The burden of expectation

POLITICAL resignations can provide endless material for media excitement, opening the floodgates of speculation about motivation, potential scandal, political bargains and dark secrets only partially obscured by sterile press releases and polite farewell speeches.

POLITICAL resignations can provide endless material for media excitement, opening the floodgates of speculation about motivation, potential scandal, political bargains and dark secrets only partially obscured by sterile press releases and polite farewell speeches.

Some resignations have the potential to shock the country and rock politics. The resignation of Ivan Valentovič as health minister was not such a departure. Neither journalists nor Valentovič’s party colleagues were shocked to see him go, or to hear the personal reasons given for his going. No journalist had expected Valentovič to say much more.

The media had been predicting his demise for the past couple of months; Labour Minister Viera Tomanová continues to enjoy similar attention.

The nomination of Richard Raši, a 37-year old physician from Košice, whom Valentovič picked to run the Bratislava Teaching Hospital, has not surprised the media much either. One explanation for that is that Raši is unlikely to stray from the path that the governing Smer party has set for the country’s healthcare system.

Given Robert Fico’s style of government, it is hard to imagine that anyone whose ideas about the healthcare system do not fully conform to the prime minister’s would get to be minister.

On the other hand, there was never likely to be a scramble of eager nominees to take a position that Valentovič described graphically as a “combination of the electric chair and the scuttle butt.” Health ministers have always been among the most scorned politicians. Rudolf Zajac, health minister under Mikuláš Dzurinda, frequently topped the chart of least popular politicians.
Valentovič maintained this unenviable tradition.

Last November, more than half of Slovaks polled said they did not trust Valentovič. According to an MVK survey, just over 51 percent of those asked about the healthcare system said they partly or completely distrusted the minister.

Almost one in three said the level of healthcare in Slovakia was among the country’s three most significant problems, while healthcare ranked fifth overall on the list of problems, behind high living costs, the growing gap between rich and poor, unemployment and crime.

More than 20 percent identified expensive medicine and high patient payments for drugs as the main problem. Around 16 percent blamed the government policies - and more than 12 percent hospitals’ technical condition - for the problems.

It is very likely that Valentovič’s departure is a sop to dissatisfied doctors and healthcare workers who have been calling for more money to be channelled into the health sector.

Regardless of who takes the ministerial chair, Slovak doctors will remain frustrated when comparing their salaries with colleagues in Western Europe, the USA or Canada, where most physicians belong to the upper middle class, earn enough to run their own clinics, and can invest in modern technology. No post-communist health care sector can yet afford to offer such standards to its practitioners.

In addition, people who lived under communism for decades are still struggling with the concept that someone has to pay for healthcare, with “free health” the enduring rhetoric of leftist parties.
However, there is some doubt about whether reversing the reforms initiated by the last government, such as the transformation of hospitals to joint-stock companies, will achieve the desired standards.

Reforming the healthcare sector was one of those herculean tasks that the Dzurinda government also left unfinished. Those reform plans were the creation of Rudolf Zajac, a nominee of Pavol Rusko’s New Citizen’s Alliance party, which has since slipped into political oblivion.

Fico routinely calls the Zajac reforms an experiment using people as guinea pigs, and called on Valentovič to provide remedies. Valentovič did what he was required to do: he halted the transformation of hospitals to joint-stock companies and took steps towards creating a single state-run health insurer.

In some respects, Valentovič’s tenure did have a central theme, which could be characterised as a ‘crusade’ against private health insurers. Fico specifically thanked Valentovič for helping to produce a law that bans them from using profits for anything other than channelling it back into the healthcare system.

The question now is how the country envisions its healthcare system and what compromises it will need to make in order to maintain accessibility and affordability while at the same time providing the funds to invest in research, development and the modernisation of hospitals.

Healthcare is one of the most sensitive areas of state activity around the world, even in countries which pride themselves on their development. Affordability crises and citizens without health insurance continue to challenge politicians even in the United States, where the question of how to share responsibility for healthcare between individuals, employers and the government is still being debated.

Many Slovaks understand that the country hungers for healthcare reform but both the public and the politicians fear the burden it imposes.

Richard Raši will not carry this burden alone, and very few expect him to. But perhaps he will surprise.

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