Seven-year-old Theo McDonald, a medical card patient, was diagnosed with a squint at the age of nine months and eventually saw an ophthalmologist at the age of two. He was put on a waiting list for surgery and waited five years.
For a full year Theo's mother, Adrienne, went to the surgery of her GP, Dr Brendan O'Shea of Newbridge, Co Kildare, once every two weeks for a consultation, during which Dr O'Shea would get on the telephone to plead Theo's case.
Unfortunately, Theo did not get his surgery until he started school, which meant he was bullied and called "cross-eyed". He got off the school bus every day in tears. "Before he went to school, he had no idea there was anything wrong with him," says Adrienne. But Theo is a tough, outgoing character and seems to have bounced back, she adds. Theo's sister Zowie (12) has been told she needs braces, but will be 16 or 17 before she gets them. "It's cruel, but no one is going to die," says Adrienne.
If Theo had been a private patient, he would have seen the ophthalmologist between the age of one and two, and would have had his surgery within a month or two. Zowie would have her braces now if her mother could afford to pay privately.
Examples of the differences between public and private care abound. Michael (60), a VHI subscriber, found out several years ago that he needed a bypass. He was admitted to hospital as a private patient as soon as his angina pain became frequent. He was treated as an emergency and within a week had his bypass. He went back to work, starting several successful businesses and enjoying an excellent quality of life. At the same time as Michael was being diagnosed, Joe Walsh (60), a medical-card patient who lives alone in a one-room rural cottage, was also suffering from angina. He weeps as he recounts how he could not walk 500 yards without taking heart tablets and how he lived with the constant anxiety of knowing that without a bypass he would die. Joe lived like that for five years before he got his bypass. "I thought I was going to die. It was very lonely," he says.
Recently, he had his bypass and his quality of life has improved, but he has not got over the feeling of being a dispensable member of society. "I get depressed at night-time and cry at the films on TV. I couldn't get VHI because I was too sick to work. I could be dead now," he says.
Dr O'Shea, the Newbridge GP, says that the hospital structure contributes to delays. Junior doctors - some of whom cannot communicate effectively in English - tend to pass the buck on repeated clinic visits so that no decision is made until a patient eventually sees a consultant, he claims. In Australia, he points out, there are no junior doctors. There are consultants and doctors at GP level, all of whom are capable of making decisions. Nor are there waits for CAT and MRI scans, as there are here. Every local hospital has these facilities and so a GP who orders a scan can get the scans, bloods and other tests done within hours, rather than waiting weeks or months, as patients do in the Republic.
People rarely die due to waiting lists, but what does happen is that their quality of life is destroyed and they spend many years as invalids, when they could be living full lives and contributing to society. Or, like Theo, they endure bullying and tearful days at school for no reason other than inequality in the health service.