Why do we suppose that governments can run health services when they can't run airlines, railways, buses, telecommunications or any other major enterprise? Wherever government runs anything you see political interference, low pay, lack of accountability and incompetence. Given that central truth, it is remarkable that our health service is as good as it is.
There is a reason for this: it is the personally counter-productive dedication of those who work in hospitals. By their vocations, they tolerate the intolerable and accept the unacceptable. And because they have a peculiar culture of stoic endurance, almost impenetrable to outsiders, they do not complain; indeed, I suspect that those parts of their brains able to speak for the rest of their minds are removed at medical school. If a few complaint-cells manage to escape excision, they are silenced the medical ethos. The doctor who draws attention to herself is deemed to be behaving unprofessionally. Doctors are a secret sect, like the Druse, bound by oaths of silence.
Rising early
I know a few consultants. One is up every morning at 4.45 to go to work. The others are sluggards, often lying in bed as late as 5.30 a.m. It is, of course, a scandal that these creatures are drawing public money, especially since they often put in only 14- or 15hour days, every day of the week. Wake up at seven on a Sunday morning in your hospital bed, and the haggard creature shimmering beside you is your consultant, who might well have had has much as five hours sleep.
Doctors have themselves to blame. They have the public relations skills of the North Korean politburo. Ask anyone who has never been in a hospital bed what consultants do, and they will reply: Play golf. A tiny few do. Most don't. They are the most conscientious, underpaid and overworked group in Irish life, yet they have proved incapable of dismantling the caricature of the consultant wending his carefree way around the 18 holes en route to a huge gin and tonic at the 19th.
The truth is, people don't like doctors. We all know that one day a doctor will look us in the eye, with a terrible truth in his heart. So people want to believe the worst of doctors, and by God, it's not difficult. Is the sound of laughter the sign of a group of consultants approaching? Has anyone ever left a hospital with reports of what hilarious, fun-loving characters the doctors there were?
And is that surprising? It's an armour-plated sense of humour which can survive the seven years of medical school, with lectures and practicals all day, and hours of study every single night of their student lives. Or the 18-hour days in casualty. Or knowing that almost every week of your working life you'll be talking to someone really nice who you are certain will die very soon, causing unbearable grief and suffering.
Head of police
So there we are: on the one hand a hospital consultant, on the other that fun-loving cheeky chappy, the North Korean head of police. Who do we ask for tea? Step this way, Chief Kim Il Thumbscrew, and tell me: one lump or two?
Additionally, these unfortunate, unloved doctors are burdened with the dead weight of being run by central government; and as we know, governments can't run taps. Worse, and perfectly mystifyingly, we have created a political culture which expects this service to be free and instantly available at the point of supply. Nothing else in life is free, yet for some reason we assume that medical care, involving enormously skilled people, and the most capital intensive equipment anywhere in any society, should be provided without charge. A pint of Guinness? You pay for it. A new wall? You pay for it. A haircut? You pay for it. A full body scan requiring a multi-million pound machine and a highly skilled team of radiologists and radiographers? You expect it free.
A free service is an abused service, as any visit to a hospital casualty ward will show you (the £20 admission fee being a fiction). Yes, of course, there is something morally grotesque about a pensioner being denied treatment for months because she can't afford to go private. On the other hand, every single health service which has attempted to provide free and immediate treatment has buckled under the weight of expectation and casual abuse its very freeness invites.
Medical cards
And in addition, we have added our own twist to a worldwide tale: the iniquitous medical card scheme, Tammany Hall meets the Hypocratic Oath. Over 90 pet cent of the population of Donegal have medical cards, given them as bribes by politicians. Donegal can't provide instant medical service, free of charge, to that many people. We have created an unworkable system; and when it doesn't work, we blame the honest souls who are breaking themselves trying to work it.
Let government farm out management of hospitals to private enterprise. Pay hospital managers and consultants huge amounts of money to do a good job. Sack them if they don't. Abolish medical cards and introduce a new means-tested system, freed of manipulation by politicians. Insist on universal health insurance and universal health swipe-chargecards, so we know who's getting what. As a disincentive against frivolous abuse, everyone, saving the chronically sick, but including pensioners - many of our richest citizens are pensioners - should be charged at least a nominal fee on their swipecard at the point of supply. Health needs wealth. It's time we faced up to that truth.