Trade unions in talks about healthcare reform with president

In late July 2008, the three largest healthcare service trade unions met with the Polish president to discuss healthcare provisions. The main objective of the meeting was to express their concerns to the president about the proposals of the lower house of parliament (Sejm) in the area of healthcare, in particular the proposed changes to the law on healthcare centres. However, the meeting ended without any firm declarations being made by the president on the possible healthcare reforms.

On 29 July 2008, talks on healthcare provisions took place between trade unions and the Polish President, Lech Kaczynski, at the Presidential Palace in Warsaw. The talks were attended by representatives of the All-Poland Alliance of Trade Unions (Ogólnopolskie Porozumienie Związków Zawodowych, OPZZ), the Independent and Self-Governing Trade Union Solidarity (Niezależny Samorządny Związek Zawodowy Solidarność, NSZZ Solidarność), the All-Poland Trade Union of Nurses and Obstetricians (Ogólnopolski Związek Zawodowy Pielęgniarek i Położnych, OZZPiP), as well as the Polish Chamber of Physicians and Dentists (Naczelna Rada Lekarska, NRL), which is a self-governing healthcare organisation. However, no representatives were present from the All-Poland Trade Union of Physicians (Ogólnopolski Związek Zawodowy Lekarzy, OZZL), the largest trade union of physicians in the country. Moreover, OZZL is the most market-orientated of all of the healthcare trade unions and thus supports the privatisation proposals of Prime Minister Donald Tusk’s government. The trade union and NRL representatives expressed their anxiety about the way in which healthcare regulations were being prepared, focusing in particular on the proposed changes to the law on healthcare centres.

Trade union views

In an official letter addressed to President Kaczynski, prior to the scheduled meeting, the representatives of healthcare trade unions contended that the proceedings of the governing coalition ‘violate any rules of social dialogue, contribute to the dissemination of misinformation and fail to recognise solutions and arrangements agreed upon earlier in the past’. Simultaneously, the healthcare union representatives emphasised that they appealed to President Kaczynski as the guarantor of social dialogue and, in particular, as the head of the state, who should be informed of their opinion and presented with detailed information on the subject. Therefore, they intended to brief the president at the arranged meeting on the work that had been carried out on the government proposals.

Question of privatisation of hospitals

The trade unions claimed that the governing coalition, comprising the Civic Platform (Platforma Obywatelska, PO) and the Polish Peasants’ Party (Polskie Stronnictwo Ludowe, PSL), along with Prime Minister Tusk and the Minister of Health, Ewa Kopacz, promoted the immediate and compulsory privatisation of hospitals. However, the opposition parties – mainly the party Law and Justice (Prawo i Sprawiedliwość, PiS) and the Democratic Left Alliance (Sojusz Lewicy Demokartycznej, SLD) – as well as the majority of the healthcare service representatives claimed that the transformation should be introduced on a voluntary basis. Furthermore, it was pointed out that the coalition’s proposals envisaged that the right to a decision on privatisation was vested almost exclusively with the local authorities, which would as a result acquire 100% ownership of all privatised hospitals in their area. However, the above solution appears unacceptable to both the opposition parties and healthcare service personnel. The trade unions claim that, according to the version of the proposal that was given to the healthcare service for consultation, the transformation of hospitals into businesses was to be voluntary, not compulsory. However, the lower house of parliament (the Sejm) passed a formula of compulsory transformation, while at the same time withdrawing from this the guarantee of employment in affected hospitals, for which the trade unions had fought hard.

Expectations of talks

A spokesperson for NSZZ Solidarność, Maria Ochman, stated: ‘We do not want to resort to veto. As the law is still being debated in the parliament, there is still time to amend these proposals.’ This statement best mirrors the expectations of the healthcare organisations’ leaders who participated in the talks at the Presidential Palace. They hoped to obtain a promise of a firm declaration of the president’s explicit expectations towards the government as well as the convening of the Cabinet Council – a common sitting of the government and the president, which is reserved by the Constitution for special occasions.

Outcomes of meeting

During the meeting, President Kaczynski emphasised that while he was in favour of a market economy, he also strongly felt that healthcare should not be subject to the free market. According to the president, the bills proposed by PO lack the restrictions that would protect healthcare services from the influences of market economy mechanisms. However, the president made no firmer declarations. Following the meeting, the Undersecretary of State in the Chancellery of the President of the Republic of Poland, Andrzej Duda, announced that ‘Lech Kaczynski has expressed his hope that the governing coalition will enter into dialogue with the representatives of healthcare services’ and that ‘at present, nobody is considering a veto as regards the healthcare service bills, as a veto is an absolutely final measure’.

Commentary

The public healthcare system is in desperate need of rehabilitation laws, and it is also likely that healthcare services will have to undergo a process of at least partial privatisation. However, the way in which the governing coalition communicates with its social partners may induce President Kaczynski to veto the bills and block the reforms, as the coalition lacks an adequate number of mandates in the Sejm, rendering it unable to reject the president’s veto. Moreover, in recent times, relations between Minister Kopacz and the representatives of healthcare services have been deteriorating – which seems to be mostly due to the minister using personal rather than subject-related arguments. Regrettably, it appears that Prime Minister Tusk has been known to use similar rhetoric. Considering the overall atmosphere, it seems most unlikely that the talks between the government and the healthcare service will be resumed. In this case, the possibility of any serious healthcare reforms being launched is doubtful.

Jacek Sroka, Institute of Public Affairs (ISP)

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