You want a first-class health system? Fine, but it’ll take a dictatorship

Coming up to the election, the Green Party’s Eamon Ryan invited members of the press to the Irish premiere of Al Gore’s movie, An Inconvenient Truth. It was a clever PR move, designed to raise awareness of the real and present threat of extinction implicit in climate change.

If she had the time, Mary Harney should do the same thing with Sicko, the latest offering from American film-maker Michael Moore, famous (or infamous, depending on your point of view) for Bowling for Columbine and Fahrenheit 9/11. It garnered huge attention when it got its world premiere last week at the Cannes Film Festival. If the PDs moved quickly, they could host its Irish premiere before the election, with the Minister for Health giving the briefest of introductions.

“You think healthcare in Ireland is unsatisfactory?” she could rhetorically ask. “Well, get a load of this, friends.”

At the end of Moore’s film, whingers about the Irish healthcare system would be blessing themselves vigorously and begging forgiveness for thinking bad thoughts about it. Because, compared with Moore’s portrayal of the US system as chaotic, costly, unfair and dangerous, 36 hours on a trolley in A&E here would look positively inviting. Similarly, his examination of US health insurance systems would make Irish options look efficient, equitable and effective.

Of course, while claiming to make documentaries, Moore never starts from a neutrally exploratory position. He always starts with a thesis. In the case of Sicko, his thesis concerns “45 million people with no healthcare in the richest country on Earth”. He started the research for the movie (and his critics would put inverted commas around the word “research”) by issuing an internet invitation to Americans to contact him with their horror stories about healthcare.

They contacted him, all right. They told him their stories. Stories like the one about the 18-month-old toddler who died of a seizure directly after being refused admittance to a hospital because her parents had no insurance. Stories like the 9/11 workers who couldn’t get treatment at home for the illnesses caused by working at Ground Zero and ended up in Cuba instead.

So how could screening Sicko be useful to Ms Harney? For the same reason it would be useful to Dr Liam Twomey, the Fine Gael health spokesman. For the same reason it would be useful to whatever unfortunate ends up as Minister for Health after the hung Dail, which looks increasingly likely after the General Election.

It would be useful because it would establish that no matter how much money you shove into healthcare, no matter how well planned it is, no matter what vested interests are tackled, healthcare is like a virus which constantly morphs into a form resistant to the most recent prescription. It might also surprise some Irish viewers to learn that US healthcare doesn’t do as well on some measures — such as infant mortality — as does the system in Cuba.

The entire movie has infuriated the US government, not least because Moore portrays the Cuban system as knocking on the door of perfect. As, it must be added, would a couple of Irish hospital consultants who have experience of it.

Riled, the Bush administration always does the same thing the Vatican did over the Da Vinci Code book and movie: take action that gives what they want to suppress enough PR fuel to get noticed all over the world.

In this particular case, Mr Bush’s Treasury Secretary, Henry Paulson, initiated an investigation to find out if Moore’s filming in Cuba broke America’s trade embargoes against that country or travel restrictions on visits by Americans there. Notified of this action, Moore went into typical publicity overdrive, claiming to have had to “spirit” a duplicate master negative of the film out of the US lest the government prevent him showing it at Cannes.

“I’m the one who… has to hire lawyers and sneak my documentary out of the country just so people can see a friggin’ movie,” he announced.

Moore juxtaposes the best of Cuban healthcare with the worst of what’s happening in his home country, asserting that, in the US, pharmaceutical companies and health insurance companies are not only making huge profits at the expense of the ordinary patient, but are manipulating politicians into passive non-resistance (on the part of the Democrats, because Moore’s a Democrat) or active collusion (on the part of the Bush administration, because Moore hates that administration with a passion.)

Were Ms Harney to use the film as an electoral device, viewers might initially be a bit puzzled as the movie progressed. They would wonder why she had invited them to view a documentary that was so negative about a free market economy nation and so positive about healthcare in a small, embattled, leftover Communist nation.

The instructive difference between Cuban healthcare and our homegrown variety is simple.

Cuba’s a dictatorship.

The tall lad with the beard decides who gets paid what, who answers to who and who goes to jail if they get publicly argumentative about his diktats. It’s him who decides how much of GDP goes into healthcare and tells his people that immediate free access by everybody to a top-notch hospital is a hell of a better option than having money in your back pocket with which to buy a second home, a Lexus or a pair of Jimmy Choos. And it’s him who can commandeer the Cuban airwaves for uninterrupted rants lasting three hours.

Ms Harney can’t do any of that. Nor can Dr Twomey, if he were to get the Department of Health and Children after the election. Mr Castro can achieve excellence his way with neither trade union opposition nor pesky journalistic questions. In Ireland, it’s all about contracts, unions and questions.

The question to Enda Kenny about what other health projects will be sacrificed to pay for the 2,300 new beds Fine Gael promises is just the beginning of the problems implicit in that apparently clear and popular decision. If implemented, it would pull the rug out from under HSE chief executive Professor Brendan Drumm who’s on record as saying we don’t need anything like that number of beds. Implemented, it would also raise questions about the impermeability of the border between policy and implementation, between government and the HSE.

Maybe it’s just as well the minister doesn’t have the time to arrange a Sicko premiere. Because the viewers just might decide that the only way to get the Irish healthcare system right is by installing a dictatorship, rather than picking either FF/PD or FG/Lab. Benign, of course, that dictatorship would have to be. Time-limited, indubitably.

And left-wing. Definitely.