Healthcare costs - Failures that make reform an imperative

THE VHI’s 1.5 million customers face an increase in charges of 8% next month.

For some the increase will force them to forego the security blanket offered by private health insurance. Those who can afford it will pay up but with increasing resentment because, no matter what Health Minister Mary Harney contends, no matter what we spend on the HSE, we still have a two-tier if not three-tier health system. Very few of us have the courage to throw ourselves at the mercy of the public health scheme if we can provide an alternative.

The memory of Susie Long’s death – October 12, 2007 – is too fresh and none of us is prepared to countenance having to wait for urgent assessment or treatment if we were in a similar position.

Remember, Susie, who relied on public health services, spent seven months waiting for a colonoscopy and in that time her cancer became untreatable.

In January 2007, she discovered that another patient, who had private insurance, had been diagnosed within three days of referral and would recover.

The injustice of Susie’s death provokes outrage and fear. We have been assured that the provision of cancer services have improved but, as in virtually every other aspect of Irish life, trust is the issue. We are not prepared to take the gamble so we’ll pay for health cover.

The provision of universal healthcare should be possible in a functioning, modern and caring society – France, Sweden or Denmark say – but as yet it has eluded us. Just as President Barack Obama has discovered, deeply entrenched interest groups still seem to have undue, unshakeable influence. As long as this continues the Susie Longs will fall between the cracks.

Our health system, just as our pension provision schemes, are symptoms of a failed social and economic model and are two of the areas where deep, fundamental change is needed.

This is especially true in Ireland where we will, in a very few decades, have a very large proportion of older people in our population. This large demographic will depend on pension schemes now in crisis and health insurance schemes struggling to stay solvent.

VHI anticipates underwriting losses of at least €80m in 2009. It will generate losses of over €170m in meeting the healthcare needs of its 280,000 customers who are aged 60 and older.

This is despite lower treatment costs, though the number of procedures has risen by over 70% in five years. It would be interesting to see what proportion of this increase can be attributed to the new, commercial hospitals.

Minister for Social and Family Affairs Mary Hanafin is to publish the National Pensions Review shortly and this will indicate whether the future is to be just another version of our failed past or possibly embrace the kind of radical reform so badly needed.

If we are to learn anything from our current difficulties then it must be that we cannot trust the structures of the past to support our future and unless, this time around, we have the resolve to shape them to society’s needs we are doomed to endure crisis after crisis.

Healthcare provision and pensions would be as good a place as any to start building a viable future.