Sunday 17 December 2017

Disgraceful 'two-nations' system must be dismantled

Critics of James Reilly's UHI plan fail to see it's about fairness, justice and equality.

The average premium for health insurance is now €900 after tax. Thinkstock
The average premium for health insurance is now €900 after tax. Thinkstock
Jerome Reilly

Jerome Reilly

It is time to end the caste system in the provision of healthcare in Ireland. It is time to dismantle the fundamental abuse of human rights that lies at the heart of the current model.

That it has gone on for so long should be an affront to those who believe in basic principles of equity and fairness. It is morally indefensible that a cohort of people has faster access to better medical care because of how much they earn.

It is repugnant that access to medical care available to the chosen few is smooth and rapid not because of pressing medical need but because they have the ability to pay for blue chip private health insurance.

It is reprehensible that the Irish people have been forced to endure this 'two-nations' healthcare system for so long.

And it is a stain on our political class, and the brahmins of the medical profession, that they have kicked Health Minister James Reilly around the place and pilloried his efforts to bring basic equality to the health system.

Behind the painted smiles of the consultants lies that old truth that oligarchies protect themselves at all costs.

Survey after survey has shown that Ireland's consultant class are among the best-paid physicians in the world.

Survey after survey has shown that Irish people believe our medical class earn too much money. And the argument put forward by the critics of Dr Reilly, led by the medical profession, that his proposed system is unworkable, does not hold water.

It works in other countries. Why can't it work here?

That argument also presumes that our current system works well enough. That is manifestly untrue.

During the halcyon days of the Celtic Tiger spending on healthcare quadrupled at the same time that waiting lists soared and more and more people were dumped on trolleys in hospital corridors.

The elderly, without health insurance, were left effectively housebound waiting for hip replacements or for cataract surgery.

There has been some measurable progress. The time spent waiting for surgeries has reduced; the scandal of seriously ill patients forced to lie in hospital corridors has eased. But it is coming at a cost.

We are still left with a health system which is top-heavy with administrators and managers and a class of super-rich consultants.

Yesterday, it emerged that proposed health budget savings of some €200m, agreed under the Haddington Road deal on pay and productivity, will simply not happen this year.

And this is the system that is so cherished and so lauded by opponents of Universal Health Insurance (UHI)?

In his introduction to the white paper on UHI, The Path to Universal Healthcare, Dr Reilly sets out the central tenets of his proposals.

A single-tier system will deliver proactive, integrated care at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. And it will provide equal access to healthcare based on need rather than the ability to pay.

How can this be achieved?

The basic principles underlying UHI is a multi-payer system where all citizens can buy insurance from competing insurance companies.

All those on a medical card will have their insurance paid. Those on low and middle incomes will be subsidised by the State. Most of the money will come from general taxation. Public hospitals will remain in State ownership.

Yes it is aspirational, yes it is loftily ambitious. It took the Dutch some 19 years to bring in fully their version of universal healthcare.

Dr Reilly, despite facing intolerable opposition from within led by Minister for Public Expenditure and Reform Brendan Howlin, has given himself a tight deadline with the full introduction planned for 2019.

But it is worth aiming high. Universal Health Insurance is about fairness, equality and justice. It is astonishing that critics of the system can't grasp that essential truth.

Sunday Independent

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