Attacking healthcare workers is an odd way to fix healthcare – but Orbán solves all his issues with attacking and waging wars, so what did we expect?
It is impossible to describe just how bad the state of healthcare was before the pandemic struck. There a few posts on this blog, and although they are the normal and not outliers, they barely scratch the surface. News coming out of hospitals, even photography in or near one has been forbidden, long before Covid. Just last year, Orbán delivered one more kick in the side of the country’s poor, already on the floor and with no hope to get up again – he excluded them from the free state healthcare. That’s 700 000 people (out of 9.3 million) who got a letter in the middle of the pandemic to pay up or pay up. If they had an address, that is.
As bad an underfunded that might be, state healthcare is the only one poor people could hope for as those who can afford private healthcare have moved to private health providers already. It is anyone’s question who would then remain to use the crumbling state hospitals.
Actually, it would be private healthcare patients, whose care is still mostly taking place with state equipment and in state hospitals, because the private healthcare system is not complete. (The unstable legal environment and Orbán’s famous hostility to private healthcare has a lost to answer for.) Private healthcare in Hungary cannot address more serious diseases or complex problems – not to mention that private providers also charge the social security after their privately paying patients.
So the worst health outcomes in European statistical comparison are paired with extraordinary corruption – and it is not even convenient for the paying patients. The system of “gratitude money”, aka. bribes to doctors permeates the entire healthcare and society. According to a survey by K-monitor, a corruption database, the amount Hungarians pay in bribes to doctors every year is the same size as the annual budget shortfall of hospitals.
But paying bribes cannot buy you health – especially when the doctors in question are vile to begin with and regard the extraction of bribes as part of their salary. Getting a 300 euro official pension after 30 years as a doctor is not tenable – yet their current salary level can easily leave them there. Still no excuse for extorting bribes, but no one said that each and every doctor is an angel – even they didn’t say that. (Some regard themselves as gods, but gods are not angels either.)
Contrasting Orbán’s stadium obsession with the disintegration of state-funded healthcare due to lack of funding is a standard talking point about Orbán domestically. It is a testament to the effectiveness of Orbán’s propaganda that his core supporters, over-50s, haven’t blamed him for it. Yet.
Meanwhile, Orbán’s favorite healthcare talking point is that hospitals keep hoarding debt – i.e. they keep ordering supplies even when state funding runs out halfway through the financial year. Otherwise they are not allowed to go into debt without permission. Orbán’s solution was to strong-arm the hospital suppliers to accept reduced payments – risking future supply. Welcome, pandemic!
Entering a hospital is a dreaded prospect, as underpaid and overworked staff is pitted against fearful and desperate patients and relatives, seeking medical attention amidst a chronic shortage of doctors and medical professionals. Hospital departments have been shutting down for lack of nurses and doctors for years, the standards of care are lowered to improve statistics, even the cleaning standards have been lowered to one cleaning a week or less due to the lack of staff for that kind of money. Doctors and nurses made a few hundred euros. Janitors were supposed to get even less. Who would do that?
And that is not an accident, but a willful policy. Orbán had every tool to finally reform healthcare, even to introduce market elements to it. But after ten years in power, the most notable thing about healthcare policy was Orbán’s deafening silence about it, paired with tall tales about so-called “superhospitals” being built in the future – unclear who would pay for the service.
His disdain is tangible. Even after he identified the state of healthcare as one of the reasons his party lost in October 2019, he couldn’t bring himself to even make empty promises that would later be forgotten. His contempt for both patients and doctors is explicit and Fidesz’ concept of how to solve the problem is exhausted in the erection of big buildings to become “superhospitals”, but it is difficult to see when they might come to fruition and who would work in them. All that seems to be clear is that they will operate on a typical, Orbánist faux-market model, and that the usual oligarchs are surrounding these projects.
The state of healthcare has been so bad that photography and reporting from hospitals had been banned long before the pandemic. And during the pandemic the most effort was no doubt put into keeping information from coming out and clamping down on those who leaked it. In true autocratic fashion, it was the emergence of bad news that was handled, not the actual problem.
The way Orbán started handling the situation was part communication (banning information coming out of hospitals, talking to the media, photography in hospitals, etc.) and part attack. (But not before a bit of branstorming in true, communist central planning comrade fashion, when our party and government actually floated the idea of reeducating downsized public servants into nursing – because, you know, peasant-peasant, all trained monkeys, they slave away wherever you put them down. And because that’s how the comrades above imagine nursing works. Any idiot can do it just tell them where the bedpans are.)
Orbán prefers to focus on corrupt hospital directors who go into debt, so he started the clampdown by banning them from taking on debt. So they started ordering supplies without funding because their funding ran out early in the year but they were still obliged to accept patients. Then Orbán attacked the suppliers of hospital equipment to accept reduced payments or nothing. (Good luck securing future supplies after a move like that.)
Then there were the nurses. Desperate for any little money but banned from going on strike, they tried a little, silent demonstration – they were later forced to sign a new contract that made the quasi-military personnel with worse conditions but in exchange for the promise of a slightly better salary.
This was healthcare workers’ salary table in 2019. Numbers are in HUF (divide by 360 for EUR value). The numbers are gross salary – so deduct 30-40% for taxes. Column 2 is number of years worked. (Comuns H-I-J are doctors)
According to this table, in 2019 the most junior healthcare worker, like a nurse in his first three years, makes 155 thousand HUF gross salary per month. It translates to 101 thousand HUF net – which is 281 EUR net take home salary per month.
The most senior doctor, after 49 years in the system could take home 357 thousand HUF, or almost exactly 1000 EUR per month. That is how they end up with 300 euro pensions, and this is why some of them treat their jobs as a feudal land and extract as much of it as possible. Or leave the country.
In 2020, after the mighty raise, they now have these salaries. (Columns H-I-J are doctors)
Mixed results – but at least they were contractually enslaved before the pandemic struck. When medically trained individuals were banned from leaving the country due to the pandemic emergency, they were already too deep to react. And no, their salaries were not normalized. Orbán always gets what he wants by promising as little as possible – and when extortion is the name of your game, that little can even be in the negative. What conditions they will have to endure in exchange for this is another matter.
Featured image: Marabu – It reads: “Hungarian doctors and patients” and depicts Orbán during the early days of the pandemic, when he still tried to win it.