Heart Beat: I note with interest that the Minister for Health has not invoked the risk equalisation scheme among the medical insurers at this time. I read her candid exposition of why she had so decided. I applaud her for her forthrightness and indeed courage.
I personally think, as I have written, that competition is necessary for the proper functioning of this health insurance market and that risk equalisation made a mockery of it. Those who write about the large numbers of young and relatively healthy subscribers in Bupa and Vivas conveniently forget that for very many years these self-same people joined the VHI.
Then was the time to make preparations for the future. However, we all know that monopolies become complacent and client care becomes of secondary importance. I feel that the best thing that has ever happened to the VHI has been the introduction of competition.
I am sure that once the chimera of risk equalisation has been dispelled, VHI will respond energetically and constructively to the real world. I do have certain sympathy with it because if my memory serves me well, some years ago, its reserves were expropriated into the public purse. Once again in this country "mine and thine" had become blurred conceptions. This money belonged neither to the Government of the time nor to the VHI. It belonged to us, the subscribers.
Another health service conundrum resurfaced recently. I would welcome help from any quarter who can explain it simply to me, and thus allow me to avoid the conclusion that I may be sinking into senility. Basically it concerns the availability of private beds in public hospitals. Simple.
There are supposed to be at most 20 per cent private beds in each public hospital. Simple.
Some hospitals are apparently generating extra money by having 35-50 per cent beds occupied by private patients. This is apparently naughty but again a relatively simple concept.
The bloody consultants again are lining their pockets as usual. Revolting of course, but this is what you would expect. Simple.
So where is this problem I can't get my head around? Well, there are a couple of things really.
Firstly, is not everybody entitled to use the public health service? This right was bestowed on us all as a gimmick to buy an election in the not-too-distant past. The privilege is no longer free but it is relatively inexpensive. So how come this 20-80 per cent division into public-private, if everybody is entitled to be there anyway, riddle me that?
That's the easy bit. The next is more difficult and requires a deep working knowledge of higher mathematics. As we have noted, 20 per cent of beds in public hospitals are designated for private patients. However, according to the Minister and many other sources, around 50 per cent of the population are covered by private health insurance. To my simple mind, this would suggest that of every 100 patients admitted, say through the A&E department, 50 per cent are going to be private. To put it in a nutshell, if half the population are covered by private insurance and they are as entitled as anybody else to be in a public hospital, what is the problem?
Do we discriminate against the people who take out health insurance, those in effect who are doubly taxed, by rationing their access to the main public hospitals? The so-called private hospitals do not at present provide the all-inclusive cover of the public sector.
To complete the circle of absurdity, these insured folk are further discriminated against by finding the beds in the private hospitals full with public patients from the National Treatment Purchase Fund, which pays the private hospitals better than the medical insurers.
So why do patients insure themselves and their families? This is a good question and the answer is no longer readily apparent.
There is, however, an overall solution - make everybody private. Let the private sector take over from the shambles we now possess. These private hospitals must take the rough with the smooth, and not be seen as a pathway to riches for some entrepreneurs.
The State's role would be to license and inspect them to ensure that between them they deliver a totality of service and training. The State would also have a role to play in determining loci, with regard to the geographic provision of service. It won't come cheap, but it can hardly be as inefficient and costly as what we have now.
Maybe it is not too late to learn and then we could borrow the epitaph of Don Quixote for the Minister and her department - "Morir cuerdo, y vivis loco" translated as "to die in wisdom having lived in folly". Needless to say, I don't actually wish them dissolution. Maybe a long rest will suffice and, of course, we all know that the Dáil has just risen for its long-deserved break.
This gives hope to us all, for doesn't the Good Book say, "the wisdom of a learned man cometh by opportunity of leisure; and he that hath little business shall become wise" (Ecclesiastes ch.38, v.24).
I know, I know - they're not really on holidays. There are committee meetings, constituency work and countless other onerous tasks to be done.
Any citizen, who might have the temerity to suggest that three months vacation might seem a bit excessive, would certainly merit the malediction to begrudgers as a fatwa from the overworked members.
Maurice Neligan is a cardiac surgeon.