In the past, it may have been said the introduction of a universal healthcare system, which governments have been toying with since the nineties, was as likely as a Cyprus settlement. Although we have entered the final straight for the implementation of the national health scheme (Gesy), as we have done on several occasions with a settlement, it does not seem a certainty. Every day more medical specialties announce they will not participate in Gesy (eight at the last count), while unions of pubic hospital workers have turned down pay and conditions proposed to them by the State Health Services (Okypy), which will run the hospitals.
The root of the deadlock, which President Anastasiades will try to resolve on Monday by meeting representatives of the Cyprus Medical Association (CyMA), could also be linked to Cyprus problem practices. Negotiations are conducted as a zero-sum game and never as a win-win situation. The idea of compromise seems alien to our culture, even though everyone pays lip service to consensus. In reality, consensus involves the stronger party in a dispute – the one capable of blackmailing the other into submission – getting everything it wants. We have seen this happen on countless occasions, the government surrendering to co-op, teaching, nursing and doctors’ unions.
None of the health stakeholders, in private and public sectors, view Gesy as a win-win, a cause worth making some compromises on because it will benefit the whole of society. They all want to maximise their respective advantage because this is what the union culture they all subscribe to has taught them, a view reinforced by the way our politicians have been conducting negotiations for the settlement of the Cyprus problem. Anastasiades, for instance, every few days finds a new issue relating to a settlement on which he declares his unwillingness to compromise. The health stakeholders are just following this example in digging in their heels.
Of course the president, whose only concern is winning the publicity war, is now repeatedly underlining his commitment to Gesy as he had done to a settlement. In an interview, published in Phileleftheros last week, an uncompromising Anastasiades declared “the implementation of Gesy will be carried out as it was planned.” A few days later, repeating that Gesy was a “one-way street”, he ruled out the two-tier system that would allow private doctors participating in Gesy to practise privately. He would meet CyMA representatives, he said, “but they should not deviate from the provisions of the law or create a two-tier system”, as this would be discriminatory.
In short, he has also found the intransigent party to blame in the event that Gesy cannot be implemented, something looking increasingly likely as more and more private doctors opt out – Gesy will be short of cardiologists, urologists, paediatricians etc and unable to cope with the demand. Weeks ago he started firing salvos at private practitioners accusing them of being greedy and not wanting to join Gesy because they would be unable to engage in tax evasion. The scapegoats he would offer the public for any failure have been identified – they are the intransigent, greedy, tax-evading doctors that were not prepared to give up their private practices.
There was no word about the other stakeholders threatening the implementation of Gesy – state hospital doctors, nurses and contractual staff that all want to carry on being public servants and dismissed the €3,000 sweetener they were offered to leave the public service as “insulting.” Hospital doctors were also offered pay rises of 14 per cent to make the switch, but deemed this as inadequate. They also objected to the shift system proposed as it would eliminate overtime pay for afternoon work and complained about financial incentives being “vague”. Neither Anastasiades nor any of the politicians dared censure this greed and sense of entitlement of the privileged hospital workers who were given pay rises two years ago in order to back Gesy. At least, the greedy private doctors will not burden the scheme with additional costs if they carry on practising privately.
Anastasiades will on Monday meet representatives of CyMA who indirectly accused him on Friday of poisoning the public dialogue (another parallel with Cyprus talks?) with the smear campaign against the doctors in the presence of the bosses of the Health Insurance Organisation (HIO) which will administer Gesy. As he has publicly rejected the two-tier system there is no scope for compromise. Perhaps he will back down, concede that the preparations for a viable and functional Gesy carried out by HIO and the health ministry were abysmally poor and agree to put back the suffocating time-frame of June 1 for the introduction of Gesy. This may be the only option given the colossal mess made of the preparations even though doctors will be blamed for the fiasco.