Sunday 23 October 2016

Health insurance genie will not go back in the bottle

Failure to give the UHI proposal a proper burial could haunt the Coalition, writes John Drennan

Published 09/03/2014 | 02:30

Minister for Health, James Reilly
Minister for Health, James Reilly

OVER recent weeks, as 'Dear Leader' Enda basks in the silent applause of the citizenry, sometimes it has appeared to be the case that the Minister for Justice Alan Shatter has been the only fly in Kenny's political soup.

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If only it were thus. For though the conflict over Universal Health Insurance has been somewhat more subterranean, ultimately the bristling grandiloquence of the health minister and his UHI proposal poses a far greater long-term threat to the 'boss-man' than the theatrics surrounding his justice minister.

Such is the delicacy surrounding Dr Reilly's great folly, the smiling Labour ministers who talked about "Dr Reilly's discussion document" were not trying to make the UHI thing vanish.

This, after all, has the full public support of the finance minister and the public expenditure minister. It's just that disappearance until after the next election is an unfortunate side-effect of the Government's proposal that we have a grand old national fireside chat about the great health service we are to have in the next millennium.

Ironically, had the Coalition given UHI a proper burial rather the current death by a thousand indifferent cuts, where even the proposal for – wait now, this is a good one – a 'citizens' assembly' was dropped, it might have been the best result of all.

Instead, by failing to put the beast out of its misery, it could, alas, be the case that it has created a whispering spectre that will haunt the Coalition and spook the electorate over the next two years.

The problem is that the UHI genie is out of the bottle. and like the famous moving finger, not all your tears or art can reverse this. The even bigger problem is that the UHI genie is not out of the bottle in a good way.

Both the health minister and the Taoiseach have attempted to drape UHI in the sort of NHS rhetoric of the Forties or Lyndon B Johnson 'Great Society' rhetoric of the Sixties, but this is a siren song that is not capturing Paddy's suspicious ear.

It doesn't help that insofar as Paddy connected with the health section of the current Coalition's election manifesto, the voters believed the then Opposition was telling Paddy it would replace his costly private health insurance with a new free system.

It has therefore come as a bit of a shock to an electorate who are already somewhat sensitive about the Coalition's adherence to the Pat Rabbitte theory of election promises that a coping class who do not have a bob will be expected to pay even more and that the payments will be compulsory.

When it comes to idealism rather than cash, there are also no shortage of doubts over the relevance of comparisons to great reforms like the establishment of the NHS.

One key difficulty is that the circumstances are not precisely the same as those that drove the UK precedent. This was established in a green field-type scenario, while Dr James is trying to build castles in the sky, or worse still on the higgledy-piggledy foundation stone of the dysfunctional health service.

The whole imbroglio may also have ongoing serious internal ramifications for the stability of an increasingly ramshackle Coalition.

If the problem was merely confined to Fine Gael being less than amused at the cheek of Labour daring to engage in a humane killing of the minister's feral UHI pet, it would be containable. The unfortunate impression, however, has also been created that while Enda is fully supportive of the health minister's "modest proposal", the finance minister is somewhat more dubious.

The normal squabbles between ministers and Coalition parties are entirely containable but tension between a Taoiseach and a finance minister is the political equivalent of pressing the nuclear button.

For now the trouble has been contained by the Labour-driven relegation of Dr Reilly's white elephant, apologies, white paper to the status of a 'discussion document'.

However, any premature celebrations should be chilled by the reality that the Government appears to have acquired the endemic Irish disease of evading the sorting out of difficult problems immediately.

This may have the plus side of avoiding immediate pain but the problem with allowing wounds to fester is that inevitably some variant of political gangrene sets in and the saw has to be used where a bandage might have originally sufficed.

One of the more intriguing features of Irish politics is that for all the dominance of health in our political discourse, it has never been the decisive factor in an election.

However, if it has not fully broken in the rogue UHI horse, the Coalition may yet break that duck in a most unwelcome fashion.

Sunday Independent

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