March 2014        

James Reilly’s plenary indulgence

Mediaeval Christians believed it was possible to win divine approval through the purchase of indulgences—an early form of insurance, guaranteeing preferential treatment in the next life. The process suffered a terminal blow when angry Germans objected, saying that the scheme unfairly favoured the wealthy.
     Moving on a few centuries, we find the coalition minister for health, James Reilly, offering us a product that is just as dubious, also heavily biased in favour of the well-heeled, and differing only to the extent that the Fine Gael deal ensures preferential treatment for the wealthy in this life rather than somewhere beyond the grave.
     The Fine Gael minister has told the Dáil of his Government’s intention to introduce a package of “universal health insurance.” For many people this proposal may seem like a good and positive step, as the present health system in the Republic is a shameful two-tiered mess. Anybody doubting the seriousness of the crisis facing our health service need only reflect on what Prof. Anne Scott of DCU School of Nursing recently told RTE’s “Morning Ireland” programme, that five thousand nurses have been taken out of the Republic’s creaking health service since 2010.
     The reality of Dr Reilly’s proposition will not, unfortunately, match the guff he has generated for his plan to address this problem. No matter what assurances are given to the contrary, any system based on insurance will have diverse layers of quality of treatment and different waiting times for patients. Facilities and skills inevitably follow the money in profit-oriented markets, and each step away from a universal health service (such as the British NHS) is a step towards American-style health markets, where a privileged few receive superb attention while the less well off struggle for what is left.
     While differences of opinion between the Department of Health and Department of Public Expenditure appear to centre purely on cost control, it is necessary to keep in mind that private-sector health care is not just unfair but is wasteful and ineffective.
     The iniquity involved in discriminating between people in poor health hardly needs describing. Differentiating between those who are left to suffer longer than those who can afford to have their pain alleviated, or those who live longer than others on the basis of personal wealth, is just plain offensive.
     Multi-tiered private-sector health care, moreover, is too often wasteful of precious resources. The temptation to capitalise on an available pot of money frequently results in unnecessary expenditure. We have all heard stories of profligacy in the present system: two half-full ambulances simultaneously covering the same journey because one carries insured patients while the other has public patients, an unnecessary extra night in a private ward for policy-holders, or a superfluous consultancy check-up. It would be naïve to believe that this would be any better under Reilly’s new scheme.
     What this drive towards marketisation will also ensure is the continuing closure of local hospitals, with the inevitable loss of local nursing and medical expertise, especially in rural areas, as people in Cos. Monaghan, Roscommon, Offaly and Kerry already know. Inflated claims about “centres of excellence” served by fast, modern transport are unconvincing at best. These large new centres rarely compensate for the presence of trained personnel living locally and not necessarily on duty in wards.
     What are the chances now of a road accident victim, or a construction site casualty, or a worried parent, being able to call upon a nurse living close by or on her way to work in any of these regions? Before long, the benefit of stabilising an individual through the “golden hour” of an emergency will apply only to those who live in large urban centres.
     The fact that the O’Reilly package may not succeed in passing through the Dáil this time around should not lure anyone into a false sense of security. Hard-boiled advocates of a rigid, right-wing agenda are determined to press ahead with a drive towards still greater marketisation and will view any setback now as purely temporary. After all, it is not that long since both parties in the present coalition Government were proclaiming their opposition to household and water taxes.
     At the heart of this UHI issue lie some extremely important matters that we cannot afford to lose sight of. In the first place is the crucial question of whether the people of this state are to be treated as citizens or as consumers. Have we inalienable rights as members of this society, or are we “customers” of those who are in the business of making a profit? This is a matter of fundamental importance, relating to how this country and society function. If health care can be marketed through the private sector—what O’Reilly wants—then every other aspect of human life will be subject to the same yardstick.
     Health care is widely recognised by an overwhelming majority of people as a crucial necessity. We have seen, for example, the broadly based and energetic campaigns in rural Ireland to prevent the closure of local hospitals; we know how anxious people are about the curtailing of medical cards, and how worried we all are abut reductions in hospital staffing levels. What is not always so widespread, though, is a realisation that closures and cut-backs are not purely local or isolated issues. Giving health care over to the market through universal insurance further undermines the welfare safety net and makes working people more vulnerable.
     In reality, it is another step in a continuing campaign to diminish the strength and influence of the working class in this society.
     A comprehensive national health service, free at the point of entry, is not a privilege: it should be the sine qua non of a democratic civilisation in which there is an abundance of wealth, albeit unequally divided. The right to an equal share of the benefits of medical science has to be understood to be an essential component of a social wage that each and every citizen has an entitlement to draw upon.
     This is a crucial point in any campaign to stall James Reilly and replace his scam with an acceptable alternative. The promotion, development and expansion, where possible, of the social wage, including health care, is a working-class demand that organised labour should emphasise and around which it should campaign. Ireland’s organised labour movement, supported by the citizenry, has the capacity to organise a successful campaign to block this move.
     There is, however, a responsibility on us all to join in this struggle and not resort to the old cop-out of demanding that the trade union leadership alone delivers for all. It is crucial that Reilly and his supporters are prevented from introducing this policy. We need to muster the resources necessary to ensure that James Reilly’s medical indulgence is foiled.

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