ANALYSIS: Voters must not only choose between the parties' contrasting health policies but also judge whether the parties will fund them. The parties' arithmetic may prove irrelevant because the recent deterioration in the public finances suggests that no manifesto has a realistic starting point.
The failure of the Department of Finance to anticipate the full effect of tax cuts has eroded the tax base to a greater than anticipated degree. The Government's giveaway to Special Savings Incentive Scheme savers could have funded free GP care. Voters will have to assess the depth of the parties' commitment to health and their eventual willingness (whatever they say) to raise taxes to fund it.
Implementing the 10-year national health strategy would increase health spending to over 12 per cent of GNP. Although the Government boasts that existing public and private health spending is above the EU average at over 9 per cent of GNP, the health system remains in crisis.
Given the deteriorating public finances, to increase health spending to 12 per cent of GNP will either require that other areas of public spending reduce their GNP share, that the next Government borrows for current spending, or that taxes rise as a share of GNP. No party is proposing increased taxes, apart from Labour in a marginal way.
There is a good case for raising taxation to fund healthcare, especially if it is an earmarked tax, like a universal health insurance premium. The recent British tax-for-health Budget was the most popular for 20 years.
Taxes account for 34% of Irish GDP, compared to an EU average of 47%. Three-quarters of voters said last year they would sacrifice tax cuts for a better health service.
Fianna Fáil, the PDs and Labour have promised to fund the health strategy's capital requirements of €5 billion over the next five years. Fine Gael would invest only €1.77 billion because it judges that the strategy cannot be delivered as fast as the other parties believe.
On current health spending, it is impossible to contrast the parties' commitments because they calculate differently.
Plans for current spending on all programmes, including health, show little divides FF, FG and the PDs while Labour would spend most.