bid to influence swing voters in the campaign leading up to the October 21 parliamentary elections. PiS also sought to exploit a corruption scandal over the alleged bribery of an opposition Civic Platform (PO) candidate with the goal of advancing health care privatization. However, the PiS tactic seems to have backfired - the electorate perceived it as over-reaching - which contributed to PiS' defeat. END SUMMARY. -------------- Background -------------- ¶2. (SBU) The summer of 2007 bore witness to the intensity of medical professionals' frustration and the strength of popular support for their cause. For two months, members of the nurses union camped by the hundreds in the "Biale Miasteczko" (white village) across the street from Prime Minister Jaroslaw Kaczynski's office, protesting the failure to deliver on promised wage increases. Four nurses staged a sit-in in the Prime Minister's office after he refused to meet with them. Meanwhile, doctors have long relied on bribes from patients to beef up their meager wages. This widespread practice became the target of a Central Anti-Corruption Office (CBA) investigation in recent months. The doctors' union held a three month strike, and subsequently between three and five thousand doctors announced their resignation effective November 2007. Hunger strikes have occurred in Radom, Konskie and Warsaw. Union leaders point to the anti-corruption efforts as a catalyst for the summer strikes, as doctors are now forced to rely solely on their official salary or else to into private practice, an ever more common occurence. ¶3. (SBU) Public opinion polls showed that 72 of Warsaw residents supported the Biale Miasteczko, which received donations of food, blankets and money, and was at various times joined by members of the miners, steel workers, mass transit drivers, and teachers trade unions. Public support for the strike decreased when doctors and nurses refused to return to work and hospital wards had to be evacuated. -------------- The Politics of Privatization -------------- ¶4. (SBU) On October 17, four days before the parliamentary elections, the PiS party released campaign ads in which Minister of Health Zbigniew Religa suggested that, if health care privatization went forward, average Poles would die for lack of access to affordable health care. This came on the heals of the CBA's announcement of the investigation of a PO Sejm Deputy for accepting bribes related to the privatization of a local hospital. The Ministry of Health described this as an electoral scare tactic. ¶5. (SBU) Hospitals were built by the Communist regime in anticipation of high casualty numbers from confrontation with the West. Hospitals were also popular pork-barrel projects, creating medical facilities disproportionate to local needs. A right sizing program is in process, but operating fitfully, with limited accountability. -------------- Divided Front on Labor -------------- ¶6. (SBU) Despite the appearance that their summer strikes were well coordinated, divisions between nurses and doctors are actually quite deep. Believing that their case is stronger alone, the doctors formed a separate union. Meanwhile, the nurses union stated that they separated from the Solidarity trade union confederaton, which they described as the "government sponsored union," when it was reluctant to push for further concessions. ¶7. (SBU) The doctor's union is focused primarily on increasing wages and reducing working hours. Before the initial wage hike, doctors in Poland were earning the equivalent of $600/month for 7.5 hours per week of "work" time and up to 16 hours of "preparation" time. This worked out to be 23.5 hours of work or on call and a salary about $400 less than the average Polish salary. Wage increases introduced in 2006 offered a one time raise of 30 , bumping the salary to approximately $900/month, far below the doctor's goal of $3000/month. That goal has since been adjusted, and the union is now seeking a monthly salary of $1600/month and work-hour concessions. Doctors complain that the wage increases, promised at the end of the summer strikes, have been poorly administered, leading to a series of strikes around the country since June. Doctors, union representatives commented that the pre-election strikes resulted in some of the most favorable wage agreements. Notably in Radom, doctors recently pressured hospital management to agree to a $1400/month salary. Nonetheless, the union decided not to back one party or candidate during the elections. Union representatives state that they did not wish to further politicize their demands, but they also could not identify a party that supported their demands for wage increases. The doctors union will meet on December 7 to work out a road map for 2008. However, the official conceded that further strikes are likely. Gains made in Radom have encouraged reluctant strikers to become more active in the union. ¶8. (SBU) As for nurses, plans for another mass strike are unlikely. Having won a reinstatement of their salary increases through the end of 2008, Dorota Gardias, Director of the Nurses Union, and one of the four women who participated in a sit-in in the Prime Minister's office in June 2007, stated that is was unlikely that they would mobilize a strike until 2009. With PO in office, the union plans to work actively with the new government to promote their key issues. While wage increases are an important aspect, the nurses are also looking for better sector organization and incentives. Gardias has proposed stratifying nurses' salaries based on their training and experience. This, she argued, would provide incentive for nurses to seek greater specialization training, which is not subsidized by the government. Additionally, the nurses union is actively working to have the European Court of Justice overturn a decision that deemed Polish nurses unqualified to work throughout the EU. When asked why the union was not more actively engaged in the political debate leading up to the elections, Gardias stated that the union could not support one party or candidate as there was no consensus of political views among its 74,000 members. Gardias and three of her sit-in colleagues were courted by various political parties, but only one was running for office. Gardias explained that, while she hopes to hold office one day, she refused to "betray" her commitment to the union. -------------- The Official Line -------------- ¶8. (SBU) In response to questions about the one-time increase of doctors wages in 2006, the representative admitted that even though it was officially a one-time increase, there was no way the government would be able to subsequently reduce wages due to social pressures. However, the official noted that the wage increases negotiated in the days leading up to the election, specifically the successful Radom negotiation, will leave hospitals in a difficult situation -- personally financing the difference between the government's negotiated 30 increase in doctors wages and the actual increase negotiated with hospital managers. ¶9. (SBU) Ministry of Health officials blame the unions for problems in health care, pointing to the doctors' use of patients as leverage to fight for salary increases. Despite slogans like "We want to work here not emigrate," the ministry downplayed the importance of emigration, stating that only 6000 doctors, roughly 5 of Poland's 105,000 active doctors, have left Poland (reftel). -------------- Comments -------------- ¶10. (SBU) PO campaigned on a privatization platform, but any meaningful changes will require significant political heavy-lifting, and it is not clear whether PO will step up to that challenge. The summer protests saw initial popular support that waned as hospital wards were closed. HILLAS