Madam, - It is regrettable that a senior member of the medical profession has characterised a group as patients as "cuckoos in the nest" in the public press. Professor Bury's use of the term (Letters, Nov 5th) is also without any reasonable foundation.
The vast majority of privately insured patients are entitled to treatment in public hospitals as public patients at little or no cost. When they attend privately, substantially greater payment is made through their insurance companies. They are to a large extent paying twice; firstly through the taxation system and secondly through their insurance premiums. In all the circumstances, the term "cuckoos in the nest" is both unreasonable and offensive to these patients, myself and my family included.
Prof Bury suggests that this "cuckoo in the nest arrangement should be dispensed with immediately, and without cost to the public purse". As a hospital consultant whose salary is abated by 20 per cent as part of this arrangement, I would like to point out that if the arrangement stops, the abatement must cease. Therefore there has to be a cost to the public purse.
Prof Bury goes on to suggest that private insurers have "responsibilities to their clients" that could be fulfilled by "arranging their own hospital facilities". This is tendentious nonsense. Health insurers have no more responsibility to provide hospitals than motor insurers have to provide car repair facilities. They undertake only to indemnify their clients against costs incurred. Similarly, it is ridiculous to state that insurers are "usurping public facilities" when their clients who have paid for these facilities through taxation make use of them. The insurers are not involved in deciding where their subscribers seek treatment.
The provision of totally separate comprehensive public and private health systems as proposed by Prof Bury is to my mind clearly the worst possible path to take. It would be extremely expensive. Most people currently holding private insurance would not be able to afford the necessary premiums. Many others would live so far from the one or two comprehensive private centres that would be economically viable that they would see little point in paying the premiums. The demand on the public system would be increased not reduced.
Prof Bury suggests that this transformation could be achieved in six months. It would be difficult to achieve in six years if anyone was brave or foolish enough to attempt it.
Adequate total bed capacity, both public and private, properly managed particularly in relation to delayed discharges, is what is needed to solve the back-up of patients in A&E departments. - Yours, etc,
Dr TOM HOGAN, College Grove, Dublin 15.