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 
SIPDIS 
 
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. 
 
----------- 
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