Madam, - Peter Gaffney (July 11th) is right to suggest the benefits of a universal, one-tier healthcare system "funded by. . .government insurance as in Canada." However, as someone who has been a patient in the Canadian system, I would strongly argue that he is mistaken to suggest that it would be equally desirable to have a system "funded by insurance companies such as the VHI".
I lived in Canada for three years. During this time, I never once received a bill or had to pay out-of-pocket for my or my family's GP visits, laboratory tests or time in hospital. This was also true of my ante-natal, maternity, and post-natal care, which included a number of ante-natal doctor's visits and a universally scheduled ultrasound that, according to my GP, is not universally offered here; a semi-private hospital room; appointments with a lactation specialist; a home visit by a nurse after the birth; and a subsequent hospitalisation I required (in, it must be emphasised, a scrupulously clean, modern hospital).
More than just providing insulation from financial worries, the Canadian system also shielded me from the unpleasant experience I have often had here of not knowing whether or when I will be able to receive particular tests or treatments; of having to ring around even after paid visits to the GP to arrange tests and follow-ups; and even, in a couple of instances when I lived in Cork, of physically having to bring samples to the laboratory myself.
Compare the Canadian system with the VHI. Even with the VHI, as we all know, patients are not guaranteed to receive treatment promptly. They still have to pay for GP visits. They often have to pay hefty fees above their insurance costs for maternity hospitalisations. And they are faced with numerous exclusions to coverage upon joining VHI. I learned this lesson the hard way when I left Ireland to live in Britain - where, I should say, the NHS promptly and aggressively treated a condition that I already had before I left Ireland, but that had been allowed to worsen without any treatment - and my VHI cover lapsed.
Upon my return, on attempting to re-enrol, I found that this old "new" condition would not be covered by VHI for five years. It was at this point that I became one of the 20 per cent of the population with neither medical cards nor private insurance.
To my mind, the Canadian system is infinitely better, and if we had the will it could be introduced here. Without a doubt, it would bring better and more equal care, and less anguish for patients and their families. But first we must clearly demand it, and make those in power feel the force of our demands. - Yours, etc,
JOANNE MARIE MANCINI, Inchicore, Dublin 8.