Going against the flow, Krzysztof Kieślowski used to say that the first step toward making the world a better place is to clean one’s shoes in the morning. How un-Polish! In Poland improvements have to start with a big bang. Then we’ll see what’s next.
Clean shoes are just a metaphor. However, a medical conglomerate in the US took it quite literally. They have launched a reform that made doctors and nurses wash their hands. Everyone entering a ward has to spend a minute by the sink first. If they don’t, they set off an alarm operated by a computer that monitors eye movements of the staff supplied with computer chips. The result: a reduced number of medical errors and savings of several per cent (!) in the cost of hospitalisation.
In Poland one per cent of the cost of hospitalisation translates into several hundred million złotys. But who would be turned on by this kind of reform? A government won’t legislate the washing of hands. The Prime Minister won’t organize a press conference on the issue. There won’t be an ideological war on hand washing. Nor would Father Rydzyk call for a hundred thousand people to march in defence of dirty hands.
When it comes to extraordinary things – such as miracles, assaults, wars, uprisings or big reforms – then, of course, we Poles are always prepared. If the problem stemmed only from our national character, we might be able to change it one step at a time. Unfortunately, the issue is far more serious. Its roots lie in the power of recent history, in dropping levels of adrenaline, and in ignorance.
Over the past four decades a cult of Independence has merged with a cult of Reforms in the minds of the dominant part of our political class. Big Reforms! Under communism those who cared for anything beyond their own business split into two groups: the Independents and the Reformers. To some degree this was another incarnation of the 19th century dispute between the Romantics and the Positivists. But it was also something more.
The Independents did not get involved in politics. Instead they prayed, maintained informal contacts, issued some underground publications here and there, but, above all, cultivated memories and dreams. Like ancient knights waiting for the call to arms, they kept their swords ready on the walls. If they did engage with the authorities, it was with its national-communist faction, represented by General Moczar, or with Catholics who served the regime and opportunists from the PAX association. Meanwhile the Reformers on both sides of the barricade that divided society from the regime tried to figure out how to tweak the system. From Jacek Kuroń to Stefan Bratkowski and Mieczysław Rakowski’s journal Polityka, they believed that reforms would make the system more humane and effective.
The 1989 Round Table that brought Poland its freedom was the joint achievement of Reformers on both sides of the barricade. The Independents did not participate or – as in the case of Lech Kaczyński – participated only marginally. It was the Reformers who, with brief interludes under the Olszewski and Kaczyński governments, set the tone in the so-called Third Polish Republic.
The first big reform agreed at the Round Table, which gave back Poland its independence, was followed by Balcerowicz’s big economic reform, which got the markets going, and Geremek’s major political reform that laid the foundations for democracy (although formally it introduced only amendments to the constitution). Within a single year three big reforms gave the Poles what both the Reformers and the Independents had been dreaming of for years. Neither the former nor the latter, however, took notice of the fact that the three big reforms of 1989 (plus Mazowiecki’s 1990 reform of local government), having accomplished a bloodless revolution, completed the historical mission of both groups. This denial still defines the Polish political scene and culture. For both groups are still trying to take a step back into their same old rivers.
The Independents, who have not experienced the great liberating uplift they dreamt of, haven’t stopped longing for it or planning it. The Reformers, encouraged by their historic achievement, keep trying to repeat the trick, dreaming up reforms that would allow them to relive the unforgettable year of 1989.
Over the past 20 years the division into Independents and Reformers has lost some of its edge. However, whenever the Independents proclaim great plans for reform (as they have done recently), these are submerged in a liberation sauce, whereas each time the Reformers refer to symbols of liberation, they dunk them in an effectiveness sauce along the lines of a united effort to modernize Poland. However, these days the key issue isn’t whether Poland ought to be transformed, modernized or made more effective. In a rapidly changing world frequent adjustments are inevitable. Every properly governed country does that. Our problem is that in a country where the reforming motto carries such a potent positive emotional charge based on experience, reforms become incomparably easier than small improvements, especially effective day-to-day management.
Reforming does not require huge skills of the kind critical for the effective management of a modern country, or even of an individual resort or trade. All you need is an idea, the will and political power. In the past, when politicians were losing control over a situation and didn’t know what to do, they would provoke or threaten war. These days a politician who can’t come to grips with everyday management introduces or promises reforms – preferably big, painful and unpopular, etc. The more a politician is at a loss or divorced from reality, the bigger his reform plans. For the bigger, the more painful, the less popular the reform, the less competence it requires. After all, who will focus on the details when major changes are occurring?
The most radical examples are the Four Big Reforms introduced under the Buzek-Balcerowicz government. The senior coalition partner (the right-of-centre Solidarity Election Action) AWS built its election campaign on an independence platform divorced from reality. They had only a vague idea of management. Their junior partner was the Freedom Union (UW), established by reformers still basking in the glory of 1989. Ten years after the transition the AWS-UW government carried out Four Big Reforms – in education, pensions, local government and health.
In spite of gigantic expenditures none of them has had the desired effects. Partly because their architects carried them out in an ad hoc, unfinished form (we still don’t know how the newly-created Open Pensions Fund, OFE, will pay out people’s pensions); partly because they were based on wrong-headed ideas (for example, faith in the dogma of civil society, which didn’t exist and still doesn’t exist, or in the managerial skills of local governments that were put in charge of hospitals).
In the course of the following decade successive governments had to tackle the popular cult of the Four Big Reforms as well as their adverse effects. Even as OFE began to dig a hole in public finances the authors dismissed criticism as an attempt to return to communism. [Leszek] Miller’s [social democratic] government found the courage to dismantle the state health insurance company, which immediately fell prey to politicians who used it in local power games, but did not muster enough courage to remove the dismally managed hospitals from local government control.
Where the faith in local counsellors’ ability to assess hospital managers’ skills comes from is a mystery, as is how the Reformers imagined that the recruitment of hospital directors would be guided by skills rather than routine pork barrel politics. Similarly, it is not clear how the authors of the education reform and the slogan money follows the students thought they could maintain, at a time of a demographic trough, the same infrastructure and staffing level that was necessary during a demographic peak. Encouraged by funding incentives, local governments took only a few years to get rid of hundreds of kindergartens of which there is now a dire shortage, and drove a large proportion of hospitals to financial ruin, forcing the government to make up the shortfall. A merry-go-round ensued of local authorities saddling hospitals with debt, followed by bailouts using the national budget. However, no government has shown real interest in discovering just why so many hospitals were getting into debt or how the money was haemorrhaging from the healthcare system. From the high horse of Big Reform it was sufficient to claim that hospitals were ill-managed.
Big Reformers are not interested in acquiring and spreading hospital management know-how (or the know-how necessary for managing education, a town, or demographics for that matter). What counts are visions that play the role of philosopher’s stones that will enable us to make one gigantic leap from the everyday toil of improving the world (cleaning one’s shoes in the morning) to a place where the sun always shines (and shoes never get dirty).
The PiS (Freedom and Law Party), whose philosopher’s stone was discipline enforced by repressive measures, claimed that the main problem was dishonest doctors and tried to intimidate them. The PO (Civic Platform), for whom markets are the philosopher’s stone, is convinced that hospital debts will disappear if it transforms them into commercial companies and has thus spent an entire term carrying out a big and costly reform that made hospitals go commercial. As soon as the reform was completed the new companies, freshly freed of debt at the expense of the state budget, immediately started building up fresh debt. While the government can pretend that hospitals are now the problem of local governments, it bears constitutional responsibility for providing citizens with health care, and therefore it will have to fork out again. Nevertheless, no government or health minister, nor the National Health Foundation, has been able to provide the hospitals with effective organisation and management standards and procedures of the kind every corporation provides for companies it owns. None of them has done this because no one has made the effort to acquire such knowledge, nor have local governments or the doctors who manage the hospitals.
It is not clear why the Reformers believed that the quality of management would substantially improve if a local government, following a similar procedure, appointed as company directors the same politically empowered yet incompetent directors of local government health departments. It’s also hard to fathom what profound idea lay behind the decision to finance institutions that deal with difficult and rare cases (such as the Centre for Child Health, Polish Mothers, etc.) in the same way as district hospitals. Yet the reform was sufficiently big, costly and controversial to sell politically.
Politicisation means freeing oneself from laborious analyses and the need to get into banal detail (e.g. the washing of hands), from studying the fast- evolving understanding of effective management of hospitals (schools, etc.), from the need to follow others on the painstaking path of small steps that make labour more effective and limit money-wasting.
The more painful, difficult and unpopular a reform, the better it is at this liberation. Those embarking on it not only free themselves of toil and the bad feeling that they’re not on top of the world, they also help others free themselves. You can support or reject a reform by choosing one side of the argument that is no longer substantive and skill-based. You can use a reform to mobilize your political base and draw clear political lines. You can discuss a reform ad nauseam. You can also mock its opponents (or supporters) without getting into detail, without verifying underlying arguments, without bothering to read indigestible legislation and without wading through fat tomes discussing the issues the reform relates to.
If the vision of a reform is sufficiently big, it easily turns into a media favourite. Especially when nobody knows what it’s about. For example, no one knows precisely what the recurring idea of reforming public finances actually entails. At first it seemed to concern mainly earmarked budgets, similar to what they have in Germany. It was discussed with great enthusiasm. However, once the government started to introduce part of it, a pall of silence descended. As a big idea it was attractive. Once implemented, it turned out to be difficult and boring, and consequently lost popular appeal. The government, too, has lost interest.
Something similar happened with the deregulation of the professions. It is a nice idea and there’s something to it, but its seductive power obscures the reality and deprives those seduced of their capacity to think critically. As a result, obvious ideas (e.g. that in the era of GPS a taxi driver doesn’t have to know the map of a city by heart), controversial ideas (getting rid of public notaries) and clearly dangerous ideas (abandoning skills requirements for sports coaches) end up in the same deregulation bag. Every reform produces adrenalin – like a battle.
A Big Reform is the cue that makes the entire political class – MPs, ministers, pundits, the media – immediately relocate to a miraculous land where pensioners sit beneath palm trees sipping cocktails with little umbrellas stuck in them. Or something of that nature. I sincerely warn Prime Minister Tusk, before he announces the new government platform, not to succumb to this mirage in the face of waves of a reforming tsunami that are approaching from every side. I don’t claim Poland needs no serious change. But it doesn’t need big reforms, which often turn out to be big mistakes.
Applying Kieślowski’s advice I would start reforming Poland by cleaning our shoes. For example, the government could make up for everything it has neglected in terms of issuing regulations on implementing new legislation or putting it into practice.
Perhaps, instead of “original” reforms (i.e. grand leaps) we should (as in Germany or Scandinavia) consider long-term modernisation programmes based on non-partisan (rather than non-party) consensus. Serious change takes time. Building something solid requires more than one or two terms in office. There are no philosopher’s stones in the world of politics. For example, in order to get the health system to work efficiently we have to bring together the latest findings in management, educate professionals and train managers, carry out research to reveal the true state of affairs, test various solutions in pilot projects, describe the ones that have worked… This is a job that will take many years. If Tusk could replace the logic of big reforms with the logic of long-term programmes, it could be the last Big Reform Poland will ever need. And then – wearing clean shoes and without the reforming frenzy – he’d be able to sit down with the opposition, which will hopefully have calmed down somewhat, and then calmly, step by step, detail by detail, they could identify the kind of change that is really needed.