As always, it's the simple question that stops you in your tracks. At yesterday's conference, "Health Inequalities and Poverty", hosted by the Society of St Vincent de Paul, there was a fair bit of plain speaking but there was also a fair bit of community worker-speak: resource people and facilitators interfacing with the health system and such like.

Then came the simple question. Earlier we had heard from John Monaghan, who chairs the SVP's national social policy committee, about a young woman who visited a hospital with severe abdominal pain. She was told she would have to wait six weeks for a scan. However, if she could pay £250 she could have it immediately.

The simple question came from SVP member Liam O'Dwyer. If the hospital was able to give this young woman a scan immediately on production of £250, doesn't that mean that the hospital did, in fact, have the capacity to give her a scan immediately?

Let's go through it. Here are some reasons why a hospital might not be able to give a person a scan immediately:

There's a queue for the machine and it takes six weeks to get to the end of it; we cannot afford a second machine to eliminate waiting times; we haven't got enough nurses, doctors, administrative staff etc. to enable us to do scans immediately; and so on and on.

But if you pay us £250 we'll give you a scan immediately.

So the question arises: is there a queue or isn't there? Are there enough nurses, doctors, administrative staff etc. or aren't there? And so on.

And the question that arises from that is: in whose interest is the health service being operated? Is it being operated in the interest of public patients? What about the young fellow, only four years of age, who had to wait for a year for an appointment with an ear specialist?

"While waiting, his preventable ear condition worsened to the point where he developed a speech problem," we were told. "He is now on a waiting list for speech therapy."

Is the health system being operated in his interest?

What about the woman in her 70s in Dun Laoghaire, living alone with gangrene in both feet, who was told she would have to wait five weeks for a hospital bed? In the meantime, local SVP members helped her get dressed and get in and out of bed. Her doctor, who was extremely frustrated about the whole thing, told her to take a taxi to the outpatients department and just sit there until the hospital admitted her. She wouldn't do that.

So the SVP decided to get involved and, said John Monaghan, "on intervention from the SVP with an offer to pay, a bed was made available immediately."

Oh. So that means there was a bed available all the time, does it?

Let's go on being simple. When the health system says, we don't have the capacity to treat you for six weeks or six months or two years, is it really saying something like: "We have the capacity to treat you straight away but we are keeping it to one side for people who can pay. If you can't pay, tough."?

Does this give us a clue as to why, as Audry Deane, the SVP's social policy officer, pointed out, 11 per cent of the lowest-income families have private health insurance?

Of course it does. Three quarters of health insurance members, according to an ESRI report, see it as a way to get quick treatment.

Putting facilities aside for private patients must mean - if I can be pardoned for being simple about it - withholding facilities from public patients.

That in turn means more public patients feel obliged to become private patients. Which means still fewer facilities and still longer waiting lists for public patients.

Wouldn't it be better if we could all get a decent health service without having to be in the VHI or BUPA? Now, the people who run the VHI and BUPA are very nice people in my experience but I wish I could depend on the public health system so much that I didn't feel I had to buy health insurance from them. I bet I'm not alone.

And here's the really galling thing about it: that ESRI report found that a 25 per cent rise in premiums would be needed if the public hospitals were to be fully reimbursed for their services to private patients.

The fact is, the parents of that child who waited a year for an appointment with an ear specialist pay taxes which subsidise the treatment of people who have insurance - treatment provided with the "capacity" which was not made available to that child.

It might bring some justice into the situation if all private medicine was delivered in entirely separate private clinics with their own fulltime staff - including their own consultants - and if there was major investment in public hospital services to make public healthcare a viable reality for all of us.

Or is that too simple?

pomorain@irish-times.ie