Your Health In Their Hands

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From top: Leo Vardkar and Simon Harris; Dr Julien Mercille

The government has been moving fast to reform our healthcare system.

But it’s doing it in the wrong direction.

Dr Julien Mercille writes:

We start today’s column with two simple, yet revealing, questions.

Question 1: What is the most important issue for Irish people?

Answer: Healthcare. Opinion polls show that free universal health care is priority number one.

Question 2: What is the most misrepresented issue in public discourse?

Answer: Healthcare.

Coincidence?

There is for sure a lot of media reporting on healthcare and much attention paid to it within government. However, so much of it is pure sensationalism that explains nothing about what’s really going on.

We hear scare stories of bugs and superbugs in hospitals, of people being parked on trolleys, of people dying because a doctor didn’t spot a fatal disease on time, of hospital managers being incompetent, of the HSE being a bureaucratic dinosaur, of hospital building plans being suspended for years, of potential strikes by nurses or other health professionals, along with so many other tabloid-type high-impact stories.

Yet we learn nothing about what the real problems are and how to fix them.

Another strand of reporting claims that “nothing gets done” in the HSE, or that “nobody in government has the energy to reform healthcare”. But that’s complete rubbish too.

The truth is this: the government has been moving rather fast to reform our healthcare system. But it’s doing it in the wrong direction entirely, namely, it’s going towards privatisation.

That’s been very clear since James Reilly became Health Minister, and the same plans have been pursued under Leo Varadkar and Simon Harris.

But in healthcare, the facts are very clear and the solutions very obvious and easy to understand. The problem is that almost nobody ever talks about them.

We have progressive activist groups on housing, finance, homelessness, migrants’ rights, education, abortion, sex work, anti-racism… but as far as I’m aware, there is no campaign for a public healthcare system funded by general taxation, which is the best system because it’s (1) cheaper, (2) more egalitarian, and (3) better for health.

Understanding these three points allows anybody to win any debate about healthcare against those who claim that a privatised, market-based, for-profit system is better.

(1) Cheaper

The United States has by far the most privatised system in the world. Accordingly, the two graphs show that it is twice as expensive as other developed countries’ systems, which are largely public.

graph

Why are for-profit systems so expensive? One reason is that they need to generate profits and pay bonuses for executives, taking funds away from care. Another is bureaucratic waste.

Privatised systems involve a lot of paperwork to assess insurance claims, to code and price hospital services, to record all transactions taking place in the market, and so on. In Ireland, there are now over 400 insurance plans available.

This makes it extremely complicated to manage and involves armies of private bureaucrats to process.

The US has the highest administration expenditures among developed countries, accounting for 25% of total hospital spending, compared to 12% in Canada and 16% in England (which have public systems). The US would save $150 billion a year if it reduced its administrative expenses to Canada’s level.

(2) More egalitarian

That’s easy. Access to public systems doesn’t depend on how well off you are—everybody has the same access. You are treated according to your health needs, not according to your wallet, and this is how it should be.

(3) Better for health

The fact that less well off people have a hard time accessing healthcare results in poorer health outcomes. But there’s a second aspect as well. For-profit hospitals tend to provide care of lesser quality and mortality rates are higher in them because they dedicate fewer resources to doctors and nurses. There’s no surprise here: they want to cut their costs to boost their profits, so they cut in the services they give you.

This is why the editor of The Lancet, the world’s leading medical journal, blasted market-based reforms in Britain, putting it bluntly: “People will die because of the Government’s decision to focus on [market] competition rather than quality in health care”.

Recall also that the US has some of the developed world’s worst health outcomes, even if it spends much more money than other countries on health.

For example, life expectancy in the US is only 78.7 years whereas all other developed countries are above 80.0 years. Also, infant mortality is at 6.1 deaths per 1,000 live births in the US, the worst among developed countries.

Government strategy

In sum, the government’s strategy is this. First, cut funding to the public healthcare system, which will then become chaotic and incapable of delivering good healthcare.

The media will then join in and publish all sorts of horror stories about our hospitals. A mood will set in: “public healthcare = bad”.

Then, surprise surprise, the private sector will come in and say “hey, you see how bad the public system is? You need the private sector to save you and we should therefore establish a more private system!”

This is what has been happening. Public spending on health has been reduced by 12% since 2009.

Staff numbers have fallen by 14,000, or 13% of total staffing since 2007.

We have the scare stories all over the place in the media with trolleys and bad ambulance response time, etc.

Then we have the government’s plans to push further the system towards privatisation, including creating hospital groups, a purchaser-provider split, activity-based funding, and greater “autonomy” for hospitals. I talk about this at greater length in chapter 7 of my latest book.

For example, Leo Varadkar said this explicitly recently:

“Where hospitals consistently under perform in terms of clinical outcomes, patient experience and financial management, it should be open to the provider to transfer management of the hospital for a period of time to a private provider”.

The Irish Medical Organisation (IMO), which represents doctors in Ireland, strongly criticised Varadkar and stated that his idea that profit-minded private businesses could take over public hospitals was “grossly insensitive and ill conceived”—it “will downgrade public service and pave the way for privatisation of our essential health services”.

The IMO recalled that for-profit medicine “has been a disaster in other countries”, most evidently in the US.

Therefore, we need to start taking action to reclaim and improve our public healthcare system. It will be better for health and more efficient financially.

Julien Mercille is a lecturer at University College Dublin. Follow him on Twitter: @JulienMercille

60 thoughts on “Your Health In Their Hands

  1. Kolmo

    I wish people would stop calling it ‘free’ – it isn’t free, it paid for by the tax-payer, you and I, like water, roads and schools, we should be proud to pay for an efficient public systems, they just need to be made more efficient, then I’ll be proud to pay taxes for them

  2. Harry Molloy

    Would Julian advocate redundancies in the bloated admin side of the HSE where all the money is wasted?

  3. The Dude

    It is particularly noticeable the amount of health insurance adverts on radio and TV these days, that used not be present previously.

    It is noticeable too how those same outlets somehow overlook debating key issues as raised by Dr. Mercille above.

    Interesting too how the last Taoiseach and former health minister, Brian Clowen, has gone working in this same sector – now being on the board of the Beacon Private Hospital, which separately is owned by [Redacted].

    Funny how it all works. Or doesn’t. Funny how stories now emerge amidst the Irish propaganda hegemony as to how people without health insurance have to wait 25 times longer for essential cancer tests, and are dying – with the effect of such stories coincidentally encouraging (terrorising) others to buy insurance. It’s a funny old world.

    1. Lordblessusandsaveus

      That’s exactly what’s happening. Frightening people into going private.

      The Irish State is knowingly and willfully killing it’s own citizens under an ideology of privatization.

      Kill off a few thousand less well off people who we don’t care about because we don’t know them and use their horror stories to make everyone else accept privatization.

    2. rotide

      There have always been ads for private healthcare on tv. They’ve always been a staple of advertising. Maybe you just didn’t notice them before or maybe you’re just deliberately tryign to back up your point with things your making up, it’s what Julien does.

      1. Tish Mahorey

        Rotide being obtuse again.

        There was ONLY Vhi for decades and now there are four or five players in the market all advertising heavily and in most cases are only selling on discounted cosmetic services which they buy at a greater discount such as teeth whitening or laser eye surgery.

        And all the newspapers editorials are pushing the privatization agenda, keeping their health insurance customers happy. And the PR agencies help them with that by providing stories and examples for them to use.

        You know the health service is being pushed towards privatization. You know it. So stop pretending you don’t.

        I know this industry from the inside so I I know what I’m talking about.

        1. Kieran NYC

          “I know this industry from the inside”

          I thought you were a bitter graphic designer? And not a bitter healthcare worker?

  4. J

    What % of the public healthcare is funded by private insurance? Also a very important question to ask . If Jules wants free healthcare for all, he needs to address how this will be is funded. A balance of equity, efficiencey ( follow NHS practice and close those hospitals that are not viable… Roscommon anyone?) and economics is needed. Would such a balance be achieved in an NHS type system?

    1. Dara

      It’s the opposite and I quote the great HouseIrish Times
      “St Vincent’s Private Hospital in south Dublin has a parasitic dependence on the adjacent State-funded public hospital, the head of the HSE has said.

      He said there were concerns the private hospital was being run off the back of St Vincent’s public hospital which received €206 million in State funding.
      He suggested it was coming close to the stage where the HSE could not accept the situation any more.”

      http://www.irishtimes.com/news/health/st-vincent-s-private-has-parasitic-dependence-on-public-hospital-1.2186325
      Not to mention the private systems being funded by over prescription of medication for ‘problem areas’ but that needs some obsessive type to start going through the data…oh look there’s the CSO stuff gotta be records for medical cards or postcodes and treatment outcome, right?

    2. some old queen

      The real question is how much of private healthcare is funded by public? We already know that consultants who work in both areas use public facilities for their own profit. Abusing such is fraud, plain and simple.

      1. Dara

        And how do we find this out? Seeing as our journalists are muzzled or house trained or just don’t know what to do with data. We have unemployed physics graduates the data is out there, not much else to do, may as well fond the answer to that one.

        As responsible citizens like.

    3. Lordblessusandsaveus

      “What % of the public healthcare is funded by private insurance? ”

      Zero percentage. Stop trying to push the idea that private policies are subsidising public patients you right wing troll.

      1. J

        If you have private healthcare and are treated in the public hospital the insurers will pay the hospital AND the consultant.
        Lord Bless US and Save us, one can be left without being stupid. Your yawning sanctimony is in communion with BS neurosis. Congrats. Pat on the head from Bodger.

        1. Dara

          Did you miss the ‘parasitic dependence on the adjacent State-funded public hospital’?

          Here it is again: A parasitic dependence.

          http://www.irishtimes.com/news/health/st-vincent-s-private-has-parasitic-dependence-on-public-hospital-1.2186325

          Shure its only an oul post theocratic knee jerk, using the poor to fund St Vincents Private, resulting in worse outcomes for the poor, who deserve to be punished. Part of the natural order right? Have to be reminded of their place? St Vincents learned a trick or two from their predecessors.

  5. Dara

    It’s the opposite and I quote the great HouseIrish Times
    “St Vincent’s Private Hospital in south Dublin has a parasitic dependence on the adjacent State-funded public hospital, the head of the HSE has said.

    He said there were concerns the private hospital was being run off the back of St Vincent’s public hospital which received €206 million in State funding.
    He suggested it was coming close to the stage where the HSE could not accept the situation any more.”

    http://www.irishtimes.com/news/health/st-vincent-s-private-has-parasitic-dependence-on-public-hospital-1.2186325
    Not to mention the private systems being funded by over prescription of medication for ‘problem areas’ but that needs some obsessive type to start going through the data…oh look there’s the CSO stuff gotta be records for medical cards or postcodes and treatment outcome right?

  6. Nilbert

    I read this in Lionel Hutz’s voice: “Understanding these three points allows anybody to win any debate about healthcare against those who claim that a privatised, market-based, for-profit system is better”

  7. Eoin

    The only reason health is such a big issue is because people have forgotten (or don’t realise) we’re being bled dry by the EU and the gambling bond holders. Knowing these guys I wouldn’t be surprised if I found out they deliberately ruined the health service to give us a distraction from the fact were are being robbed by bond holders and the EU. It’s coercion and downright theft. Get the bureaucracy and cronyism out of health to fix it. Same as everything else here.

    1. Tish Mahorey

      The health service is being destroyed but not for that reason. It’s being done to make privatization seem like the only viable option.

      It’s a well known tactic worldwide. Anyone who works in the financing and planning of public services knows this.

      1. Vote Rep #1

        I disagree. There was a stat on here that shows we are paying a higher percent from the budget towards healthcare than any other EU country. The health service is being destroyed but by the lack of appetite to reform it properly. Instead we have different governments who have either thrown money it or made cuts, depending on the state of the coffers. Its an unholy mess and fixing it will be dirty and painful and no short-termist government well go near that.

        1. Harry Molloy

          I agree with this.

          Heath is too big and clunky to change the approach towards it every time we have a new government. Needs to be depoliticized and have a cross party approach and long term strategy agreed.

          It’s too important for political point scoring.

        2. some old queen

          @ Vote Rep #1

          Yes there was a stat all over the media that that claims we are paying a higher percent towards healthcare than any other EU country.

          That stat INCLUDES private health care which in itself is much higher cost than most other EU countries. The stat for funding public health care provision is way down the ranking?

          The devil is in the detail.

    1. Harry Molloy

      Thank God for AIB , BOI and even the central bank for their massive contributions this year, in excess of what was required.

      agree we should certainly be striving for 12.5% but would highlight that we would be foolish to believe we would get 12.5% of all that Apple or Medtronic earn globally just because they have HQs here, that money wasn’t earned here and will be simply shifted elsewhere if we aggressively chase it. So it would be foolish to base any financial planning on pulling in such cash.

        1. Harry Molloy

          was a bit tongue in cheek alright, but they did pay over 20% if I recall correctly :-)

  8. some old queen

    I think the principle of an NHS has to first championed, just like Rory has done here. It is an ideal platform for SF/SD/AAA and Labour (if they ever get their act together again) to unite and start calling out this clearly anti democratic agenda. For profit health care doesn’t work and is hugely unpopular with the public so I really don’t know why they aren’t doing so already.

    1. Dara

      This one was Juliene but nice1 for the heads up..please stop trying to reanimate Labours corpse.
      Have you ever heard of a country called Scotland and this party called the SNP?

  9. Tucker Done

    “Question 1: What is the most important issue for Irish people?
    Answer: Healthcare. Opinion polls show that free universal health care is priority number one.
    Question 2: What is the most misrepresented issue in public discourse?
    Answer: Healthcare.”

    Source: none

    Julien consistently degrades his contributions by the absence of evidence. It’s not that there is none, just that he doesn’t seem to think it worthwhile to reference really annoys me. Before anyone jumps, two links to his Journal article (no references there either) and a link to his book doesn’t count

    1. Declan

      I thought it was water according to sections of the Dail.

      But don’t we already pay for healthcare through our general taxation, something something, I’ve paid already.

      Also he’s great at using “bureaucrats” a it’s so faceless and such an easy band wagon to jump on sort of like terrorists.

    2. Dara

      Actually the Irish Times own exit poll put it up there as the top issue across the social spectrum.
      More taxes for a better quality public health system.

      1. Declan

        I’m with you on the taxes as we have to pay our way but that applies to everything (even water bills). The publicity water got as a government issue during the formation talks is a joke but all parties (that includes all those not in Government) are to blame for that. They needed to feed the beast it’s become.

        I don’t think the comments from the commission on broadening the tax base got enough publicity as it deserved.
        http://www.irishtimes.com/business/economy/commission-tells-government-to-broaden-tax-base-1.2652024

    1. Dara

      What if somebody genuinely cannot pay for medical treatment?

      Are we going to be the type of society where your life is valued by what is in your pocket?
      We already are this type of society just with a veil of humanity, an apartheid health system which is what we have now already has vastly better outcomes for private patients.
      If you genuinely don’t have the 15 euros a week then you just don’t deserve that time sensitive scan as much as somebody who does have 15 euros a week.
      That’s where we are now as a society.

      Do people really want to go further?

      1. Declan

        I think Clampers is been flippant re water protestors – that or I’ve been trolled :(

  10. Lordblessusandsaveus

    *** BE VERY CAREFUL WHEN CHANGING POLICIES ***

    Most insurers are now tricking customers into accepting new policies with new terms and conditions by offering them a discounted version of the plan they are on. They tell you it’s the same cover but for less money to encourage you to stay with them, being all nice and helpful right?

    Wrong.

    What they are doing is giving the Actuary in the insurance company control over your care plan instead of your Consultant. This means that the insurance company determines what course of treatment and what drugs you will be given or NOT given.

    This is the American model where an effing accountant over-rides the knowledge and advice of the Medical Consultant to save the insurance company money.

    It’s piggery.

  11. dav

    Fair play Julian, we must fight the neoliberal policy of profiting from peoples pain and suffering.

  12. nellyb

    We’ll have the same waiting times, the same facilities and the same staff, but all of it costing a lot more money to taxpayers’ pockets – to pay management boards for corporate turrets and large bonuses.
    When standards are not enforced, the best of systems will be defunct. If we can’t even do very basic tasks, like proper cleaning, what chance do we have in performing more complicated duties??? More money won’t change it. Feckless fest will pursue, public or private.

    1. some old queen

      Given the increase in population, demanding for more money would be a reasonable request. But this point funding front line staff to levels of 2006 is an absolute minimum?

  13. Owen C

    “Yet we learn nothing about what the real problems are and how to fix them.”

    And we still don’t. This was just a rant about privatisation. How does that help fix the current system?

  14. Big_G

    Argument collapses under the weight of crappy healthcare system pre-2009 cuts. Crappy healthcare system was always crappy.

  15. some old queen

    This is an interesting movement in Britain. We Own It. https://weownit.org.uk/ They pretty much nail all the private/public arguments down.

    The Tories are trying to sell the land registry now?

  16. gclub

    As an Architect you rarely have a “greenfields” site and need to design a solution which fits in with the existing environment. You have the same challenges in your organisation with an existing culture, traditional learning programs, performance management processes, assessment tools, existing technologies and systems.

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