Fine Gael recently launched its new Health policy called FairCare. The party claims its proposals ‘represent the most fundamental reform of the health system since the formation of the State.’ The new policy involves a massive surge in privatisation and ‘marketisation’ of health care. It essentially hands the running of our Health Service to private insurance companies.
“At the moment Ireland has two administrative systems for health – one public (the HSE) and one private (the insurance companies) …Over time these two systems will become one, run by the insurance companies.” ( FairCare, page 7.)
The document is replete with the ideology and the terminology of market capitalism. Thus ‘health providers will be paid for how many patients they treat. Patients will be a source of “income” rather than a “cost”, just as they are in private hospitals today.’(page7) ‘A Fine Gael Government will encourage insurance companies from other European countries, who have experience of implementing social insurance models, to enter the Irish market.’(Page 8 )
While claiming that a ‘not for profit’ ethos will inform their system, in reality the Fine Gael blueprint brings cut throat competition for profit into the system. Private – and very much ‘for profit’ – insurance companies would control the entire hospital budget. Public hospitals would be turned into autonomous units which would have to compete with other hospitals, including private hospitals, for ‘business’ from these companies.
Just like the banks and developers whose activities have crashed the Irish economy, private insurance companies are driven to maximise profits for their shareholders. Fine Gael would give them inordinate power over patient care in Ireland. In order to squeeze more profit out of the system they would put relentless pressure on hospitals and those who provide care, to cut costs.
Hospitals and their doctors and nurses and administrative staff would be forced into a vicious competition driven by the commercial imperatives of the insurance companies. The drive for cost cutting to secure private profit would inevitably distort what should be the basic criteria for proper health care which is basic human compassion and wellbeing of the patient.
It is false to suggest that such a system puts patients first. In fact the patients would be caught in a conflict between their direct carers, whose interest is to do the very best for them and the insurance bosses, who want to cut costs.
In the Fine Gael plan, there would also be a big extension in privatisation in primary care. The new primary care centres envisaged would be built by ‘the private sector’, including, presumably, speculators and developers, with tax incentives from the State. Services such as Xray, ultrasound, Endoscopy, Physio, CT and MRI scanning would be provided, essentially moving from public hospitals to private control.
Fine Gael says that its plan relies heavily on the Dutch model introduced in 2006. The Dutch Health System is far from a controversy free area. The level of hygiene in hospitals is a big issue as is the quality of the food for patients. The insurance companies are squeezing staff costs with the result that there is a shortage.
In Holland health insurance is not cheap. Premia are currently over €1,000 for an individual with the average family paying over €4,000 per year. Under the Fine Gael plan the 16% of taxpayers in this country who put their trust in the public health system without private insurance, would be forced to take out the private insurance which would involve a considerable economic burden.
The Irish Health Service needs massive transformation but the choice must not be between Fianna Fail and Fine Gael privatisation. The real way forward is hinted at in a column in yesterday’s Irish Daily Mail by John O’Keefe, the Dean of Law at Dublin Business School.
Having had two of his children treated recently in the Children’s Hospital in Crumlin, he pays a marvellous tribute to the staff there, support, nursing and medical. ‘Let’s look to this hospital and acknowledge how the staff there work each and every day… They get it right because they do the basics superbly well and there are no weak links in the chain – from cleaner to surgeon or from porter to CEO..’
He goes on, ‘Here you have the template for not just the recovery of the HSE, but the recovery of the country as a whole.’
I have long argued that the key to the transformation to our Health Services is to bring the frontline staff to the very heart of a democratic structure governing the system as a whole and its individuals components such as hospitals . With their commitment and sufficient resources we can create a one tier public Health Service for all our people. That is the alternative to the profit seeking privatisation philosophy of Fianna Fail and Fine Gael.
Originally printed in Daily Mail Column on 6th of May, 2009