Madam, – Norman Stewart’s bad-tempered rhetoric and his rejection of our suggestion that healthcare could be provided inexpensively and equitably to all citizens through an extension of the medical card system provided by mandatory health insurance seem to be based on several prejudices (December 11th).
He exhibits a hatred of Britain’s National Health Service (although Denmark, Finland, Italy, Spain, Greece and Portugal have similar systems); an even greater hatred of our own HSE (which, in fairness, has accepted that it must restore subsidiarity); an antipathy towards doctors in general; and, most of all, an utterly fallacious belief in a free market where private enterprise has the answer to every ill.
We are firmly on the side of our patients – all of them. What we advocate contains no personal advantage to any of us. Mr Stewart’s argumentum ad hominem is misplaced.
The scheme Mr Stewart advocates, where all patients have private insurance and are treated as private patients, is precisely the type of healthcare system that exists in the United States. That market-justice model has proved to be the world’s most expensive healthcare system and is among the least effective in OECD countries.
The US spends 17 per cent of its GDP on health, more than double what Britain spends, but it has consistently mediocre outcomes. US citizens die younger than British citizens and more of their babies die.
Mr Stewart might turn for enlightenment to that great Irish socialist George Bernard Shaw. Shaw shared Mr Stewart’s dislike of doctors, but his intelligence was greater than his prejudice. One hundred years ago, in his preface to The Doctor’s Dilemma, Shaw wrote: “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done.”
And that is precisely what Mr Stewart would do. Moreover, he would dismantle a health system based on not-for-profit public and voluntary hospitals, with strong community roots and Samaritan traditions, in favour of the god of competition and corporate transformation.
Shaw’s seminal ideas included the municipalising of Harley Street and the paying of doctors out of public funds. He got his way to a large extent.
Less than 40 years on, as Britain raised itself out of the devastation and ashes of the second World War, a truly visionary Labour government rewarded its torn and battered citizens with the most radical universal health system the world had seen. And while most European countries also developed systems of universal healthcare, consecutive Irish governments continued to burden our citizens with an unfair, divisive and ramshackle system that is now becoming strikingly similar to that of the US.
The challenge facing Ireland is to find a method that could rapidly amalgamate our two entirely different systems of hospital care, one tax-based with salaried providers and one based on private insurance with fee-per-item contractors, into an equitable and cohesive system in which primary care is also fully integrated and central.
We have offered a simple solution that could be implemented almost immediately. The system would be universal but would not be “free” (an idea that Mr Stewart seems to find particularly disagreeable). A substantial majority of citizens would pay for their medical cards through a mandatory insurance scheme: it is, in fact, a system of “universal health insurance”.
And, yes, we are from Limerick, a city where we witness, in our daily work, the hopeless effects of social exclusion and poverty. These are precisely the effects of the rampant free market so beloved of Mr Stewart. In the free market, the man, the woman, the child who falls behind is left behind: there is no safety net. Like practically everyone else in this progressive city, we want this to end, and to end quickly. Handing healthcare over to the insurance industry and to for-profit hospitals is not the answer.
The angry legions of elderly men and women who poured into Kildare Street after the Budget were not demanding private medical insurance, and with good reason. Wisdom comes with age. – Yours, etc,