In Fuller Democracy 2016, I asked people what kind of healthcare model they supported. 95% of people said that they supported a tax-funded, universal healthcare system, such as exists in Canada and the UK. 65% of people supported a tightly-regulated, income-pegged insurance model, as exists in Germany. No one – literally no one – supported American-style health privatization.
So, I have begun to formulate a plan for healthcare improvement along Canadian/British lines.
The first prong of my strategy is to oppose all further healthcare privatization.
The second prong is to maximize the efficiency and outcomes of the existing public system in order to make it capable of picking up the slack once the private system is abolished.
The third is to phase out private healthcare by bringing all doctors and hospitals/medical centres into a centralized system of universal healthcare (excluding some dental care and costs of eyeglasses, as these are also excluded in Canada, our reference system).
Now, prongs one and three are fairly straightforward. Phasing out private healthcare may require some changes to the law, but it would ultimately be possible to make these changes.
Prong two – maximizing the efficiency and outcomes of the existing public system to make it fit for purpose – is the difficult bit.
The good news is that reforming and improving our healthcare system would not require spending more money – Ireland is already spending more money on healthcare per capita than most developed nations. In fact, it would not require even hiring any more doctors. Canada has fewer doctors per capita than Ireland does, and a similar number of specialists per capita, despite the fact that Canadians are much more geographically spread out than Irish people are, making delivery of services more challenging.
The bad news is that the problem is a lot deeper than money.
There are some things that could be optimized about Irish healthcare: some consultants are overpaid; medical help could be delivered more efficiently in strategically placed medical centres equipped with basic diagnostic equipment; a significant portion of funds doubtless goes missing as a result of the confusion and overlapping administration of our entwined public and private systems.
But even all of this does not fully explain the difference in input and output in the Irish healthcare system, which, to put it bluntly, is practically the Bermuda Triangle of disappearing healthcare funds.
The only real explanation for the state of our health system is widespread incompetence and corruption, which results in everything from insufficient upkeep in training to taking decades to build a hospital. It also results in plan after plan after plan for medical improvement not being implemented. When obvious improvements go un-realized for so long, it is because there is an entrenched culture resisting that change.
This leaves us with a problem: how do you get rid of something so rotten and so entrenched? Burn the whole thing down and start again? It’s certainly a tempting thought, but unfortunately it would temporarily leave us without a healthcare system at all.
So, while I am reluctant to call on outside help, I feel that the situation demands it. The problem is not a plan for healthcare improvement – that is easy enough to come up with and we’ve had dozens of them, the latest being the Sláintecare Report – the problem is enforcement. I would propose therefore to simply import several dozen health care executives from abroad (possibly some of them could be Irish people who have spent a very long time abroad) and give them a decade-long carte blanche to do whatever is necessary to rebuild the healthcare system from the ground up. And, let me be absolutely clear, I mean whatever is necessary. I’m sure this would entail much wailing and gnashing of teeth. Indeed, it would be a bad sign if it did not. But there’s really nothing wrong with our healthcare system apart from gross mismanagement and poor training, and it has become obvious that the inertia of the system is such that that cannot be fixed from the inside.
My policy in this regard would go much, much further than the ‘Health Tsar’ the current government are, as of time of writing (August 2017) considering appointing. This ‘Health Tsar’ would be empowered to make ‘recommendations’ on the implementation and costing of the Sláintecare Report, which itself proposes an investment of 3 billion Euro in healthcare (unnecessary, as we have seen that our problem is not a financing problem), and gives the usual goals of ‘improving waiting times’. While it does also have the laudable goal of disentangling public and private hospital services, the Report, and the Health Tsar plan, do not go nearly far enough, are often vague in their core approach, and engage in the usual tactics of throwing good money after bad while appointing someone to issue toothless ‘recommendations’. We need to first plug the holes in this leaking ship before pouring more money in, and that means a thorough, probably quite painful, cleaning up of the system all the way through. Time to take the medicine.