The extent of dissatisfaction with waiting lists in the public health system is underlined in the report of the Economic and Social Research Institute (ESRI), details of which we publish today. Also underlined in the report - funded by BUPA Ireland - is the fact that getting quicker access to treatment is a powerful incentive for taking out private health insurance.
The survey found that most people believe compulsory private health insurance should be introduced for people on higher incomes. Naturally, support for this course is strongest among those who are least likely to have to pay for compulsory insurance.
But there is a great danger in this simplistic approach. Who, in such a system, will pay to train the doctors and nurses, an activity to which the private sector contributes practically nothing? Who will pay for the emergency departments, a service which, again, the private sector does not provide?
Earlier this year, Dr Niall Maguire, the medical editor of Forum, the journal of the Irish College of General Practitioners, wrote in an editorial of how he is "confronted with post-operative complications in patients just discharged from various private hospitals. If I manage to speak with the consultant involved, the invariable advice is to refer to their public hospital team. Never has the private hospital accepted an urgent readmission."
Despite the battering which the public health system takes in this report, it is that system which trains the doctors who work in the private system and which picks up the pieces when things go wrong in the private system. The notion that simply introducing compulsory health insurance will solve the problems of the health service is half-baked.
One thing that is clear from this report - if we had a public system which could eliminate or greatly reduce waiting lists, a major incentive for taking out private health insurance would disappear. There is, of course, a wider issue here. It is about how the overall health system should be reformed and how that reform should be financed. Such a reform is likely to include measures to increase bed numbers, provide a high quality training system and transfer tests, certain forms of surgery and other functions to general practitioners.
It may also include the introduction of a common waiting list to ensure that those who get to the top of the list get there by virtue of their medical need and not by virtue of having private insurance. These are issues of enormous complexity and cost. It may well be that, ultimately, the financing of a new system will be through taxation or through a universal insurance system in which costs are shared by the public and the Exchequer.