In the coming weeks and months the Labour Party will release a series of documents setting out the party's position in relation to the health services. These papers will share certain common characteristics. They will not be costed. They will not be specific. They will not be properly thought through. They will be easy to run away from.
The first of these position papers was launched last Monday. Delving beneath the optics and generalisations inherent in this document, one encounters a single incontrovertible fact: it proposes to cure all of our healthcare problems through the simple panacea of routing health funding through insurance companies.
Under this proposal, a premium will be paid by all citizens to a private health insurance company; in return the insurance company will buy services on the citizens' behalf from the health institutions. For many this premium will come from their own pockets, above and beyond their other tax obligations. For others the Government would pay their insurance premium. The central question of who pays what and how much is not addressed. The sole disclosure is that the issue is to be calculated by "a sliding scale".
Here, as elsewhere, the document is vague. It is purposefully so. Its language is loose and lends itself to quick and easy interpretation from a variety of defensive perspectives. Only four days after releasing the document, realising that the closure of local hospitals was emerging as the primary concern of those familiar with the contents of this document, Labour backtracked and announced that they would guarantee funding for local hospitals. They are now proposing both to keep current funding structures and replace it with a private contract system. Plainly they can't have it both ways.
Even if it the proposal were costed and found to be feasible, such a system would be grossly inefficient. The German health system, which is based largely on the participation of insurance companies, has been described by Prof Alan Maynard, director of the Centre for Health Economics at York University, as one of the most inefficient in the world.
One of the few concrete statements contained in this document reads: "Public and voluntary hospitals will be required to cover their operating costs through income from health insurers and patient co-payments where applicable." A concomitant of such a policy is the centralisation and concentration of healthcare in larger facilities.
Where one of the smaller regional hospitals is unable to win a service contract from a private insurer it may be forced to restrict services or close altogether. At a time when decentralisation and social inclusion are central to Government policy, to expose our local hospitals and the population who rely upon these hospitals to such a perilous and uncertain future would be folly indeed. The Labour Party too often forgets there is an Ireland beyond the cities.
This document is such an amorphous statement of policy, so open to fundamental transfiguration, that it helps to focus attention on the confusion within Labour today as to its very political raison d'etre. Traditionally Labour has looked to the National Health Service in the UK as the Holy Grail in terms of health services. Indeed, in his statement on this present document, the deputy leader of the party, Mr Brendan Howlin, mentions how enviously Labour has viewed the NHS. He goes on, however, and states: "Now is the time to surpass it." This policy document does surpass the NHS ideal, but in which direction?
In the UK the most prominent proponent of the type of policy advanced in this document is Mr Michael Portillo. Memorably, such a policy was advanced in the UK in September 1982 when a Central Policy Review Staff cabinet report, recommending a health system run largely by health insurance companies was disclosed to the media. The disclosure triggered one of the biggest political rows of Lady Thatcher's premiership, and even she was forced to shy away from it.
A recent editorial in the British Medical Journal commented that such private insurance-based health systems tend to be less progressive than systems relying on general taxation for funding. The rich pay less under these systems. This is a right-wing, uncaring policy. That it emanates from a party ever seeking to make political gain from its caring, progressive, left-wing credentials must make us question the very relevance and ideological position of the Labour Party today.
Governance does not concern quick fixes, it does not concern amorphous policies meaning all things to all people, nor does it concern fundamental confusion on health policy. Governance concerns clear aims coupled with clear methods to reach those aims.
We aim for a system of healthcare of the highest quality, which is accessible to the poorest of our citizens without undue delay or inconvenience. To reach this aim we are focusing on individuals, not systems; on preventative care, not simply disease management; on a seamless, unified, as opposed to a fragmented service. We are implementing fundamental changes in the way healthcare is delivered.
We will ensure that the extra £1 billion being spent on the hospital system goes directly to the hospital system, that the extra £1 billion being spent on community services goes directly to community services. Not rerouted through health insurers.
Labour has announced that this policy document is governed by the dual principles of excellence and equality. It is not. The sole objective of this policy document is to garner publicity. It owes more to opportunism than to excellence or equality. I welcome any opportunity to engage in serious debate concerning health policy - that is my job. But let us have serious debate, an informed debate. Health policy is too important for anything less.
Micheal Martin is Minister for Health
Garret FitzGerald is on leave