A LOOMING affordability crisis in the American health care system has turned healthcare reform into a vital agenda for the upcoming US presidential elections.
Recent surveys show that more than 50 percent of Americans think that presidential and congressional candidates' views on healthcare reform will influence their vote in November.
Most Americans support policies that provide coverage to uninsured adults, and believe that the cost of health care should remain a shared responsibility between individuals, employers and government. According to the Commonwealth Fund, a private US foundation for independent research, these views are shared across the political spectrum.
Across the Atlantic, Slovaks are gripped in a similar crisis. Polls show that the majority of Slovaks understand that the country is in urgent need of healthcare reform but fear the consequential burden. Most Slovaks remember when doctor's visits were free, and they are reluctant to give up one of the few perceived perks of communism and share the cost of treatment.
Reform in this sector remains one of the last Herculean ventures of the Mikuláš Dzurinda government.
The healthcare reform scheme manufactured by Health Minister Rudolf Zajac, a nominee of Pavol Rusko's New Citizen's Alliance (ANO) party, is the most explosive topic on the parliament's September agenda.
The reform includes a law that would transform insurance companies into joint stock firms, and creates two types of health insurance: obligatory and voluntary.
Rudolf Zajac's reform package has secured him an eminent position as one of the least-liked ministers of the Dzurinda team, which already ranks low on public opinion charts.
A mid-August poll suggests that more than 58 percent of Slovaks are hostile to the proposed reform, interpreting it as an end to free healthcare. However, polls also show that people feel that more explanation is required in order to understand the essence of the reform. For now, the fate of the reform rests on whether there is agreement in parliament on transforming health insurance companies into joint stock companies.
Zajac argues that the only way to revive the healthcare sector and free it from astronomical debt is to impose tough budgetary rules on the insurers. Only then will they avoid deficits.
Opponents of Zajac's healthcare reform package foretell a bleak future for joint stock health insurance companies, predicting that these will either collapse or be undermined by interest groups.
A Polis survey carried out on behalf of the Slovak Chamber of Physicians reveals that a majority of respondents disagree with the joint stock transformation proposal.
The source of mistrust stems from the fact that, as joint stock firms, health insurance companies will have the green light to use premiums for purposes other than covering medical bills.
Reform package detractors, including the Slovak Chamber of Physicians, demand that insurers should at least function as non-profit organisations if the government refuses to maintain them as public institutions.
Zajac rejects the argument, stressing that even if health insurers were public institutions, there would be no guarantees [that the funds would not be misappropriated]. He adds that turning insurance companies into non-profit organizations would invite private interest groups to take over.
While Zajac remains overly confident in his reform proposal, Christian Democrat (KDH) leader Pavol Hrušovský is uncertain whether all 68 coalition MPs - eight members short of a parliamentary majority - will vote for the reform.
But the question that causes Minister Zajac to lose sleep is not whether the reform passes but rather in what form it will pass.
Zajac is not interested in cosmetic improvements. What he really wants, he says, is an in-depth reform. If his health reform is "deformed" by the amendments he promises to wipe his hands of the entire package.
The New Citizen's Alliance has been passive in its efforts to win coalition support for Zajac, who earlier this year threatened to resign if the reform fails.
It is hard to imagine Zajac pushing ANO boss Pavol Rusko into leaving the ruling coalition in case the reform fails. Rusko quite enjoys his role as economy minister and is unlikely to abandon it for the sake of loyalty.
Currently, three different healthcare reform plans are under review.
Opposition party Smer intends to drag the reform to the Constitutional Court once it is passed. Its boss Robert Fico has prepared a version of the reform. Smer and the Movement for a Democratic Slovakia (HZDS) are in league to sack ministers of the Dzurinda government - an indication that the HZDS is not likely to give a helping hand to Zajac. However, this does not mean that HZDS would help Fico become the father of healthcare reform, either.
Free Forum's Zuzana Martináková also came up with her own health reform package. Surprisingly, her first critic was her own party colleague Ivan Šimko, who said it was needless.
Last week Zajac said that he has not received signals that his healthcare reform package will go through. Even so, his venture might be the one that takes longer to complete.
Besides, the adoption of the law package is in fact only the first step, and there is still a Pandora's box full of unanticipated problems that might emerge.
By Beata Balogová
13. Sep 2004 at 0:00