We are finally beginning to glimpse Minister James Reilly‘s vision for the health service but, unfortunately, it is a mirage. It is based on a new approach in politics, a constantly shifting vision of something good that moves further back every time we approach it.
Such is the case with Universal Health Care – launched last week but not available in practice for at least five years. It’s like the famous songline, “You’ll get pie in the sky when you die” – a promise that the long-term future will be different, if only you’re around to experience it.
We’ve been here before, of course. We’ve had the mental health strategy, the primary care strategy, the waiting list plan and a host of other really good things that, if they were implemented, would be excellent improvements. But, of course, they haven’t been implemented because ultimately, the dream is thought to be good enough for accumulating political capital while we’re waiting for the health service to miraculously change by itself.
So, instead, we have grandiose plans for a system that can’t be introduced for five long years, and there’s the problem. Health provision across the world is changing rapidly. You can no more produce a plan for five years’ time than you can predict who’ll be in government then, and in the meantime, it seems that all Mr Reilly will do is point to his ‘plan’. At least he didn’t try to make it a five-point plan like Enda Kenny’s. Does anyone remember that, or what became of it?
Putting things so far off in the future is a cop-out, plain and simple. But there’s much more wrong with this idea than just that. In five years, healthcare will have changed radically. For example, Sir David Nicholson, the head of the UK’s NHS, has pointed out that in a few years we will have fully mapped the human genome, so we will be able to predict with a good degree of accuracy which people are going to get the long-term, serious illnesses. And, of course, we should do that, if only to see what can be done to possibly prevent such illnesses from happening at all.
Nicholson believes that in such an era, systems based on insurance models will be defunct, since it will be possible for an insurance company to test its potential clients for diseases, and if they’re clear, give them great deals. But what of those who test positive? It’s not a problem for the insurance company, but it is a problem for the people concerned, and, if we are truly a caring society, for everyone.
What we have to remember here is that nothing in this proposal is going to make the health service better. Nor is it going to be cheaper. You, the end user, are just going to pay for it in a different way than the way you do now. On top of property tax, water tax, universal social charge, the RTE tax (TV licence) and everything else, you will have to pay your health insurance premium whether you want to or not.
If you decide to emigrate at 40, you will be ripped off again as all the money you have paid in during that time will be wasted (given that you’re much more likely to use the health service as you age). On the other hand, it will be a beacon to anyone with an Irish connection who might wish to retire here, knowing they can avail of a health service in their old age for which others have paid.
Are there good things in the proposal? Yes. The notion of a health service that doesn’t discriminate based on income is obviously a good and fair idea. But we don’t know yet if that will be the case.
The basic problem with the health service is that there are too many managers and not enough doctors. What are we doing about that? We are pushing GP’s out of business, limiting training and pay possibilities for junior doctors and hospital consultants, and failing to provide services where people really need them.
It won’t matter what kind of system we have in five years if these trends aren’t reversed. What good is free GP care if you have to wait a week to see a GP? What good is it if you are equal with everyone else on a waiting list, but it still takes a year to see a consultant?
In this scenario, the well-off will still be on a second tier simply because they can afford to pay. The well-off will always get access to treatment.
What needs to be done is a reorganisation of the health service and a reallocation of funds so that we have the doctors and the system fit to tackle the problems we face now. All the plans and strategies are there, all that’s missing is the will to introduce them.
Instead, what we are getting is simple misdirection – look what’s happening here instead of looking at what’s really happening. Mr Reilly has failed to achieve anything so far in health. His past is a past of failure and his present continues that failure. We are now expected to believe that his future will be very different.
Mr Reilly defines radical change and improvement as something that can only happen (after three years in office) in five more years. If he had said that the dog ate his homework, it would be more believable. And all we should say in response is, “Next!”
This article originally appeared in The Sunday Independent here.
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