ONCE EVERY so often I panic about money, and I look around for some economy I might make, and I think "Why don't I drop the VHI? I get no value out of it. If anything happens I'd nearly prefer to go public than help to line the pockets of some of the richest people in the country..."
But then I pull myself together. We know not the day nor the hour. And as long as I can buy my way out of it, I'm not going to put up with waiting months to see a consultant and more months for treatment. A moment's thought, and I realise that I'm very lucky to have private health insurance, and even luckier to live in Ireland where there's only one private health insurance scheme, and it is administered by a semi state body by public servants, rather than profit seeking individuals.
This week there will be another development in what I shall tactfully call the evolving relationship between the parties to health care in Ireland. There are about 100 hospitals in the country and 18 of the private ones are putting up their charges. They haven't agreed the increases with the VHI. So if you go into the Blackrock Clinic or Galvia or one of the others, when you get your bill the VHI will pay the amount they've paid up to now. The extra you'll have to pay ourself.
This row, as I understand it, is about costs. The private hospitals want the same increase for all 18 places, negotiating as one. The VHI wants to negotiate one by one with each place, because it sees some places charging a lot more than others for the same thing. Some places charge twice as much for a hip replacement or a hysterectomy than others. A barium enema can cost between £4 and £110. A chest X ray between £23 and £56. An MRI scan between £215 and £330.
Scans are a good case: the VHI provides full cover for subscribers using the MRI scanner in Cork. But if you use the scanner in, say, the Blackrock Clinic, no increase has been agreed and you are not fully covered.
But then I noticed a remark the director of the Blackrock Clinic made in last week's Irish Medical News. "We have not spoken to the VHI in years," Mr David Gray said. This is an extraordinary state of affairs to exist between that clinic and the insurer of 35 per cent of the population. No wonder there are occasional stand offs.
BUT this is only a tiny part of the costs problem. We all have bodies which do nothing but age. We all demand more and better and state of the art health care.
And we demand it for everybody. We would find it hard to live with ourselves if we knew that a traveller child, say, with leukaemia, was denied the chance of a bone marrow transplant because of its cost.
We wouldn't tolerate such and such an expensive medicine being denied to someone because, say, they were unemployed. We certainly wouldn't accept anything at all being denied to our good selves on grounds of the national economy.
And the perceptions behind these feelings are surely correct. Health care is the one thing that capitalism might not subsume. Because health doesn't have a value. It is priceless. It is a state quite outside our own power to command. About sickness and accident and dying, we do not, to repeat, know the day nor the hour. You can't buy health and you can't buy life, so the ordinary rules of buying and selling cannot apply in health care.
On the other hand, you can't spend the entire Gross Domestic Product on health. Every year for the last five years 10 per cent more has been spent on health. This kind of increase cannot go on indefinitely. Some choices are going to have to be made.
The one thing I don't want, as the coming crisis is confronted, is to see the VHI enfeebled. I think it is one of this country's success stories. And I think it suits us. Because most people here would vehemently deny being Thatcherite. Yes, they'd say, they believe in the profit motive, in competition, in aggressive marketing, that anyone has the right to accumulate wealth.
But the passion for wealth, they would say, must be tempered by some degree of social responsibility and by a managed compassion towards the less advantaged. In other words, what happened to health care in the US would not - we would say - be acceptable here. We would not approve of doctors building private hospitals in which they offer procedures to the well heeled, while the poor have nothing. We want, as always, a middle way.
We have the makings of a middle way. Our private hospitals exist, of course, to make a profit. People are somewhat confused about that, because so many of them grew out of not for profit places run by religious. But now they have shareholders to answer to the Blackrock Clinic, for instance, is part owned by the British private insurance company, BUPA. At the same time, people across the spectrum, if they can pay the VHI premium, have access to these places when they become sick.
And the VHI stands as their representative in their dealings with these hospitals and with all the rest of the health care providers who have a dual focus - the specialists, the drug companies, the technology suppliers and so on - all who work in this field from a mixture of altruistic and properly selfish motives.
If it ever came to a contest between the two, and altruism, as in the United States, was in danger of being overcome by the superior energy of money, the VHI would have a moderating role.
I'M glad to see its influence in play in the whole complex field. As it is, I could claim resentfully that my VHI money is paying for everyone else's pregnancies and heart by passes and so on. But my day will come. Younger people will be paying for me, if I turn out to be a charge on the health system. It all keeps the notion of"us" going. It's not just me and my moneybags, beating my way to the front of the queue.
I have no doubt that the matter of the 18 private hospitals will be resolved. Because this is not a game where there are winners and losers. The whole system will fail unless health professionals feel fairly treated.
The consultants, for instance, have largely sorted out the problem about "balance billing" with the VHI, presumably through negotiations in good faith. And patients, too, have to feel that they are not powerless within the system. For those of us fortunate enough to be VHI members the VHI supplies the collective power we would not have as individuals.
As for those of us not fortunate enough to be in the VHI, all I can say is that this State was founded on the concept of private property. Health care in Ireland, apart from the religious, was private and profit making from the start. No political party has ever dreamt or ever will dream of challenging that. There was never anything like the great egalitarian push that brought about the British NHS in this country.
Private health insurance must exist as long as private health provision exists, but it is better, surely, that the insurer in the middle not also be private.