Trade union leaders want real solutions to real problems. Really? What are the solutions and why don't the unions want them?
Trade unionists-doctors kept saying that wage growth was not the primary goal of their action. That the main goal is to draw attention to inefficiency and corruption in health care. That they mainly want to "turn" with this.
I know how to achieve these goals. That procedure has been known for quite some time. However, the question is whether the trade unions really want to solve these problems, or whether their "fight against corruption in health care" is just a cover.
Master and administrator
The whole problem is actually simple - the state is an incompetent master (hospital owner) and so the administrator (hospital management) can do whatever he wants. Need to be corrupt and manage inefficiently. Due to the inability of the state to enforce the responsibility of hospital management, this management passes very well. In economics, this is called the problem of the master and the administrator.
Everyone should specialize in what works best at best. The state is obviously not exactly the best in the role of lord - it is not able to enforce the responsibility of the management of hospitals and the entire state health care system towards the entrusted funds.
In the market, the whole problem is solved quite simply - a company with incompetent masters, where management works in the environment moral hazard he probably won't do very well. The economic results will not be worth much, the share price (the value of the master's property) will fall.
The master is informed by a fall in stock prices that something unfair is happening in his company. He basically has three amounts: he can start doing something to make his stock price rise again, he can sell his shares to a more capable master to see at least something of the stock, or he can let everything go and let the company go bankrupt. But it is always he who bears the direct effects and consequences of his incompetence (does not take place socialization of losses).
A more capable master usually fires the original management, puts in a more credible (for him) leadership, and it is in his best interest to investigate any past corruption for some compensation. It is in the Lord's interest that the share price rise. In other words, in the market, if a company is held by an incompetent master, the incapable one is naturally replaced by a more capable one, or the incapable one bears all the consequences of his actions. Responsibility is fully transferred to the owner, who fully and effectively enforces it on the management of the company. Corruption is usually much lower than in the public sector.
The state is an incompetent lord. This is obvious from the level of corruption. So it would be logical to privatize hospitals, sell them in shares and let the new owners deal with the old management.
With the privatization of hospitals, it would begin to work the market of masters and administrators, where there is no room for corruption and incompetence. Where there is no place for socialization of losses.
We have tackled corruption and inefficiency. What about medical salaries?
If we were to privatize hospitals, we must logically get rid of the state tariff system of salaries. The issue of salaries would have to be dealt with by each hospital owner separately.
If there are really few doctors today, if more doctors are really needed in hospitals, then this means that the demand for doctors is higher than the supply for doctors. In other words, in the private sector, this would lead to higher medical salaries. They would not be the same everywhere, which is the advantage. If there are few doctors and if all hospitals need some doctors, they will compete for them - in salaries, work environment, equipment, benefits…
An ideal environment for higher medical salaries, right?
If wages actually rise and corruption is curtailed, we have a much more efficient system of operating hospitals. Is not it great? Isn't that exactly what the trade unions are calling for? Of course, yes!
But where do hospitals get money from? It's from the salary of health insurance companies.
If the issue of expenditure is solely the responsibility of the owners (ie management) of hospitals, we must also give them responsibility for the issue of hospital income. In other words, we need to get rid of payment orders and let hospitals negotiate payments with each health insurance company individually.
But what does that mean? That there must be competition between health insurers. The health insurance market must be freely accessible to any competition. Why? Well, so that health insurance is not too expensive.
In order for competition to really work between health insurers, we need to give them the biggest competitor: uninsured. In other words, Insurance must not be mandatory by law, but must be a voluntary matter for each of us.
Every health insurance company would then have to convince us why we should have that insurance at all. That is the basis of competition.
In other words, we urgently need health insurance reform. We need to turn the current tax into real insurance.
Reality or a cover?
When we know the solution to all the problems, when we know "how to do it" and how to satisfy the doctor, the question is why the trade unionists themselves do not really like this solution.
The answer may be simpler than it seems. The privatization of hospitals, the opening of the health insurance market (and others) would logically lead to the creation of competition between doctors. Their chamber is their guild.
Medical Chamber = few doctors. Few doctors = great bargaining power about salaries. Great bargaining power on wages = great enforcing power of the incapable.
Failure to solve current health problems suits the most incompetent doctors (from any point of view). This may be why trade union leaders reject real solutions.