Tuesday 27 September 2016

GPs must fight back against auction politics - for their sake and for ours

Published 19/06/2015 | 02:30

Minister Kathleen Lynch and Minister Leo Varadkar, pictured with under six year old children Isabella Heapes age 3 and Kiya O’Connor age 4 from Macken Street, Dublin at the launch of the online registration system for the new Free GP Care for Children Under 6 service
Minister Kathleen Lynch and Minister Leo Varadkar, pictured with under six year old children Isabella Heapes age 3 and Kiya O’Connor age 4 from Macken Street, Dublin at the launch of the online registration system for the new Free GP Care for Children Under 6 service

Free GP care for children under six is one of those things that seems like a good idea until you look a little closer. Everyone likes the idea of something for free. But of course it's not free, is it? It will have to be paid for out of the public purse. So that's the first thing that's wrong with it. It's not what it says it is.

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Everything that has to be paid for out of the public purse means something else doesn't get paid for. That's simply the way these things work. Choices have to be made. Money spent on this scheme means less money spent on care for the elderly or those suffering from mental health problems. These groups are much more likely to need medical care than a three or four-year-old.

Ireland is still very heavily in debt. A big proportion of the money the State raises in tax has to go each year towards meeting the interest payments on our national debt, never mind paying off the loan itself.

So anything extra the State spends puts off the day when we'll have our debt down to manageable proportions.

At the moment the Government is gambling on interest rates remaining low and economic growth coming to the rescue. This is why it feels free to return to the days of giveaway Budgets. But it is a big gamble. It is gambling with our economic future in order to get re-elected next autumn or next spring or whenever it decides to call the next election.

Ireland is a country that seems to learn nothing from its past, or else learns all the wrong lessons. The economic crisis ought to have cured us of pork-barrel politics. Clearly it hasn't done that at all.

This 'free' GP care for the under sixes is a classic case of pork barrel politics and the Government wouldn't be offering it to us if they believed that we, the voters, had finally turned our backs on politics of this kind. Clearly we haven't.

If we had truly learnt the lessons of the economic crash, we should completely reject politics of this kind. We should automatically reject any political party that engages in auction politics of this sort out of fear that we will restart the whole process that landed us in an economic mess we haven't really climbed out of yet.

At the very least, we ought to have a major political party on offer that rejects politics of this type out of hand. Fianna Fáil, which was a master at politics of this sort, clearly hasn't given up the old ways. Its criticisms of the Government scheme are mostly of a technical sort.

Fine Gael's chief regret has always been that it was never in Government long enough to engage in pork-barrel politics on a grand enough scale. Actually, that's a little unfair because Alan Dukes, for example, showed responsible leadership when he didn't oppose the needed spending cuts imposed by Ray MacSharry in the late 1980s and early 1990s.

But under Enda Kenny, Fine Gael has shown a great fondness for pork-barrel politics. It did so when he led the opposition and it is doing so now. Only the troika and hard economic realities previously stopped him from indulging himself.

Indeed, the reason he can now return to pork-barrel politics at all, and the reason why Fine Gael now seems like the natural party of Government and not Fianna Fáil, is because Fianna Fáil's past fondness for auction politics caught up with it with a vengeance. There is every chance the same thing will happen in time to Fine Gael.

The free GP care for the under sixes also shows that this Government, and indeed Irish politics generally, has a great fondness for State-funded programmes.

Fine Gael, and Labour to a lesser extent, know that private businesses do a better job growing the economy than anything the State can manage, but apart from that they have little time for anything the private sector can offer.

There is a particular distaste for the idea that anyone would make a profit out of healthcare. This distaste exists even if it can be shown that the private sector can provide healthcare services better, and for lower overall cost than the State.

This distaste for private health-care seems to have infected Fine Gael as well, hence the ambition of the Government to eventually roll out 'free' GP care for everyone.

This would be almost certainly a disaster.

As it is, about 40pc of the population holds a Medical Card. This entitles them to (notionally) free medical care with a GP.

Some of those entitled to a Medical Card are sick and so have good cause to visit their GP frequently. Many others hold a Medical Card because their income falls below a certain level.

This second category is more likely to visit their GP than those who do not have a Medical Card. This stands to reason. If a service to free to the customer, why not go to your GP more often?

If we offer free GP care across the board, demand for their services will increase. That means waiting times for GP services will inevitably grow, just like in the public healthcare system generally, and the amount of time they can give to each patient, including those especially in need of care, will diminish.

A GP friend tells me that in the UK it is increasingly the case that patients do not get a same-day appointment when they ring their local GP. They can be waiting for days before they get to see him or her.

This would be inevitable. To repeat, if you make something notionally free you only increase demand for it. Doctors end up having to see lots of people who aren't really sick.

It's a great pity that more than 60pc of GPs have already signed up to the new scheme. They probably felt obliged to because if a neighbouring practice signed up and they didn't, they might lose patients.

What must be clear to most GPs, however, is that to an ever increasing extent they are being turned into de facto State employees.

The Medical Card system has already gone a long way towards that with this latest scheme being another step in that direction. If GP care becomes entirely free that will be that, except that GPs will be paid a lot less for their pensions, etc, than actual State employees.

It's a win-win for the State, therefore, a lose-lose for GPs, but actually a lose-lose for the taxpayer also.

This is because the public is currently happy for the most part with the service our GPs provide. If GPs are effectively absorbed completely by the HSE, this will change rapidly because GPs will then be entangled in all the problems that beset the HSE.

So for their own sake, and the sake of the public, GPs need to start fighting back much more effectively against their absorption into the public health system by the State and against the pork-barrel politics this scheme represents.

Irish Independent

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