From Socialist Voice, December 2008

Dismantling the public health service by stealth

The “National Treatment Purchase Fund” is the most explicit demonstration yet of the dismantling of the public health system.
     Other actions by the Government are more indirect and are going on behind the scenes. The “co-location” of private hospitals in the grounds of public hospitals is also open by necessity (and is being vigorously opposed); but the Treatment Purchase Fund is a very difficult issue. To oppose it is to appear to say to sick people who have been on a waiting list for an excessive length of time that they should wait even longer.
     It should nevertheless be opposed, because it is the means of dismantling the public health service. The total collusion between the Government (as the instrument of private business), the civil service and the medical profession in the systematic capitulation to privatisation is one of the most disgraceful acts of betrayal of the people.
     With the baying of the Government parties and Fine Gael for “cutting costs,” where are the intrepid investigative journalists asking for an investigation into the cost of paying private hospitals for treating patients while cutting the funding of public hospitals? Far from raising such questions, they add to the hue and cry with their lame questions about cutting costs and attacking public-service workers.
     Will the Government publish a breakdown of how much they pay each year to private providers, by type, for all services, including “advice” from financial and medical consultants―who are themselves involved in private hospitals? Will they publish a list, with amounts, of those receiving these funds, as they do for the legal profession? This would allow the real cost of public health to emerge, rather than the cost of subsidising private health-for-profit operators.
     Does anyone investigate the ratio of occupied public hospital beds to the number occupied in private hospitals? Or ask what is the real function of the Treatment Purchase Fund, apart from dampening outright opposition at levels that could not be contained? It is to fill the beds of private hospitals, at the taxpayers’ expense.
     These hospitals do a roaring business at weekends, treating public patients, and a walk through any private hospital reveals the fact that there are empty beds needing patients. As it costs more to treat a patient for private profit than at pure cost, the costs can only increase beyond the taxpayers’ ability to pay, and then the pay-or-die system will be complete.
     Public hospitals are being told to redirect patients to the treatment fund. Surgery is being delayed in public hospitals while surgeons are available, because of the lack of funds.
     From time to time these issues are raised on the radio, but usually in short slots on daytime programmes, which necessarily exclude large sections of the population. The debate on prime-time current affairs programmes is limited to proponents of the prevailing ideology; and the excuse, according to one brave consultant who exposes the system, is that when it is known to the Government who is debating with them they decline to take part. Then the television producers say they can’t debate the issue, because it would be “unbalanced.” What media adviser thought of that one?
     In the one or two exceptions to this the audience gave the panel such a roasting that they are not likely to expose themselves again. And even that was such a loaded panel that the opposition was limited to very brief comments from the audience.

Privatisation and the European Union

The latest nail in the coffin of our health service is the tax allowance for the holders of private health insurance to subsidise the VHI, because of its older membership. This is a direct result of the action of unscrupulous health insurance companies with a younger membership in refusing to participate in a proposed equalisation scheme that would spread the cost among all companies. They rigorously opposed it in the courts, using the Competition Act (2002)―an instrument of the European Union―and they won, because the law operates on a system of protecting private ownership at the expense of the rights of the people.
     As a result, VHI premiums will become unaffordable, and then what will the Government do if everyone goes back to the public health system? This is something they must avoid at all costs, until the project of handing over the public health service is completed.
     The tax allowance for subscribers was accompanied by a threat to the younger population that if they don’t join a private health scheme early in life they will be penalised later by higher premiums. Now, why should people be threatened if the public health service is to continue? Because, largely, it won’t be, except in a skeleton form with poor service for society’s “failures.” And who cares about them?
     It’s easy to lay all the blame on Mary Harney, and indeed her ideology and that of the defunct PDs was the instrument for starting this process. But the real blame lies with the European Union and its policy of privatisation of public services, which is itself a project of the group of twenty of the largest capitalist countries and their programme espoused in the UN Investment Reports since the 1980s. This ideology is firmly stated: that public services must be dismantled, and that this is a great source of profit for private companies, particularly transnational corporations.
     We are seeing this today in Ireland, where American companies are cleaning up, and indirectly causing the premature death of public patients.
     How can the trade union leadership stand by and let their own members suffer, both in their employment as union members and as citizens needing medical treatment? Employers act in their own interests instantly when anything threatens them; and the trade unions can do the same, as united they are the larger force in society. There are many trade union groups taking action; but it needs the stronger force of the leadership to give this direction and strength.

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