The main thrusts of Fine Gael's new policy document for the funding and structuring of the State's troubled health services are to be welcomed. It may not be politically insignificant, in terms of the next election, that they are largely reconcilable with the Labour Party's most recent policy proposals for radical changes in the manner of health service funding. These advocate a compulsory universal health insurance scheme for all so that persons may have equal access to essential care when this is required. There is a clear consensus in the country now that the two-tier system which has developed, without any announced government policies to aid or abet it, is unacceptable - even repugnant. Every citizen of the State must have a right of access to care when that care is needed, regardless of financial status and dependent solely upon medical need.
What Fine Gael may discover, if they are voted into Government at the next election, is that most of the devils that may beset them are in the details of what they propose rather than in their broad strategy. For instance, they may find that preventive health care is much easier to propose grandly than to implement effectively, and that their budgetary outlines may require significant revision. They may learn that, while the hospital consultants are publicly proposing that their number be increased very substantially, the proposals to create a new grade - enigmatically described as a "hospital specialist" - might meet with long-ingrained resistance from some influential consultants. Their proposal to convert hospitals into autonomous institutions may require the creation of formal statutory bodies to link those autonomous bodies with the community services whence their patients ultimately come.
The document promises that, within a year of taking office in Government, a White Paper will be published on health policy after extensive consultations - but it does not spell out with whom these consultations will be undertaken. It further promises that within the second year of their administration, their Government will pass a fundamental new Health Act which "will provide for specific and measurable strategic objectives to govern the resource allocation process for the next 10-year period with a mandatory review process built into the Act". For the first time, health care policy will have a statutory basis and, while it may prove a heavy burden on the Government in terms of delivery, the State's poor recent history of health care delivery requires such statutory accountability.
The need to change both the method of funding the health services and the structures which deliver those services, is unarguable. This policy document offers some steps along the road towards doing that, even if, as suggested, the devils may turn out to be in the detail of both what is included in the document and what is not. None can deny the urgent need to increase drastically the income levels at which citizens become eligible for medical cards: the document promises to do this immediately should Fine Gael get into Government. For the rest of both the legislative and structural changes promised in Government, the party has set itself a very tight timetable.