Madam, - I would like to respond to the letter from Dr Gerry Burke, Mr Hugh Flood and Prof Pierce Grace (December), which was a response to my letter of December 11th.
To begin with, the doctors seem surprised that a member of the public should be bad-tempered over the state of healthcare in Ireland. Well, I suggest they get used to it, because there's a lot of bad temper and anger out there. And with the latest round of healthcare cuts over the next year or so, the public will get a lot more bad-tempered.
Burke et al. have somehow convinced themselves that I was proposing that Ireland adopt a US-style healthcare system. Nothing could be further from the truth. I proposed a universal health insurance system. Everyone knows that one of the biggest healthcare problems in the US is precisely that health insurance is not universal. I fail to understand how they could make that connection. I pointed out that the Irish Labour Party proposes a universal health insurance scheme; the idea that the Irish Labour Party would advocate that Ireland adopt the US healthcare system is just bizarre.
Burke et al. allude to the origins of the UK National Health Service. In fact the NHS was the brainchild of William Beveridge, a Liberal. As a former member of the British Liberal Party, I would be only too delighted if old Beveridge had hit upon a good idea. But as a pragmatist, I look at results; and I'm forced to conclude that the NHS is just not producing the goods. It would be quite wrong to let sentiment allow a failed concept to continue, at the expense of patients.
Having lived in Germany for many years, I have seen excellent healthcare and I have seen how it can be achieved. The key is universal health insurance.
Every person in Germany is required to have health insurance. About 90 per cent belong to Gesetzliche health insurance funds, similar to the VHI, of which there are several hundred of various types. That means that every citizen is treated the way private patients are treated in Ireland. They can choose which doctor, specialist, hospital or clinic to attend. Private for-profit hospitals and clinics, city hospitals, county hospitals, university hospitals, non-profit private, voluntary sector, charitable — practically all are equally available to every patient. It's about as egalitarian as you can get.
One of the most striking characteristics of healthcare in Germany is diversity. With no centralised Government-run structure for healthcare delivery (no HSE, no NHS), the system is open, liberal and highly competitive. It's also highly distributed, with a very high degree of local control at hospital level.
Because money comes from treating patients ("the money follows the patient") the hospital has its own source of income; it's not dependent on Government. Again, because the money comes from treating patients, it means that, unlike in Ireland, patients are the number one priority; without patients, a German hospital would quickly have to close.
Most Germans don't care, and largely don't know, who owns the institution they attend. All they care about is the quality of treatment (and perhaps the reputation of the head doctor). The obsession with ownership of healthcare institutions displayed by Burke et al. is symptomatic of the ideology-driven approach to healthcare in this country. The fact that Burke, Flood and Grace refuse to recognise the failure of the NHS, pointing instead to its ideological purity, is another sign of the same disease. We need to stop worrying about ideology and start being pragmatic and results-driven.
We need to seek excellence, and punish failure. - Yours, etc,
NORMAN STEWART,
Seapark,
Malahide,
Co Dublin.