A lot of ifs, but maybe ambitious plan could be a runner
THE Labour Party's ambitious manifesto has the virtue of being costed and backed up with a comprehensive 90-page document.
But achieving its aims is very much contingent on the figures adding up if it is part of the next government.
It is also heavily reliant on getting agreement from GPs and consultants to radically change the way they are paid.
In the case of consultants, they will be asked to give up €75m of their salary -- over €30,000 each -- if the State can pay for free GP care for all by 2014. GPs will also have to forego private income and agree to a yearly capitation fee to cover each patient who registers with them.
And the pace of the changes may be too fast for Fine Gael if it becomes its new coalition partner. Former Irish Medical Organisation (IMO) President Dr James Reilly -- now Fine Gael's spokesman on health -- would have to ask his former consultant comrades to take the salary cut so everyone can have free GP care.
The ability to fund free GP care for all by 2014 is also dependent on cutting the State's drugs bill.
This is achievable, but it must also get payroll savings of €175m by shedding Health Service Executive (HSE) staff.
And another €100m must be generated by the HSE by getting better value for the services it buys.
Labour will also have to find another €371m to pay for the universal health insurance scheme to be introduced in 2016. The National Treatment Purchase Fund and the purchasing arm of the HSE will team up to become a public health insurer. People can also buy their insurance from private providers.
At that point hospitals will be paid on a procedure basis. The responsibility for overall health spending will revert back to the Department of Health. Labour also aims to bring in mental health services under the umbrella of the universal health insurance scheme.
If health insurance is affordable and people are guaranteed to be seen in a reasonable time, Labour's plan will get public support.
But the party's plan will require a massive amount of legislation, budgeting and sacrifices by some of the health service's strongest vested interests if it is to become a reality.