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Susie Long (1966 – 2007): She struck a blow against the privatisation of healthcare

category national | miscellaneous | opinion/analysis author Saturday October 27, 2007 18:38author by Jolly Red Giant - Socialist Party/CWI Report this post to the editors

The recent untimely death of Susie Long was widely covered in the media in the South. Susie made a powerful impression in January of this year when she spoke on RTE radio of how she had developed terminal cancer of the colon. It was a tragic and shocking story.

By Joe Higgins

Using the pseudonym, "Rosie", as her 13 year old son, Fergus, didn't yet know the awful reality, Susie Long explained how she had been referred for a scan by her local doctor in the summer of 2005 but being a public patient was on a waiting list until the end of February 2006.

The scan showed she had cancer. Worse it had spread to the lungs. And criminally this had very likely happened while she was on the waiting list.

During her twelfth chemotherapy session, Susie heard of a fellow patient whose chance of recovery was far better than hers because he had his scan done three days after seeing his doctor. He had private insurance. When she went home that evening and saw a Department of Health TV advertisement warning that bowel cancer can kill but not if it is caught in time, she was so angry she decided to speak out.

I didn't hear "Rosie" on the Liveline programme but was alerted to her contribution by an email to my Dail office. It was from her husband, Conor MacLiam, whom I had known for a long time. He told me that 'Rosie' was really Susie whom I had also known and attached the email which she had originally sent to RTE outlining her story.

In the early 1980s Conor was a member of Militant, the forerunner of the Socialist Party and made a major contribution in producing our political material. Having arrived from the United States at 17 years of age and after meeting Conor, Susie also became a member of Militant. They later moved to Kilkenny where they brought up their two children, Aine and Fergus.

Susie's story graphically brought home the reality of the two tier health system in this State and shocked and angered decent people up and down the country. I got the ready agreement of the Independent TDs in the Dail Technical Group to tackle the Government over cancer services in our three hours private members time debate due a few weeks after the programme.

Our motion noted “with alarm the recently highlighted situation of a Kilkenny mother, ‘Rosie’, who, being a public patient, had to wait eight months for a colonoscopy with the most serious and tragic consequences for her health and life”, and called for “the scrapping of the Government bias toward privatisation of health care” and for a “fully resourced public health service with immediate access to services by all, based on medical needs”.

On my invitation Susie followed the debate from the Dail public gallery accompanied by Fergus. It wasn't easy for her listening to Minister for Health Harney giving the government line on the health service. She was, however, very pleased when Harney was forced to announce during the debate that in the case of her local hospital, St. Luke's Kilkenny, “The HSE has made available capital funding of €300,000 to build a new modular endoscopy unit at the hospital.” Susie was invited to be the keynote speaker when the sod was turned for that project in May. She invited me down for the ceremony but unfortunately it was in the middle of the general election campaign and I was very sorry I couldn't go.

That investment in St. Luke's has since been boosted to a 24 bed day care unit. All this was prioritised and extended in scope as a result of Susie's campaign since January. It will be an enduring tribute to her memory.

Susie was caught in a difficult economic situation like many working people. As she said, “Despite one and a half incomes we couldn't afford VHI or BUPA”. Then, showing her commitment to equality and justice for all in the health service, she continued, “But even if we could have we wouldn't have gotten it because we believed that all people should get good care despite their incomes. We thought queue jumping was wrong. We're socialists…”.

Our solidarity and support goes out to Conor, Aine and Fergus in this most difficult time. We feel sure that their deep sorrow and justified anger at the untimely and avoidable death of their beloved partner and mother will be assuaged by the realisation that she struck a blow against the privatisation of health care in this State and turned a grievous injustice to herself to the benefit of countless others in the future.

author by Jolly Red Giant - Socialist Party/CWIpublication date Sat Oct 27, 2007 18:41author address author phone Report this post to the editors

Note: Rosie, a cancer patient in Kilkenny has given The Socialist permission to print extracts from an email she sent to Joe Duffy’s Liveline program (RTE Radio One) about her diagnosis of terminal bowel cancer and the two-tier health service.

For reasons of space, only an edited version of this letter was published in the print edition of this month's issue of The Socialist. Below we publish the full letter...

Dear Joe,

Today I had my 12th session of chemo. I got to talking to the partner of a man who was also getting chemo. She told me that when her partner’s GP requested a colonoscopy for him he was put on the waiting list. She then phoned the hospital and told them he had private health insurance and he was seen three days later. He had bowel cancer that was advanced, but had not broken through the bowel wall and spread to other organs. She said the tumour was the size of a fist and what made him go to the doctor was he started to lose weight rapidly. Thank goodness they got it in time and he’s going to recover.

I then came home, flicked on the TV and got into bed. The first ad on the TV was from the government telling people that bowel cancer can kill, but not if caught in time. If Bertie Ahern or Mary Harney or Michael McDowell were within reach I would have killed them. Literally. I’m not joking. I don’t have private health insurance.

In 2005, I got a lot of diarrhoea and after a few months it became constant and blood accompanied some of my bowel movements. I went to my GP clinic in the summer of 2005. The GP immediately sent a letter to the local hospital requesting a sonogram and a colonoscopy. Within weeks I was called for a sonogram and was diagnosed with gallstones. I expected to soon be called for the colonoscopy. I waited through the autumn, then through the start of winter. No word on the colonoscopy and no word on when my gall bladder would be removed.

In November I started to get serious lower abdominal pain after eating. I phoned and was assured I would be called soon. In December I started to rapidly lose weight. I phoned the hospital again after Christmas. Again I was told that I was still on the list and would definitely be called soon. Joe, from November to the end of February I was in agony. Apart from the pain and diarrhoea I was tired all the time.

Finally, on February 28, 2006, four days after I turned 40, I was called for a colonoscopy. I woke up in the middle of the procedure and saw on a large screen, them probing a blob on my colon. They were taking a biopsy. But I didn’t have to wait for the results. I knew what I had.

I was booked in for surgery to remove the tumour. I was in St Lukes hospital for over 50 days last year. Recovery was hard, but I did it. In March, in between surgeries, I was sent to the Mater in Dublin and had a PET Scan to see if the cancer had spread. If it hadn’t, I’d live. If it had spread to other organs, I’d die. It had spread to my lungs.

I felt bad enough to go to the doctor. She did what she was supposed to do. She told them I had diarrhoea and blood from my rectum. But what could they do? So do lots of people. Should I have skipped the list ahead of those other people with the same symptoms? I don’t think so. Should there be a list so long that it puts people at risk of dying? No definitely not.

I know in my heart and soul that when I started to feel really, really bad, especially in from December to February 2006, is when the cancer broke through the wall of my bowel. Of course I can’t prove it. But I know. Because it broke through the bowel I have been given two to four years from diagnosis to live. The chemo is to prolong life, not to save it. I have three years, tops, to go. Despite that, I’m going to try my best to make it for five more til my youngest turns 18. He needs me too much now.

My husband has suffered right along side of me in his own way knowing that the woman he loves will be dead soon. My 18 year old daughter has been told and has gone quiet and doesn’t want to talk about it. But I know she’s scared. I haven’t told my 13 year old son yet. He’s too young to handle it.

I don’t blame the wonderful people who work in St. Lukes in Kilkenny. St. Lukes has the best A&E unit in the country. What did the government do? Threaten to shut it down. They also threatened to shut down the maternity unit AFTER spending millions to improve it!

My time in the Mater was dreadful. I was terrified I’d pick up MRSA because it was filthy. I was put on a ward with cardiac patients, mostly men, who because of their ill health were unable to aim too well when they went to the toilet. Once when I used the toilet my pajama bottoms soaked up urine up to my ankles. There was excrement stuck to the sides of the toilet for days at a time.

Today, when I heard that a very nice man who was in the same, if not worse condition, than me when he went to his GP is going to live because he had private health insurance and I’m going to die because I didn’t, I had to bite my tongue. I’m happy he’s going to live. He deserves to live. But so do I. Then I came home and watched that ad which told people to hurry up and get checked out for bowel cancer because it will save their lives, and I fucking lost it.

The health service has been in the hands of Fianna Fail and the PD’s for years and all they can think to do is put resources into privatisation. But it’s not just the politicians. I’m also angry at every single voter who voted for Fianna Fail and the PDs because they thought they’d get a few more shillings in their pockets but were too greedy and stupid to realise that that money they saved in wage taxes would be made up with stealth taxes. We all knew before the last election what their health policies were and the majority of people ignored this and voted for them anyway.

I’m writing to you because the way this country is run leads me to believe that contacting a radio show is the only way to try to change things like this. I hope that when Ms. SUV and
Mr. Builder goes into the voting booth, they’ll think about me, my husband and especially my children.

Despite 11/2 incomes we couldn’t afford VHI or Bupa. But even if we could have we wouldn’t have gotten it because we believed (and still do) that all people should get good care despite their incomes. We thought jumping queues was wrong. We’re socialists... just like Bertie. Ha Ha. Now I feel like vomiting and it’s not the chemo!

- Rosie

author by Ivanpublication date Sat Oct 27, 2007 19:18author address author phone Report this post to the editors

What happened to this woman was shameful and disgraceful.

Do any of you really think that her death will make one jot of difference ? I suggest not.

Why ? We have a government whose indifference and indolence is paralysing any concept of progression towards a concept of fairness. I have private health insurance because I am scared not to.

Where is health care going in this country ? It is going towards the USA model where, if you have no means or health insurance, you get the level of care and respect of a piece of shit.

author by Ivanpublication date Sat Oct 27, 2007 19:23author address author phone Report this post to the editors

A p.s. if I may.

Isn't Clinton, the ambitious presidential hopeful, the one charged all those years ago with responsibility for health care reform in the USA ? Look at it's present state of gross failure. Some performance. In Ireland she would have got a pay rise for that performance.

And this is the article who wants to be president of the USA. If they elect her they deserve what they get.

author by Bostonpublication date Sat Oct 27, 2007 19:40author address author phone Report this post to the editors

An afterthought:
Correct me if you may, but did not Mary Harney our F.Fail.Green leader in Health say some tme ago, We are closer to Boston than Berlin, on some interview , forget what it was at the time>

author by Jim O'Sullivanpublication date Sun Oct 28, 2007 09:09author address author phone Report this post to the editors

Firstly my condolenses to the Long family.

The privatisation of the Health Service has been ongoing for sometime now. The HSE is itself a very important part of the plan. It is now, as we can see, virtually a stand alone outfit that is allowed to make life and death decisons with no need to consult with the people or their elected representatives.
Indeed, Mary Harney now spends all her highly paid time cutting ribbons at the opening ceremonies of for-profit facilities. Her friends,the speculators, are rushing in to make a killing building these facilities with the help of tax payers money through generous grants packages and thereafter they will milk the goden calf of treating illness, if you can pay that is. We know the fate awaiting those that can't. We are being delivered into the American style system where money and money alone will determine what level of care people will receive when they become ill. Depressing stuff.

But is it any more depressing than the results of the latest poll which shows that the government parties, through all of this, have maintained their level of support? As a community, do we need to look in the mirror a bit more often?

author by Scepticpublication date Sun Oct 28, 2007 13:45author address author phone Report this post to the editors

We only have Ms. Long’s guess that the cancer spread while she was waiting for a test – it is not proven. More generally, it is foolhardy not to have even a basic level of health insurance which is not very costly in this country (Plan A VHI or equivalent from VIVAS or Quinn which is cheaper still) and it is tax deductible at the standard rate for a spouse paying income tax. Many people put off taking out health insurance until they are old in the hope of not needing it and dress it up as principle (“as a socialist I don’t want to jump queues etc” though it is socialised medicine that is most prone to rationing by queuing). In reality this freeloads on the system because they avoid paying in while they are young and healthy. Its also possible for someone to get a test like that a cost of a few hundred euro – again it is tax deducible but this time at the higher rate and if you life literally depends or you think it does on it you will find the money. Besides these are usually paid in arrears – they would give you some time to pay it off and one could always get a hardship payment or run a quiz night or something. Really, sentient and educated people are managers of our own health and have a measure of responsibility for managing it in the real world where imperfections and gaps might arise or allegedly arise in a public provision system dependant on the clinical judgements of the doctors employed to work in it.

author by Jolly Red Giant - SP/CWIpublication date Sun Oct 28, 2007 13:56author address author phone Report this post to the editors

an individual who has plenty of money to provide for their own health care and doesn't give two fiddlers about those who don't. You obviously have never had to decide whether to put food on the table or pay out money every month for health insurance. This of course also ignores the fact that Susie paid income tax that, according to the government, is supposed to provide proper health care for the citizens of this country and eliminate waiting lists.

author by Ivanpublication date Sun Oct 28, 2007 15:25author address author phone Report this post to the editors

There is validity in Sceptic's arguments.

Where Sceptic's position fails to correlate with reality is where people just do not have the resources to pay basic health insurance premiums or the one off costs of particular tests even if you have to wait to recover tax relief. Mind you tax relief is no value if you are not in a position to earn an income.

It is the people at the bottom of the financial heap who are struggling with illness and incapacity who suffer most as that group often also struggle financially and it becomes a self-perpetuating nightmare. the treatment that they receive in modern ireland is just obscene.

author by Jim O'Sullivanpublication date Mon Oct 29, 2007 13:18author address author phone Report this post to the editors

I find it profoundly sad and indeed disturbing, that we have reached a position where somebody would actually attempt to defend the privatisation of Health Services particularly when we can relate to experience that shows that when such Victorian values are allowed hold sway, people die needlessly. Sceptic may well be a piss taker and hopefully that is the case, but the great worry is that he is not. Sceptic's post is deeply offensive to the Long family and demonstrates the ruthless nature of PD social policy. What 's happening in our Health Service is no accident, Harney is intending the chaos.

"We only have Ms. Long’s guess that the cancer spread while she was waiting for a test – it is not proven."

This is stupid, plain and simple. Had the services been provided when needed the outcome would have been very different. To suggest otherwise is to engage falsehood.

" More generally, it is foolhardy not to have even a basic level of health insurance which is not very costly in this country (Plan A VHI or equivalent from VIVAS or Quinn which is cheaper still) and it is tax deductible at the standard rate for a spouse paying income tax."

This is straight out of the PD sanctuary where the real world never enters. It completely glosses over the reality that we have many within our community that cannot afford adequate nourishment never mind the luxury of buying insurance of any kind. In Sceptic's world such people have no value.

" Many people put off taking out health insurance until they are old in the hope of not needing it and dress it up as principle (“as a socialist I don’t want to jump queues etc” though it is socialised medicine that is most prone to rationing by queuing)."

All working people in Ireland already pay for Health Services and indeed because of how the system is set up, they actually subsidise the luxury treatment available to those that can afford to buy private insurance.

"In reality this freeloads on the system because they avoid paying in while they are young and healthy."

More poppycock. The freeloaders are those on large incomes who are subsidised by those with little or nothing by tax refunds on such insurance payments.

" and if you life literally depends or you think it does on it you will find the money."

What happens if you can't?

" Really, sentient and educated people are managers of our own health and have a measure of responsibility for managing it in the real world where imperfections and gaps might arise or allegedly arise in a public provision system dependant on the clinical judgements of the doctors employed to work in it."

What of those that are not "senitent and educated"? Are they expendable? Are you a Nazi?

author by Scepticpublication date Mon Oct 29, 2007 14:01author address author phone Report this post to the editors

Those who are sentient and educated should take responsibility for managing their health - not leaving their fate to a large public health behemoth and then blaming it entirely for decisions affecting them. I am not saying that they public system should not be a lot better than it is but the huge extrapolation and use of this single case is misleading and is even moral blackmail. Going on once again about the PDs is a revisited red herring - private health insurance has existed since 1957 well before the foundation of the PDs in 1985 and the pubic/private mix system goes back much further, well before independence. There is no point in protesting hurt feelings and the like - this emotional case was promoted in the public domain by Joe Duffy as a debate stopper. Then to query any of the assumptions of Mr. Duffy is to “attack” the unfortunate woman at the centre of this case. This is not a recipe for an enlightened debate about the best way forward. The best way to ensure more case like this is not to adopt your own solution of a single public provider for all health care. This model is as far as I can see only favoured now by the Shinners among the Dáil parties (as far as I am aware). The Labour Party has moved to a system of private health insurance for all – an implicit recognition that the public system is not up to the task and will just continue to eat up the money thrown at it. This from a pro trade union party despite the health service having 120,000 almost all unionized members. That speaks volumes.

author by Seán Ryanpublication date Mon Oct 29, 2007 14:42author address author phone Report this post to the editors

Private insurance and/or privatisation. It's a world of meaning unto itself. There are many things however that it doesn't mean.

It doesn't mean that the number of doctors and other healthcare providers will increase.

It doesn't mean that more healthcare providers will be educated.

There are many other negative things that private insurance doesn't directly spell out, the two I've mentioned, I've mentioned because they specifically relate to the reasons behind the healthcare crisis experienced in Ireland at present. This is very important as privatisation is being touted as a cure-all for the illness in our healthcare 'services.'

Private insurance and privatisation does mean that, using what healthcare providers exist, a prioritisation will be established whereby the rich will be regarded as more important than the poor. The degree of emergency will not play a part in this picture, unless it is the degree of emergency a rich person is experiencing. Ironically, the rich can write off their premiums in their taxes. So medical care remains socialised in practice, with the exception being that third party parasites come into the picture making money by adding more red tape to a behemoth already burdened to the point of collapse with bureaucracy. The cash guzzling, inefficiency-promoting health boards who do nothing more than suck money out of a dead system, could be replaced with a single decent computer network - though I doubt the well paid 'civil servants' would let go of this one.

There is only one way to fix the medical emergency that is being experienced in Ireland at the minute. Education. We must educate and train medical experts and have an over-abundance of them rather than the lack of them. A limited resource dictates high cost and, that's ever before the bureaucrats piss into the stream.

I remember Jim using a phrase in another article (unrelated to this one) where he described the Government as letting the fruit rot on the vines so that we'd welcome privatisation when it came. That's what our government's whole modus operandi consists of on every front and Sceptic's quite correct (for once), the PD's are not responsible for it, it was here long before them, they just exemplify it.

Susie Long was a human being first, and a very decent one by all accounts. A cash register should have not been the tool used to decide whether she lived or died. It is unpardonable to suggest that any life is more precious than the next. Degrees of emergency must and should decide the order in which one is seen and treated if there must be a queue. The queue at present adds to the degree and number of emergencies rather than alleviate them. That, in and of itself, is proof of what I'm saying.

author by Scepticpublication date Mon Oct 29, 2007 15:53author address author phone Report this post to the editors

”IT DOESN'T MEAN THAT THE NUMBER OF DOCTORS AND OTHER HEALTHCARE PROVIDERS WILL INCREASE”

Universal health insurance, with full subsidy for those who need it, on the lines promulgated by Liz McManus would increase the supply side of health care as to put it at its simplest the money would follow the patient and the supply side would react to price signals – something that does not happen to the same extent in the public system. The system has been tried elsewhere giving better outcomes than in Ireland including for those who would not be able to afford insurance on their own. I don’t see tinkering with the public system along the lines suggested as leading to outcomes half as good. It is a leveling up scenario.

Related Link: http://www.labour.ie/manifesto/5.html
author by Seán Ryanpublication date Mon Oct 29, 2007 16:59author address author phone Report this post to the editors

Well I must admit that Sceptic seems to have hit the nail on the head despite his somewhat incoherant post.

He's not explained the inherant correctness of privatisation or insurance. He's just made reference to the fundamental principal of capitalism. 'Follow the money.'

The funny thing (in a very serious way) about this lie (i.e. that money following the patient would increase the services offered) is that most people, when confronted with it, don't question it.

Private insurance exists for one purpose. To make money. An insurer does not make money if he pays all he collects to either the insured or to the person providing the service to the insured. The insurer does however ensure that the service provider, if he exists, provides a service for the insurer's client in preference to someone who isn't the insurer's client. This is basically what I've pointed out alreday. The degree of medical emergency is dictated by how rich the sick person is rather than the degree of the medical emergency.

What medical service does an insurance company provide?

None. A medical insurer takes up time that could be spent on sick people. That's a vast simplification but it's very apt.

I still stand by my first comment. Insurance and privatisation do not mean that medical services ratios to patients will increase. It just restructures the rationing of these services and this artificially inflates prices. To deflate prices and to actually solve the problem we must educate and train more personnell. Fuck the money and following it, it's not about money and it never should have been. If there were a saturation of medically competent personnell, the insurance parasites and other parasites would not be sniffing around to begin with. Get to that point and you know you are on a winner.

author by Scepticpublication date Mon Oct 29, 2007 20:26author address author phone Report this post to the editors

WHAT MEDICAL SERVICE DOES AN INSURANCE COMPANY PROVIDE?

It is a financing service it provides, not a health service. “Follow the money” is a quote from the Labour Party and refers to money following the patients. For instance the hospitals that patients choose to be treated in will get commensurate resources. Unlike Sinn Fein, The Labour Party has abandoned belief in the power of a bureaucratic monolith to centrally decide resources. Its not as if that approach has not been tried. The right thing for socialists to do now is to follow the Labour Party and get over this irrational fixation against using market type mechanisms in resource allocating decisions as this approach has been found wanting. Where has you model been tried Sean Ryan or where is its theoretical underpinning or is champion ? There are already 120,000 people working in the system a massive increase in recent years – almost a doubling. How many more should we have - another doubling? Or trebling? What you are putting forward is not coherent or tested. At least the Labour Party’s proposals are.

author by Seán Ryanpublication date Mon Oct 29, 2007 21:10author address author phone Report this post to the editors

The fact that there are 120,000 healthcare workers in the country tells us nothing useful. This figure should be broken down into specifics for any reasonable debate to occur.

However, let's look at some figures that can be used to debate rationally.

There was approximately €16 billion spent on health in Ireland in 2006. There are approximately 5 million people in Ireland. This means that every man, woman and child in this country spent €3,400 per head on healthcare last year. Let's say that the average person pays €50 per visit to a doctor and let's pick a figure out of the air of €25 for a visit to the chemist aferwards. This would mean that every man, woman and child would each pay a visit to their doctor 48 times a year - close to once a week. We know that nobody pays 48 visits to their doctor a year much less the whole bloody population. What if they did?

Let's give everyone a visit of 15 minutes (short I know - but tempis fugit etc.). Okay (15 X 48 X 5,000)/60 = 60 million hours of care. Let's not overwork our doctors and insist that they work only 37 hours a week. So 37 X 52 = 1924 hours per anum. 60 million divided by 1924 would say that 31,185 doctors would be required to provide this service. The State pays the equivalent of this degree of service. Does the actual degree of service or quality of same reflect this?

Not by a very very long shot. Why?

The parasites I've already spoken of.

Now with regard to what I've suggested being actually tried. What I've suggested boils down to simple logic and simple logic has been tried and tested since man first boasted he was a sentient being. My logic is akin to saying that if you grow enough food you can feed everyone. Skeptic's logic is suggesting that If you grow only a tiny percentage of the food you need that privatisation will ensure that everyone gets fed.

author by Scepticpublication date Mon Oct 29, 2007 23:34author address author phone Report this post to the editors

It is not clear what your €16b includes but it seems to be just public spending on health ignoring the spend from private sources that is, out-of-pocket and health insurance. You give examples based on GPs but that ignores the biggest item of spending which is the acute hospitals networks. The reality is that about 75% of public spending on the system goes on salaries and pensions. Would you cut these even as you increase the overall payroll? I don’t think you have an appreciation of the outputs you want to see improved and yet you treat the input (much more taxpayers money) as if it grows on trees. And since you don’t like markets or health insurance presumably the scope of the public sector would have to be greatly increased to take account of the half of the population covered by health insurance and you would have to replace the premiums they pay by yet more taxpayers funds. None of this adds up. You would destroy those parts of the system that do work well for your ideological reasons putting those now covered into a public system which would have to double in capacity at least to cope with it. You would also take away the safety net of the NPF. Where is the evidence any evidence that all this might work?

author by Watcherpublication date Tue Oct 30, 2007 08:43author address author phone Report this post to the editors

Sceptic plays the usual game of constantly moving the goalposts whenever challanged. The simple fact remains that as a memebr of a community, it is reasonable to expect to be able to access basic services when needed and they are best provided on a communal basis.

As each indidvidual is different, therefore their needs also vary greatly. The whole concept of humans coming together and working together as a unit is based on the reality that each individual can best have his/her needs met within that arrangement. For example, there are people who need medical attention all their lives, while there are others that require little or none. As in other vital areas, it is the communal system in which we live that allows the person with high dependency to be able to acces services to meet their need. Living in a system which the PD's advocate, whereby each individual can grab as much of the collectively produced pie as they can get their hands on and hold on to it for his/her individual use alone, greatly restricts that availability of resources for common use. The Victorian era is the best example. The consequece is great wealth and affluence on one end and great suffering and misery on the other. The best solution is a progressive tax system with accountable government managing the spending of taxes collected to ensure that basic services are provided for all, on an equal basis, to the best standard that the collective can afford.

Private health insurance, as it is being developed here and it must be said advocated by the PD's, is also a communal system. People pay a fixed amount and call on services as required. Again, some people will draw very little from the central pool, while others will place very heavy demands on it and out of all porportion to what they contributed. It is in fact the community pooling resources to spend on individuals on the basis of need. The big problem with it is, it is exclusive and based on ability to pay. It collates a group from within the community to form a club and in doing do, mitigates against the capacity of the community as a whole to organise and provide medical services that would be open to all people based only on medical need. The other huge difference is of course, that private insurers are not interested in the common good . Their primary objective is to make profit, and as much profit as possible. In addition, in order for individuals to enter the scheme, they must be able to afford it. It is therefore discriminatory and as large numbers of people will be excluded, it ought not to be considered at all as a viable means of delivering vital services.

The present situation where two systems are allowed to run in tandam is incapable of meeting the need. The private health insurance was allowed to grow from a very small and shallow base over time and was essentially used by people to "top up" the services that where available in the public system. Single rooms, choice of doctor etc. This has however been allowed to expand into the critical area of determining waiting times for treatment. Queue jumping. People with private health insurance are able to quickly access treatment which can be life saving and this is being allowed to be used to essentailly blackmail people into taking out private insurance in order to grow that sector. That is why Mary Harney will never address the issue of unequal access. Because she is ideologically driven, she has no problem with money buying places in hospital queues, she knows that to remove unequal waiting times will result in less people taking out private insurance as a safety net. And the reason that is of such importance to Harney is because she does not beleive in community and is an advocate of "everyman for himself" She sees private health insurance as a way of lessening the tax burden of the wealthy. Her beloved Ameican low tax economy.

There is nothing new about what has been suggested in a "new" Labour Party policy of universal insurance mentioned by Sceptic. In fact, the PRSI system is precisely that. The great problem with a specific payment into a universal insurance scheme is of course that it will not be related to ability to pay. That is, that those who earn most should pay most. That is the only way that the communal principle works, which of course exploits the ability of the collective to provide vital services to all as and when needed. Labour need to explain how that principle can be preserved and maintained in what, I presume, is a proposal to introduce a Health Insurance package run by the private sector.

Regardless of what scheme is developed, it must have at it's core, the fundemental principle that treatment can be accessed on an equal basis by all when needed. That is surly the objective of those that aspire to live in a civilised society as opposed to the vulgar miasma that Harney and the PD's plan for us.

author by The Screaming Skull - Stoics R' Uspublication date Tue Oct 30, 2007 14:37author address author phone Report this post to the editors

We're all doomed.....doomed,I tell you!Every single one of us is going to die!So-no time to waste on boring old politics,then. I'm off down the pub.

author by Scepticpublication date Tue Oct 30, 2007 20:12author address author phone Report this post to the editors

“THE BIG PROBLEM WITH IT IS, IT IS EXCLUSIVE AND BASED ON ABILITY TO PAY”

Watcher you are wrong as the Labour Party proposal is that the State will pay the private insurance premiums of those unable to pay. You are also wrong on the analogy to PRSI. Entitlements under PRSI do not include health care even though the health levies are collected under the rubric of PRSI. These levies create no entitlement. You are confusing a universal social insurance health system with the consumer driven health system as advocate by the Labour Party and provided through private health insurers. The Labour Party has explained its policy at the link below. As regards Harney the main plank of her policy has been to defend community rating and to ensure consultant provided care for all. She is much more concerned abut public patients than she is given credit for. Liz McManus is much more emotionally adverse to the notion of profit - that is almost a dirty word to her. But even she knows that the public system must be radically changed and the public sector does not have the capacity to deliver effectively and with value for money. These people are practical politicians – they are not neocommunists still waving the red flag about or phone in radio show hosts who can luxuriate in ideologically pure but impractical slogans about health care.

Related Link: http://www.labour.ie/policy/listing/20011101160931.html
author by Jim O'Sullivanpublication date Wed Oct 31, 2007 10:07author address author phone Report this post to the editors

The comments here need to be clarified. Is Sceptic now saying that services should be available to all,based only on need and with equality of access? Is this discussion now essentially about how to deliver such a service?
Regarding Labours policy, this appears to be a significant departure from Socialist thinking on the issue. The policy document will need careful study, however a scheme that envisages all persons paying the same amount into a common pool from which health services will be financed flies in the face of a basic socialist demand of meaningful redistribution of wealth. Payments must be progressive to serve that end. The provision of vital services is one of the best vehicles for wealth redistribution by providing services that individuals on the lower points of the socio-economic scale could not provide for themselves.
Regarding the privatisation element, private entities exist to make profit and not to do service.Therefore all patients are regarded as customers. Who will make decisions regarding what level of treatment is necessary? Clearly, a profit motivated entity would place profit at the top of the agenda and not the best interests of the patient.
A recent story illustrates the point. A mother living in Canada, which has a national service open to all as needed, was expecting an unusal multible birth. The birth would require special equipment that is rarely called upon and the local hospital had all the facilities availble to safely deliver. However, at the last minute, the hospital accepted an emergency case which required the specialist equipment. The hospital manager rang around and located a hospital with the necessary equipment and the woman was airlifted to that facility. In the end, all went well for both mothers concerned. The second hospital involved was located in the USA and the Canadian Health Service subsquently received a bill from that private US facility for 250,000 dollars. The question is, had that mother been a patient relying on a privately run facility, would the decision to locate and send her to the other hospital, at that cost, have been taken. I seriously doubt it.

author by Jim O'Sullivanpublication date Wed Oct 31, 2007 18:37author address author phone Report this post to the editors

This is a report carried on Oceanfm and indicates that the privatisation process is well advanced and is being done despite widespread popular opposition to it. Clearly Harney is determined to saddle the country with the American style health care that puts profit before people and has created a serious health care crisis there. It is estimated that 45 million Americans do not have access to any level of medical care at present and are totally dependent on charity when they run into ill health.

The report is:
"Breast Cancer Care Units Set to be downgraded at Sligo General Hospital look set to be replaced not just by 8 centres of excellance but also with a number of private hospitals providing the same care in the future.
That's according to North West Independent MEP Marian Harkin.
Marian Harkin has condemned any such move and urges people to resist it from the start.
According to Minister Harney’s National Quality Assurance Standards for symptomatic breast disease service, announced last May, best practice is to provide a centre of excellence for every 300,000 to 350,000 population
Mr. Harkin says using Minister Harney’s own figures would mean that not 8 but rather 12 or 14 centres of excellence for breast cancer should be available across the country.
Ms. Harkin says these figures do not add up and it appears that private hospitals may be the facilities where the additional units of excellence will be located."

author by Scepticpublication date Wed Oct 31, 2007 19:25author address author phone Report this post to the editors

I do say that that services should be available to all based only on need and all told I consider the Labour Part’s proposals the best way of ensuring that even if it does constitute a “significant departure from socialist thinking” because we will never get anywhere if we are stuck forever in traditional socialist thinking on health along the UK model. You are wrong to think that the health system should be a vehicle for the distributing of wealth – it is the tax system and other fiscal instruments that should do that if that is your priority. Making the health system reply on progressive payments to private insurers would need a large bureaucracy to administer. Moreover a dedicated social insurance rate for health as in France is not progressive – it is a fixed rate. Incidentally pooling risk and savings for insurance and credit was a mark of the early British working class self help and solidarity. Health insurance has a good communitiare pedigree.

“CLEARLY, A PROFIT MOTIVATED ENTITY WOULD PLACE PROFIT AT THE TOP OF THE AGENDA AND NOT THE BEST INTERESTS OF THE PATIENT.” Comments like these show you don’t really understand the nature or reality of business which are not just profit maximizing machines in a crude sense like a horse trader at a fair might be. If the remuneration of the business is contractility related to the delivery of service the way to revenue enhancement of the long term is by maximizing the quality of service – they are not trade offs. Moreover business so long as they are subject to competition must compete for business on quality of service. If competition is working profits will be moderate. By contrast your rose tinted view of public service is simplistic. Some are excellent but without competition laziness and self-centeredness creeps in. The staff may not be chasing profits but be marking time and doing the minimum. All to often public service organisations are run in the interests of the people who work in them and not the people they serve. They become unaccountable and impossible to reform.

author by Jim O'Sullivanpublication date Wed Oct 31, 2007 19:44author address author phone Report this post to the editors

"Moreover business so long as they are subject to competition must compete for business on quality of service. If competition is working profits will be moderate."

Within this lies the weakness of the case to leave the provision of health care to private providers. Far from not understanding how business works, the fact is that all business activity works towards a monopoly. Business hates competition and constantly works to eradicate it. There are many ways that this is done. The most common method here is for companies to agree to sectionalise the market and agree price structures. In your model, the Insurance business will be a central player. It is well known that this business engages in sectionalising the market by the creation of categories and by controlled quoting effectively cedes sections of the market to each other.
The problem to be addressed remains essentially the same. Private operators will put profit before service. There is a legal obligation on directors to operate at all times in the interests of shareholders in the first instance.

I am presently reading through the Labour policy and will reply in due course.

author by Scepticpublication date Wed Oct 31, 2007 19:54author address author phone Report this post to the editors

All business does NOT "work towards a monopoly " and in any case measures can be taken to uphold competition where it is insufficient. There are powerful remedies available against abuse of dominance in EU law for example. To uphold competition in a community rated health insurance market with multiple players is quite feasible. Australia is one example if not an exact parallel.

author by Jim O'Sullivanpublication date Thu Nov 01, 2007 09:26author address author phone Report this post to the editors

"All business does NOT "work towards a monopoly ""

This would indicate that you know little about business and how it functions. Monopoly is the perfect operating environment and therefore it is self evident that mangement's aim for it in any of it's forms for that reason.
The problems associated with private involvemnent in the health sector are further compounded by the fact that sick people cannot be regarded as "normal" customers with the option of deciding not to accept an offer of treatment.( Regardless of how many companies are operating, you cannot have "competition" if the "customer" has no real choice for any reason.) Sick people are captive "customers" and it is a well held view that exploitation will always attend within a health service provided by private operators for that reason.
In markets where the "customer" is a captive, the Nash Equilibrium comes into play where rather than compete, companies maintain size and output to meet the demand for their section of the market which they hold by using advertising and branding. Price, quality of service etc are the same and companies involved ensure that the equilibrium is not disturbed so as not to provoke a competitive reaction by any of the other companies operating in the sector.
Regulation does not work in the health sector for a number of reasons and the phenominal profits of pharmacutical corporations proves this. Governments have tried to regulate the cost of drugs with litle or no effect.

I assume that Labour's policy has taken on board these concerns and the foundations of it's proposals are not sitting on the idea that "regulation" will solve these problems. If it is, it's a none runner and at best could only be described as an Election promise. I intend to study the document to-night and will post views thereafter.

In the meantime you are urged to reassess the proposition that health services can be provided by private operators to the benefit on the people.

author by Scepticpublication date Thu Nov 01, 2007 22:56author address author phone Report this post to the editors

There is a pricing issue with new drugs to do with remuneration of the heavy investment involved. In fairness the only entities that produce new drugs that make life better for people are multinational pharma firms. However that is a separate issue in a separate part of the health industry. As regards asymmetry of information the patient will have a GP or a consultant at least to advise him or his relatives on his treatments. There are medical ethics; medical audit and clinical management issues that guard against over-treatment but above all it is not in the interests of insurers to pay for overly elaborate treatment. This REDUCES their income not increases it. The Irish health insurance market is very atypical, especially with risk equalisation and is very well supervised – eg. by the Financial Regulator, HIA, Department of Health, the Competition Authority, the National Consumer Agency and the various Ombudsman offices. If threw was compulsion there would be even more oversight. There would be few opportunities for collusion or a market carve up or massive over-pricing or over- treatment. For all that if one wants to find faults or risks one can readily find them. The crucial issue is which is the least bad system. All we can be sure of is that we cannot go on pouring billions into the public system for such little result as we have seen since 1997. There must be new thinking and the Labour Party proposals are worth looking at.

author by Jim O'Sullivanpublication date Fri Nov 02, 2007 08:42author address author phone Report this post to the editors

One has to wonder if this is a real discussion. Posts are going all over the place and are essentially waffle.

"There is a pricing issue with new drugs to do with remuneration of the heavy investment involved."

Drugs are over priced, that is a matter of fact and the cost is not related to "heavy investment", it's related only to whatever price the company can get. That's how business works. Get what the market will pay. People when ill are ultra vulnerable as their choice is very limited.

"In fairness the only entities that produce new drugs that make life better for people are multinational...."

With the compassion of Mother Teresa too no doubt. Talk to AIDS sufferers in Africa who are ruthlkessly used and manipulated as drug companies manipulate governments to extract evey last cent possible. That is what business is all about, less of the fairey tales.

"However that is a separate issue in a separate part of the health industry."

What? Drugs are the core of it. Treatment is essentially the administration of drugs following diagnoses.

" As regards asymmetry of information the patient will have a GP or a consultant at least to advise him or his relatives on his treatments. There are medical ethics; medical audit and clinical management issues that guard against over-treatment but above all it is not in the interests of insurers to pay for overly elaborate treatment. This REDUCES their income not increases it. "

This is a strange statement. It is well a established fact that in private health, people with money are over-treated while those without are under-treated. The notion that over-treatment would result in reducing the income of private insurers is really laughable and demonstartes a total lack of understanding of how business operates. They will simply increase permiums to guard their profit margin. If they can't do that they will fold their tents and seek greener pastures.Monopoly beckons if, given the tiny size of the Health market in Ireland, it does not already exist.

"The Irish health insurance market is very atypical, especially with risk equalisation and is very well supervised – eg. by the Financial Regulator, HIA, Department of Health, the Competition Authority, the National Consumer Agency and the various Ombudsman offices. If threw was compulsion there would be even more oversight."

The position at present is very different from what you propose, a fully privatised system. It is not credible to suggest that business will allow themselves to be regulated to the point where the customer holds the aces. That simply will not happen and suggesting that it might once again indicates a total lack of understanding as to how business operates. You use the word "compulsion" which essentially means "captive" Read up on the consequences where the customer is "captive"

"There would be few opportunities for collusion or a market carve up or massive over-pricing or over- treatment."

This again shows your innocence. Business will find a way. Example. Drive to any small town in Ireland. Usually you will find three or four petrol stations. All will be charging the exact same price for petrol. Move to the next town and the same companies will be charging different prices to match the other local outlets. The pub trade is the same. It is well known that employees of supermarkets visit the opposition and list prices for comparison. Supermarkets only "compete" on a tiny fraction of their lines. The government has failed to even stop price fixing in such transparent markets, how could it hope to do so in a privatised health system where each course of treatment is unique and at the discretion of the medical teams involved

"For all that if one wants to find faults or risks one can readily find them."

This is not a question of finding fault, it's a question of ensuring that people receive medical treatment whenever they need it and don't suffer or die needlessly. That is what this post is about.

"The crucial issue is which is the least bad system."

This again betrays you. The crucial issue is to ensure that medical treatment is available to all as needed. Ensuring that that is done in the most cost efficient manner is about managing rsources.

"All we can be sure of is that we cannot go on pouring billions into the public system for such little result as we have seen since 1997. There must be new thinking and the Labour Party proposals are worth looking at."

What "little result"?. The health service is saving lives everyday of the week. What cost human life? What better way is there for a state to spend it's money than by relieving pain and suffering? The present antics are about cutting spending so as to maintain a low tax economy which benefits the wealthy in the community. It is th interests of the wealthy that are driving current policy, not the best interests of the patient that is why the country is convulsed on the issue, p[eople are beginning to see what really lies behind Harney's actions.Take off the blinkers and address the issue honestly.

By the way, your love affair with Labours policy leaves me worried given the above comments and also leaves me wondering, did you vote Labour last May and can Labour count you among their supporters?

author by Scepticpublication date Tue Nov 06, 2007 18:25author address author phone Report this post to the editors

"DRUGS ARE OVER PRICED, THAT IS A MATTER OF FACT AND THE COST IS NOT
RELATED TO "HEAVY INVESTMENT",
That is assertion. It can take twenty years of R&D, trials and the
authorisation process to bring a new product to market and the price will to a large extent represent the intellectual property value of this investment. What is the right price for drugs since you consider drugs are over priced? There are certainly high priced but that is not the same as overpriced. You reference to Mother Theresa is also flawed. What are demanded are drugs that bring benefits to patients and the market provides that. Self interest on the part of theproducer and the interests of the consumer are not mutually exclusive as you suggest. It does not take a philanthropist to act beneficially. The baker bakes bread to make a living for himself not the feed people as Adam Smith described (a more reliable guide to economics than the sage of dialectical materialism).

"IT IS WELL A ESTABLISHED FACT THAT IN PRIVATE HEALTH, PEOPLE WITH MONEY ARE OVER-TREATED WHILE THOSE WITHOUT ARE UNDER-TREATED."
More assertion. It is not at all an established fact. As regards asymmetry of information the patient will have a GP or a consultant at least to advise him or his relatives on his treatments. There are medical ethics involved in prescribing treatment and also medical audit and clinical management issues that guard against over-treatment but above all it is not in the interests of insurers to pay for overly elaborate treatment. Over treatment REDUCES their income it does not increase it. Are you saying that the VHI is a price gouging and exploitative entity? A look at its board and its accounts over the years and its low administrative costs do not suggest this – quite the opposite. It is a public interest semi state a moderate rate of remuneration for those who work in it and has no outside shareholders.

"THE POSITION AT PRESENT IS VERY DIFFERENT FROM WHAT YOU PROPOSE, A FULLY PRIVATISED SYSTEM. "
It is a Labour Party proposal - not mine and it is not a fully privatised system but an extension of VHI type cover to all in order to eliminate the two tier system once and for all.

"IT IS NOT CREDIBLE TO SUGGEST THAT BUSINESS WILL ALLOW THEMSELVES TO BE REGULATED TO THE POINT WHERE THE CUSTOMER HOLDS THE ACES. "
It is not a zero sum game between consumers and producers as you suggest and there are very powerful legal remedies in law to prevent any abuse of position to occur. In the Irish system you have both community rating and a choice of suppliers and it is a genuine choice. See how hard Quinn and VIVAS are competing in the market. The effects of a well regulated environment for business are ameliorative.

"DRIVE TO ANY SMALL TOWN IN IRELAND. USUALLY YOU WILL FIND THREE OR FOUR PETROL STATIONS. ALL WILL BE CHARGING THE EXACT SAME PRICE FOR PETROL. MOVE TO THE NEXT TOWN AND THE SAME COMPANIES WILL BE CHARGING DIFFERENT PRICES TO MATCH THE OTHER LOCAL OUTLETS."
Prices equalize under competition as well as under collusion so similar prices don't point to collusion in themselves. Collusion would be illegal – prosecutions have taken place.

"EACH COURSE OF TREATMENT IS UNIQUE AND AT THE DISCRETION OF THE MEDICAL TEAMS INVOLVED"
Not true. Health Insurance companies have set prices for treatments and most treatments are categorized. They reimburse up to set price level or scheduled fee. It is not difficult
to benchmark the price of the vast majority of treatments – witness
the casemix system.

"WHAT "LITTLE RESULT"?. THE HEALTH SERVICE IS SAVING LIVES EVERYDAY OF THE WEEK. WHAT COST HUMAN LIFE?
The problem is that the increases resources put in have not cured it and have caused a lack of faith in the capacity of the system to overcome the problems which you yourself have drawn attention to. If it were just a question of resources and obvious management changes it would be easy. It is you that was using the Suzie Long case to highlight problems in the public system. The problem in that case – a two tier health system – is precisely what
the Labour Party proposals are designed to address and is the most promising approach I have seen. The Labour Party seems to have less of an ideological hang up about new thinking than you. You are dogmatically attached to public only financing and delivering of health services. You seem to have an outdated communist or hard left socialist view of anything other than the NHS model developed in Britain in the 1930s and an inaccurate stereotyped view of business that sees any attempt to use anything other than the public service as bad and exploitative as if there are not a host of different problems with a public sector approach like high levels of absenteeism and demarcation disputes we have seen recently.

Related Link: http://en.wikipedia.org/wiki/Case_Mix_Index
author by Jolly Red Giant - Socialist Party/CWIpublication date Wed Nov 07, 2007 00:46author address author phone Report this post to the editors

quote:
"It can take twenty years of R&D, trials and the authorisation process to bring a new product to market and the price will to a large extent represent the intellectual property value of this investment. "

The reality is that for the majority of the drugs produced by pharmaceutical companies the R&D is actually conducted in universities who receive rather megre donations in return for the companies having full rights to the result of their research (result of the privatisation of education)

quote:
"Self interest on the part of theproducer and the interests of the consumer are not mutually exclusive as you suggest."
There have been numerous examples of companies issuing drugs that have caused known side-effects just to get a return on their investment - of companies altering the potency of drugs for issue to state -run services - of companies blatantly contriving to fleece patients out of money to make a quick buck. When you have a situation that the be all and end all of the production of drugs is the bonuses resulting from a positive balance sheet, concern for the patient goes out the window. Furthermore, if I ever end up in a hospital I want to be treated as a 'patient' not a 'consumer'. The consumer always gets the raw end of the stick. If he/she didn't no company would make a profit.

quote:
"It is a public interest semi state a moderate rate of remuneration for those who work in it and has no outside shareholders."
But one that operates, like all semi-state companies, on the basis of the capitalist market. It has a shareholder, the minister, and the company is obliged to secure a return for the minister. The VHI does not operate on an altruistic basis but on exactly the same basis as BUPA, Quinn, VIVAS etc.

quote:
"It is a Labour Party proposal - not mine and it is not a fully privatised system but an extension of VHI type cover to all in order to eliminate the two tier system once and for all."
One you support. Extending VHI cover will lead to the privatisation of health care. It is exactly the same scenario as the bin tax. Charge everyone for it and provide the poor with a wavier. The council pulls out of the service and the wavier disappears. Everyone ends up paying for the private operator. The inevitable logical conclusion of extending VHI to everyone is that everyone is then charged for treatment and over a period as the economy can no longer sustain it the amount of extended cover disappears with the charges remaining.

quote:
"are very powerful legal remedies in law to prevent any abuse of position to occur"
Yea right - and what planet were you born on?

quote:
"Prices equalize under competition as well as under collusion so similar prices don't point to collusion in themselves."
Competition drives out the small players in the market and leads to the big ones carving up the market for themselves and pushing up prices. You can point to any sector of the economy to see it in action.

quote:
"Health Insurance companies have set prices for treatments and most treatments are categorized. They reimburse up to set price level or scheduled fee. It is not difficult to benchmark the price of the vast majority of treatments – witness the casemix system."
I seriously hope you never end up in a hospital where they make a decision on your treatment based on whether it is affordable under their 'scheduled fee'

quote:
"The problem is that the increases resources put in have not cured it and have caused a lack of faith in the capacity of the system to overcome the problems which you yourself have drawn attention to."
The problem is that investment in the Health system would need to go up by another 50% just to get it back to the stage it was at before the health cuts of the 1980's (under Labour's Barry Desmond).

quote:
" If it were just a question of resources and obvious management changes it would be easy."
Not if you don't put enough in and spend what you do put in recruiting administrative staff to send bills out to people for A&E visits.

quote:
"The problem in that case – a two tier health system – is precisely what the Labour Party proposals are designed to address and is the most promising approach I have seen. "
Yes the LP proposals would eventually eliminate the two tier system by doing away with the possibility of people without money receiving any medical treatment.

quote:
"The Labour Party seems to have less of an ideological hang up about new thinking than you."
No, the LP actually is completely hung up on ideology - it has embraced the idea of the market solving the health crisis - just like Harney.

quote:
"any attempt to use anything other than the public service as bad and exploitative"
Show me a single private company that hasn't engaged in exploitative practices!

quote:
"there are not a host of different problems with a public sector approach like high levels of absenteeism and demarcation disputes we have seen recently."
Again accept the right-wing slant of all the events that have occurred over the past week rather than looking for the point of view of the workers involved. Of course the fact that the workers are over-worked, under-paid and subject to constant harrassment by management to meet 'targets' has nothing to do with it. I remember being at a union/management meeting not too long ago in a public sector employment and the HR manager in the company spent an hour claiming that the company had never received a medical cert citing stress as the reason for absence, yet the line manager was able to tell me afterwards that a third of all the certs that cross his desk cite stress as the cause of absence. The company cannot admit that they are driving people into the ground because if they did they would be force to do something about it.

author by Jim O'Sullivanpublication date Wed Nov 07, 2007 09:33author address author phone Report this post to the editors

Thanks Jolly Red, in truth I was dreading having to revisit this thread having concluded that rational discussion with Sceptic may not be possible for whatever reason.

I have read the Labour document and am disappointed, however given the date of the document and the fact that two leaders have come and gone in the meantime, it is not clear if it is current party policy.

What we must aim for is very simple: A Health Service that is available to all citizens when needed and based solely on clinical need. The two tier system must be banned. Mary Harney currently has the country convulsed with her antics and that is because what she is about is the growing of the for-profit sector within the health service. That clearly will copperfasten discrimination. If Mary Harney wanted to create a first class health service for the people of Ireland, which she claimed before the last election is what she was about, she would immediately take measures to rid of of the two waiting list system that operates at present. She refuses to do so simply because that would cut across her plan to grow the for-profit sector. Money is being put before patients.

author by Scepticpublication date Wed Nov 07, 2007 19:14author address author phone Report this post to the editors

Jim O’Sullivan: That is substituting platitude for argument. We all agree we want an equitable system. The problem is how to get there. But it is not so simple to run the health services in an efficient manner and it is your subsequent double thesis (the problems are lack of money and Mary Harney) that does not bear scrutiny. All that is needed is more yet money? But the approach of massively increasing funding has been tried and it has not improved the services enough to keep health stories off the headlines and off the Joe Duffy show. See the Department’s trends report below which shows that total public health expenditure has risen from €3.6 billion in 1997 to over €12.3 billion in 2006, an increase of more than 236%. The politicians listened to those who told them back in 1997 that lack of money was the problem and went with an explosion of funds. They will be more wary of another major escalation of funds by over 200% that might not solve the ills of the service which is why the new thinking exemplified in the Labour Party approach should be looked at. Again you go on ad nauseam about Mary Harney and trite clichés “money is being put before patients” and the like. This is an attempt at political point scoring and an evasion of the difficulties involved. It is typical of you to intervene in the Suzie Long case with your PD stuff again. In fact the main policy formation and structural changes of recent years was brought in by her predecessors. Harney has been there a few short years only. I am convinced you are keen to have a go at Harney and not in resolving the problems of the health service.

Jolly Red Giant:

IT IS EXACTLY THE SAME SCENARIO AS THE BIN TAX.
It isn’t. There is no suggestion that the state withdraws from the system nor could it. This has not happened in other states like Austria and the Netherlands. Anyway the waiver for necessitous households has not been withdrawn in respect of refuse charges in Dublin.

THE PROBLEM IS THAT INVESTMENT IN THE HEALTH SYSTEM WOULD NEED TO GO UP BY ANOTHER 50% JUST TO GET IT BACK TO THE STAGE IT WAS AT BEFORE THE HEALTH CUTS OF THE 1980'S (UNDER LABOUR'S BARRY DESMOND
This is not the reality. Check the level of spending in the health trends report linked.

YES THE LP PROPOSALS WOULD EVENTUALLY ELIMINATE THE TWO TIER SYSTEM BY DOING AWAY WITH THE POSSIBILITY OF PEOPLE WITHOUT MONEY RECEIVING ANY MEDICAL TREATMENT. On the contrary it is the opposite – the levelling up of all to the higher private standard of care.

NO, THE LP ACTUALLY IS COMPLETELY HUNG UP ON IDEOLOGY - IT HAS EMBRACED THE IDEA OF THE MARKET SOLVING THE HEALTH CRISIS This is assertion. The case has been argued comprehensively by the party. You cannot just dismiss it in a dozen bilious words and expect any credibility.

AGAIN ACCEPT THE RIGHT-WING SLANT OF ALL THE EVENTS THAT HAVE OCCURRED OVER THE PAST WEEK RATHER THAN LOOKING FOR THE POINT OF VIEW OF THE WORKERS INVOLVED. That is the problem with the present system. It is very prone to strikes and other IR problems including petty demarcation disputes as well as very high levels of absenteeism. Further those who work in the health service are not underpaid by any standards. The problem is it is run to serve the interests of those who work in it rather than those who are treated in it.

“THE VHI DOES NOT OPERATE ON AN ALTRUISTIC BASIS BUT ON EXACTLY THE SAME BASIS AS BUPA, QUINN, VIVAS ETC.” It is run in the public interest. It has to make a surplus but not a profit and it makes a small surplus. BUPA is not a profit making firm either – it is a provident society. The Minister for Health may be the owner of the VHI but has no shareholding in it nor is there any remuneration to the Minister, let alone is there a required rate of return to the Minister. Nor does it raise funds commercially and its capital is not remunerated. You are quite wrong about the VHI. It is anything but an avaristic capitalist vehicle.

THERE HAVE BEEN NUMEROUS EXAMPLES OF COMPANIES ISSUING DRUGS THAT HAVE CAUSED KNOWN SIDE-EFFECTS JUST TO GET A RETURN ON THEIR INVESTMENT - OF COMPANIES ALTERING THE POTENCY OF DRUGS FOR ISSUE TO STATE -RUN SERVICES - OF COMPANIES BLATANTLY CONTRIVING TO FLEECE PATIENTS OUT OF MONEY TO MAKE A QUICK BUCK.
Where and when were these cases? In the US or Canada or the EU in modern times? All drugs have side effects. Drugs would not be licensed unless there are proven to be efficacious and that the side effects have been investigated. Drug suppliers cannot retail drugs without FDA or a similar body’s approval. What are you arguing for? Tighter regulation of drug companies? Their abolition?

REMEDIES THERE ARE VERY POWERFUL LEGAL REMEDIES IN LAW TO PREVENT ANY ABUSE OF POSITION TO OCCUR. Your dismissal of this statement is wrong – there is an entire body of EU and national competition law governing this area and the remedies are indeed powerful.

COMPETITION DRIVES OUT THE SMALL PLAYERS IN THE MARKET AND LEADS TO THE BIG ONES CARVING UP THE MARKET FOR THEMSELVES AND PUSHING UP PRICES. What are you saying? Have no competition? Is every economist who has written on this field entirely wrong? Should we have everything provided by the State on a non-commercial basis on classic soviet lines. Has this been shown to work? Get real.

I SERIOUSLY HOPE YOU NEVER END UP IN A HOSPITAL WHERE THEY MAKE A DECISION ON YOUR TREATMENT BASED ON WHETHER IT IS AFFORDABLE UNDER THEIR 'SCHEDULED FEE' The vast majority of cases are so treated and no problems occur. Exceptions are allowed for exceptional cases – it is not an inflexible system.

Related Link: http://www.dohc.ie/press/releases/2007/20071030.html
author by Jim O'Sullivanpublication date Wed Nov 07, 2007 19:46author address author phone Report this post to the editors

"We all agree we want an equitable system. The problem is how to get there"

Start by banning queue jumping. The State still controls most of the health infastructure available and therefore should have no difficulty stopping the two tier waiting system. Harney chooses not to do so. Do I really have to explain why?

How can you possibly have an equitable system with for-profit entities involved?

author by Scepticpublication date Wed Nov 07, 2007 22:04author address author phone Report this post to the editors

The Labour Party proposal points to an equitable system via commercial insurance. Where is the flaw in it that makes you write that the scheme design so flawed that this is impossible as you assert? ? What are they missing?

The only way to stop the present system right away would be for the State to take extra powers to ban commercial health insurance contracts. It could not do this legally without a constitutional amendment followed by a extra 1.2 million people thrown entirely on the public system with all the dislocation this would cause. Even then it would probably require an overthrow of the existing legal order as the right to contract private health insurance is likely to be a right under European Law as well as domestic law.

author by Michelle Clarke - Social Justice and Ethicspublication date Wed Nov 07, 2007 23:57author address author phone Report this post to the editors

This article is written by a man with over decades of experience at the forefront of Irish medicine. It is frank, outright, and informative. You will find it in the Wednesday Health supplement.

The time surely has come to deal with health and decide the public / private equation in medicine based on Social Democratic principles.

Michelle

Quotation
The Scaffold and the Struggle
'If they want to hang me, let them. And on the scaffold I will shout
'Freedom for the working class'

By Mary Harris Jones 'Mother Jones' (1837-1930) US union activist

Related Link: http://www.Common
author by Jim O'Sullivanpublication date Thu Nov 08, 2007 08:28author address author phone Report this post to the editors

"Where is the flaw in it that makes you write that the scheme design so flawed that this is impossible as you assert? "

Where did I make such an assertion? This is the difficulty with this consversation, somebody is not reading the posts.

Is the Labour policy the same as what operates in France?

author by Scepticpublication date Thu Nov 08, 2007 19:30author address author phone Report this post to the editors

“HOW CAN YOU POSSIBLY HAVE AN EQUITABLE SYSTEM WITH FOR-PROFIT ENTITIES INVOLVED?”

The Labour Party explains exactly how with its scheme.

The French system is a social security type system based on a flat rate payroll tax which is not progressive. The Austrian and Dutch systems use commercial insurers.

author by Jim O'Sullivanpublication date Fri Nov 09, 2007 10:20author address author phone Report this post to the editors

“HOW CAN YOU POSSIBLY HAVE AN EQUITABLE SYSTEM WITH FOR-PROFIT ENTITIES INVOLVED?”

Sceptic replies: "The Labour Party explains exactly how with its scheme."

Essentially the Labour Party policy document mimics the French system. An analysis of the French experience will indicate that problems caused in the system are primarily a result of "private" activity within the system. For example, French patients are prescribed between two and four times as many medicines as in the rest of Europe and are now Europe's heaviest consumers of medicines.

You raise France which operates a much fairer system generally with around half of workers paying little or no income tax. Health contributions are based on earnings by way of a virtually falt rate tax with contributions directly related to gross earnings. Small earners pay less, big earners pay more. Regardless of what system is in place, the equity of access and the absence of waiting lists is more likely related to the fact that the French are one of the highest spenders on health with a spend of around 15% of GDP.

Other countries that standout are, Austria, Belgium, Germany, Japan, Luxembourg and Switzerland. In each of these nations, individuals, regardless of their income, have access to the health care they need without waiting lists.

The answer would appear then to be to simply import the system that any of these countries use. But don't hold your breath, because the bottom line is that Harney is not interested in such things as equity, justice and fairness. Harney is an extreme right wing capatilist who is only interested in providing money making opportunities for her like thinking friends. That is why whatever she is currently about will end in failure, as far as the civilised among us are conerned, and will likely be disasterous if you happen to be at the lower end of the socio-economic scale. This stuff is not about semantics or word playing, it's about life and death issues. Have you learned nothing of late at all?

author by Scepticpublication date Fri Nov 09, 2007 14:05author address author phone Report this post to the editors

"ESSENTIALLY THE LABOUR PARTY POLICY DOCUMENT MIMICS THE FRENCH SYSTEM"

It doesn’t. It is an adoption of the Austrian system to the Irish circumstances. The French system is a social security health system with the various drawbacks which that implies. The Austrian system is a consumer led health insurance system and is the one which the Labour Party promotes as ensuring equity, quality and affordability. As you write favorably of the Austrian system am I to take it then that you finally accept the Labour Party proposals?

You then go on again about Harney but this scheme is not her policy – that is a red herring. Implementation of the Labour Party scheme would be very much better, for the reasons outlined, than what either you or Harney are proposing or were. You cannot stay on topic for more than a moment without an anti Harney rant. That is obsession.

author by Jackpublication date Fri Nov 09, 2007 14:37author address author phone Report this post to the editors

Last time I looked Harney was the Minister un-responsible for Health. It is only proper that she gets it in the neck at every opportunity for the shambles she fails to take responsibility for. She is ideologically driven and any one who fails to recognise that or actually defends her position is a vested interested or a bleating reactionary.

I seriously doubt septics Labour credentials but since that party has been over run by champagne socialists for years I wouldn't be surprised what comes from them.

Back to the matter at hand. Any attempt to solve the Health Crisis by private investment or opening it up to market forces is folly and wont work. Everywhere it is tried it fails. That is all one really needs to consider when making the desicion as to what constitutes good health care.

The choice is simple. Do you want to pay for a quality health service through taxation or dont you?
Why give the money to a private Health Insurance company who will dump you back on the public system if your illness becomes overly complicated, when you can pay that as a tax to ensure everyone gets access, good treatment and in a timely fashion.

Thats what you get if you model it on the French system.
If not you get poor quality Health Services and a greater chance of avoidable death.

Septic talks about the French system as if it is to be shunned when claimin it has various drawbacks.
For whom exactly? Because it certainly isn't patients, who are of course central to all this arent they? Their concerns comes first dont they?

It seems to me that Septic is one of those selfish right wing libertarian bastards who simply refuses to part with his hard earned cash unless it is purely for his benefit.
Not to worry, you are hardly alone in this Banana Republic.

By the way, continually refering to an individual who is central to the topic being discussed isnt obsessive. Or are you another one of those hacks who thinks the buck stops at the HSE, not the minister?

author by Scepticpublication date Fri Nov 09, 2007 18:49author address author phone Report this post to the editors

“DO YOU WANT TO PAY FOR A QUALITY HEALTH SERVICE THROUGH TAXATION OR DON’T YOU?”

That is the wrong question for this reason: The assumption has been that there is a positive correlation between inputs and outputs to the Irish public health service. Increase the amount of money in and automatically there will be an increase in output and quality. The experience of the last ten years has been to challenge this assumption. The money has gone in by the billion and has not led to the better outcomes required. There is a common interest in not wasting taxpayers money if it is not yielding what it is suppose to. Otherwise one is spending money for the sake of it and that is unsustainable. It is not a question of personally not wanting a quality service or not wanting to contribute increased tax to it. It is that prior assumptions have to be revisited and new thinking indulged in.

author by Jim O'Sullivanpublication date Fri Nov 09, 2007 18:54author address author phone Report this post to the editors

"ESSENTIALLY THE LABOUR PARTY POLICY DOCUMENT MIMICS THE FRENCH SYSTEM"

"It doesn’t. It is an adoption of the Austrian system to the Irish circumstances."

The Labour Party document that I read most certainly does not reflect the the Austrian system and if the Labour Party want to make that claim, at that point ,a discussion would be warrented. Each state within Austria has significant powers over the delivery of services and accordingly, services can vary from Sate to State.

" As you write favorably of the Austrian system am I to take it then that you finally accept the Labour Party proposals? "

A silly question. Within Europe all other systems are preferable to the one that operates here for the simple reason that here we have a pronounced two tier system which developed essentially because private involvement had not been controlled and was allowed to grow. The Canadian authorities for example, recognised the dangers that uncontrolled private activity causes for the objective to provide a health service accessable to all and delivering equity in treatment and strictly control any such private activity by legislation. It is therefore profoundly disturbing that we now have in charge of health provision here, thinking that has learned nothing from the history of health service provison and is clearly promoting privatisation.

"You then go on again about Harney but this scheme is not her policy – that is a red herring."

Where did I say that this scheme was Harney's?

" Implementation of the Labour Party scheme would be very much better, for the reasons outlined, than what either you or Harney are proposing or were."

Anything would be better than what Harney is doing-not proposing. What am I proposing btw?

"You cannot stay on topic for more than a moment without an anti Harney rant. That is obsession."

Harney is currently dismantling what there is left of what could be referred to as a National Health Service and replacing it with a system where the tax payer provides infrastructure and speculators are then allowed to use that infrastructure to make money from the provision of services. Access to these services will be determined by ability to pay.This system has resulted in people dying prematurely and will lead to more of that if it is allowed to grow. In addition, Harney has no mandate to impliment this privatisation policy.

And just to repeat; What I and other civilised people want is a health care system in place that will treat people based only on clinical need, with no queue jumping or some people falling through so called non-existant safety nets etc. Equity in access and equity in treatment.

author by Miriampublication date Sun Nov 18, 2007 16:29author address author phone Report this post to the editors

Letter in yesterday's Irish Examiner:

17 November 2007

Why they feared me — an ordinary person with cancer

I WRITE in the wake of the uncertainty surrounding the exclusion of oncologist John Crown from the Late Late Show panel.

I had the honour of being a Late Late show guest more than a year ago.

My reason for being there was in part to highlight my book, If It Were Just Cancer, but also as a founder member of the lobby group Patients Together.

I am an ordinary person, a cancer patient who suffered the indignity of A&E, a filthy ward, the fear and terror of not getting a bed and, as a consequence, denied the right to avail of my urgently required chemotherapy.

From the day I was given the all-clear I vowed that on behalf of all the others not as blessed as me, I would highlight our suffering. Nothing more, nothing less. I wanted people to know what it meant to be seriously ill in modern

Ireland.

I am not an academic. I am not a mover-and-shaker. I grew up in a close, loving family of eight in Finglas, Dublin, in what was known as a ‘corpo purchase house’.

I left school at 15 and had a son at 19. I worked in a tyre outlet and as a company rep and eventually started my own business in 1994.

My new-found position under the spotlight on the Late Late Show, in the papers and on the radio was terrifying and I lost many hours sleep with the worry of letting everybody down.

I never envisaged this would be where my cancer would take me. My mother believes I survived at God’s will to do this work. I am inclined to believe I am driven by those gone before me, goading me to stand up and be heard.

Where am I going with all this? The night I appeared on the Late Late was one of the most privileged in my life. My family, friends and supporters were dotted around the country watching and my heart was bursting with pride and fear. I wanted to say something that would touch people — to make them understand how we as patients are being failed. I was sick with nerves, but I knew the girls on the ward were with me in spirit.

I made it through the show, but fell into my son’s arms crying and shaking when it finished. It was all too much. The relief that it was over was immense. I remember one of the researchers coming to me and hugging me: “Well done, Janette, you were brilliant and you have caused such a fuss.”

I was worried. What had I done? The researcher went on to explain that certain people had been screaming down the phones wanting to know who made the decision to put me on the show and why were they not told I would be on?

The researcher took much delight in their agitation because they apparently find it so hard to get any comments, returned calls, etc, from these people, and now they were hopping mad, phoning in more and more as I was speaking.

What in Gods’ name could make these people so irate? Little old me rattling on about the indignity of our health service? What was I saying that incited such fear and upset?

I have found the answer: I was telling the truth. I was an ordinary person telling how it is. I had nothing to gain and nothing to lose. Until that moment I had never realised how powerful the ordinary person who is willing to stand up and be heard can be. I find it so sad that we have a section of our community driven with desire to silence the truth.

Following the show and my naive decision to gate-crash a HSE press gathering, I received texts from a prominent health correspondent saying he had received calls questioning who I was? Who was funding Patients Together? Who was yanking my chain? How many members do we have, etc?

I will save these people any further time-wasting and stress worrying about me. I am a nobody, a taxpayer, an Irish citizen, an honest and loyal person who whispered a promise to the dead that I would be their voice until our overcrowded, under-funded, diseased health service learns to treat us with dignity and care. Really you have nothing to be afraid of.

Janette Byrne
Patients Together


http://www.irishexaminer.com/irishexaminer/pages/story....1.asp

author by Michelle Clarke - Social Justice and Ethicspublication date Sun Nov 18, 2007 17:59author address author phone Report this post to the editors

Our system of health appears to have deteriorated so much over the years.

Tonight Dr. Maurice Nelligan, a seasoned medical veteran, with much experience, at all levels, public and private is to appear on Would you Believe at 10.30 (Sunday)

He is a retired cardiologist and writes most weeks in the Wednesday supplement.

To me, he appears a common sense and wise man.

Michelle

Related Link: http://www.copine.ie
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