Hungarian Spectrum

At last: Hospinvest has taken over the hospital in Eger

I assume everybody remembers the political struggle over the fate of the practically bankrupt hospital in the city of Eger in northern Hungary. By the way, Eger occupies a famous place in Hungarian history because of the successful defence of the town's fortification against a Turkish onslaught in 1552. According to the Hungarian version 2,000 men held the fort against 80,000 Turks. One of the most popular novels in Hungarian literature is a book written about the event. The English title is The Eclipse of the Crescent Moon and the author Géza Gárdonyi (1866-1922). The defenders of the fort are considered to be national heroes. Few words are uttered about the fact that 44 years later, in 1596, the fortress of Eger fell and the Turks settled the town for almost 100 years, converting the Christian churches to mosques and erecting a rather impressive minaret, still the pride of the city. The hospital in contention is situated very close to this minaret and, I am sure, the defenders of the hospital (this is actually what they call themselves) often compared themselves to the brave band of 2,000 fighting against those 80,000 Turks.

Well, just as the defenders of 1552 couldn't save the city for good, the defenders of the hospital also had to give up their "heroic" struggle against the "foreign capitalists" who run Hospinvest, a business venture specializing in hospital management. They did everything they could to thwart the deal between the County of Heves, the owner of the hospital, and Hospinvest. It is worth noting that the hospital had been run so badly that every quarter they were deeper and deeper in the red. The County of Heves had to subsidize them. Eventually it became obvious that the county simply couldn't keep up the hospital. Moreover, the hospital needed capital improvements costing billions of forints, and there was no money to invest. Something had to be done. Through a perfectly legal bidding process Hospinvest got the privilege--if you can call it that--of running the hospital and investing billions and billions into improving the rather sad state of this particular medical establishment. The "defenders" for their part tried everything. They brought suits, they appealed, they tried to muscle their way into meetings, they held vigils and demonstrations, and according to the latest, they even did some physical damage, especially in the Department of Pediatrics. What the damage consists of we don't know. The spokesman of Hospinvest was very tight mouthed about it, simply saying that a police investigation is underway.

The "defenders" in the end were reduced to a small contingent of department heads of mostly far right persuasion. Apparently, they were hoping to "privatize" the hospital themselves. Or at least they were hoping to continue what is customarily done in Hungarian hospitals--conducting private business at the hospital's expense. As far as I can figure out, Fidesz wanted to divvy up the hospitals among doctors. Make them the owners. The problem with this plan was that it was not really privatization since the doctors didn't have the pooled resources to make the hospitals solvent and were not sufficiently savvy financially to have ready access to the capital markets. So basically the plan would have been a government subsidized giveaway to the doctors, undoubtedly weighted in favor of the top brass in the hospitals. The doctors would own the hospitals, the government would continue to pump money into them. With Fidesz's defeat in 2002 that plan came to naught. To add insult to injury, in 2006 came the SZDSZ-led Ministry of Health and SZDSZ's new ideas about privatizing health insurance instead of privatizing the medical establishments. I'm pretty sure that this was a blow to certain segments of the medical establishment and also explains in part the doctors' fierce opposition to the reforms.

In any case, the "defenders" lost. The number of demonstrators became smaller and smaller and by yesterday morning when there was supposed to be a big rally in front of the hospital only two older women showed up and ten minutes later left, realizing that the demonstration was off. The "defenders" were hoping for chaos but there was none, although they tried to organize an onslaught of thousands of phony patients that would have paralyzed service. They claimed that there were shortages of doctors in this or that department but in the end that didn't turn out to be true either. The latest is that they are trying to convince the local city council to establish a hospital just for them. Given the financial situation of Eger as well as the country as a whole, somehow I don't think that the City of Eger, even with a city council where Fidesz is in the majority, will be able to set up a second hospital, a pretty expensive undertaking especially if the Hospinvest-run hospital expands services as promised. I'm afraid they will have to go elsewhere. That is, if anyone wants to take troublemakers. If I were the head of a hospital I don't think that I would be too crazy to have Dr. Alfréd Pócs, aka the shaman, on my staff.

The lunatic fringe in Hungary: a case study

Reading reports of the seemingly endless struggle over the fate of the deeply indebted Ferenc Markhot Hospital in Eger, I came to realize that the opposition to privatization has shifted from professionals to the lunatic fringe. More about one of the luminaries later.

The last time I wrote about the hospital in Eger I mentioned that Hospinvest claimed that they had 750 or so contracts and therefore would surely receive permission to operate the hospital. On the other hand, the "defenders of the hospital" also claimed to have 750 signatures of people who refused to cooperate with Hospinvest. There was a slight arithmetical anomaly: the hospital's staff was not 1,500  but only about 1,200. Since then a public notary has confirmed that Hospinvest does indeed have the number of contracts it said it had. But the "defenders" don't believe the public notary, and they came up with a new list of 120 names, all doctors who refused to sign a contract with Hospinvest. And, they added, how can the hospital that originally had 150 doctors operate with only 30? This list of names showed up on the internet. A doctor acquaintance shared the link. Although I immediately took a look at the list I didn't save it. A day later the site no longer existed (or at least the link no longer functioned). I assume that some of the doctors on the list objected. Yet a couple of days later Eger newspapers still referred to the list, though without individual names.

Now I hear that the "defenders of the hospital" are organizing another demonstration in front of the cathedral and that for good measure fifty Goy bikers are also heading for Eger. At this point one becomes suspicious about the nature of this defense team. One becomes even more suspicious when one hears that Kazakh doctors are coming to the rescue. Kazakhs? What on earth is going on here?

And now we have arrived at a poster child for the lunatic fringe, Alfréd Pócs. At least he is a doctor, unlike Pál Szabó, another leader who was described as a doctor defender by Magyar Nemzet but turned out to be the hospital's porter. However, Dr. Pócs in "civilian life" considers himself to be a shaman! He has two defender colleagues. First is Kristóf Mánya, a pediatrician who between 1998 and 2002 served as a Fidesz member of parliament but since then has moved to the far right. He is now a supporter of MIÉP and Jobbik. Until recently he worked in the hospital in Gyöngyös but moved to Eger as head of pediatrics after he had a quarrel over money with the hospital in Gyöngyös. Where he will be working next I have no idea but somehow I don't think that it is going to be in Eger. The other defender colleague is Katalin Tóth. I couldn't find out much about her except that she is a doctor at the Markhot Hospital. I assume that she is comfortable with the political ideology of the shaman and the MIÉP supporter. What is incredible is that Fidesz continues to support this increasingly right wing anti-privatization movement. At least this is what one learns from the Fidesz homepage.

Do you think I succumb to hyperbole when I talk about the lunatic fringe?  A few words about Alfred Pócs should set the record straight. In the far-right Magyar Demokrata Pócs gave an interview in September 2006. From this interview we learn that Dr. Pócs became interested in early Hungarian history as a result of his conversations with his grandfather, an ordinary peasant but with "a fantastic knowledge of Hungarian history." It didn't matter what the subject was; he could always answer his grandson's questions. He claims, of course, that people know very little about the subject of Hungarian antiquity because of "one hundred and thirty years of anti-Hungarian propaganda." In this interview he attacked the generally accepted Finno-Ugric theory, (very simply put) identifying an early group that later split to became Hungarians and Finns. Linguists might have devoted their entire careers to establishing semantic and syntactical parallels between Hungarian and Finnish, but his retort is simple: "On the Holy Crown at the depiction of Jacob and Peter there are four lions, not a polar bear or a reindeer." It hurts it is so stupid. And why are the Hungarians so great? To give a single example, according to him there are sources that attest to the fact that the Huns were Christians already in the fourth and fifth century and taught others to be good Christians. Also "our Scythian ancestors became Christians very early because the apostles Philip and Andrew went to Scythia to spread the Word." This man surely cannot be taken seriously. Yet he is heavily involved in radical politics with the blessing of the Hungarian opposition.

The same Alfréd Pócs was the "shaman" who in the name of the Holy Crown "took back the gas field near Makó." During another interview after the gas field incident, he explained that the Holy Crown is God himself.  But a few sentences later we find out that "the Holy Crown is ourselves." As for the gas field and the Canadian company that is investing billions of dollars in it, Dr. Pócs has interesting ideas. Once the wells are functioning one cubic meter of natural gas might be produced for a mere four forints. If it is that cheap why couldn't the state give the gas to the Hungarians for free? He expressed his surprise that no Hungarian party has thought of that idea. "That's why I said that the Holy Crown could do that!" Can this man be a good doctor? There are rumors that he has had some professional mishaps in his career. The latest only a few weeks ago when a he saw a boy with a broken nose and jaw and Dr. Pócs sent him home with only a pain killer. His parents subsequently took him to a real doctor who had to operate on the young man.

I do hope that Hospinvest will not hire Dr. Pócs even if he changes his mind about signing a contract. This man is a lunatic. In brief, the cause of the defenders is not in the best of hands. I would be more cautious if I were the head of Fidesz.

"Defenders of the hospital" and Hospinvest

Those of you who read my blog regularly surely remember the story of the Ferenc Markoth Heves County Hospital and Hospinvest, a company that manages several other hospitals in the county and elsewhere in the country. However, here is a brief summary. The county hospital, situated in the city of Eger, was (and still is) in terrible financial shape. Every year the county government was called upon to cover the hospital's losses. Moreover, both the physical plant and the hospital's medical equipment were in desperate need of capital investment. The county simply didn't have enough money to make something out of this hospital in which altogether 1214 people worked, including 148 physicians. Either someone had to take over the management of the hospital or it had to be closed. The Medical School of Debrecen showed some interest in assuming control. But the county, where MSZP has a majority, opted for Hospinvest, apparently because their offer was superior.

There was an immediate outcry, including some incredible scenes during the council meeting, demonstrations, and strange happenings inside the hospital. Hospinvest remained resolute and insisted that eventually they would convince the staff that it was in their best interest to become Hospinvest employees. Those who called themselves "defenders of the hospital"--that is, the anti-Hospinvest camp--claimed that the staff would never sign on with Hospinvest and therefore the bid to privatize the hospital would fail. To be certified by the National Health Service (ÁNTSZ) Hospinvest needed 608 signed contracts with employees (that is, a majority of the hospital work force). This morning Gábor Deák, vice president of Hospinvest, announced that they have more than 700 contracts in hand. Moreover, they have applications from 150 well-qualified people to fill jobs that will remain open if the "hospital defenders" don't change their minds.

It seems that the "hospital defenders" lost this round. However life is never so simple in Hungary. The defenders claim that they have 721 names on their list who claim that they didn't sign any contract with Hospinvest. Gábor Deák calmly announced that he has in hand over 700 signed contracts. The "hospital defenders" claim that out of the 150 doctors 123 announced that they would never sign any contracts. Hospinvest, on the other hand, claims that three-quarters of the heads of departments as well as head nurses have already signed. (I realize that this is not an apples to apples comparison.)

The real sticking point between Hospinvest and the employees of the hospital was the question of the latter's civil servant status that, they believed, gave them job security. But what if the hospital goes bankrupt and must be closed? Their civil servant status won't help a bit. I understand that those who work in Hungarian healthcare find these changes unsettling. However, looking at the issue from the outside one can say that these changes are long overdue. Moreover, healthcare isn't like manufacturing. When private companies took over state-owned factories a lot of people lost their jobs and became permanently unemployed. But healthcare is in the service sector and addresses a vital domestic need that will undoubtedly grow over time.

Another thing worth considering is that these demonstrations against the privatization of hospital services occur only where MSZP has a majority. In Fidesz localities, privatization goes on all the time without the slightest upheaval. Thus one has the sneaking suspicion that the "hospital defenders" get  encouragement and support from Fidesz for its own agenda. They become pawns in a larger political game.

Lajos Papp, the world famous cardiologist

I humbly confess that I had never heard of Lajos Papp as a world famous cardiologist, as some people call him, before his name kept cropping up in extreme right-wing circles. To my mind, he is the parody of all those semi-mad nationalists who think that God just dropped them into the twenty-first century by mistake and that their real selves rode next to Chieftain Árpád leading the Hungarians into the Carpathian basin at the end of the ninth century. For everybody's edification here is Dr. Papp's, pardon, Professor Papp's portrait. 

I corrected myself because today when György Bolgár introduced him as Dr. Lajos Papp, renowned cardiologist, he corrected him: he was Professor Papp. To my mind Dr. or Professor Papp is a little mad and I'm surprised to see that some people take him seriously as a man whose only purpose in life is "to heal the Hungarian People." Written this way: both words capitalized although according to Hungarian spelling rules neither "Hungarian" (magyar) nor  "people" (emberek) is capitalized. But, obviously, for our super nationalist this is not good enough.

But if his aim is "to heal the Hungarian People" who put him through school and without whom he would be nothing, then why did he announce, in an open letter published in Magyar Nemzet, his retirement not only from his job as director of the Heart Center (Szívcentrum) of the Pécs University's medical school but also from his work as a surgeon? In his letter and many of his subsequent interviews we learn the answer: the Hungarian government, the ministry of health, the president of his university are all guilty of "Hungarian Genocide" and he will not assist them in their murderous activities. Why are they murderers? Because they demand that he spend only a certain amount of money, less than he would like. The murderers above him want to make sure that he schedules cases so that the center can break even financially, with urgent cases of course receiving top priority. Whether this is a good method of controlling cost, I can't tell. However, this is the situation and I'm sure that really urgent cases are handled immediately and that no one died or is dying because of neglect.

It seems to me that Professor Papp and some of his enterprising colleagues came to the conclusion sometime back in March that they as entrepreneurs could do a better job than the government. In plain language, they wanted to privatize the services of the Heart Center in Pécs. It seems that neither the dean of the Medical School nor the president of the university had any intention of allowing them to privatize the center. Instead, they warned Papp several times to improve the Heart Center's financial performance: month after month it was in the red. And then came the open letter that appeared in Magyar Nemzet, in which he called the president of the university a mass murderer who is responsible for a number of deaths. In the same open letter Papp also announced his plans for retirement within a few weeks. It seems that this letter was the last straw for the president of the university: a couple of days ago he announced that after consultation with the dean of the Medical School he decided to relieve Papp of his duties as of the end of this month.

One would have thought that Papp, who wanted to retire anyway, would leave quietly. After all, he didn't want to be part of the Hungarian Genocide committed in the medical field by the Gyurcsány government. But no, what did I hear this morning? Dr. Papp is contesting his dismissal. According to him, he was appointed for five years to head the Heart Center of the Pécs Medical School, and therefore he is legally the head of the center until 2012. Unless he was sentenced by a Hungarian court for a misdemeanor or was deemed incompetent he has the right to his job until that time. And surely he was neither sentenced nor is incompetent. He explained that years ago he had been in a similar situation and then it took him nine years to win his case against his former employer. But now he doesn't have that much time: he himself has had six heart operations and surely he will die before a Hungarian court rules in his favor. Thus the whole thing is about as confused as Dr. Papp himself. Does he want to retire or not? Did he want to privatize the Heart Center? What does it mean that he doesn't want to work anymore as a surgeon but "he wants to heal the Hungarian People"? Why is he suing the university if he wanted to retire anyway?

It seems that working with Dr. Papp is not an easy business. Rumors are flying about conflicts at every job he has ever held. I'm sure that his nine-year fight in a dispute with a former employer is just the tip of the iceberg. There are other rumors: apparently he not only accepted money in envelopes from grateful patients, which is not illegal, but he demanded a certain fee ahead of the surgical procedure, which is illegal. I have relatives in Pécs with medical connections, and the rumor in town is that the fee was 100,000 Ft for the world famous surgeon to operate on you. That may not seem overly expensive, after all it is only 400 some euros, but considering that it is illegal to ask money ahead of time and that medical treatment should not involve extra expense it is pretty bad. Especially from someone who loves "the Hungarian People" so much.

As for his interesting turn of phrase that instead of performing surgical procedures he wants "to heal the Hungarian People," I think I have the answer. He wants to be the real "doctor of the nation." He wants to get involved in extreme right-wing politics. I do hope that he will be able to speak only in the name of very few people.

The nation's doctor: István Mikola

Lately I have been wondering what happened to István Mikola, whom Viktor Orbán called the "nation's doctor." He was very active in the campaign against the co-payment and hospital fee, but once the referendum was over Mikola disappeared. Every time there was anything concerning healthcare issues the Fidesz put forth another "political expert" (szakpolitikus) as the party's frontman. He is, of course, also a physician, Imre Pesti. But he is a great deal less entertaining than Dr. Mikola was.

Anyway, I couldn't figure out what was going on, and I must admit that I'm still not sure. But it seems that many people in Fidesz, perhaps even Viktor Orbán himself, are unhappy with István Mikola, once the favorite of the party's leader. The most recent rift occurred over the issue of privatization of healthcare services. Fidesz is dead set against any privatization and is currently trying to prevent HospInvest from gaining control of the hospital in Eger. Mikola, hand in hand with Mihály Kökény, an MSZP medical expert and former minister of health, went to visit a hospital in Kiskunhalas, already in the hands of HospInvest and Halas-Med Kht. and said a few words about the benefits of privatization in Hungarian healthcare.

HospInvest is high on Fidesz's hit list: the party accuses it of egregious exploitation of the facilities and the staff of hospitals under its care. So it is understandable that Mikola's appearance with Mihály Kökény and his positive attitude toward HospInvest was too much for the party and its satellite media organs, the daily Magyar Nemzet and the weekly Heti Válasz. Heti Válasz considered the Mikola affair so important that the editors placed Mikola's picture on its cover with the caption: "Mikola's hidden face." Heti Válasz accused Mikola of being part owner Halas-Med Kht., a company that was ostensibly created for the sole purpose of advancing and benefiting from the privatization of the hospital in Kiskunhalas. We do know that István Mikola has had fairly extensive business dealings in the healthcare field. Before Mikola became minister of health he held a majority stake in Phonendoscop, a consulting firm, and even during his tenure, he didn't really part with his interest in the business venture: he simply signed it over to his children. Mikola was on the board of Mamma Klinika Rt., a firm that takes care most of the mammogram screenings in Hungary.

So it is possible that Mikola has a vested interest in the privatization of healthcare services, in sharp contrast to the Fidesz platform. It is also possible, as Árpád W. Tóta suggested the other day in his blog, that Mikola became emboldened by Viktor Orbán's "secret speech" that showed a bit more realism toward the problems of the Hungarian economy. This explanation seems forced to me. I am more inclined to think that for one reason or other Orbán dropped Mikola, hence his disappearance from the political scene of late, and that Mikola now believes that he doesn't have much to lose by being a political maverick and perhaps a healthcare entrepreneur. He will not become either deputy prime minister, as Orbán promised in 2002, or minister of health in the next Orbán government.

One thing is sure: Mikola can be a political liability. Once he blurted out, before the 2006 elections, that if Fidesz managed to push through dual citizenship for Hungarians living in the neighboring countries, the party would govern Hungary for at least twenty years. That was a terrible faux pas. A lot of people began to realize that Fidesz support for dual citizenship wasn't exactly altruistic. Moreover, it only rallied the other side. (This twenty-year scenario crops up here and there. Most recently it was István Stumpf who predicted that Viktor Orbán might become prime minister for twelve years and then could be president for eight.) Mikola also said some very stupid things about psychiatry, children, and teachers who should just rap offending children's knuckles with a ruler--that would solve a lot of problems. One also ought not forget his most unfortunate reference to single men and women, calling them hordes who then march on Andrássy Street, clearly referring to homosexuals. So, all in all, Mikola is no great loss to Hungarian politics.