Fourthwrite .......................Issue No. 11

Maintaining our good health  

 by Patricia Campbell

Health care in Ireland, north and south, continues to be a major issue. In a society that claims to accept the principle that everyone should have a reasonable standard of care, we are witnessing the continuing implementation of market principles to health care and the ongoing closure of hospitals? The recent sanctioning by the Republic’s Health Minister, Micheal Martin, for an increase in subscriptions for VHI members has serious implications for the delivery of health care. In addition to an increase of charges for the state owned lucrative insurance company, the minister confirmed that the government is to introduce the controversial ‘risk equalisation scheme’.  In response to the Finance Minister’s order for cuts in public spending,  Michael Martin has also introduced a slowdown in health-care staff recruitment and a raised ceiling for drug refunds. It is reported that the financial plight of the health boards and hospitals in the Republic is deteriorating, with little prospect now of additional state funds to bail them out. 

Meantime in the north, Public/ Private Partnerships (PPPs) is being introduced into our grossly under-funded health service leading to an increasing emphasis on privatising health care. Along side this shift goes the direct burden of health care costs on to the individual. Patients waiting on trolleys and unacceptable waiting lists are now commonplace in the health care systems and are one manifestation of rationing within health care. Private health insurance is a growth industry. Many doctors make a tidy living through private practice and pharmaceutical companies are worth billions on the stock exchange. It would appear that far from shaping a radical plan for delivering health care, containing costs of the health services are instead much higher on the political agendas of those politicians with responsibility for making and implementing policy. This plan is far from promoting equality of opportunity and eradicating discrimination.

Increasing demand for health care and escalating costs of providing health care gives rise to the argument that health care must be rationed. In reality, there is less spent on health services in Ireland, (north and south of the border) than any other country in the western world. The money is there; it is just not being channelled into health care. It is important to note that in the competition for resources the losers will always be those whose power in society is most limited, i.e. the old and frail, those with learning disabilities and the disadvantaged. The health policies of ‘Thatcherism’ remain in the ascendancy, as do those that have been influenced by the ideologies of political liberalism, monetarism and free market economics. All advocating a smaller role for the state in economic and social affairs.

Privatisation is a covert strategy for reductions in state provision. It proceeds on a purely cost-driven basis thus reduces health care to a cost counting exercise. The move from ‘collectivist’ approaches, which are best seen as a role for the state to health care is becoming more evident as policies are becoming more ‘individualist’. The latter approach fosters notions of individual responsibility and assumes that individuals can afford to choose health and buy health care in situations where the state does not provide or purchase. It must be argued however, that this approach breeds inequality and grinds down those who are not in positions of power or in a position to counter inequalities because they lack resources, power and influence. The decision by the Health Minister in the Republic to introduce an equalisation scheme into VHI has major implications. There will be a knock on effect, as the example of the U.S.A. indicates, that the operation of such a market/private insurance based system of health care has traditionally raised a number of concerns regarding inequalities and inefficiencies. More fundamentally the issues which concern groups whom the insurance industry will effectively label as the  ‘bad risks of an industrial economy’.

The classic bad risks for health care insurance will no doubt include the elderly, the disabled, the chronically ill and a whole host of others, which the lucrative insurance companies would term the, ‘undesirables’. The search for excuses not to treat people will go on, hence decisions are made on who gets to live well and who suffers or dies. What will become of those who can not afford V.H.I insurance? Will they be denied appropriate treatment or forced on to the free market. At the end of the day, there is little denying that underlying all of this is the basic inequality of our society. The major determinant in health provision will remain based on how rich you are. Those with better housing and education will make better use of the health service, they will have the resources and finance to by-pass the waiting lists when they need to and access better long-term care when they are old. Power is taken from people and a growing significance is placed on profit making organisations. With the introduction of PPPs in our health service north of the border, profit makers will claim to be ‘our glittering new friends in business’.

Apart from serious concerns raised by a number of organisations regarding the implications of PPPs introduction, the unions argue it is the promotion of the financial interests of the private sector and it is an attack on the fundamental values of public services. This does not augur well for  the future. Long waiting lists for treatment continue and many will tragically die prematurely or be parted from their life savings due to unavoidable misfortune. Failure to provide such care should be a matter of concern to us all. Every citizen should be entitled to use a state funded comprehensive health care service, which is free of market forces and for which entitlements are not limited, by our social and economic position in society. Put simply - why should the right to health care remain an area of controversy and conflict?