A Sick System




From top: Tony O’Brien, chief executive of the HSE; Anne Marie McNally

Do we want to live in a country where our wellbeing is determined by our bank balance?

Ann Marie McNally writes:

A conversation over a few pints on Saturday night went something along the lines of ‘I went the doctor last week and she sent me straight to the hospital with a letter for an urgent appointment…three days later I got a letter for an appointment in the middle of July’.

The person, my own demographic, was horrified to learn that I didn’t have private health insurance.

I don’t, I cancelled it about three years ago when, despite paying around €1800 a year, it still cost me a fortune to be treated for a broken leg in the swift clinic of which I was only entitled to claim €300 back.

The economics of it didn’t make sense to me so I cancelled. I figured, hey I get an MOT every year, I’m doing good and surely I’d be better of saving a few bob for an emergency medical fund in case it’s ever needed. Seemed rational at the time.

Fast forward three years and the visit to the doctors which resulted in the information that I was to make my way to the hospital post haste.

The Doctor (whom I’d paid €70 to see) asked me the insurance question. No, says I, but I’d be prepared to pay for the required procedure privately.

She nodded understandingly but said;

‘Can I advise that unless you have approximately €10,000 you’re prepared to spend on this then I don’t recommend you go the private route. The initial consultation may be fine but if there are further interventions and a possible hospital stay involved then the costs will rapidly mount.’

Needless to say, I was shocked and promptly reassured her I’d stick with the public system!

I trotted off to the hospital and 3 days later when I got the letter advising me of the mid-July appointment, I was pleasantly surprised. That’s not bad at all I thought, 2.5 months, that’s a hell of a lot better than I’d expected.

It was only in conversations with friends the following day that I realised my expectations were ridiculously low.

A significant health concern, a doctor’s letter with urgent written all over it and my expectation was for an appointment longer than 2.5 months into the future! Is that how conditioned to poor public services I had become?

In the meantime, had I the financial wherewithal to stump up the money that it would have cost (still an undetermined amount), I’d have been seen to that week and any potentially dangerous issues dealt with or peace of mind restored with an all-clear.

My health, and potentially my life, was to be determined by how much money was in my bank account. In a civilised democratic society my health was suddenly less important than the person who had more money than me. T

hat’s ultimately what it boils down to…your wellbeing is determined by your bank balance.

How civilised is that?

Last week a Motion the Social Democrats put forward was signed by 89 TDs. A majority of the Dáil and a mixture of deputies from across the party and independent spectrum. Soon after, the newly appointed Minister for Health intimated on national media that he supported something similar.

That Motion was a call for the establishment of a Cross-Party Forum on Health with a view to achieving a single tier universally accessible healthcare system.

A system where medical need rather than bank balance would determine your healthcare treatment. A civilised system.

In Post World War 2 Britain the Tories and Labour came together and agreed on the need for such a system.

They put their differences aside and they made it happen, for the good of the nation. It’s time our politicians took a similarly mature approach to this most fundamental of issues.

Anne Marie McNally is a founding member of the Social Democrats. Follow Anne Marie on Twitter: @amomcnally

62 thoughts on “A Sick System

  1. Owen C

    “I don’t, I cancelled it about three years ago when, despite paying around €1800 a year”

    Eh, what plan were you on? The AAA++ one? Mine costs 67 quid a month for a fairly decent one with Aviva.

        1. ivan

          aye – with the consultant behind the black cape thing….

          The tripod will play hell with him…

        1. Mani

          Don’t feel bad for him. The cameras just for proof of life of the gerbil he put up there a month ago.

        2. Clampers Outside!

          Thanks Rob!

          No worries Mani, he was a special breed of pot-holing gerbil on a recce before the camera arrives…. he’s fine now, playing with the neighbours kids.

    1. Punches Pilot

      @Owen C

      Might have been two adults and two kids despite there being no private hospitals for kids in this country! You’d have to laugh.

          1. Owen C

            I apologise if thats not the case. I don’t know why that was my assumption (genuinely). And i do know how much you value apologies (still waiting for mine as it happens).

            If the 1800 was spread across 2-3-4 people, please let us know. It would also suggest medical insurance is not that expensive per person. Which was kinda my point.

  2. garthicus

    I pay €358 a month to cover my family, 2 adults, 2 kids under five. (€153 for me covered by company/BIK, €205 to cover the family), as much as it is, I wouldn’t change it. My wife has had a few procedures this year already and the receipts have added up to over €10k so far, which I have not had to pay out for (along with being attended to almost immediately/without delay). Is it fair? No, is it essential? Yes.

  3. Punches Pilot

    This is a typically Irish problem (and a comment on a news website can not possibly even begin to address all the reasons behind this remark) because Irish society as a whole is greedy. Simple as . We have no shortage of hospitals, no shortage of staffing if needs be and no shortage of administration. The problem is what ever ends up getting put in place will ultimately be run by greedy people who’ll milk it for their own benefit as has been seen with our current system. They (they) wont let it (profit stream and position of privilege) go. The pool is too small. We are doomed. It could all be fixed in the morning if we could just remove the top layer. Sadly, as with everything in this country, from legal to banking to building and medical, its the same old circle going round and round. Closed shop.

    1. Dόn 'The Unstoppable Force' Pídgéόní

      No, it isn’t an Irish problem. it’s a problem in every society where politicians don’t value the health service like they should. Everyone could have an NHS (or better) if there was the political will to do so.

      1. Nessy

        +1,000 hospital trolleys

        There’s no political will because there’s a massive amount of money to be made off the backs of the sick. The way things are going, it’ll be just as bad as the States, if not worse

  4. Owen C

    Went to VHI. One Plan Extra costs 1464 per year. Full accommodation in a wide range of private hospitals with semi private rooms, and semi privatee & private rooms in public hospitals. Lots of other bells and whistles, full maternity care, mental health treatment, foreign medical emergency care, medical expenses etc. That’s today’s price. Anne Marie was paying more than this three years ago. I ask again – how high level a plan was she signed up for at that stage?

    1. Dόn 'The Unstoppable Force' Pídgéόní

      It’s not just how high a level plan she was signed up for, have to factor in pre-existing conditions, family history etc as well.

      Health insurance companies are complete scammers

      1. Starina

        worst job i ever had was temping for an insurance company about 15 years ago. I had to type up the hand-written applications coming in from elderly people, and because I sat next to the team that did approvals and denials of applications, I learned to know straight away who would be denied…HIV+, cancer, genetic diseases…the approvals team were a bunch of sociopaths.

        1. Dόn 'The Unstoppable Force' Pídgéόní

          Yup. Worked in mental health hospital where people in crisis were flipped back into the public system when their private care did cover some treatment. Having to tell them that was heartbreaking.

          Completely business, no empathy.

          1. mildred st. meadowlark

            I’ve seen that side of the mental health system in this country. It’s downright ugly. They have no empathy.

          2. Dόn 'The Unstoppable Force' Pídgéόní

            I had to stop working there, it was really affecting me. No way was I qualified to be telling someone weeping on the phone that they were effectively back to square one – I was agency for god sakes!

    1. Junkface

      That was in the Middle Ages when we had a large population of Monks studying the Bible.

  5. phil

    Let me relate my story.

    I never thought much about the health system , but now, Oh boy do I .

    I have one of the top plans with a Health Insurance provider through my work, I never needed to use it as I believed I was reasonably healthy and tried to stay so.

    3 years ago , I had a very sudden onset of 10/10 pain for no apparent reason. I was rushed to a VHI swift care clinic where they x-rayed my limb , found nothing , meds didn’t give me relief, and they got worried and told me to get to a Hospital fast . The nearest hospital was a Hi-Tech hospital , I rang my provider to find out if I was covered , It was a Saturday, after 3pm so no answer, I logged into their website and checked my plan. This was the first time I ever looked at it , I was confused, it said I was covered , but there me be an excess, or a shortfall, two words I could not understand, I had 10mg of morphine in me at this stage and no pain relief, I just went there. I was still there on Monday and rang the provider again, they could not assure me that I was covered and the plan was as complex as some Mobile phone providers.

    The Hospital was lovely and seemed to be empty,I was the only patient in A&E, the staff were interested , and jumped to it, X-ray, MRI, and emergency surgery , and I was recovering in much relief within 3 hours of arrival.

    Thats the great thing about private health insurance. Now the crappy bit ..

    They didnt know what was wrong with me, and in house consultant came to see me and she said , you are in my field , but you are going to be a difficult diagnosis , you are not presenting typically, take this toxic drug and come back and see me in 6 months. That was a 15min conversation. That was it, I suffered from terrible side effects for months , next appointment meant nothing , she ordered no more tests , and left my fear and worry for the GP. After 9 months the GP wanted to talk to me, she had a tricky subject to discuss, basically she gingerly suggested I ask for a second opinion. She told me to be careful , consultants can be a bit tender about this subject. I went to the Consultant , and after a progress chat I asked as Im still presenting unusually , would it be reasonable to reach out to her colleagues to see if they had see someone present like me . Second opinion she asked me , I nodded, she then wrote a name on a piece of paper , and told me that the new doctor would manage my care from now on, basically get lost.

    The New guy changed my diagnosis , but in the end seeing him every six months for 10 mins , I didnt seem to get anywhere . The GP then suggested that she admit me to hospital , a public hospital , which she did, the advantage… there was a team of Nurses and Doctors in the ward that specialised in my condition . Now Im in the public system , things are improving, when I dip I pick up the phone and speak to one of them, and they reassure me , and if needed I can call in to chat to them about my condition. I feel better , I may be nowhere near a solution , but I feel looked after.

    No I will say the hospital is a kip hole, but as an outpatient now, Im

    So what did I learn. If you need surgery fast, private system is fast and their wards are like 5 star hotels , if you are having trouble getting diagnosed , the public system is where you need to be. I was amazed that in the public system in some fields of medicine, there are far more specialized professionals , as so few as an outpatient in the private system.

    finally the bill I saw from the Hi-tech hospital , the drugs, xray , MRI , and surgery came in under 300 euro , the bed for 3 nights was about 4k .

    Sorry if that was too long to read , I left loads out …

      1. Dόn 'The Unstoppable Force' Pídgéόní


        Plus many private doctors in certain specialties practice in public hospitals as well – so you get exactly the same treatment but fork out for it (for certain conditions). While that might be great if you had a long waiting list for something relatively routine, serious conditions like cancer you will be seen super quick in the public system. They don’t mess around with that stuff.

        1. DubLoony

          Had relative who being treated for cancer 2 weeks after going to his GP. There was no mucking about with treatment, social workers there to help with the paperwork to get medical card, lots of support. No way he could have got the expertise & support on private care.

          I know people give out yards about the health system, usually its the difficulty in getting in, not the treatment once there.

          1. Dόn 'The Unstoppable Force' Pídgéόní

            Just think how wonderful all treatment could be if instead of paying for private health care, people were willing to pay more tax for an efficient health system! People moan about taxes and then moan that public services aren’t good enough. I do wonder if they ever try to join the dots there.

          2. mildred st. meadowlark

            If the taxes were used as they aught to be. instead of paying for nonsense such as unvouched expenses and reports and tribunals that have zero practical impact, I reckon people would be on board with higher taxes etc. But I’m stating the obvious here

          3. Dόn 'The Unstoppable Force' Pídgéόní

            I’m not sure what tribunals etc you are specifically referring to but every system has issues that could be improved if greater care was taken. And if successive governments didn’t fupp things up that didn’t need to be touched in the first place.

    1. Clampers Outside!

      If the private system can’t find anything to fix they don’t want you hanging around… if they can’t get you into an operation they can charge for, they don’t want to know.

      So, the private system is milking the public system in this regard. Taking those already diagnosed and giving them a quick operation they can charge an arm and a leg for, then out you go. Who’s next for the expensive table… who already has a diagnosis…. it’s all a con.

      The two tier system is a joke.
      Thank you Mary Harney you useless waste of a lot of space.

      1. DubLoony


        Find it hilarious listen to radio ad about Blackrock private A&E – the open til 6pm!
        Just make sure to schedule your heart attack at the right time.

        1. Andy

          My dad had a number of falls (dizzy spells) 2 years ago and after the 1st time going to Vincents (waiting over night on a trolley with junkies walking around whaling at nurses and patients) my mother decided never again and took him to Blackrock the next 2 times (once waiting over night for it to open).

          They should place a garda in each A&E and have a separate padded area for the drunks and junkies. Last thing regular Joe Soaps want is to be subjected to that when worried stiff about whatever ails them.

      2. phil

        Clamps I agree with most of what you said bar the public system leaning towards expensive tests. I hit the books re my condition, and asked the Hi-tec consultant for test X, basically a test for a condition that thousands of people have who are often misdiagnosed with my condition, she told me , ah thats a very expensive test and it would probably reveal nothing. I suggested, as she wasnt confident of my diagnosis lets just do it, I have good health insurance I dont mind paying the excess. She barked at me to stop reading crap on the internet. I do accept she may be one in a 100, but she is a darling of the field , you would likely have seen her in photo ops for quangos

        When I got into the public system , the head of my department told me, Im going to run every test on you , even mad things like STD’s and tropical diseases . I asked can you do test X , the doctor smiled , and said of course, and chuckled that it was nice to meet a patient who has done some reading. The test came back negative but my mental state vastly improved, they are really trying and they find my case very interesting.

    2. some old queen

      My own private health care experience. A friend had serious back problems and needed two disks removed. She was covered by insurance and went into a prominent private hospital. Two days after the operation I popped in and she was sitting on a chair beside the bed. She had just been moved into a semi private ward and before I left she got up on the bed, with the top part sitting at 45 degrees.

      The bed collapsed and chaos ensued. It took over an hour to get her sedated and comfortable in a new bed. It transpired that am engineer had been working on this particular one for most of the day.

      Because of this, she then required a second operation and later discovered that the insurance did not cover the extra stay. The hospital then pursued her for the balance and was going to take it to court. She was forced to threaten to counter sue before they eventually backed off.


  6. some old queen

    I am not sure if any polls have been done on this but I am pretty sure the majority of people are in favour of a National Health System. At the back of all this is a political ideology which favours the ‘for profit’ model, even though it has been proven time and again that an NHS is way more cost effective.

    So now they want to introduce Trust management which may bring some level of financial accountability but is also probably going to compound the problems even further. They have trusts in Northern Ireland and the difference in quality of service between them is shocking.

    1. DubLoony

      What system actually works properly – good health outcome, efficient & costs not increasing at explosive rate – that we could emulate?

      Cuba has 1 doctor per 250 people, health checks every 6 months and integrates mental health as well. Reason is that they can’t afford anyone to get seriously ill, they just don’t have the capacity to deal with it.

      So keep the weight down (not problem in Cuba), get exercise (salsa), eat well (all the local organic food). That takes care of preventing most western illnesses.
      Still wouldn’t want to live there.

        1. garthicus

          I loved the health care system in Canada, especially when I also had top rate health insurance too from my company. Sigh.

          1. MoyestWithExcitement

            Them and the Scandinavians just seem to get it, in general like. The Canadians seem to be the only rational English speaking country in the world when i think about it and loads of them don’t actually speak English. Us, the Scots, Yanks and Australians all seem to have issues with alcoholism, depression, religious whackery and Ayn Rand fans in our societies.

      1. Dόn 'The Unstoppable Force' Pídgéόní

        NHS had 70% approval among the public in 2010 before the Tories started in on it. And people give out about it here so much because they really don’t know how lucky they are.

    2. Andy

      Yeah, or maybe it’s the fact those who pay for PHI know that an Irish ran NHS would be total crap.

      They know they’ll be the ones asked to pay for this new beefed up HSE where there’ll be very little cost control, the Unions will run the show, there’ll be strikes before every election, there will still be delays in treatment, there’ll still be high absenteeism, A&Es will remain a warzone on weekend nights, there’ll be no improvement in outcomes etc.

      So, in fact, maybe they’d rather pay for a private insurer to argue costs & bills with a private hospital where the Private Hospital itself is managing down costs, where you’re unlikely to witness fights in waiting rooms, and where you’re likely to be treated in a speedy manner.

        1. Andy

          Fear of having to rely on the Public System.

          “More public system” will not alleviate that fear.

          1. some old queen

            And ‘for profit’ will? Lying in a bed because a consultant with a vested interest says you should is not an alternative I look forward to.

Comments are closed.