I SERIOUSLY debated cancelling my private health insurance recently. When the renewal notice arrived in the post I did a double-take at the size of the bill, cross-checked the increase -- which was almost 20pc -- and gulped.
Value for money it wasn't. In fact, it struck me as a hefty charge to cover what I regarded as an insubstantial risk. You can never discount the danger, but I'm still reasonably young and healthy (touch wood).
Obviously I knew I'd be taking a chance if I withdrew my subscription -- but wasn't the State my buffer? If I fell seriously ill, I'd be entitled to treatment. I might not get the doctor of my choice, but selecting one in the first place is a confusing business.
In the end, I kept my policy but scaled it down to a more basic arrangement. Fear was the reason I paid up; not dread of illness but of trusting to the public system. I was afraid of waiting lists, delays and being fobbed off.
I don't care about private rooms and five-star facilities. Anyway, a private plan is no guarantee of a room if none is available. One senior citizen undergoing cancer treatment told me he pays €3,000 annually in insurance, has had private health care all his adult life, but has only occupied a private bed once or twice since his diagnosis.
But I would like speedy access to consultants and treatment if I was struck down. Do I believe the public system would automatically supply that? Unfortunately, no.
Insurance is about risk transfer -- someone else accepts the risk. So that's what I did: I bought myself certainty and peace of mind for another year.
But what an indictment it is on a country if its people cannot bring themselves to rely on the State. Despite all workers paying health levies, and a sizeable proportion of our taxes funding the health service, half of us feel required to make additional provision. We take out private policies with one of three competing companies. People on quite modest incomes scrape together the money because, like me, they do not have faith in our public health structure's ability to meet their needs quickly. Private plans are not regarded as a luxury but as a necessity.
Increasingly, however, private health care is becoming unaffordable. The triple blow of upward pressure on premiums, increasing taxation, and workers losing their jobs or having their incomes trimmed has already led to cancelled subscriptions -- and will precipitate more.
This week's announcement from VHI -- the largest private healthcare provider -- that premiums are going up by 8pc from February 1, on top of a 23pc increase a year ago, will cause its 1.4 million customers to ask themselves the same question I did. Do I dare to let my health plan lapse? I expect to have the same discussion with myself again when my policy is due for renewal towards the year-end. Only Pollyanna could fail to see further price rises on the horizon.
Yet a quandary exists in that those who decide the private safety net is a luxury they can surrender will add pressure to the public system.
Healthcare is a running sore here, although it is also a dilemma for many countries -- it will define Obama's first term in office, while governments in Britain regularly fall over NHS rows. Cuba is often cited as an example of an excellent public healthcare system, but in Cuba a taxi driver earns more than a doctor because the taxi driver has access to tourist dollars. Not ideal there either, then.
Insurers tend to blame our relentlessly regular premium hikes on the community rating levy, whereby everyone pays the same regardless of age. But what really gets customers hot under the collar is consultants' fees: we suspect we are cash cows to them.
I'll never forget the dicky-bowed consultant in a Dublin hospital who could find nothing wrong with me, after I presented as an emergency. As he discharged me, he read my address from my notes -- from which he gauged an ability to pay. And at once he said if I'd like to make an appointment to see him privately, he'd run some tests. No wonder healthcare in Ireland is an open sore.
LAST year Fine Gael unveiled its health plan, based on the Dutch model: obligatory universal private health insurance for all citizens. While not without flaws, it has to be worth considering. Other parties, including Labour, also have alternatives.
Under the Dutch scheme everyone pays a flat rate, obligatory health tax, with subsidised premiums for low-income households. All citizens are in the same boat regarding essential procedures, but can pay extra for add-ons.
It is another tax, however, and we all know how we feel about taxation here. Especially as our universal levy would be high, considering the small size of our population. I'd prefer to pay more and have a top notch public healthcare system. But there is a convoluted relationship between taxation and services in Ireland -- one does not lead straight to the other.
The key question is this: are we convinced our political masters would organise enhanced healthcare arrangements if we supplied them with more money? We live in a country where our leaders don't even see to it that roads are gritted adequately in winter. So we can take that as a no. Meanwhile, you have to be in the whole of your health to be ill here.