Commentary: The worst legacy of this Government for health is that it cut taxes so much it cannot fund its own health strategy, asserts Maev-Ann Wren
Michael McDowell considers a free GP service a "loony left" idea. That's Europe for you. What is it with the French, Germans and Swedes that they cling to the notion that accessible healthcare makes you healthier? We do not live as long as other Europeans, and the gap has widened - that is the bottom line for our health. At age 65 we have the lowest life expectancy in the EU. Thirty years ago Irish men lived longer than the average European.
What shortens our lives? Heart disease, cancer, suicide - our death rate from each exceeds the EU average. Growing inequality also denies people years of life. Inequality has grown in Ireland during the boom, exacerbated by cuts in tax rates. That makes this a sick society. Not just figuratively, literally.
Where do the health services come into the picture? We don't try to prevent illness, not seriously. Family doctors are not paid by the State to practise preventive medicine or to treat any but the over-70s and the very poorest. Forget preventive medicine, the sick often cannot afford to see a doctor and buy drugs.
Michael McDowell has a point. If the "loony left" should get into power, more sick people would gain access to doctors. GP waiting times would increase, unless we trained and employed more GPs. Like the UK, we have many fewer GPs than the EU average.
Access to hospital services remains a nightmare for public patients. Private patients don't wait, not really. An ESRI survey couldn't find one who had waited a year. But for public patients the wait can be years and years. No one in officialdom asks precisely how long. The waiting lists are the tip of an iceberg, its invisible base those who can't afford a GP or who await the specialist consultation which will put them on the list.
The much-derided NHS does incomparably better: at the end of March only two patients in all of England had waited longer than 15 months for surgery.
The Government considers a waiting list of 26,000 compares favourably with the hundreds of thousands treated each year. Only if apples are oranges. It is nonsensical to compare a stock (patients waiting) with a flow (patients passing through beds). Compare like with like, the patients in acute hospital beds today with patients waiting, and the picture changes. For every patient being treated there are more than two waiting, one for over a year. If it feels like a crisis, the odds are it is a crisis.
Healthcare was the major casualty of the tax-cutting formula for recovery we adopted 15 years ago. Hospital beds were cut wholesale. Patients fleeing the public system made private providers rich. Two-tier medicine became entrenched. A penny-pinching society considered public sector employees parasites and reduced the number of nurses being trained .
Recovery - more jobs, more people - was celebrated with more tax cuts to fund holiday homes and overseas holidays. The health needs of the rising population were only finally recognised in an aspirational strategy at the end of the Government's term. The population of the Dublin area is conservatively estimated to have grown by 14 per cent in the last 10 years, an extra one person for every seven. There remain fewer than 5,000 acute hospital beds for more than 1.4 million residents and floods of patients from the provinces. Patients overnighting on accident and emergency trolleys are inevitable.
But, you ask, this Government has increased health spending, why are we still in crisis? The increase was from a very low base: per-capita spending exceeded the EU average for the first time last year, having fallen below 60 per cent in 1989. There is a huge deficit in capital spending to make up: only now in its final months does the Government propose to increase hospital beds. Earlier decisions like increasing the number of nurses in training will take time to bear fruit. And much so-called health spending is in fact social spending.
Some spending is very poor: the Government has allowed local resistance to prevent regional centres for cancer care replacing scattered inferior services.
Spending remains inequitable - the sickest do not receive treatment first; the State subsidises private medicine by giving tax reliefs to VHI members and to investors in private for-profit hospitals and by permitting salaried public employees to staff them. Lip-service to equity is not reform. Four years after a forum began discussing how consultants might treat public patients instead of junior doctors, a taskforce resumes the discussion.
The Government's health strategy continues the two-tier system, its tax strategy promotes it.
That's this Government's worst legacy for health. It cannot fund its own health strategy. It may not even be able to fund this year's health spending.
Major hospitals say they have not yet received adequate funding to maintain services and suspect that after the election they will be forced to make cutbacks.
The European "loony left" has funded equitable health care by tax and social insurance and sees it as an investment. They live longer, too.
Maev-Ann Wren is an Irish Times journalist