Minister for Health Leo Varadkar was very pleased with himself during the week. He told journalists, far too smugly, that the previous week he signed up as a private health insurance subscriber to beat the deadline of next week, after which those over the age of 35 will face higher levies.
Varadkar (36) had allowed his health insurance cover to lapse and he joined up, he said, for two reasons: “As Minister for Health, I wanted to take a lead. I also wanted to avoid the levy ... I can honestly say that I feel a lot better having taken out health insurance again.”
I did not feel much better for reading that. Varadkar taking “a lead” involves him becoming a cheerleader for private health insurance as Minister for Health in a government whose stated aim is to develop a “universal, single-tiered health service, which guarantees access based on need, not income”. Varadkar has been very quiet about the universal health insurance necessary for this and very vocal about private health insurance, to the point where People Before Profit TD Richard Boyd Barrett has legitimately accused him of acting “like a tout for the private health insurance industry” instead of doing his job, “which is to have a public health system that is available to all who need it”.
Bevan’s NHS
This two-tier health system has been such a blot on modern Ireland’s copy book for so long that the very least Varadkar could do is express profound regret about its continuance instead of patting himself on the back. Nearly 70 years ago, Aneurin Bevan, as British minister for health, established the National Health Service – with the support of his Labour colleagues, claiming “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means”.
At the same time in Ireland, James Deeny, as the State’s chief medical adviser, chaired a departmental committee that formulated radical proposals for a free and comprehensive national health service, funded largely from general taxation, and incorporating virtually all GP, specialist, and hospital services; the intention being that private medicine would be a minor and peripheral activity.
That committee’s report was described by one of the historians of the Irish health system, Ruth Barrington, as “probably the most radical document ever produced on the Irish health services”. But it was not published owing to opposition within government and from the medical profession, though one of its major recommendations, the establishment of an independent Department of Health, was implemented in January 1947.
Reaction to the Deeny committee’s proposals and some of what later evolved from them, including the Mother and Child scheme, underlined the power of vested interests, including the Catholic Church, to block the principle of universal healthcare. Scaremongering about State interference in health care abounded, as did the variety of blocking mechanisms and insufficient political will that have bedevilled reforms to this day.
Far too many tragedies and premature deaths have highlighted the consequences of the failure to confront this and deliver on the vision that was outlined as far back as the 1940s. Eight years ago, 41-year-old Susie Long died from bowel cancer due to a seven-month delay in getting a colonoscopy because she could not afford private healthcare.
Anger and frustration
Before her death, she explained the anger and frustration she felt on hearing that an individual with the same condition as her was going to live because he had private health insurance and she knew she was going to die because she did not. She criticised politicians in charge of healthcare because “all they can think to do is put resources into privatisation”.
Have we really travelled very far in the years since? For all the promises of “steps towards universal healthcare” coming from the Department of Health, what it sees as an essential part of this is “promoting a sustainable, cost-effective private health insurance market…and implementing a package of measures to increase the number of people with health insurance”.
And there lies the problem. How can promoting greater uptake of private insurance be seen as a step towards universal health care in the absence of a plan for universal health insurance?
As health policy analyst Sara Burke pointed out last month, “It is a fundamental problem that the Minister does not seem to realise that increasing the numbers of people with health insurance is directly contradictory to steps towards universal healthcare unless one is planning for universal health insurance. And as far as we all know, there currently is no plan, no clarity, no timetable or vision for a universal health insurance system in Ireland.”
The situation that led to the premature death of Susie Long remains; private patients get access to healthcare much more quickly than those dependent on the public system.
In the light of that reality, assertions by the Minister for Health of leadership through beating the new private insurance levy deadline are completely inappropriate.