Eilish O'Regan: 'Why the blueprint for ending two-tier hospitals got such a tepid response'
Ending our two-tier hospital system, where insured patients can jump the queue, may be one of the nation's big ambitions.
So why did the report on how this inequitable set-up can be dismantled meet with such a tepid response yesterday?
The expert group led by Dr Donal de Buitléir, tasked with drawing up a report on removing private practice from public hospitals and alleviating waiting lists, says the reform should start from now.
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It is admirable for its conviction and lack of cop-out.
All newly recruited hospital consultants should be required to only work in public hospitals.
Their salary, after a 30pc pay anomaly is fixed, would rise to €213,274 a year in time and they would forego private practice income which could be around €500,000 annually.
Instead they will devote their career to working in a public hospital and not receive a private fee from any patient.
Existing consultants would get a payment in return for switching.
Not surprisingly, there was no rush of enthusiasm from doctors' groups yesterday.
The reality is unions have been working for years now in the opposite direction.
They have increased the number of consultants who can change their contracts in favour of treating private patients in their public hospital or off site in a private hospital. Only 169 of more than 2,500 consultants are on public-only contracts.
The report proposes a new "Sláintecare consultant contract" for doctors who would only treat public patients.
It is vague on how much consultants would be paid in compensation to leave their private practice behind.
But based on past experience this would add hundreds of millions to the cost of reforms.
Public hospitals would lose more than €500m in income from private health insurance for treating fee-paying patients and this would come from the Exchequer. The report points to savings which could subsidise this, such as having to fund less tax relief for health insurance. But it also acknowledges extra tax would have to be levied on the public.
The public would need to be convinced of an improved health service before buying the need for more taxes and believe it would not go down some black hole.
Public hospitals would also need investment to absorb the extra public patients treated and this would add around €40m a year to State funding.
The report does not contain any analysis of the capacity of private hospitals to cope with increase in business from private patients.
The Private Hospitals Association yesterday welcomed the report and called for a planned and phased implementation of the policy change over a pre-agreed time period.
It is significant that private health insurance companies were silent on the report yesterday, given its implications for their business.
It envisages there will be an exodus of around 800,000 people from health insurance if people are convinced they would get timely public care.
That is bad news for the industry which would be mostly left with older subscribers, who are most costly. Premiums from younger healthier people would dramatically fall.
Subscribers, including older people on fixed incomes, could end up paying higher premiums, which could be up to a third more expensive.
Much will depend on the next steps from the Government, which cannot afford to disappoint the public with another health promise that turns to dust.
If nothing else, the report has set the Government a challenge it cannot walk away from.