The urgent yet long-neglected reform of Bulgaria’s health care system is symptomatic of the social, political and financial failings of which the country has failed to cure itself.
It is true that most of these problems have their roots in the "socialist" system that prevailed before the changes that began at the start of the 1990s, when most areas of public policy willfully acknowledged neither the laws of economics nor the realities of Bulgaria.

The people of every country can dream of an affordable, full-service health care system in easy reach of every person in need of care and treatment, and it is indeed a noble aspiration. Yet no country has achieved a flawless system, either in affordability or in standards of treatment, and Bulgaria is not alone in not being able to afford the skewed system that it has inherited.

It is one thing to have a hospital in every town, as was the goal of the regime now past, but it is another when treatment at most of these hospitals is inadequate, and the fact of their existence worsens the burden across the country, leaving many hospitals under-funded and under-equipped and in some cases, inappropriately staffed.

In the years since the transition began, a lack of professional management has not helped, aggravating the management of budgets that, in turn, were drafted and handed out by incompetent politicians.

The system proposed by the Health Ministry is by no means flawless, because it will remove even the semblance of health care close to home for several communities. It may even be that the criteria drawn up for funding were designed precisely to justify the closure of smaller hospitals, rather than simply making an outright political decision to wield the axe.

Whatever the background, it is inescapable that reform is urgent when even at the larger hospitals, patients have to dig into their own pockets for everything from medicines to toilet paper. Some people who should be admitted simply avoid staying in hospital.

Nor is it correct that in some cases, proper treatment can only be had abroad. The reform process that is being attempted involves some amputations, a measure that is drastic, but sometimes necessary.