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THE BACKGROUND
A strike of medical personnel has been going on for the last three weeks in Poland.
The strike follows mass actions in April when personnel from all 650 state-funded hospitals in the country protested and struck, performing only vital operations. As of May 30, over 120 hospitals in the country have gone on strike or have declared that the are going.

The national health care system is a disaster. A couple of years ago, Poland spent up to 6% of its GDP on health care, ranking it on the bottom of OECD countries in this areas (along with Turkey). As the government forces more and more private health care onto the public, the state budget for this year only envisioned 3.9% of the GDP for this purpose. Many hospitals are underfunded and medical workers are notoriously underpaid.

There are many doctors in Poland who have worked over 30 year and who earn only slightly over $350 (250 euro) a month. (The industry average is about $500.) As a consequence, fewer people want to be nurses or doctors, at least 5% of Polish doctors have already emigrated, many doctors work double shifts or second jobs to supplement their incomes making them overworked and more prone to provide lower quality service. Another consequence, unfortunately, is that many doctors demand payments for services that are supposed to be free or give preferential treatment to paying customs and that many hospitals refuse to treat uninsured patients for free or provide only minimal, sometimes substandard services, demanding that patients pay out-of-pocket expenses for anything they perceive as “expensive treatment”.

Medical personnel are demanding an immediate 30% pay raise which would increase by 100% next year. They are also demanding that the government raise the amount of GDP spent on health care.

SUPPORT RANK AND FILE WORKERS – OR SOME UNIONS HAVE GOT TO GO

It is worth noting that despite these demands, the medical workers’ union (OZZL), which called the strike, does not seem to have a clue in terms of political economy. Like many other Polish trade unions, they follow in the tradition of Solidarity, which stood politically for the market economy (and which even was responsible for many neo-liberal policies which attacked workers), but then seem to be totally shocked when the policies they advocate are put into force and then somebody loses a job or the government stops subsidizing something.

On the OZZL web page, we can read:

“In our program we back up introducing of free market into the healthcare system everywhere, where it is possible. We demand to establish rational, free-market and competing healthcare system in Poland. This is our basic task.”

The OZZL has adopted dozens of positions on the medical system “supported” by the Adam Smith center and the libertarian capitalist UPR. (We suppose actually that people from these think tank and party helped write these papers.) There are many contradictions in what they write, but most often they speak of privatization, free market, etc.. It is in fact very difficult to understand exactly how they can combine their different positions.

THE NATIONAL HEALTH SYSTEM

Although the government claims it cannot afford to give the medical workers such big raises, it did manage to give raises to employees from the National Health Service – NFZ. The head of NFZ, Jerzy Miller, earns a veritable fortune by Polish standards.

It is well-known that the system is poorly managed and rife with corruption. For this reason, many people would like to see the system totally scrapped.

Many radical activists are divided in this issue, especially as they see the alternative that will replace it may be even worse for the poor. For an opinion on this, see below.

LOCKOUT

For weeks, the government and certain parts of the media have been heavily criticizing the hospitals and threatening a lockout.

Workers at MSWiA Hospital, Lodz

The latest threat came from the Minister of the Interior (MSWiA), Ludwik Dorn. The Ministry (MSWiA) has its own hospitals and its hospital in Lodz joined the strike; 80 doctors (from personnel of over 500) went on strike. Obviously NOW it was totally intolerable for them to think that maybe people from the Ministry (or their families) may be denied health care, so Dorn told the director of the hospital to fire the doctors. When the director said no, Dorn threatened to close down the hospital.

The situation with MSWiA is still not clear. This morning (May 31 – one day after the threats), workers from other hospitals went to MSWiA hospital for support. (UPDATE!!!! May 31, afternoon - the workers in MSWiA stopped their strike although the medical workers strike is still going on. The workers signed an agreement to get a 30% pay raise but apparently they'll be getting it in 10% installments.)

This follows a very rough campaign against the doctors made by the politicians and media; they said that doctors don’t have a right to strike, the exaggerated reports of abuse (like nurses leaving infants on life-support systems to fend for themselves) and even one newspaper called doctors “terrorists” who “hold the population hostage”.

In response to this and in response to a few weeks of discussion amongst anarchists as to the health care problem, the following article was written.

Do Health Care Workers Have the Right to Strike?

The journalistic establishment recently found a new ethical question which to ponder: do health care workers have the right to strike? The moral consensus among journalists and members of the political establishment said “no” – a doctor or nurse’s first obligation is to his or her patient. Leaving a patient’s side or shutting down non-essential medical service in order to pursue other aims was called “irresponsible” and even likened to terrorism.

Of course it is easy to imagine the plight of a patient in need who does not receive proper care. It is something that should outrage the senses of any decent human being.

The problem is that such outrage is slightly misplaced in the situation of the strike.

It is true that strike actions are often inconvenient, and in this case perhaps even dangerous, for the working public. This is one of the unfortunate effects of our political and economic system.

The reality of the matter is that the health care and even the lives of many more citizens is negatively effected to a much greater degree on a daily basis by constant mismanagement of the health care sector and public funds. Where is the indignation of the moralistic journalists and politicians every time a patient gets substandard care or cannot afford medicine and treatment? Where is the indignation about the great masses of people who are suffering from lack of proper care, about lack of equipment for treatment? Where is the indignation about the poor standard of living of medical workers and their families or about what they are forced to do to raise this standard, whether by demanding bribes (the easy way) or by working double shifts (the hard way)? The real question to ask is why when health care workers take some action to change things, they are compared to terrorists while the people actually responsible for the problems (NFZ officials and the government) are spared the epitaphs?

Obviously, when you get past the sensation of the issue, most people understand exactly that the public health sector is in crisis. They understand that health care workers are underpaid and that this may result in fewer people choosing that profession, a drain on professionals or doctors who work too much and thus are more likely to make mistakes.

Unfortunately this reaction one of the oldest and most difficult social problems we have to face: when there is a problem, there are people who are easy to blame, but these are usually not those responsible. The understanding of economics and the functioning of society and politics is often such that people to do see beyond what they have contact with on a first hand basis. People can understand that there are doctors, that they are humans like them and that they have responsibilities towards people like them. It is much harder to imagine that there is also such an institution as the state which collects money from us and which disposes of it and it is more abstract for people to imagine that the actions of the state are, in fact, directly responsible for the actions of the doctors. Without this analysis, anger is usually misdirected. Those held responsible for all social failure, all misery on earth, tend to be normal people, the ones victimized themselves.

In this situation, we would like to redirect the question away from the doctor’s right to strike and back to the tragic situation of the health care system and lay the responsibility where it belongs – with the health care bureaucrats, medical industry and the state.

Decent Health Care – a basic right and indicator of our humanity

The question of health care is a complicated one but we hold a few basic ideas to be true:

First: that human beings are the world’s most valuable assets, and not because they are economic tools for creating profit and wealth, and not because they are “genetically superior” in any way. We show our true level of humanity by our attitudes to human health and towards those unfortunate enough to be deprived of it. It is simply immoral to deny a sick person care; if we as a society are to be different than the cruel and debased Nazis, then we can imagine the ill, the handicapped, etc. as playing an integral role in society – even in cases where the person does not produce a large amount of surplus profit for some corporation or is not a source of taxable revenue for the state. It is an extremely cruel and de-humanized system which determines who should live and who should die by the amount of money they have accumulated; but this is exactly what happens the more medical services are treated as a commodity which must be profitable instead of as something which society creates together to protect themselves, protect their families and neighbours and to care for those who need more treatment and whose very existence may depend on human caring and mutual aid.

Second: The implications of the doctrine of profitability place profits over people. The profit motive promotes a Social Darwinism which is only countered by collective commitment to contribute towards the extra care needed by some members of our society. The commitment towards these contributions however are being eroded by individualist and capitalist philosophy but also by abuses of trust committed by those who oversee social medical programs.

Third: The corporate, commercial health care sector has committed numerous atrocities by putting their commitment to profit above their commitment to people. Medicine should be motivated by the call to help people – not by share prices and profit reports.

Fourth: Health care workers, as extremely valuable and useful members of our society, deserve to have a decent standard of living, just like any other workers.

We see the basis of the problem in the public health care sector to be the fact that it is in fact controlled by a political and economic elite – not by the public. The state and the public are two very distinct entities.

As the general public is forced to pay taxes and ZUS, but it is denied the possibility of directly deciding on and controlling spending, it becomes the victim of fiscal mismanagement and abuse. Poland is right down at the bottom in the list of all OECD countries in what fraction of its wealth it spends on health care. The decisions on how state budget is allocated, we are always told, is for the “overall good” but we can see that much of the budget is actually spent on things that are not nearly as important, or on projects that enrich an elite of the society or the politicians themselves. They have effectively convinced the general public that it is better that they are not allowed to make decisions themselves, because they have no “specialist knowledge”, etc. etc. in fact, this is what has given the state its greatest claim to power – it’s ability to effectively destroy people’s faith in each other and the decision-making abilities of their neighbours.

Health care professionals, we would be told, are not in a position to run the health care system themselves, in coordination with society, because THEY simply cannot be trusted. They are self-serving terrorists, after all.

But this is exactly what we need for the system to run properly.

We are offered various solutions to the health care crisis. ZUS and the NFZ, which are run very badly and are full of corruption, we are often told, would be better replaced by private systems. We are told a lot of market ideology, but we are not given any answers as to how this system would avoid the problems of other, largely private systems we find around the world. For example, the situation of the US where many millions of working class people cannot afford basic health care and often fall victims to serious health problems because they could not afford regular monitoring or who are sunk into poverty or lose their property in the case of some serious health problems. They do not tell us how they will manage to avoid this except with some “promises” that they will take care of the poor. The US spends a much higher percent of its GDP than Poland (350% more) on servicing the poor; yet despite this, the health care system is generally considered a failure. Poland has more poor people, a much lower GDP and spends a much lower percentage of its wealth on health care; following such a model could lead to even worse results.

The fact of the matter is, that such “experts” pretend to know how to do things better than the public, but when held up to scrutiny by the public, they cannot give us any answers and they cannot deliver what they promise.

There is an unavoidable fact: if we are to care for people who don’t have money in this given system, there has to be public health care funds; there can never be a 100% private solution. There might as well then be a completely public health system, but one which is run without waste and with the public good in mind.

Simply speaking, this cannot be accomplished if the public attitude is that somebody takes their money and let them take care of everything. This public passivity is the cornerstone of corruption. Public money and spending has to be under the immediate control of the society: all spending has to be a matter of public record, transparent, subject to collectively decision making and the public should have the right to overturn all decisions which anybody makes against their interests of their stated mandate.

We cannot support the idea of a state-run health care system as we do not believe the state is the best instrument of running society. At its worst, it divests people of power and totally abuses its position; at its most benevolent, it acts as a protector in some areas to lull the people into passivity and abuse public money in some other area.

However, we do not support the dismantling of any system in favour of another system which would ultimately endanger the health of a larger section of society. Not because we support the system, but just that objectively we do not want even worse.

To speak of an anarchist view of society, we wish to create a social situation of equals where there are not “haves” and “have nots”; the idea that some people can afford good health or material wealth whereas other could not is not acceptable for us. A radical change of values would mean that people would not have to look at each other as “rich” or “poor”, more deserving or more valuable and less deserving or less valuable. This change of values would mean that medicine become an area of public good and necessity rather than an area for profit. With this philosophy as the cornerstone of society, the social depravity we witness today - of rich people who don’t want to pay for poor, of working class people with so little income that they are angry about sharing, of valuing human life in accordance with profit - would not play the role in social decision making that it plays today. It may be a hard road to get there, but we have reason to have faith in basic humanistic values.

We can easily see that people care about such things as hospital services, and this caring is only undermined by the constant divisive pressure put on society. Why do so many people contribute money each year to WOSP if not because they care? In reality, we see that when people trust that the money they give will actually go to help people, when they see that medical equipment is actually bought, they willingly give it. In this situation, WOSP accomplished what the state could not: to buy this equipment through a grassroots collection of money from the public. Trust in each other, mutual aid and compassion are not dead, despite the best efforts of many to convince us of it. We need to build on such experiences and understand that we are better off knowing what we are paying for and paying directly for these things than giving money to the state which misdirects an enormous portion of our wealth.

Back to the question about whether doctor’s have the right to strike. The better question is why patients – that is the general public, have not decided to strike instead. Because ultimately, the real terrorists are the people who take our money and don’t provide us with a decent health care system, and always make excuses about “not enough money”; we, the public, should be banging down their doors, throwing them on the street and taking the public health care system into our own hands, right together with the doctors and nurses who will devote their lives to treating us.