From Socialist Voice, January 2007

Choice but no choice

The crisis in the public health system continues to grow and deepen. The solutions presented by this Government, as pushed by Mary Harney as Minister for Health, are exacerbating an already bad situation. Two-and-a-half years in charge of health and her ideological drive to impose private medicine continues.
     January started with 320 day patients lying on trolleys in accident and emergency departments and in hospital corridors. The Treatment Purchase Scheme—introduced as a temporary measure—is nothing more than a means of pushing public patients on a conveyor-belt system into the private hospitals and clinics, further enriching private medical corporations and the elite group of consultants.
     We ended 2006 with the announcement that the British private health insurer BUPA was pulling out of the Irish health insurance market, because it disagreed with risk equalisation—this despite the fact that it is making 18 per cent profits here in Ireland while in Britain it makes 5 per cent.
     BUPA announced that it was withdrawing from Ireland following a High Court decision to uphold the legality of the controversial risk equalisation scheme. This provides that insurance companies with fewer elderly subscribers must compensate other companies that have higher numbers of elderly—and therefore more costly—subscribers.
     Under the scheme, BUPA would have to pay its main competitor, VHI, €161 million over three years, during which time its profit would be an estimated €64 million. BUPA has about 475,000 subscribers. From this month, anyone in Ireland whose policy with the company is due for renewal will have to seek an alternative insurer.
     Irish hospitals have now become dangerous places for those who are admitted even for minor operations, because of the spread of the MRSA (drug-resistant) hospital bug. The combination of 100 per cent bed occupancy and the privatisation of cleaning services is leading to a situation where hygiene is being sacrificed.
     Cleaning workers are poorly trained or poorly supervised by medical staff to ensure that wards are properly cleaned and sterile. The majority of the cleaners are poorly paid. So the pressure on budgets is forcing more and more sub-contracting of services. Cheap is not the same as best.
     Harney continues to push to have private hospitals built on the grounds of public hospitals. This will only lead to further pressure on the public health service and further growth of the private health sector, leading inevitably to growing inequality.
     Working people should be concerned when we see individuals like the beef baron Larry Goodman being a significant investor in private medicine, in particular the new private hospital in Galway. The first and primary objective of private hospital investors is to get a return on their investment, and preferably a growing return every year.
     The ideology of this Government and in particular of the Progressive Democrats has to be confronted head on. Experience has shown that you can’t have two parallel systems of health operating, one public and the other private. The most effective and efficient way to provide public health is to have a fully integrated public health service.
     The Cuban health service is a model of how to provide a public health service to the mass of the people. The priority is the provision of health, not feeding the bloated profits of drug and medical corporations or an elite of consultants.
     The Government, the Minister for Health and media pundits continue to trot out the mantra of “giving people choice.” In fact we are not being given a choice but rather inequality. If you can pay you can avail of services that others who can’t afford (or who oppose) private medicine have to wait for. If you have the money you can skip the queue and get ahead—not because your need is greater but because your purse is deeper.
     This concept of “choice” is just old-fashioned inequality, which is inherent within capitalism. The provision of public health for all was one of the big successes of the struggle by the labour movement over many decades, aided by knowledge of the free universal health care provided by the Soviet Union. It is now being dismantled.
     We need a united campaign of all those interested in the provision of public health, to come together to defend and advance public health from the attack by highly organised special-interest groups. The ICTU has a central responsibility for taking a leading role in this. It can unite all the forces committed to public health. In doing so, trade unions would be reconnecting with their own history and roots.

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