SEAN BYRNE,
Sir, - Tommie Gorman's account of his cancer treatment has struck a raw nerve with some medical consultants, as shown by letters from Mr Gerry McEntee (January 8th) and Dr Bill Tormey (January 9th) and the article by Dr John Crown (Opinion, January 9th). In their attempt to justify the gross inequity of the Irish medical care system and the huge earnings of medical consultants, all use misleading arguments and statistics.
Mr McEntee argues that Irish hospital consultants' earnings are in line with those of their Swedish counterparts. Irish consultants are paid a minimum of €110,000 for 33 hours' work with public patients. Some work these hours or even more in the public sector, but as they fiercely resist any monitoring of this work we do not know how many hours any consultant gives to his or her public patients. What is certain is that 80 per cent of public patients at outpatient clinics are seen by junior hospital doctors while private patients always see a consultants. For many consultants, their public salary is only a small part of their total income.
Perhaps Mr McEntee, Dr Tormey and Dr Crown would tell us, in the interests of informed debate, what proportion of their total earnings their public salaries constitute? What we do know is that the public salary of consultants is greater than the salaries paid to consultants in Sweden and the opportunities for Swedish constants to supplement their incomes from private practice are very limited because of the Swedish commitment to an equitable healthcare system.
If the good doctors could not afford private health care insurance, where would they prefer to be seriously ill - Ireland or Sweden?
The Review Group on the Waiting List Initiative concluded in 1998 that "some consultants may find it attractive to maintain a public waiting list because a proportion of those waiting may opt to be treated privately". Some of the more generous and public-spirited consultants even suggest to their public patients that they use their savings or borrow in order to be treated privately. Those consultants remind one of Aneurin Bevan's comment that in order to establish the National Health Service in the UK he had to "stuff the doctors' mouths with gold".
Mr McEntee makes the extraordinary assertion that the current grossly inadequate level of medical provision for public patients is contrary to the wishes of consultants and calls for the provision of more consultants. Irish hospital consultants have vigorously protected and attempted to expand the private sector of Irish medicine and continue to do so. They seek more consultants, but only if such consultants are given unlimited opportunities for private practice which, as Prof Muiris Fitzgerald, Professor of Medicine at UCD, has argued, would simply reinforce the inequity of the system.
The arguments of Mr McEntee and Dr Crown recall the assertion last year in one of Maev-Ann Wren's series of articles on our health service by Mr Finbar Fitzpatrick, secretary of the Irish Hospital Consultants Association, that "we have one of the best health care systems in the world. Why change it?" Presumably he meant best for hospital consultants. (As Mr Fitzpatrick is also director of elections for Fine Gael, it is to be hoped that, in the event of the party being in government, he does not influence its health strategy.)
Dr Crown is dismissive of what he calls "bureaucratised" and "socialised" medicine and recommends the US model of health care. He asserts that the best cancer care in the world is in the US and that it is available to all but 10 per cent of the population. Twenty per cent of the US population have neither private health insurance nor are covered by Medicare or Medicaid, the publicly funded programmes for the elderly and those on low incomes.
Does Dr Crown believe that those people have access to the best cancer care in the world? Many of them cannot afford even GP services and most Medicare and Medicaid patients have access to much less effective care than those who can afford private insurance.
The problem of the uninsured in the US is so acute that President Clinton made tackling it a priority for his first presidency but was defeated by the interest of private medicine. It is hardly surprising that Irish consultants favour the US system of care because only the US system offers medical consultants the opportunity to earn more from private practice than in Ireland. Yet as the series of articles in The Irish Times last year showed, the most equitable healthcare systems in Europe with the best levels of care and treatment for all patients regardless of income were in countries with the smallest private sectors.
Tommie Gorman sought and received the care he did in Sweden because he rightly concluded that for his resources and level of insurance cover he would get more timely and effective treatment there. This fact may be unpalatable to consultants but as Maev- Ann Wren concluded last year on the response of consultants who saw her motivation as social envy, "It is easier to rubbish unpalatable views by discerning personal motivation, to confuse individuals with issues; it is harder to accept the challenge of meeting rational arguments with rational refutation."
Tommie Gorman's courageous programme did a valuable service in drawing attention to the gross inequity of our medical care system. It illustrated the stark "Boston or Berlin" choice to be made about our health service. The most telling response was Dr Bill Tormey's justification of consultants' earnings: "We also know our value is greater than £70,000 a year and to hell with with begrudgers". Could this be the motto of the Irish Hospital Consultants Association? - Yours, etc.,
SEAN BYRNE, Sutton Park, Dublin 13.