Fine Gael’s progressive health policy January 11, 2012
Posted by WorldbyStorm in Irish Politics, The Left.trackback
Here’s an interesting guest post from Joe.
A point that seems to have been missed in discussions on our current government is that its health policy is progressive. More specifically, Fine Gael minister James Reilly’s health policy is progressive. He proposes to have a single tier health system in place in about 9 years time (or as he puts it “after two terms in government”.) A single tier health system – isn’t that what left reformists and social democrats would want?
Currently it is the case that if two people are in equal need of treatment, the person with private health insurance will receive treatment ahead of the person without. People die because of this. They haven’t got private health insurance. People who have private health insurance and who may be a lot less sick, still get treated ahead of them. A lot of working class people have private health insurance (VHI, Aviva, Quinn). Many do not. But the reality is that people die because of this – surely that is all the indictment we need of the current system. And surely then we cannot but be supportive of attempts to rectify it.
Reilly’s proposal is that a system will be implemented whereby every citizen will be covered by insurance. Those who can afford it will be obliged to take cover from private insurance companies. Those who can’t will have their health insurance paid for by the state. Thus treatment will be prioritised based on medical need rather than ability to pay. Clearly there will be a cost to this – and that cost will be borne by the taxpayers in terms of high premiums for those who can afford to pay and higher taxes to cover those who can’t afford to pay. But isn’t that what European / Scandinavian-type social democracy is about? And shouldn’t we support it as progress in the right direction?
Okay, there is also an element of privatisation here in the involvement of health insurance companies. But if you or I are sick and we get treated fairly by this system (i.e. no-one gets to jump the queue on us), are we going to complain? To paraphrase Mao: “Who cares whether the cat is black or white so long as it catches mice?”
Now there’s many a slip twixt cup and lip. This proposal is a massive change in the way health services have been traditionally organised and delivered in this country. The Minister says he’ll publish a White Paper on the proposals by the end of this year. He can expect a lot of interest from powerful interest groups including medical consultants, health insurance companies, public service bureaucrats, trade unions and so on.
But he has one advantage in that he knows and has worked in the system for a long time. He is a very successful medical businessman and he was also very active in his union, the Irish Medical Organisation. He led negotiations with the government of the day on behalf of general practitioners in the IMO. Apparently the deal that he helped to win for them was pretty good. The fact that he is a very successful medical businessman in his own right may yet prove problematic for him – if it is seen that his businesses benefit from government policies in any ways.
Health has been a quagmire for Irish governments for generations. Part of the rationale for abolishing the health boards and establishing the HSE was to take the delivery of health services out of the political arena. It was felt that local interests and local politicians held too much sway. That removing the health services from direct governmental control would free them up to design and deliver services based on need rather than on local political considerations. Mary Harney was the Minister when the HSE was established. One consequence of its establishment was that the Minister and her department now had a lot less to do. They allocated the funding to the Board of the HSE and left them to get on with delivering the service with a lot less political interference than previously. This having a lot less to do seemed to suit Harney who seemed to lose interest anyway as the PDs declined.
Reilly on the other hand was not going to sit around and watch an independent Board deliver health services in the iffy way they have continued to be delivered since HSE was set up. In fairness to him, he has a vision and wants to implement it. He is getting stuck in and word is that he isn’t the most-loved Minister ever among the health management bureaucrats in his Dept and in HSE. But if he is like a bull in a china shop, who cares? Part of the plan is free GP care for all – and the first part of that is being implemented this year with extension of free GP services to certain classes of patient. What’s not to like? And if the end result is a single tier and fair health system along the lines of the Dutch model, I for one will not be complaining.
Here’s a link to what the government are saying about this:
I had a quick look through the manifestos – on the JUST FANTASTIC Irish Manifestos Archive – and every party (aside from FF) had a commitment to some sort of single-tier universal system. Might be something where there’s vague political agreement.
And if the end result is a single tier and fair health system along the lines of the Dutch model, I for one will not be complaining.
The Dutch model is young, and there’s signs that the health insurers are starting to find ways to game the system (I looked into this a year ago). And what this about is privatising the whole shebangs, but imposing strict rules on the “market” to deal fairly with citizens (which has always worked out well in an Irish context, mar dheá).
A wholly public system would be infinitely more preferable – no skimmers in the middle. Why exactly do we need insurers now, at all?
This looks more like a bailout for the insurance companies,one tier public and a progressive tax system I say.Regarding Maos quote, I think the Black cat would care, if the White mouse was getting all the mice. Lol
That should read white cat.
1. By this logic, the US, it could be argued, has a single tier health system.
2. You really think in a fee based system of health system that all insurance policies are going to be equal?
3. Do you really think the poor saps stuck with govt insurance will be treated equally?
4. Do you really think a fee based health system won’t game govt insurance?
5. How much more govt bureaucracy will be added by to ‘insure’ state insurance compliance (ie not overpaying health care providers) as the Irish state will most likely have to comply with new budgetary limits set acrss the EU (i.e. permanent austerity)? [More tax Euros to bureaucracy, less to front line services.]
This is just plain privateering at its abject worst.
When you change the societal ethos from one where health care is considered a universal need to be met by the wealth creation of the entire society to one of the profit motive with inherent conflict between health care providers and insurance companies, you change the ethos fundamentally. When the conflict between insurance and health providers changes to one of mutual looting for profits, then the real rot will become apparent
This is NOT progressive – not socialist – not democratic. It is regressive in every sense of the word in relation to humanity. It is a Libertarian’s dream – commodify everything.
Harney set the stage by destroying the basic ethos of health care in Irish society along with many of the infrastructural components. Reilly is finishing the job.
Ireland seems hell bent on creating inquality, an alienation society, and poverty in the name of profit. It won’t be called profit. It’ll be called efficiency or some such other. The results will be American in time. Very profitably efficient for the few.
I think my fecking head’s going to explode.
Does anyone know of a good book that explores the nexus between govt policy and practice and the insurance industry? We tend to think that govt policy constrains the insurance industry, but I’m beginning to think that insurance companies hold more sway over govt policy and are the edge of the wedge to create a Libertarian state where govt is merely a legal enforcer for privtate profits.
I guess it is more like what the Obama healthcare plan is pushing towards, albeit that’s not truly universal, more than the status quo in the US.
My concern with universal health insurance is probably not dissimilar to those raised above. Firstly it attempts to bring private sector entities to the feast. Secondly that seems to me to point to problems further down the line.
That said given the inequities in the system as currently structured the question is would the current policy push constitute a dangerous cul-de-sac or a step forward to universal provision which progressives can then amend in the future into a true NHS.
“I think my fecking head’s going to explode.”
MDAM,
+1.
I’m waiting for someone to start commenting here under the hame “boiling frog”, or similar.
This is a wholly over optimistic reading of Reilly’s plans. As Joe mentions Reilly is a successfull medical businessman, and it’s the business perspective rather than the medical perspective that will win out in Reilly’s mind. Without going into too much detail I have a degree of insight into Reilly’s previous incarnation as a medic and I think it’s fair to say he’s a better businessman than medic.
There are two observations that I can make. Firstly, Irish medical care is predicated on inequality and the generational accumulation and consolidation of power for the Irish medical profession. There is a lot of money to be made from continuing and entrenching health inequality; anyone who expects the medical profession, collectively, to forego that money, and it concomitant power, in the name of equal access to treatment for all citizens, is patently not fully acquainted with the realities of Irish life. The nightmare scenario for the Irish medical profession is one where everyone can access treatment for free (i.e. funded from general taxation) in public hospitals where medics are paid a standard (very high) salary with no opportunities for private fee income, which would surely evaporate if there were a decent egalitarian public health system.
The second observation relates to the inevitable gaming of the system that insurance companies will engage in to maintain and increase their profits. And profit, rather than decent universal health care, will be the core objective of the healthcare plan Reilly and Fine Gael are proposing. ‘Prime Time’ did a recent programme on the Dutch model which is under increasing strain after just several years in operation, strain that will surely increase into the future. If Reilly’s plan is implemented expect huge public relations offensives to maintain the illusion of equal ‘universal’ health care, while the system continues largely as it does now as the medical profession profitably exploits a population segmented into medical cards, private but no health insurance, public with no health insurance, private health insurance and the many variations of these categories that exist.
As an aside, trying to raise two small children has eradicated, completely and comprehensively, any respect or regard I might have for the medical profession. While deferring to their clinical judgements, the idea that this group of people should be the key arbiters of what type of healthcare system, and what funding model is should be based upon, is deeply dysfunctional.
This view is coloured by my experience of having a sick child over the Christmas who ended up hospitalised after several trips to out of hours GPs and casuality. Each trip, naturally, skinning us of 60 euro and the bills for casuality will be 100 euro for each of both trips. As one of those who doesn’t qualify for a medical card but who can’t afford health insurance, I feel that the medical profession collectively regard the population as a collective cash cow to be milked ruthlessly, whatever about the qualities of individual doctors. I mean it was 60 euro for a GP consultation fee in 2006 and it’s still 60 euro today, despite four years of recession and massive austerity.
“Who cares whether the cat is black or white so long as it catches mice?” was Deng Xiaoping and most decidedly not Mao.
That’s also an unfortunate analogy given the dismantling of China’s public health care system under Deng and his successors.
If it’s any consolation David Cameron made the same mistake with that quote in a Q&A in the Guardian Saturday magazine before Christmas. The Guardian also corrected it as being a Deng quote.
Indeed I referred to it in a letter to the Guardian shortly after Deng died, so I’m surprised everybody at the paper doesn’t know it by .
If you want an analysis of the FG healthcare policy and the dangers of UHI then read this -
http://www.macliam.org/Health/AnalysisFineGaelFaircare.pdf
I would also suggest having a read of Marie O’Connor’s book emergency on the creeping privatisation of the Irish Health system.
+1 on the above link. Good work from Dominic Haugh
“evidence shows that there are significant problems with the Dutch model of Universal Health Insurance. In particular, contrary to the claims by Fine Gael, the Dutch model of Universal Health Insurance has seen increasing costs, rejection by the public and rising insurance premiums for policy-holders. Furthermore, it has caused a major financial crisis in the Dutch healthcare system where over 50% of hospitals are heading for bankruptcy. To back-up their claims Fine Gael use reports from two right-wing pro-privatisation groups who receive funding from a lobbying company with close links to multi-national pharmaceutical companies, private health insurance companies and private health care providers, all of whom would be interested in exploiting the new Universal Health Insurance system that Fine Gael propose to implement.”
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The Health Commission which spawned this was chaired by Alan Dukes in 2007/8 and if I may put on my Max Keiser hat the “FairCare” plan was drafted by FG and now Reilly’s policy adviser Sean Faughnan. Former investment banker with ex JP Morgan, Goldman Sachs and Credit Suisse.
+1 as well Jolly – excellent analysis
CMK:
Not being sarky, but I thought the A&E charge does not apply to children?
Pretty shocking if it does.
As somebody with an older family member who paid out 400 Euro for A&E trips over the last 12 months I sympathise with anybody who gets stuck with it.
Remember when Harney introduced it, and it was presented as something to stop drunks abusing the system?
I can’t remember; I’m presuming it does because I have a distinct recollection of paying this charge in years past when the children were very small. I’m waiting for the bill in any event. But even if we didn’t have to pay the out of hours GP and costs of medicines were 150 euro. Also, our out of hours GP service are real humanitarians where on one occasion I explained to them that I hadn’t got their fee and could they send me a bill and they more or less told me not to bother coming if I hadn’t go the cash; this for a sick child of less than two years. My sister, who is a long term resident of Belfast, is aghast at this carry on, but we seem to accept in the Republic being fleeced by doctors as the natural order of things. Which is just how they like it.
The out-of-hours service are mercenary. We had an emergency in the middle of the night back in October and we had no choice but to pay the frightening charge if we wanted a visit. This is one area that could be fixed if there was a will to take on the medical profession.
Good comments all. Jeebus, I thought I’d be absolutely slaughtered on here for that post!
After I’d written it, a friend pointed out to me that a minimum social democratic demand would be an NHS-type system i.e. universal one-tier health care, paid for out of general taxation. So no involvement of insurance middlemen.
CMK hits the nail on the head with his description of the greed of the medical profession in this country. But don’t give up all hope, CMK – there are some genuine progressive “left” doctors out there. But overall the profession reflects the greed of the ruling class and the Irish bourgeoisie.
Another source to add to JRG’s is “Irish Apartheid – Healthcare inequality in Ireland” by Sara Burke.
Joe, I agree that there are progressive doctors out there, and I suppose there are stranger things than left wing Irish doctors. And you’re correct that the greed endemic among the medical profession is a reflection of broader trends among the upper echelons of this society. What disappoints me is that there is no organised, visible caucus of medical professionals who argue for a universal health care system that is not based on a discriminatory insurance system. Those who do appear content to keep quiet and let things continue as they are. Of course, I do recognise that it is a hierarchical profession built on the intimidation of its members and so, understandably, it might well be better, careerwise, to keep quite about the professions contribution to structural health inequality.
There are a couple of other useful points: the medical profession are THE key drivers of health privatisation in Ireland. Largely for the obvious reason that they have the most to benefit from it. Look at any private hospital, nursing home, clinic that has been built or is being built and medics will be the forces behind it. Also, because medics have a foot in both private and public sector provision they know just what they can get away with in terms of building for-profit hospitals. So, they carry out surgery at these hospitals, but don’t build capital and labour intensive ICU units because if these prove necessary they can transfer patients to these units in public hospitals. Ditto with A&E clinics like the ridiculous Beacon Clinic where A&E opens at 8am and closes at 6pm. This is conveniently when all the minor (but profitable) non-life threatening injuries can be hoovered up; the public sector A&E then kicks in with the heavy duty road traffic accidents, violent assaults, requiring costly and complicated medical interventions, after 6pm etc.
That’s not to mention the mistreatment and overwork endured by all of those bleary eyed Asian and African hospital doctors who appear to get all of the shitty shifts while their Irish colleagues concentrate on the important business of establishing a lucrative private practice.
There is no end to the cynicism of the Irish medical profession but, alas, they’ll keep getting their own way and will continue to pick people’s pockets while demanding reverence and respect which belies their actions as a collective entity.
What disappoints me is that there is no organised, visible caucus of medical professionals who argue for a universal health care system that is not based on a discriminatory insurance system.
Err, wasn’t there such a call last year, that was then roundly attacked by the “responsible” Irish political class and media?
Eh, was there? Glad to hear it but not surprised they were shouted down. I know there are individual doctors and even consultants, who are sympathetic to universal healthcare. But they’re very much in the minority.
Sorry, it was 2010:
http://www.imo.ie/news-media/press-releases/2010/imo-calls-for-public-deba/index.xml
I do recall Harney attacking this (of course).
Are comments going missing on this site? WbS?
Was in the spam for some unknown reason EWI. Released now.
Thanks, Garibaldy
I would say that it is insurance companies more than medical practitioners who stand to gain from privatisation. A lot of policy in Ireland is implemented at the behest of the insurance industry, which is yet another example of how successive governments have bent the knee to finance.
Fine Gael’s approach, it should be remembered, is always dressed up as somewhat progressive. This is because the average FG party hack sees this country as being ‘too left wing’ to implement their poles without some sales gloss. FG say that they will not increase taxation because tax increases hinder job creation more than spending cuts do (FG 2011 Manifesto). This is a rather contentious issue, but Fine Gael nevertheless state that they have conclusive data to support this. Of course, one should always remember that Fine Gael are, and always were, opposed to tax increase or high taxation in principle because it runs against their ethos of ‘self reliance’. If Fine Gael have convinced someone that they have adopted a ‘progressive’ then it is a victory for their PR machine rather than an adoption of liberal/left wing policy.
For “job creation” read “profit”.
And for ‘poles’ read ‘policies’.
If there is a universal health insurance scheme, is it still legal to set up private clinics/hospitals in which those who can afford it can get high quality treatment, quickly?
If so, in what sense is the system ‘one tier’?
Well, in that case the amount of taxes coming from them to pay their fair share would make such a point moot, as everyone else would be getting care as nearly close enough to make no difference, with no public subsidy whatsoever for the private system (which is now receiving huge amounts, even after the abolition of the 40% tax relief).
Here’s a question. Why is the LP wedded to universal insurance rather than universal healthcare?
The same answer as the Deng Xiapong points made above, unfortunately – the co-option of socialist principles by neo-liberalism.
Putting the same question another way perhaps answers it: Why will the Labour Party not support a genuinely progressive and sustainable system of taxation?
Definitely. It gets to the heart of matters.
[...] shown. Here’s Labour Party member Dr. Gerry Burke on FG’s plan in 2009. And its being discussed on Cedar Lounge where I filched Dominic’s report [...]
Interest article here with insight into Reilly’s plans for the HSE and asking who’s really running the health service under the new regime.
http://www.medicalindependent.ie/page.aspx?title=whos_calling_the_shots