How will they safeguard our health? Kaja Filaczyńska of the Left and Kamil Barczyk of the Nonpartisan Local Government Representatives

Grażyna Hanaf’s guests are: Kaja Filaczyńska, a New Left candidate ranked third on the list and an endocrinologist, and Kamil Barczyk, a Nonpartisan Local Government Representatives candidate for the Senate and director of St. Luke’s Hospital in Bolesławiec. Although they agree that healthcare needs substantial funding, the candidates from different political camps disagree on where the money for healthcare should come from. Kaja Filaczyńska and Kamil Barczyk also differ ideologically: the hospital director would like the anti-abortion regulations from before the pseudo-ruling of Przyłębska’s Constitutional Tribunal to return, while Kaja Filaczyńska supports free, safe and legal abortion.

Grażyna Hanaf: Good morning. Today our guests are Kaja Filaczyńska of the New Left, number three for the Sejm, and Kamil Barczyk of the Nonpartisan Local Government Representatives, running for the Senate. Good morning. I’ll start with Ms Filaczyńska, who is an endocrinologist. How long do your patients wait for an appointment through the NFZ?

Kaja Filaczyńska (NL): In the public system, whether in Chojnów or Lubin, my patients very often begin their appointments by saying: “How difficult it was to get an appointment with you.” So this is a major problem in the Polish healthcare system. Access to specialists is difficult. In my practice, however, I also see that many people could be very well cared for by family doctors, because they have been treated for a long time and are in a stable condition, and the guidelines allow for this. But limited access to family doctors as well means that they seek help from a specialist.

All right, and precisely how long do people wait to see you through the NFZ?

Kaja Filaczyńska (NL): Waiting lists for endocrinologists are among the longest. There is also a division into urgent and non-urgent queues. In many clinics, the wait for a first appointment is more than a year under the regular procedure. Too long. It is scandalously long, because often the reason a patient was referred to a doctor may no longer be relevant after such a long time. It is much more important for access to a specialist for that first appointment to be quick, so that we can assess whether the patient needs specialist care or, after the diagnostic process is completed, can return to their family doctor.

What idea does the Left have for this?

Kaja Filaczyńska (NL): I’m fortunate that the Left has taken access to healthcare very seriously for years, and we know that implementing sensible reforms requires investment in the healthcare system, above all in medical and non-medical staff, but also in purchasing more services. We therefore propose a significant increase in funding.

In other words, more money. You used a nice expression: stirring tea does not make it sweeter. I’ll ask Mr Barczyk how the Nonpartisan Local Government Representatives view more money. As a hospital director, you are looking for an endocrinologist, so a second question: does the Bolesławiec hospital have an endocrinologist at all, and how long is the wait to see them?

Kamil Barczyk (BS): At present, we employ five specialists or doctors undergoing specialist training who see patients at the endocrinology clinic. There are days when two or three endocrinologists are working at the same time, but there is demand. Our current waiting list for a first-time patient extends to February next year, so it is not a year, but I think our hospital is a specific and exceptional place in this respect, because if we go to other counties or regions, the waiting time will be significantly longer.

And, of course, would local-government representatives like more money for healthcare?

Kamil Barczyk (BS): It is indispensable for changing healthcare. We need education and staff training, and we need increases in the number of medical services provided without limits, as is the case, for example, in outpatient specialist care. We need a significant increase in spending on primary healthcare. We have no system at all for prevention and education starting at school, implemented in schools. We do not have a complete programme currently addressing rare diseases in a comprehensive way. So there are major gaps in specific areas, and increased spending is truly indispensable, but it would make this healthcare a better investment and improve its organisation. That is what Ms Kaja was saying.

So you both agree: more money. But I’ll ask our guest specifically: more money for whom, and then I’ll put the question to Mr Barczyk.

Kaja Filaczyńska (NL): Yes, exactly. But I see a certain dissonance here, because the Nonpartisan Local Government Representatives propose a significant reduction in revenues for both the central budget and local governments, and there is no way they would have money for this investment. The Left, on the other hand, proposes placing a burden on large corporations and using KPO funds, so that the money would actually be available and the spending would not burden sick people and the poorest, as well as...

Ms Filaczyńska, who should receive this money?

Kaja Filaczyńska (NL): One of the biggest problems with access to healthcare in Poland today is the scale of inequality. In smaller towns and for poorer people, access is significantly worse. Unfortunately, Bolesławiec offers a very good example: because funding is limited, the Bolesławiec hospital is opening a private psychiatric ward that will be very expensive and inaccessible to most children and most families who need this care. So my view is that, as politicians, we have a responsibility to develop a public healthcare system that will be available to everyone, regardless of their financial means. This pyramid of health needs should be structured so that we allocate much more funding to prevention and primary healthcare, making the first point of access to the healthcare system as good as possible. We want to expand primary-care teams so that people have access not only to a doctor and a nurse, but also to physiotherapy, a dietitian and a psychologist. We want medicines to be cheaper; in Poland, chronic treatment is currently very expensive.

I’ll interrupt, because we already know that the money should go to family doctors and medicine reimbursement. But several points were raised regarding Mr Barczyk. Do the Nonpartisan Local Government Representatives really have no idea how to finance healthcare? Will they take money away without contributing any?

Kamil Barczyk (BS): Of course healthcare funding must come primarily from the state budget, and we have specific ideas for this. We want to reform the VAT Act. We have reports and analyses stating that the shadow economy represents 740,000,000,000 złoty in annual lost potential revenue for the state. Of course, the Left does not talk about this. It is counting on KPO funds without realising that these funds are intended mainly for investment, not for purchasing healthcare services, whereas we want there to be more healthcare services. They should be valued appropriately so that everything can function properly and the system is accessible to patients. So, just as you, doctor, presumably see patients privately in your office, as do many doctors, we are also trying to improve accessibility and organise conditions in various ways. At present, private medicine accounts for almost one-third of healthcare spending in Poland.

Yes, Mr Barczyk, but the idea of a paid psychiatric ward has caused enormous emotions throughout Poland. You were even criticised by PiS. How does that fit with equal access to treatment?

Kamil Barczyk (BS): This must be changed so that psychiatric services receive higher valuations. It is scandalous that, at present, the valuation for child psychiatry is around 300–400 złoty. Perhaps in some regions—because this is also unequal for different hospital units—it is 600 złoty per patient-day. We calculated that the valuation should be well above 1,000 złoty per person per day for patient treatment. At present, renting a hotel room costs 300 złoty. So how can the psychiatric care system in Poland be organised at such a low valuation? And this is not only about child psychiatry, but many other areas too. We are talking about some areas of rehabilitation, as well as some hospital services. I believe primary healthcare can obviously function better, but it needs significantly more funding. So that patients can actually be seen?

I’ll ask our guest, Ms Filaczyńska: would the greater funding for child-psychiatry specialists that Mr Barczyk mentioned equalise these disparities? Is that how the Left sees it? Or do you have another idea?

Kaja Filaczyńska (NL): There is a great deal to do in the area of children’s and young people’s mental health—not only in healthcare itself, but also in community care. I speak with child psychiatrists. Often, intervention is possible during a hospital stay, but if a child later returns to an unfriendly school, peer violence or a violent family, a very large part of the medical staff’s work goes to waste. The Left has a number of proposals concerning children’s and young people’s health, beginning with a safe, friendly school whose curriculum is not overloaded, so that teachers do not keep changing. Children are now very worried about instability and what their future will look like. Many people will not be able to afford housing. Students sometimes give up their studies because they cannot afford accommodation. We want to invest in building student dormitories and introduce scholarships for students, so that children from smaller towns have opportunities for development. In the area of children’s and young people’s health, it is also important...

We have moved into a major topic. I’ll just let Mr Barczyk speak, because there is also an idea concerning education—briefly, as I still wanted to ask about ideology at the end, and we have little time. Mr Barczyk, do you also have an idea for schools? Is it similar to the Left’s idea? You apparently want to provide more money, some kind of vouchers, from what I read in the programme—vouchers for each student, which the parent would distribute among teachers.

Kamil Barczyk (BS): We want to change the education funding system. Above all, we want to reward people in order to improve the quality of education. Teachers’ remuneration must also increase proportionally. This is extremely important, because without this money, we cannot really talk about teaching quality. Sometimes we can say that teachers have to pretend they are teaching because they lack motivation and resources. That is what education in Poland looks like. It cannot be that a teacher starting their career earns the minimum wage, even in healthcare...

But how would you spend this voucher? I understand that I receive a 1,200-zloty voucher, right? Let me finish—you give me a school voucher worth 1,200 złoty, and I allocate it to a specific teacher? Would it work somehow like that? Or for several teachers? What do I do with the 1,200 złoty?

Kamil Barczyk (BS): It is really one instrument for improving the education system. The 1,200-zloty voucher—we can discuss this—is one tool for supplementing the entire system. But what should we focus on? The basics. Another of our arguments for improving the quality of education in Poland is free meals for students, which are...

Yes, but I’ll come back to the voucher after all, because I’d like to know what I can do with 1,200 złoty a year. Who can I give it to? If I wanted to?

Kamil Barczyk (BS): We could be talking about purchasing infrastructure or the necessary equipment that is required.

Can I buy my child a laptop or books? Whatever I want? Because that is how I understand it.

Kamil Barczyk (BS): It is a supplement. It would certainly improve conditions. Education is a multifaceted field, just like healthcare.

We’ll leave education there. It is also a huge topic, and we only wanted to present you briefly. I can see that the Left has a different idea for Poland than the Nonpartisan representatives, who are more right-wing here. You seem to favour money and a kind of self-reliance in how you approach citizens. Let me ask both of you: Ms Filaczyńska, do you see the Nonpartisan Local Government Representatives as a right-wing group that will give people money and tell them to manage on their own, more or less?

Kaja Filaczyńska (NL): Yes. Even the VAT idea raised here is, in my view, very harmful, because VAT disproportionately burdens poorer people. Wealthier people, in my view, spend more on food, and at a time when we already have high prices, this is a solution that will hit the poorest. It means building the state on the shoulders of the poorest, while abolishing personal income tax, PIT, would create enormous holes in the budget. These are also very liberal solutions that increase inequality and lead to the state withdrawing from the most important areas. The Nonpartisan Local Government Representatives can promise things I strongly agree with, but when I see that there is no funding or that the funding is shifted onto the poorest, I know these are bad solutions: they deepen inequality and take away opportunities.

Mr Barczyk. What about the Left’s social handouts...

Kamil Barczyk (BS): A social programme in which we estimate that building 300,000 homes would cost hundreds of billions. It is truly a strange programme, an unprecedented housing-construction programme worldwide, but of course we can discuss programmes. We are talking about a pragmatic approach: tightening up the tax system, tightening taxation of large companies and foreign corporations, and tightening VAT without burdening the poorest. For example, do you know why medical entities must operate with an exempt VAT rate? Why can’t it be 0%? These are very specific solutions that would improve the situation of the poorest, even by abolishing PIT charges, but also by expanding and optimising the system and introducing a different VAT law. It must be simple and clear. We have a great many...

Mr Barczyk, one last question—I was supposed to keep an eye on the time. This final question is a litmus test of what the parties stand for. Mr Barczyk, women’s right to legal and unrestricted abortion. Yes or no?

Kamil Barczyk (BS): I support the compromise that was passed before the current amendment.

Ms Filaczyńska, unrestricted, legal abortion is the Left’s banner issue.

Kaja Filaczyńska (NL): Of course: unrestricted, safe and available at every healthcare facility, together with free contraception and reimbursement for in vitro treatment. Women should have full rights and full access to healthcare, and Poland should have civilised legislation. Enough of women dying in hospitals because they lack access to healthcare. So yes, of course. I hope we will change this law in the Sejm very soon.

Ms Barczyk, a few more words in defence of what you call a compromise.

Kamil Barczyk (BS): The conditions established previously were also consistent with medical knowledge. There were not the controversies introduced by PiS during its term, when many discussions began about what could and could not be done, and about the lack of knowledge concerning abortion. This is a very serious problem, and I believe this medical procedure must be sanctioned in some way. We can discuss it and consider it from many perspectives and in many circles, beginning with doctors and ethicists and including our society.

I’ll interrupt—and leaving women aside. Ladies and gentlemen, I was supposed to keep this to 15 minutes.

Kamil Barczyk (BS): The in vitro procedure should also be allowed more widely.

So in vitro, yes, and legal abortion, no. All right, thank you both very much. Kaja Filaczyńska, third place, New Left, and Kamil Barczyk from the Senate. Thank you very much for this conversation. I think our listeners were very satisfied with your answers. Thank you kindly. Goodbye.

Kaja Filaczyńska (NL): Goodbye.

Kamil Barczyk (BS): Thank you very much.