the state of health: the health of state

Prime Minister Socrates’ resignation yesterday further darkens Portugal’s financial predicament and almost certainly means that the IMF will put the company into receivership. Socrates was sent down because he had no real ideas. No one has any real ideas. The belt-tightening measures he proposed were no more than a blow upon a bruise to middle and working class Portuguese, sacrificing the public sector and raising taxes.

The Portuguese economy is a miserable, disabled slug and the mistakes of government so blatant that even as an outback-ratrace-refugee I experience this disgrace every day. 1. Trying to interest Portuguese businesses in a miniscule investment in the preternaturally healthy expatriot micro-economy is close to futile. 2. There is, not just widespread, but almost complete IVA tax avoidance. 3. The public sector is deep in a bog of bureaucracy, over-regulation, paperwork and delay. Sometimes I wonder if the “system” functions at all. For the expat this is a nuisance, but for the Portuguese it is a gross injustice.

The health department is what hurts me the most. Free health care is a beautiful thing and an endangered idea is this world of rationalisation. The quality of care here is above criticism. But accessing that care is nigh impossible. This is how it goes:

Ring doctor. In meeting. Ring doctor. Doctor overseas. Ring doctor and make appointment in a weeks’ time (this is going in the back door – the alternative might fill the page). Arrive at appointment a half hour early to beat the “queue”. (The first big mistake is this habit for calling everyone for an appointment at the same time: waiting rooms full of sick, humiliated sick and germ swapping sick getting angrier all the time. It costs nothing to give people specific times and to keep a schedule. Elementary. Ask the Germans.)

I wait two and a half hours to see my brilliant doctor who determines I need physiotherapy. Another hour while she works out where to send me, how to send me and to fill in the respective forms I need.

Back to those waiting times: Doctor’s appointment takes 3.5 hours for every person in the waiting room. That’s 35 hours of productive time wasted that I can see at a glance. People take whole days of work just to see a doctor. Huh?

The next day I go to the physiotherapy place and wait half an hour before excellent person explains how my form will be looked at and it will be determined whether or not I should receive services – by what is written on the form. Wait a week. Get a call for an appointment in a month. In a month go to appointment a half hour early and wait two hours before the secretary sees me and says that my form does not have the correct stamp. A fight breaks out between excellent person and new person about the stamp. It exists, but the stamp is in the wrong place on the form. This has to be rectified, but I still get to keep my appointment. Another fight between excellent and other. The form is fine. New person fills out 5 forms and does a little data entry. I am dispatched to another waiting room. I wait with the same people as before, for an hour. People discuss amongst themselves how long they have been waiting, what is the order of the queue, mobile phones ring as anxious spouses wonder when to put the stew on. Cousins, elsewhere in the queue, drop by to swap complaints and there are tears. Small kindnesses are past between us.

It’s my turn! Doctor is kind, tolerates my Portuguese, is attentive, earnest, squeezes my neck for 2 seconds and determines that I qualify for treatment. Unbelievably, we are all waiting to audition for physiotherapy, not to actually receive any. This queue was to sort out the malingerers from the crippled. I mistakenly thought that that was what our family doctor was for.

I’m assured I will be contacted briefly for an appointment time. I’m still waiting.

Did I tell you about the time I waited 18 months to determine whether a lump in my armpit was breast cancer or not? Compare the Australian free healthcare system. My sister is on her way to the post office. Between the house and destination there’s a mobile mammogram truck. She sticks her head in to ask what the drill is and they invite her to come right in and take off her shirt. In 15 minutes she’s back on the street knowing that she’s good to go for another two years.

Just how many Portuguese die while waiting for treatment? Who keeps a record of how much a patients’ illness, and the cost of treatment, escalates while they wait?

I don’t take pleasure in criticising a country in which I am a guest. But sometimes it takes a foreign perspective to see the problems in the wider context: of the damage already done at home or of battles already fought and won. No country is perfect. My point of view comes from love and respect for a Portugal which is not fullfilling its potential. Whose government is failing. Where solutions exist and no politician has the integrity to implement them.

Perhaps at the very core of the Portuguese problem is the disfunctional judicial system. There are laws, but finally, no one is held accountable. While corruption exists, democracy fails.

Anyway, there’s nothing worse than a back-seat critic. Or is there? How about an amateur economist?

1. Sell the $1 billion worth of submarines ordered by the previous Government. Sell them at a loss and still this injection of cash will serve the people in a way tax cuts will not.

2. Decrease IVA to 10% and implement a long term 100% compliance strategy which targets sector by sector starting with lawyers.

3. Halve the size of the public service but invest in state of the art technology and training to get government departments working efficiently and effectively.

4. Raise minimum wages. Raise taxes on cigarettes, imports, luxury vehicles and dare I say, fuel. Raise the tiny fee we pay to see a doctor – we voluntary foreigners – raise it by 3 euros and you won’t be hurting anyone.

5. Invest in radar speed detectors throughout the entire country to both lower the accident rate and raise revenue. This surely would pay for itself and then some. And then some more.

6. Put a Government levy on credit card spending. Stiffen the regulation of banks, limit their rights to charge fees and tax banking sector profits. Reward personal saving.

7. Devise a nationwide campaign to promote “made in Portugal”. Restore the Portuguese pride in their country and bring them back to their grass roots local economy and away from the corporatisation of the EU.

Rant over. Goodbye Socrates. Never has there been a Prime Minister so cute or with a more appropriate name. I only pray there’s a Plato to follow you.