One of the questions uppermost in the mind of Slovak citizens these days is whether they are going to have to pay full price for medication at the country's pharmacies. But few seem to be asking themselves whether paying for drugs isn't something that has to come sooner or later.
The situation in Slovakia's health care sector is as complex as it is critical. The country's pharmacies have been warning the government for months that they cannot keep supplying people with subsidized drugs for which they receive no subsidies. The government has done nothing, and now is faced with a desperate pharmaceutical industry that plans to start charging people immediately if a September 3 government session does not produce immediate financial relief.
Affairs have come to such a pass because Slovakia's pharmacies are not able to squeeze the funds to which they are entitled out of the country's private and state insurance companies. The insurance companies, for their part, claim that no legislation exists to force companies to hand over the health care contributions they are required to pay on their employees. The non-paying companies, when they don't complain of legislative chaos, argue that the entire economy is suffering from a shortage of capital for which they, the corporate sector, are not to blame.
To be sure, if the government just put the squeeze on the largest non-payers and stumped up some funds itself, everything would go swimmingly. But of course, we are three weeks before elections, and no one is about to do anything so unpopular.
Which begs the question - can Slovakia afford to entitle its citizens to fully or partly subsidized medication?
From most quarters of the country, the answer would be a resounding yes. Slovaks are poor, and cannot afford the extra money that the pharmacies are demanding. Drugs have been subsidized as long as people remember, so things should not change just because of an abysmally inefficient government and a few corporate renegades.
But perhaps the dilemma is better viewed from a less emotional standpoint. In making the transition from a command economy to a free market, people have to get used to doing with less of some specific things - things that are provided free of charge by the government.
Anyone who has ever been to a Slovak pharmacy and waited in line for a prescription will have seen people walking out with virtual armfuls of bottles, capsules, eye droppers, inhalers, pill packets and lozenges - everything except a cab ride home. Penicillin, asthma medication, anti-depressants...these are all expensive drugs that people either get for free or pay a pittance for.
What is more, the doctors who prescribe these drugs do so with any airy swirl of the pen, happy in the knowledge that tests and treatments of even marginal utility will be paid for by the state, no questions asked. Doctors overprescribe, and patients learn to treat their ailments with a blizzard of medications.
And that, in a nutshell, is why the Slovak health care system is in a bind. People use too many expensive drugs that they don't pay for.
One of the first disciplines imposed by a free market is that of achieving the maximum efficiency of capital, be it money in the hands of the government or of corporations. Companies which waste funds do not survive, and governments which spend more than they earn are eventually brought to earth by voters and by lenders.
Slovakia has a long way to go in eliminating inefficient use of capital. From grandiose highway programs to free education to cheap health care, the country will find its state spending and social programs cut to the bone over the next decade. It will be painful, not least because people's expectations of financial support from the state remain so high in the aftermath of communism.
It is precisely for this reason that both opposition and government parties should start telling people the truth. They should start simply: "We don't have money" might be a good way to begin. "Borrowing more will ruin us at current rates. We can't afford to give you what you've grown accustomed to, because that kind of all-embracing social safety net has become an anomaly in a fiercely competetive global economy."
The country is still waiting to see how the government will handle the pharmacies crisis. But whatever measures it takes - ignoring the matter, releasing funds, blaming the opposition - these will only postpone the legislative reforms and 'cognitive adjustments' required to put the health care sector on a more realistic footing. But if politicians don't start telling people to scale back their expectations now, they'll find themselves telling them not to get sick in the near future.
7. Sep 1998 at 0:00