February 2017        

A planned health crisis

Eoghan M. Ó Néill

The headlines scream that once again Ireland is hit by an annual health crisis—that each winter, just around Christmas time, we are hit by a crisis in our A&E departments brought on by elderly bed-blockers and those who refuse to take the flu vaccination.
     This year a record 540 people were on trolleys. The Government and the private sector came to the rescue by providing private beds, paid for from the public purse.
     Why is it that every winter we are hit by a health crisis? And why is it that every winter the crisis is worse than the previous one?
     The answers don’t lie in “bed-blockers” or in a refusal to get the flu vaccination.
     To begin with, the crisis in the health service is not just a winter crisis: it is a permanent crisis that only gets worse during the winter months. Nor is it a uniquely Irish phenomenon but one that is to be found throughout the capitalist world, all of which shares the same common cause: disinvestment in health in preparation for privatisation.
     If journalists wanted to know the real cause of our health crisis they need look no further than the statistics produced by Eurostat (the EU statistics agency), the OECD, and the World Health Organisation. There they would find that capitalist governments have been systematically running down public health services for decades while continuing to support and subsidise the private sector.
     The health service has not fallen into crisis: government policy has been to drive it into crisis.
     Though there have been recent claims that Ireland spends more on health than most EU countries, this is only true if you include the amount spent on the private sector: subventions to private hospitals, health insurance payments, payment for visits to GPs, and prescription charges.
     Strip away all these payments to the profit-seeking sector and the figures tell a different story. Data from the Central Statistics Office shows that between 2008 and 2013 spending on public health fell by 3½ per cent, while spending on private health increased by more than 50 per cent. Figures from the OECD show that the number of hospital beds in Ireland has been consistently falling, from 30,834 in 1980 to 11,989 beds in 2014—a loss of 18,845 beds!
     In 1980 Ireland had a ratio of 9.03 beds per 1,000 of population; by 2014 this had been reduced to 2.6 per 1,000. Compare this with Greece—a country our government has sneered at. In 1980 Greece had a ratio of only 6.23 hospital beds per 1,000 of population—a figure significantly lower than Ireland’s. By 2014, however, the situation had almost reversed, with a ratio of 4.2 hospital beds per 1,000 of population in Greece—almost double that of Ireland. Despite “austerity” and attacks on the Greek economy by the imperialist EU, they have managed to better provide for the health needs of their people than the cloying, obsequious Irish government.

Hospital beds per 1,000 population, OECD countries, 2014

International comparisons

What is happening is not unique to Ireland but is part of a pattern that is evident throughout the capitalist core. Disinvestment in the public health service throughout the capitalist world is preparing the way for a massive move towards privatisation. The trade agreements of CETA and TTIP are designed to further eviscerate public services, such as health and housing, and open them up to privatisation. This is evident in CETA, where the Irish government refused to protect the public health service from privatisation—indeed it refused such protection to all our public services, paving the way for the vulture funds and transnational corporations to sweep in and profit from our public services.
     This is in line with the international move from public services to commodified, profit-seeking private services. The table shows the level of disinvestment measured by loss of hospital beds in public hospitals in capitalist OECD countries.

Number of hospital beds, fifteen selected OECD countries

Czech Republic1990102,810201467,937
United Kingdom2000128,8342014176,323
United States19691,616,0002013914,513
     Capitalism seeks to resolve its crisis by opening up new markets. Public services are to be run down by means of government disinvestment and neglect. The private sector—which continues to receive public subsidy—will be heralded as the most efficient model for providing public services.
     Transnational corporations will be welcomed as the saviours of our health systems and will make huge profits from those who can afford to pay; those who can’t will be left with, at best, a health system that is dysfunctional, overcrowded, and incapable of providing the health service our people deserve and need.
     Seems familiar? That’s because it’s already happening. Our government is neglecting the health needs of our people, putting the health and the lives of our most vulnerable people at risk in order to pursue an ideology of profit over health.
     There is an alternative: a socialised public health service, based on need rather than profit. We are witnessing the destruction of our public services in the interests of profit: our public housing, our public health, our public education, our public infrastructure and transport—all are being systematically destroyed to pave the way for profit-seeking vultures.
     We need to join up the dots if we are to protect our public services and to expand them. It is not a question of money—Ireland is a rich country—but of having the necessary political will.

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