ABSTRACT
Over the past two decades, divisions have taken shape in Poland that have given rise to high levels of social tension. Huge inequalities have been created, and health care changes have brought those inequalities very close to the bone. The raising of financial barriers to health care has made the lack of a sense of physical safety part of the ‘exclusion’ experienced by a large part of society. The corollary is the growth of the health care market, which has continued throughout the financial crisis – the pharmaceutical industry has been rated as a ‘high-potential foreign direct investment sector’ for the coming year.2 The spirit of optimism that surrounds such well publicised predictions contrasts with the silence that accompanies the experience of absence of care. It is striking to note that, despite the massive insecurity that is being experienced in the face of Poland’s health care changes, there has been little discussion or research about what loss of health care safety, in tandem with other social changes, has meant in people’s lives.3 Marketisers cite the growing health care market – the total amount of money spent privately on health care – as reassuring evidence that ‘Poles are better off’. A different story is told by national death rates. Mortality among men was 48 percent higher in Poland than in the countries of ‘old Europe’ in 1990 when communism ended; by 2009 that figure had risen to 58 percent.4 This increase was largely because health improvements in the intervening period had not been shared equally across the population, but were limited to a relatively narrow affluent social group.5 Health care changes have been hitting hardest where people need care the most. This chapter examines the events and processes through which Polish health
care changes that centre on privatisation have been pursued over the past two decades – in the face of the profound scepticism, fears and opposition of the public, and despite evidence that casts significant doubt on the extent to which markets have resulted in improved health outcomes, ‘efficiency’ or access to care. It highlights the complex processes through which marketisers have drawn on long-standing symbolic distinctions between modernity and backwardness both discursively to legitimate the effects of markets, and to
promote markets in health care through the creation of a political economy of shame. The chapter identifies key policy decisions through which the gradual but inexorable dismantling of the state-socialist universal system of health care has been occurring and an increasingly privatised system put in its place. It argues that, in order to secure social acquiescence to these strategic changes, reformers have obscured their political implications by deploying disguising discourse when explaining their goals. These discourses overlay globally circulating themes such as ‘efficiency’ and ‘quality’, and resonate with the concerns of liberals to achieve a ‘modernity’ for Poland based on marketisation, which, it is held by unspoken assumption, will ultimately be to the benefit of all. The credibility of this thesis depends on the erasure of the expansion of health care inequalities and the social suffering that the changes have already brought.
