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Sunday 21 September 2014

Gene Kerrigan: Saving a child's life too costly these days

Published 27/01/2013 | 05:00

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Once the bondholders are paid off sure who cares about education, health or public safety, writes Gene Kerrigan

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Let's imagine there's a boat a few miles off the Clare coast, and it's sinking. And there are 120 of our young daughters and sons on board. We know what would happen. The lifeboat people would move heaven and earth to save them. The local communities and those further afield would offer unlimited assistance.

The nation would hold its breath as the rescue got under way. The parents, siblings and friends of those on board would receive our unconditional comfort and support.

Suppose, though, the rescue would be particularly difficult, because of local tides and sea conditions. Suppose it would take a long time and use up a whole lot of resources that the rescue services couldn't afford. Suppose the lifeboats couldn't launch, the helicopters couldn't take off, until a National Centre for Rescue-economics gave them the okay. Suppose the NCR said the proposed rescue wasn't cost-effective.

Would we shrug and say sorry, we simply don't have the money? Would we watch – sad, but fiscally righteous – as the boat slowly sank?

Something like that happened last week. Not exactly, and the people involved are not at all callous – but the National Centre for Pharmaco-economics (NCP) decided that saving 120 young lives wouldn't be cost-effective. We simply don't have the money.

The NCP is a panel of doctors who do important work. They measure the effectiveness of new drugs and technologies, weighed against costs, and advise the HSE. If we pay for a new product for patients threatened by disease X, how will that affect the medical budget? How many fewer patients threatened by disease Y will be deprived of treatment? Are we getting "value for money"?

It's unfortunate that such assessments have to be made, but no country, no society, can afford every treatment for every patient suffering from any condition, at whatever the cost. We simply don't have the money.

Now that we've taken on the job of saving Europe's banks, we have even less to spend on lifesaving medicines. In approving new treatments, the NCP used to have a threshold of €45,000 per year of life saved. Due to the fact that we simply don't have the money, that was cut last year to €20,000 per year of life saved.

Last week, the NCP decided the State can't afford to supply a new drug called Kalydeco to cystic fibrosis patients. It costs far too much. About €230,000 a year, per patient. We simply don't have the money.

CF is a young person's disease, for the stark reason that it kills them off before they've a chance to become old persons. It attacks the lungs. It requires repeated treatment to ease the condition, sufferers are open to various deadly infections – and they're aware that it's terminal, even after they've endured the exhausting treatments.

For some reason (the Celtic gene), it's more prevalent in Ireland than anywhere else. Yet CF patients and their families have had to struggle for years to get treatment that people in other countries already enjoy. Young people have suffered, many have died, while the State was being pushed and prodded to provide resources that could save lives. Apparently, we simply didn't have the money.

Now, Kalydeco, a drug that tackles the underlying cause of the disease, offers hope for people with a certain mutation of CF – and that's about a tenth of Irish CF sufferers, or 120 young people.

It can possibly double the life expectancy of patients – people who just a few years ago would have died in childhood might now live into their 50s and 60s.

All is not lost. The drug research was part-funded to the tune of $75m (€56m) by the non-profit Cystic Fibrosis Foundation in the US. The HSE is in negotiation with the manufacturers, Vertex Pharmaceuticals, for a price reduction. The company is already prepared to do deals in the US – providing the drug free to people with no health insurance and household income of $150,000 (€111,000) or less. Officials here are hopeful of a price reduction.

And who knows where further research may lead, medically.

Of course, when it comes to medical treatment, or to education – or to any basic service supplied by the State – we're a small country, in a recession. We simply don't have the money.

We leave autism patients without the support they need. We can't afford drugs, approved in the UK, that could relieve sight problems or treat prostate cancer. We simply don't have the money.

And, on top of that, we got a hint recently of the depth of the problems caused by the historic underfunding of the public health service. A chap called Barry Cummins was asked to affirm that he still wants treatment for the condition for which he had been referred. He couldn't. As he now lives in Sydney. He had been on the waiting list since 1996.

We'd love if this didn't happen, if kids weren't deprived of treatments that would restore their hearing, if hundreds of people weren't waiting for hours and days on hospital trolleys – but, sure, we simply don't have the money.

How might we arrange things best, so that these obscenities don't happen? Well, we could budget for the basic things – health, education, public safety – then the other necessities, then desirable things, then the luxuries. And then, tax and spend accordingly.

In such a society, we wouldn't pay a Taoiseach €200,000. We simply don't have the money. We couldn't pay Bertie Ahern a pension of €150,000, we couldn't pay Mary Harney a pension of €130,000. We wouldn't be paying John Bruton a pension of €141,000 (on top of his job as mouthpiece for the finance business). We simply don't have the money.

We wouldn't be so generous with tax breaks and loopholes for the rich. We wouldn't – as Michael Taft pointed out, using OECD figures – have a tax rate of 31 per cent for high-earners (over €118,000). Not when it's 38 per cent for the same people in Italy and 49 per cent in Belgium. Not when we have only the 12th highest taxes on high earners of the EU-15 countries.

No, we simply don't have the money for that. We simply don't have the money to allow us take on the private debts of Irish, German and UK bankers, to the tune of an astonishing €64bn. We wish bondholders all the best, but we simply don't have the money to pay off on their failed bets with private bankers.

Yet, we do.

The arses of failed politicians grow ever larger, resting on cushions of money we can't afford. The country has acquired the reputation of a dodgy tax haven, as we tailor our laws to suit the rich. Our current politicians simper and grin their way across Europe, seeking a small discount on the billions in debts we don't owe but which they insist on paying.

Someone posted online a picture of a determined Enda Kenny – and a quote: "I would rather close every hospital, school and business in this country than see the bondholders out of pocket by one cent."

This is, of course, a typical internet lie. Mr Kenny never said that. But, it would be easy, from his actions, to suppose he did.

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