Quality, accessible healthcare is what voters really want
This General Election demonstrates the gaping disconnect between the Irish people and our politicians. In polls, citizens repeatedly state that their primary concern is health - yet it is crime, 'fiscal space' and the make-up of the next government that dominate the campaign.
Scrutiny of the parties' manifestos throws some light on where they stand on health. What's most obvious from the Government parties is their abandonment of their flagship policy of universal health insurance from the 2011 election. The Labour Party no longer even mentions health insurance in its health policy, while Fine Gael kicks it into the distant green fields, having openly abandoned its 2011 plan for compulsory private health insurance.
Fine Gael, Labour, Sinn Féin and the Social Democrats all commit to introducing universal healthcare although Fine Gael and Labour fail to show how they now intend to achieve universal access - in particular how to get rid of two-tier access to hospital care. Fine Gael's manifesto promises to increase private health insurance coverage, which, in the absence of universal health insurance, implies continued unequal access for public and private patients.
Sinn Féin, the Social Democrats and the People Before Profit/Anti-Austerity Alliance clearly nail their colours to a tax-funded, universal health system, akin to the British NHS. Noticeably, Fianna Fáil and Renua make no commitment to universal access based on medical need, indicating their intent to maintain the current status quo, which privileges access to essential diagnosis and hospital treatment for those who can afford to pay privately.
Only Sinn Féin specifies how it will undo two-tier hospital care - by building up the public health system's capacity and investing in public hospitals. Sinn Féin says it would end private care in public hospitals and withdraw all tax reliefs for private health insurance within a term in government.
There is unanimity among all parties on the importance of delivering more healthcare through primary care: more GPs and practice nurses, better access to diagnostics and the management of chronic diseases, more care provided at home and in the community. However, there are differences between the parties in the extension of free GP care - Labour is still committed to universal free GP care, this time by 2021, Fianna Fáil and Sinn Féin would extend it on the basis of low income, while Fine Gael is no longer committed to universal free care.
There is consensus for some quick wins from most parties - issuing medical cards to 10,000 children who get Domiciliary Care Allowance who are currently without them, reducing drug costs, expanding free and subsidised dental coverage and the introduction of a sugar tax. They are all looking for more staff, more hospital and community services and a larger budget allocation. Obviously this is dependent on them having the revenue to do all this.
But credibility is an issue for all parties. Fine Gael and Labour's failure to deliver their two flagship projects - universal primary care and universal health insurance - makes it hard to believe any of their commitments this time round. All parties make commitments to tackle over-crowding in emergency departments, long waits for hospital treatment and therapies such as speech and language, but again, given the failure of Fianna Fáil, Fine Gael and Labour to deliver on these while in government, it's very hard to have faith in them now.
Fine Gael and Labour want to lower drug charges, charges they increased during these last five years in government. Fianna Fáil wants to abolish drug charges it introduced for medical card holders and increase the numbers of home-help hours it slashed while in government. Fianna Fáil is all for primary care - even though it oversaw the publication of the primary care strategy in 2001 that largely remained unimplemented when it left office 10 years later.
Sinn Féin is promising to abolish all drug charges and public hospital charges, pledging a system free at the point of delivery. It's the party with the most radical health policy in the run-up to this election. However, its credibility must also be questioned - its plan quite clearly states it would abolish all tax reliefs for private health insurance, even though Gerry Adams (wrongly) denied that this was its policy on his Sean O'Rourke radio interview last Thursday.
What will influence health policy in the next five to 10 years is the make-up of the next government. Will it maintain the status quo or progress universal access to high-quality care? The next Programme for Government will indicate the direction taken. However, if past form is a good gauge of future performance, then it's really the minister that matters in health.
A coalition is inevitable. Whoever holds the health ministry will yield most power to determine the critical path health will take in the years ahead. Ultimately it is their responsibility to reconnect Irish people and politicians by delivering a high-quality health system, accessible to all.