An unhealthy system badly in need of reform

Much as we might think, we are not alone in trying to sort out our health system.

It seems like the whole of the developed world has similar problems. People are living longer partly as a result of an easier lifestyle and partly driven by new medicine and medical procedures.

It’s all become a very costly business and being in the middle of a major downturn isn’t helping.

However, we are all starting off from different places in trying to sort out health care provision. A general perception of healthcare in the US has been one of an insurance-driven process where people in dire need have been turned away from hospitals because they either did not have insurance or had inadequate insurance. Getting a job with health and dental cover is the ambition of so many people.

Barack Obama has put much of his political capital in the success of his efforts to have an affordable health system. Unfortunately, given the polarisation of politics between the Democrats and the Republicans his efforts continue to be mired in opposition and predictions of imminent disaster. Democrats believe in government intervention which unfortunately can amount to a “nanny state”. The Republicans, on the other hand, believe in the “free market” with minimal if any government intervention. However, it’s anything but free and it certainly does not operate on a level playing field. Despite the mountains that have to be climbed to make it work, economist Paul Krugman believes that Obamacare might actually be a success story and quotes the test case being undertaken in California as evidence.

However, it remains to be seen if Republican opposition and even sabotage might still win the day.

Here in Ireland we are not sure what we want. Insurance continues to be a big driver for early and easy access to the system.

However, government in an effort to squeeze every penny from every source to meet the demands of the troika is putting health insurance beyond the reach of many people.

That is particularly so of the older generation, very many of whom are on fixed pensions and cannot afford the recent government policy driven hikes. And if they cannot afford those they will have no chance of meeting the intended bed cost increases which are projected to up premiums by 30%.

Given some recent stories it’s not too hard to believe that the unwieldiness of the HSE and its top-heavy management, coupled with the apparent policies of individual hospitals and the complicity or, perhaps, the laziness of insurance administrators, are major contributors to the ridiculous levels of medical inflation we have witnessed for some time.

A case in point is the recent letter in this paper referring to a day patient in a private hospital who went into hospital at 8.45am and was gone by 10.15 after a 15-minute procedure only to be charged €1,175 which excluded surgeon and anaesthetists fees, having spent less than 90 minutes in a hospital room. To put it mildly it’s mind boggling and might be described as larceny on a grand scale.

Reported comments some weeks ago attributed to Prof Michael O’Keeffe went so far as to say private patients who spend time on chairs or trolleys are being fraudulently billed for use of private beds.

One can only wonder if the insurance companies actually do anything about it, or care about the practice, or are even complicit in it. Given the amount of traction these stories get it’s hard to believe they are not aware of them.

Like with most things in Ireland we will never resolve the issue if we do not agree on what we are trying to achieve and then eliminate the dead hand of the vested interests who appear to have no interest in improving the system for all of the people if it means the chosen few lose out.