Your Health - Whose Business?

national | anti-capitalism | news report Tuesday April 11, 2006 12:35 by Cathy Swift - People before Profit Catherine.Swift at may dot ie 086-0679708

4th People before Profit information evening

On April 7th, the fourth in a series of information meetings organised by People before Profit was held in the IFI in Dublin. This meeting - on the issue of privatisation of the Irish health service - was addressed by Louise O'Reilly of SIPTU, Peadar O'Grady of the SWP and Dave Hughes of the INO. Participants were urged to support the Patients Together Lie In at the Dáil on Good Friday at 12.00.

Your Health – Whose Business?

The fourth in the current series of People before Profit information sessions took place in the IFI, Dublin on Friday 7th April. Speakers were Louise O’Reilly, Assistant Branch Organiser of the Nursing Unit in SIPTU, Dr Peadar O’Grady of SWP and author of Why the Irish health service is in crisis and Dave Hughes, Deputy General Secretary, Irish Nurses’ Organisation. The evening was chaired by Cathy Swift of People before Profit.

Louise O’Reilly began by referring to the context of current moves towards privatisation of the Irish health service. As Minister for Health, Mary Harney is leader of the PDs who are on record as favouring inequality in society as this gives those of us, who are not currently top of the social heap, aims to aspire towards. The system which this government currently favours is one in which health is organised on a for profit basis and that the best solution to the current crisis is one in which can be sorted out by opening it up to the commercial market, as has been done in the States.

In the opinion of SIPTU, such a scenario will foster a two-tier health system where the richer one is, the healthier one will be. At the same time, the health services will be asset-stripped and essential tasks such as cleaning will be outsourced. Instead of cleaners being a key and valued part of the institution, they will be hired by private companies who seek to make profit out of their employment by cutting corners. This also has the effect that the authorities governing the health system (now the HSE) will no longer be responsible to the public for this aspect of the health services.

In a similar vein, the HSE is absolving itself of the State’s traditional duty of care for the elderly by outsourcing home helps to private companies such as “Comfort Keepers”. Although this is often described as increasing efficiency, a brief look at the costs make a nonsense of such claims. The current cost for home helps employed by HSE is 14 euros per hour. Comfort Keepers are paid by the HSE at 20 euros per hour while at the same time paying their staff an average of 9.50 euros per hour. The only gainers are Comfort Keepers share-holders, not the elderly, nor the staff nor the Irish tax-payer.

The system currently being designed is one in which the Irish public has to subsidise private health care which, in turn, can cherry-pick its patients from the young, the wealthy and those without a medical history of extreme need. It is a system which marginalises the most vulnerable. To reverse the damage, a partnership approach to all workers in the health industry is needed where resources go to those who need them. The Irish taxpayer has already paid for such a system and it deserves one going forward.

The second speaker as Dr Peader O’Grady who spoke of the sense of crisis engendered by the remarks of Brendan Gleeson. He saw the fundamental problem in the Irish health care system as being one of capacity with not enough beds in the health service and he also argued that a system when payment was required of someone who had fallen sick was the most inefficient system of health provision possible. (As initial charges, Irish patients have to pay fees to the GP, the pharmacist, and to casualty before they receive any treatment whatsoever.)

Dr O’Grady argued that the number of patients on trollies in the Irish system were not a mark of failure but rather of deliberate policy to run down public services and limit the capacity of the public services. (The HSE has recently announced that the system does not require more beds although others feel that a further 3000 beds are required to bring us up to normal European levels.) The government’s aim instead is to send patients to private hospitals whose construction is funded by enormous tax breaks. These private companies will include large multi-national corporations who see involvement in health primarily as a way of gaining government money for its share-holders. This focus on profit-making opens the door to waste of public funds: according to the FBI, 5-10% of American health spending disappears because of fraud. The company involved at the new Beacon health centre in Sandyford is a spin-off of Columbia Health-care which has recently been charged 1.5 billion dollars for false-billing and claiming cash for procedures not done.

There are already private hospitals in the Irish system, some of which are very successful. Traditionally these have been maternity hospitals and were located close to public hospitals. The care in such private hospitals is usually provided at consultant level with very few junior doctors although the types of treatment on offer are usually fairly limited in comparison to those available in the public hospitals. (Patients requiring more complicated procedures would be sent to the public hospitals which, because of the greater numbers going through their doors and their duty of care to all, have wider experience.) In the public hospitals, however the consultant/junior doctor ratios are reversed with many of the staff being at junior doctor level. Crises occur in public hospitals outside of normal hours when there is little or no coverage by the consultants.

In short, in O’Grady’s view, construction of more private hospitals will not move public patients to private care and thus free beds as the government are currently arguing. Instead extremely large sums will be spent which will allow investors to create provision for the less complicated procedures – he quoted Wren and Tussing’s forthcoming book that for every 22 million euros of private money invested, the government pays over 39 million. Public hospitals will be left to carry the burden of all the more complicated care that the private hospitals will avoid on the grounds that it is impossible to make profits for the investors out of the difficult cases. Instead of going health-for-leather down the road to privatisation which has been shown in America to produce inequalities, Ireland should be aiming for free health care at the point of need, funded by progressive taxation of the healthy (i.e. the richer you are, the more you pay.)

Dave Hughes began his talk by pointing out that 276 people were on trollies on April 7th and asked the audience to consider the human misery that each such person would be experiencing. The system is in such crisis that ancecdotes are being reported to the INO about an individual VHI payer who had been told by his GP that an invasive surgical procedure was necessary to check for the existence of a disease; in order to gain access to the hospital, it was suggested that the man go to hospital with a mythical pain and tell lies in A & E. He asked that people remember that in the 1970s and before, many people had not been covered by the public health care system and had joined VHI under some degree of compulsion – what are such people now getting for the many years subscriptions which they have paid over the course of their careers?

If one looks back over the course of Mary Harney’s term in office, one sees a constant attempt to blame individual groups within the sector for the current problems. In the beginning, she blamed the patients for being “bed-blockers” who were unwilling to leave their hospital beds. Then nurses were blamed for pursuing bench-marking payments and now she is blaming the consultants for refusing to renegotiate their contracts. There is a calculated campaign of diversion by picking on scrape-goats and as a strategy it’s working. Even in the last week, Brendan Drumm has been emphasising that the problems are essentially those of industrial relations within the health-care sector. Such remarks are a comfort to the average tax-payer who is made to feel that the problems can be sorted out by better management and without higher taxes as the private investor will pay for all reforms needed.

The solutions to the current Irish health care crisis are unlikely to be cheap and, in the INO’s opinion, should be state funded rather than run by and for private organisations. A person’s health should be the criteria on which they receive aid – not the amount of money they have available to pay for care. Support must be offered for all campaigns which seek to put the patients first. In that regard, Dave Hughes concluded, he would like to draw attention to the forthcoming Lie-In by Patients Together at the Dáil on Good Friday and urge everybody present to support it.

Discussion from the floor ranged widely over a large number of issues. Questions were asked about the admission system of St Lukes in Co. Kilkenny which has recently received great praise. Both remaining speakers (Louise O’Reilly had to leave) stressed that the numbers involved in Kilkenny were considerably less than in Dublin and that there were relatively large numbers of district hospitals around it. It would be necessary to know what their capacity was and what their patient numbers were (especially in Casualty) before being able to endorse the Kilkenny system as a solution to Dublin’s problems. A speaker from the Continent asked whether the “third way” of health co-operatives designed not to make a profit which had proved successful in some European countries had been investigated in Ireland. (The reply was that Ireland’s mixed system of doctors involved in both public and private work simultaneously made the Continental systems difficult to replicate here.) References were made to the costs of billing private consumers which can result in the creation of huge administrations – in a publicly-run system this cost is avoided. The situation in Waterford was referred to where the newly promised Oncology units will be delayed until 2011 because the government wishes to pay for the service via a PPP (Public Private Partnership).

On the issue of money to pay for a publicly funded health service, two points were made from the floor. One was that if Ireland had not handed over control of its gas and oil reserves to oil companies, it could, like Norway, fund an extremely good health service at little cost to the private citizen. The second point was that the Irish tax system had been created with a review to subsidizing wealthy institutions. Personal taxation, for example, was at 20-42% but taxation of banks was at 12%. Why should this be so? And given the profits made by banks, was there not something to be said for upping their contribution and using the resulting funds for community welfare such as a public health system?

The upshot of the meeting was a decision to do their best to publicise the Patients Together Lie In at the Dáil on Good Friday at 12:00 and to urge all present to attend. It was also agreed that volunteers would commence working towards a large Health Conference in the autumn which would involve a wide-ranging discussion of issues currently facing Ireland and attempt to produce alternatives to the solution of private health care on the American model which is being so strongly pushed by the current government. In the meantime, a working group was formed to produce a fact sheet on health and to develop further arguments and policy ideas on health. Anybody wishing to be involved in this project is asked to contact Cathy Swift 086-0679708.