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Cablegate: From Biale Miasteczko to the Ballot Box, Health

VZCZCXYZ0004
RR RUEHWEB

DE RUEHWR #2185/01 3061548
ZNR UUUUU ZZH (CCY AD264003 MSI5882-695)
R 021548Z NOV 07
FM AMEMBASSY WARSAW
TO SECSTATE WASHDC 5433

UNCLAS WARSAW 002185

SIPDIS

SENSITIVE
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C O R R E C T E D COPY CAPTION

E.O. 12958: N/A
TAGS: ECON ELAB PGOV PL PREL TBIO
SUBJECT: FROM BIALE MIASTECZKO TO THE BALLOT BOX, HEALTH
CARE GETS POLITICAL
REF: WARSAW 1757

1. (SBU) SUMMARY: While leaders of the Doctors and Nurses
Unions claim to have avoided the politicization of health
care in the latest elections, the presiding Law and Justice
(PiS) party used the threat of privatization of hospitals in
a last minute bid to influence swing voters in the campaign
leading up to the October 21 parliamentary elections. PiS
also sought to exploit a corruption scandal over the alleged
bribery of an opposition Civic Platform (PO) candidate with
the goal of advancing health care privatization. However,
the PiS tactic seems to have backfired - the electorate
perceived it as over-reaching - which contributed to PiS'
defeat. END SUMMARY.

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Background
-----------

2. (SBU) The summer of 2007 bore witness to the intensity of
medical professionals' frustration and the strength of
popular support for their cause. For two months, members of
the nurses union camped by the hundreds in the "Biale
Miasteczko" (white village) across the street from Prime
Minister Jaroslaw Kaczynski's office, protesting the failure
to deliver on promised wage increases. Four nurses staged a
sit-in in the Prime Minister's office after he refused to
meet with them. Meanwhile, doctors have long relied on
bribes from patients to beef up their meager wages. This
widespread practice became the target of a Central
Anti-Corruption Office (CBA) investigation in recent months.
The doctors' union held a three month strike, and
subsequently between three and five thousand doctors
announced their resignation effective November 2007. Hunger
strikes have occurred in Radom, Konskie and Warsaw. Union
leaders point to the anti-corruption efforts as a catalyst
for the summer strikes, as doctors are now forced to rely
solely on their official salary or else to into private
practice, an ever more common occurence.

3. (SBU) Public opinion polls showed that 72 of Warsaw
residents supported the Biale Miasteczko, which received
donations of food, blankets and money, and was at various
times joined by members of the miners, steel workers, mass
transit drivers, and teachers trade unions. Public support
for the strike decreased when doctors and nurses refused to
return to work and hospital wards had to be evacuated.

------------------------------
The Politics of Privatization
------------------------------

4. (SBU) On October 17, four days before the parliamentary
elections, the PiS party released campaign ads in which
Minister of Health Zbigniew Religa suggested that, if health
care privatization went forward, average Poles would die for
lack of access to affordable health care. This came on the
heals of the CBA's announcement of the investigation of a PO
Sejm Deputy for accepting bribes related to the privatization
of a local hospital. The Ministry of Health described this
as an electoral scare tactic.

5. (SBU) Hospitals were built by the Communist regime in
anticipation of high casualty numbers from confrontation with
the West. Hospitals were also popular pork-barrel projects,
creating medical facilities disproportionate to local needs.
A right sizing program is in process, but operating fitfully,
with limited accountability.

-----------------------
Divided Front on Labor
-----------------------

6. (SBU) Despite the appearance that their summer strikes
were well coordinated, divisions between nurses and doctors
are actually quite deep. Believing that their case is
stronger alone, the doctors formed a separate union.
Meanwhile, the nurses union stated that they separated from
the Solidarity trade union confederaton, which they described
as the "government sponsored union," when it was reluctant to
push for further concessions.

7. (SBU) The doctor's union is focused primarily on
increasing wages and reducing working hours. Before the
initial wage hike, doctors in Poland were earning the
equivalent of $600/month for 7.5 hours per week of "work"
time and up to 16 hours of "preparation" time. This worked
out to be 23.5 hours of work or on call and a salary about
$400 less than the average Polish salary. Wage increases
introduced in 2006 offered a one time raise of 30 , bumping
the salary to approximately $900/month, far below the
doctor's goal of $3000/month. That goal has since been
adjusted, and the union is now seeking a monthly salary of

$1600/month and work-hour concessions. Doctors complain that
the wage increases, promised at the end of the summer
strikes, have been poorly administered, leading to a series
of strikes around the country since June. Doctors, union
representatives commented that the pre-election strikes
resulted in some of the most favorable wage agreements.
Notably in Radom, doctors recently pressured hospital
management to agree to a $1400/month salary. Nonetheless,
the union decided not to back one party or candidate during
the elections. Union representatives state that they did not
wish to further politicize their demands, but they also could
not identify a party that supported their demands for wage
increases. The doctors union will meet on December 7 to work
out a road map for 2008. However, the official conceded that
further strikes are likely. Gains made in Radom have
encouraged reluctant strikers to become more active in the
union.

8. (SBU) As for nurses, plans for another mass strike are
unlikely. Having won a reinstatement of their salary
increases through the end of 2008, Dorota Gardias, Director
of the Nurses Union, and one of the four women who
participated in a sit-in in the Prime Minister's office in
June 2007, stated that is was unlikely that they would
mobilize a strike until 2009. With PO in office, the union
plans to work actively with the new government to promote
their key issues. While wage increases are an important
aspect, the nurses are also looking for better sector
organization and incentives. Gardias has proposed
stratifying nurses' salaries based on their training and
experience. This, she argued, would provide incentive for
nurses to seek greater specialization training, which is not
subsidized by the government. Additionally, the nurses union
is actively working to have the European Court of Justice
overturn a decision that deemed Polish nurses unqualified to
work throughout the EU. When asked why the union was not
more actively engaged in the political debate leading up to
the elections, Gardias stated that the union could not
support one party or candidate as there was no consensus of
political views among its 74,000 members. Gardias and three
of her sit-in colleagues were courted by various political
parties, but only one was running for office. Gardias
explained that, while she hopes to hold office one day, she
refused to "betray" her commitment to the union.

------------------
The Official Line
------------------

8. (SBU) In response to questions about the one-time
increase of doctors wages in 2006, the representative
admitted that even though it was officially a one-time
increase, there was no way the government would be able to
subsequently reduce wages due to social pressures. However,
the official noted that the wage increases negotiated in the
days leading up to the election, specifically the successful
Radom negotiation, will leave hospitals in a difficult
situation -- personally financing the difference between the
government's negotiated 30 increase in doctors wages and the
actual increase negotiated with hospital managers.

9. (SBU) Ministry of Health officials blame the unions for
problems in health care, pointing to the doctors' use of
patients as leverage to fight for salary increases. Despite
slogans like "We want to work here not emigrate," the
ministry downplayed the importance of emigration, stating
that only 6000 doctors, roughly 5 of Poland's 105,000 active
doctors, have left Poland (reftel).

----------
Comments
----------

10. (SBU) PO campaigned on a privatization platform, but any
meaningful changes will require significant political
heavy-lifting, and it is not clear whether PO will step up to
that challenge. The summer protests saw initial popular
support that waned as hospital wards were closed.
HILLAS

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