Fine Gael and Labour… Health for Sale.

Posted: February 2, 2011 in Welcome

At the beginning of 2011 overcrowding in A&E and hikes in VHI and Aviva private Health Insurance highlighted the long-term problems of capacity and funding in the Irish health service.
Instead of the 3,000 beds promised by FF since 2001, the Irish Nurses and Midwives Organisation now estimates 1,700 more acute beds in public hospitals have been closed since 2008.
Fear of long waiting lists and unequal access to consultant specialists has pushed half the population to take out private Health Insurance.
Hospital Consultants doing private practice are already on a salary of €200,000 a year but get the same again in fees.
That is over €300 million a year wasted.

2-Tier System

However, Fine Gael’s 2009 healthcare policy ‘Faircare’, backed by Labour, would ignore the beds crisis and encourage the private Health Insurance industry to increase their control over healthcare.
While FG’s ‘Universal Health Insurance’ sounds appealing, its real agenda is greater corporate control of the health system.
Having health insurance and having access to good healthcare are far from being the same thing.
Ask any American.
At the core of FG’s approach is a system of mandatory health insurance.
Everyone without a medical card will be obliged to pay for health Insurance.
This means transferring costs from progressive taxation (more expensive for the rich) to Insurance premiums (more expensive for the poor).
Fine Gael argues that the health system currently fails because there is both a private and public system.
But their solution is to give the private system the upper hand and take over administering health on a for-profit basis.

Market

It could hardly be any clearer.
Huge EU and US health insurance companies will enter the Irish market and shape the direction of health policy by controlling funding but also through lobbying and bribing politicians.
Their motives will be directed by profit rather than by a planned approach to public health.
Private capitalists investing in primary healthcare centres will expect high profits.
What remains of the public system will be driven by a policy known as ‘Money Follows the Patient’ (MFTP).
Under MFTP, health providers will be paid for how many patients they treat.
Patients will be a source of ‘income’ rather than a ‘cost’, just as they are in private hospitals today.
GPs will compete to win contracts to treat patients from the insurance companies.
The more they capture, the more money they earn.
In this new market utopia, health care purchasers and providers (buyers and sellers) are separated but both will be driven by market motives.

Quality?

But this only begs the question: if patients are regarded as cash cows, what quality of treatment can they expect?
If more patients equals more money, is there not an incentive to process them quickly?
Also, more people treated for diabetes, for example, might mean that diabetes is on the increase because preventive health approaches are not being funded.
What will happen to people with such long-term (‘chronic’) conditions?
Will GPs not also have an incentive to avoid taking on ‘awkward’ cases which require frequent long-term treatment but get low payments from the insurers?
And what of the claim that the wonders of market competition will drive health costs down?
Commenting on the Dutch system touted by Fine Gael, health analyst Sara Bourke points out that:
“While there were reduced costs due to competing private providers in the first two years, the costs (in Netherlands) have gone back up by 10% in 2007 and 2008”.
Also the government has had to pay for about 500 extra staff to regulate the insurance industry which, unlike FGs proposal, are all not-for-profit organisations.
Like in the US, the reality is that costs would double through billing, advertising, profits, legal and accounting fees and massive executive salaries and bonuses as well as the poor quality of care as a result of organising care on the basis of profit rather than medical need.
Far from improving the current healthcare system, therefore, FG policies would exacerbate its worst aspects.
Instead of insurance and markets, Universal Healthcare needs democratically elected Community Health Councils to ensure profiteering or political corruption do not get in the way of well-planned Health services.

Principles of a national health service:

1. Universal and Comprehensive Healthcare.
The health service should be ‘universal’ covering everybody and ‘comprehensive’ covering all their health needs (including drug costs, psychotherapy, physio and other therapies and care for teeth, eyes and reproductive health). ‘Universal’ means little without ‘comprehensive’.
2. Funded through Progressive Taxation and Free at the point of use.
‘Progressive taxation’ is a fairer and more efficient way of funding healthcare. It means the more you earn the higher rate of tax you pay. Insurance is regressive (flat rate) and causes duplication waste and leads to unequal coverage. User fees are regressive and discourage the less wealthy from using necessary services.
3. Democratically Planned.
Services need to plan ahead based on knowledge of the local population and their health needs. Money should ‘go ahead’ not follow the patient. Democratic control by the local community and frontline workers is necessary to ensure healthcare (rather than profit or political careers) remains the priority.

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