The series of articles which has been published daily in this newspaper since Monday provides disquieting reading about the level of health care available in this republic. In particular it has made it clear that access to essential services is most difficult for that sector of the population which is most likely to need treatment.
There is a clear - and widening - disparity between those who must rely on the public services for their care and those who can afford care on a private or semi-private basis. This is reflected in the increasing numbers joining health insurance schemes (now up to 45 per cent of the population). And a decline in the numbers now entitled to medical cards - giving them access to the general medical services - means that more people on low incomes must think seriously before they seek attention from a family doctor. The schism is between rich and poor and it extends to the quality of care delivered, as much as to the inequitable access to that care.
In a republic which would lay claim to a social conscience, such a state of affairs ought to be unacceptable. We appear to have arrived in our present health-care crisis by happenstance, miscalculation, and lack of purpose. As the series by Maev-Ann Wren has demonstrated, we have drifted into this two-tier system and we are showing every sign now of following that much larger republic - the United States - where excellent health care is available for the great majority of the population but where the sick poor suffer dreadfully.
So what's to be done? Money alone will not solve the many problems which exist - although greater investment in health care is urgently needed. It is clear that among the measures required are several which would radically alter existing structures and systems in the delivery of health care.
A renegotiation of the terms of the contract which hospital consultants enjoy in the public hospital services must be achieved at once. There must be alteration in the proportionate numbers of consultant and non-consultant hospital medical staff. There must be more working nurses and their conditions must be attractive. And there is a strong case for an overhaul of funding so that services can be delivered without charge at the point of delivery and without discrimination between wealthy and poor patients.
There is a need to keep open the smaller hospitals but to redesignate the tasks which the less high-technology driven and less amply staffed local hospitals can safely undertake. There seems much merit in the establishment of a compulsory universal health insurance scheme in which those who can afford to would pay their own premiums and those in poorer circumstances might have all or part of their premiums paid by the State. This would provide equal entitlements for all at the point of service delivery and could remove from the Exchequer at least some of the current costs of health care.
Shamefully, Ireland is now one of the most dangerous locations in the developed world in which to fall ill. What sort of economic miracle have we wrought that has brought us to this? Regrettably, the Government appears to have other priorities. Even yet, there is no resolve to implement reform and to increase spending at the levels that are necessary to bring us into line with our European neighbours.