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Solving the HSE Conundrum
Read more about: Fine Gael, Ireland, Irish Politics, Labour Party 
Lest we continue to get distracted by polls and process, it is definitely noteworthy to point readers to the health policy announced today by Fine Gael. The policy, headlined as abolishing the HSE, reads like a step-by-step dismantling of the public-private divide to replace it with a system of private insurance and universal coverage, semi-private hospitals and money-following-the-patient. We have had the FG policy for some time, and those attending today suggested little has been added to the Dutch system epiphany today.
The policy is worth reading, for it suggests eliminating 8,000 jobs (as part of FG’s overall 30,000 target?) from the HSE and dismantling the behemoth by 2018/2019. Specifics and detail, well that is for next week.
According to Reilly:
“In 2001, Micheál Martin, then Minister for Health, announced his intention to end waiting lists by 2004. Both he and the HSE have spectacularly failed to meet this target.
“We recently witnessed 569 patients on trolleys in A&E and over 19,000 patients waiting more than three months for treatment.
“The message is simple; ‘Micheál Martin’s HSE is not working’. Fine Gael’s FairCare will completely reform the health system and is divided into three key phases:
Phase 1 (2011-14): Fine Gael will reform the current system to bring down waiting lists and build a stronger primary care system.
Phase 2 (2014): Fine Gael will change the way hospitals area paid. Block grants will be replaced by a system based on the numbers of patients they treat – ‘money follows the patient’. This will increase productivity by between 5% and 10%.
Phase 3: (2016): Fine Gael will begin the introduction of UHI. However, we know this is a long term project and bedding down all of reforms will take place during the following five years.
Well worth taking this into your electoral consideration – the HSE has claim to a huge amount of exchquer funding, in an era of cuts it is already in the firing line. FG assert you can lose 8,000 jobs and move to their system without affecting frontline services. As James Reilly is deputy-leader of Fine Gael, it seems a fair bet that the party will not allow the department to move to any coalition partner after the election. The proposal for the separation of “the purchaser of healthcare (the State) from the providers of healthcare (the hospitals)” implies the space for growth of private, for-profit hospitals.
For Labour, a universal health insurance system is underpinned by a public hospital systems drawing on public funds. We should naturally wait for the Labour health policy for full detail but as they have been on this since 2001, we are justified in not anticipating huge change. The ideological ground here is far tougher than on the economy. This is definitely something voters should be thinking about deeply prior to election day as there are plenty of non-economic social issues that need to be addressed in the post-tiger budget deficit era.
If you are looking at points of difference, you can start with the article Sara Burke (HSE analyst and journalist) wrote in response to the release of Fair Care first time around. Via her blog.
Cian,
Labour’s policy for a universal insurance scheme was sketched out almost a decade ago. It was designed for an economy anticipated to continue at reasonable levels of growth. Most of the details of how it would work in practice were not filled in; but a couple of things were straightforward.
First, that it would be extremely costly to the state, which would have to pay the insurance premia for about one million citizens who couldn’t afford to pay. Resurrecting this policy and dusting it off as a great new departure in healthcare policy is futile, since the original policy was designed for a different economy whose future outlook couldn’t be farther from where we are at the moment. Second, an unintended consequence is that Labour’s universal health insurance plan would not solve the two tier health care problem. Whilst everyone would be travelling on the same train of universal insurance cover, it wouldn’t take long for the travellers to disaggregate into first, second and third class carriages, plus the fourth class passengers who would be told they take their seats, and their chances, on the roof.
FG’s plan means that everyone will have to pay. Even Barry Andrews – whose opinion on anything I wouldn’t normally set much store on – made the obvious point that if an FF government proposed such a reform they would be immediately be accused of seeking to introduce a stealth tax. Then there’s the question of how those who just can’t pay the 500 to 600 euro a year in compulsory insurance would be accommodated and who would end up paying for that in general taxes?
James Reilly’s riposte that this system works in Holland – and he’s been up every hill in Holland examining how it works in reality – and in Canada and ..ehm.. Taiwan, is none too reassuring either. None of these countries are flat broke; we are. Further, most of our medical personnel, compared with their counterparts in even the richest countries of Europe, such as Germany, France and I reckon, possibly Holland as well, are incredibly overpaid. But the good doctor confidently asserts he will renegotiate all the key contracts with medical personnel in our system, including the one with GPs (that he negotiated himself as an IMO representative (?)),the consultants’ contracts and so on. Maybe he might give Mary Harney a ring about how easy all that’s going to be. Losing 8,000 HSE workers to redundancy will be a cakewalk by comparison.
Most dispiriting of all is the media report that at his press conference yesterday Dr. Reilly conceded it will take ten years to change the system over to his new system. TEN YEARS! Some of us may be long pushing up the daisies by the time this brave new world of cost-effective, high quality healthcase comes to fruition.
Like a lot of other pet policies so resolutely promoted by the political parties in this election, the more the details are opened up to scrutiny the more fantasic the plans appear to be. And I mean ‘fantastic’ in the true sense of the word.
Veronica, if James Reilly had said it could be done in 2/3 years we’d be rightly suggesting he was deluded and misleading people. And being very cheeky but if he was that good when he was on the side of the IMO imagine how good a deal he would be able to get when he’s on the government side of things.
Dan,
I can remember when they made Dr. John O’Connell Minister for Health … and a ruinous contract was signed with the Irish Hospitals Consultants’ Association, who privately described their negotiations with O’Connell as being like taking biscuits from a baby. Then there was Dr. Rory O’Hanlon’s tenure in the Department of Health and all those vexatious people who contracted HIV from contaminated blood imported into this country by the state and who then even had the effrontery to start dying as they cried out in vain for justice. We really haven’t had much luck with medical doctors being placed in charge of the Department of Health in recent decades, have we?
I don’t doubt the integrity or the good intentions of any and all who’ve occupied the post of Minister for Health over the past thirty years, nor the difficulties they encountered when they took on vested interests in the sector. Even the late Dr. Noel Brown ended up being fired when he fell foul of the medical establishment with his ‘Mother and Child ‘ scheme. I certainly do not doubt Dr. Reilly’s sincerity and conviction on the need for reform and his determination to take the system by the scruff of the neck and make it work for the people rather than the medical establishment, about which he’d know a lot himself. But up to yesterday he certainly was giving a good impression that his reforms would be radical and ruthless and effected within a reasonable timescale. I’m still reeling from the TEN YEARS revelation!
But isn’t the ten years the entire time scale not necessarily the time scale for us to see any changes at all? If FF had followed through on the more sensible parts of the Hanly report, we actually have the basis for the centres of excellence long ago. But that’s for another day.
Dan,
Point taken!
This has always sounded good. But as with everything here it will amount to a way for the medical professionals to fleece the State, the patients and whoever else comes along.
I rang the dept of Health to find out the more or less exact numbers that are spent on health in the State. They could only provide numbers for the Vote. Nothing on Insurance, on GP’s or any other private practitioner and drugs supplied by such. I asked them for a best guess. They came to a figure with a plus slash minus of four ruddy billion. Or between twenty two and twenty six.
I believe it’s time that the State either does an NHS on the thing or disengages entirely. Twenty five billion spent on health is just nuts.