Thursday 18 December 2014

Universal health insurance not the cure for all ills

Our health service has been mis-managed for decades, so why give the State more money to mess it up again?

Published 27/04/2014 | 13:00

Half of people are in favour of UHI in theory, but only a quarter have faith it will be implemented successfully
Half of people are in favour of UHI in theory, but only a quarter have faith it will be implemented successfully
Sunday Independent/Millward Brown poll results

THE burning question about Universal Health Insurance (UHI) is why anyone would possibly trust the Government to have more of a grip on healthcare than it already does. And that is borne out in today's Sunday Independent/Millward Brown poll. While 52 per cent of people like the idea of Universal Health Insurance, only around half that number (28 per cent) have any faith in it working. The spirit is willing, you could say.

Health is possibly the greatest single failure of government management in this country, and this is a country with a lot of failures in government management. It is a system that no one even understands enough to fix anymore; a system where all the constituent parts, from the Government to the doctors to the administrators, appear to be at war; where the last attempt to fix it involved putting another layer of management on top of it that made it somehow more unmanageable. It is a system that routinely fails people at the most vulnerable points in their lives. And now we are being asked to put complete faith in the Government to have a total monopoly on health, for there to be no alternative, no choice.

People are supposed to be apologetic for having private health insurance these days. Even if you are part of the half of the population without a medical card, the noble thing to do is apparently to submit yourself to the public health system anyway. Because the two-tier system is wrong and unfair.

Right now, if you are a typical family with two small kids you could be paying a little over two grand for reasonable VHI coverage. Most people who can afford to will do this because they believe it is the responsible thing to do for their families, because people live in fear of anything happening to their spouse or their kids.

They will also do it, of course, to "jump the queue" in case of a major health problem. You may argue this is wrong, but people are only human. What else would you expect them to do? The ironic thing is that while these people might think they have health insurance largely for their kids' sake, kids don't generally get to jump the queue, and most kids end up in the public system for most things, though deserving cases may get to jump the queue, something that will be verboten under UHI.

Whether you agree with people having private health insurance or not, it's going to be a hard sell to ask these people to pay more money for UHI.

So say right now an adult is paying €1000 for health insurance with built-in queue jumping and other perks. The Government is now going to force this person to join UHI with no queue jumping and no perks. The figure that has been mooted for UHI is €1,600 per person. We can assume then it will be up to €2,000 when it

actually comes in. So people are being asked to pay double the money for an inferior service administered by an entity that has made a singular balls of managing healthcare. Why would anyone agree to that? Even the people who agree with it in principle don't agree with it.

Clearly, many people are altruistic enough to feel that they are willing to pay double what they are paying now to have a more equitable system. According to today's poll, over half the population are willing, in theory, to take the hit – in their healthcare and in their pockets – in order to subsidise people who can't afford UHI. But when it comes to the practicalities of it, only a quarter of people have any faith in the system being successfully implemented.

These people may feel too that they are already paying enough to subsidise other people's healthcare. In this country, you pay more than half of your earnings in tax on anything you earn beyond the average industrial wage. Included in this are the Universal Social Charge and PRSI, which are supposed to cover health. Now it seems that the middle classes are expected to pay up a further tax to subsidise other people's health insurance.

But, as the odd massive disparity in today's poll between the belief in the principle of UHI and the reality of it demonstrates, even if people are happy to subsidise other people's health insurance, they may not have huge faith in giving more money to the Government to spend on health. Health is increasingly seen as a bottomless pit that runs massively over budget every year, threatening at times to wipe out all the hard won gains made in other cuts, and still fails to provide a decent health service.

It probably isn't helping people's faith in the UHI vision that the first wave of the plan – free GP care for the under sixes – is nonsense. This seems to basically involve taking medical cards from disabled children so that people like me, who can afford to bring our kids to the GP the odd time we need to, don't have to fork out.

The half of the country who needed free GP care for their kids had it anyway, through their medical cards. What was the burning need to give it to the rest of us? So that we could bring our kids to the GP more often? Research shows that if you don't pay, you tend to bring your kids to the GP twice as often. So we are going to kick off "free" healthcare for all by clogging up the primary care system, the only part of the health service that works, with barristers' kids with snotty noses? The whole thing seems to be daft and badly thought out. And GPs are arguing that it could be the tipping point that will put a lot of them out of business. You could argue that they would say that, wouldn't they, but the proof is in the pudding. The GP training scheme can't get enough takers this year and research is showing an alarming amount of GPs planning to emigrate if they are young, or retire early if they are over 50.

Bear in mind, too, there are many so called middle-class people who have opted out of private health insurance over the last few years because they can't afford it. These people will now be deemed to be able to pay for health insurance. In fact, they will be deemed able to subsidise health insurance for other people too, so they will be pursued for this new tax. Presumably these are people who gave a lot of thought to giving up their health insurance. Now they will have no choice but to pay it or to see the sheriff at the door, which is the Dutch model that we are following.

You think there's a two-tier system now? Wait until you see the bad blood this is going to cause among those deemed able to pay and those who get it paid for them. Taxpayers accept at the moment that they pay for medical cards for half the population, both out of a sense of social justice and because it is buried in there somewhere in their taxes. Wait until the Revenue is pursuing people for an extra few grand but not their neighbours, and see how that goes down.

In a broader way, this poll result could be a metaphor for our depressing lack of confidence in our political system. In an ideal world half of the population would like UHI. But in the real world only half those people think it could work, and most people just accept it won't.

Sunday Independent

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