Heart Beat:"Will you walk into my parlour? Said the spider to the fly." The election is over, results are in and the permutations and combinations of feasible new governments are being discussed.
Governor Huey Long of Louisiana, aka the Kingfish said that "the time has come for all good men to rise above principle". Does that resonate here?
Many would have you believe so, particularly in the matter of the possible coalition of Labour and Fianna Fail. Exactly why this belief is held is beyond me. I have heard Pat Rabbitte say repeatedly that this is something he will not do on principle. I feel him to be a man of character unlikely to be swayed by the baubles of office in such an administration;
"Oh no, no, said the little fly
To ask me is in vain
For who goes up your winding stair
Can ne'er come down again."
In any case there is no point in badgering these folk. They and their parties will barter and negotiate happily over the next few weeks, as we all wait with semi-baited breath. It has even been mooted that the Minister for Trolleys be returned to her post, "to complete her reform of the health services".
Reform is not the word I would have chosen, but time to deal with that if it happens. As regards that particular possibility, the Taoiseach would be wise to remember the aphorism attributed to Euripides, "those whom the Gods wish to destroy, they first make mad".
Thinking of lady politicians and health matters, I noted a speech last week by Sen Hilary Clinton at George Washington University in which she outlined a plan to reduce healthcare costs, yet paradoxically improve services. This Holy Grail sounds familiar and of course the Senator is no stranger to health matters having masterminded the 1994 Clinton Health Plan in the US, which unsurprisingly sank without trace.
This recent speech seemed to be more about cost containment than service delivery.
She claimed that 30 per cent of the rise in healthcare spending was due to increasing obesity over the last 20 years. Another 60 per cent of healthcare spend is on chronic disease; diabetes, asthma, cardiac failure and so on. The omission of cancer therapy with its huge and increasing costs, from this list, surprises me. It may simply be an oversight.
In all it was extremely simplistic and could have been drawn from health economist Will Rogers, "people are a lot sicker than they used to be. When they got sick before, they died; now they live sick". That costs money.
She was condemnatory of the huge costs of administration and the amount of money wasted through inefficiency. She pointed out that this overspend and waste has "nothing to do with delivering good healthcare". Amen, to that, I say.
There was much more that was interesting, including postulated further reform of medical malpractice legislation, to break free from the shackles of defensive medicine and its attendant enormous costs. She was also forthright in expressing concerns about the cost of prescription drugs, a concern echoed here in the last few days by the chief executive of Elan pharmaceuticals who said that the industry would have to be proactive in cost containment, or face the real prospect of killing the goose.
This latter stricture also applies to medical equipment, appliances and devices such as pacemakers, stents, joint prostheses, heart valves and countless other items. An artificial heart valve, widely used here, was seven times more expensive here than in Egypt.
We have to buy these items and drugs, but surely it should be possible to centrally negotiate prices and thus buy cheaper in quantity. I am aware that this might limit physician choice, but this would be a small price, compared to the inability to deliver any service to some.
In any event there could be an agreed appeal system to facilitate buying outside the approved list. The caveat here is that such appeals must be undertaken quickly, as problem cases occur around the clock.
In many cases, it would be unnecessary to select items or drugs and thus interfere with "the workings of the free market", a grail in itself, to some. We would say that we will not pay more than X euro for a range of items, and anybody coming in lower with an approved product is welcome in the market. All this would require the exercise of common sense, reason and cooperation among all arms of the service and I know this is a colossal ask.
I agree with Senator Clinton's assertion that the elimination of waste and over administration and rationalisation of services will free monies to provide the services everybody wants, a health system whose gateway is necessity.
Lastly to the negotiators of our future happiness, I return to the rhyme:
"And now dear little children, who may this story, read
To idle silly flattering words, I pray you ne'er give heed,
Unto an evil counsellor, close heart and ear and eye
And take a lesson from this tale of the Spider and the Fly"
P.S. For God's sake don't tell the ruling elves that they need cleaning up or straightening out. They seem a bit sensitive about that!
P.P.S. If you don't believe me, ask the PDs.
Maurice Neligan is a cardiac surgeon.