Will we pay for health service we demand?

Nearly every western country, no matter how wealthy, is struggling with the ever-rising cost of healthcare, be it private or public.

That struggle is driven by escalating if ageing populations, a widespread expectation that medical innovations should be automatically available to all irrespective of cost and, in some instances, management systems that seem less than optimal. Salary levels, and an employer’s ability to pay them, can have a profound influence too. The widening gap between rich and poor — and the not so poor — is having an impact too. This was seen in Ireland when large numbers of people were forced to abandon unaffordable private health insurance schemes because premiums far outstripped inflation or salary levels. This of course had a knock-on effect on already overstretched public health services. Poor, careless lifestyle choices, like those that lead to obesity, are playing a role too.

In America this battle is being fought around Obamacare, and though some of its bitterest opponents suggest it defines president Obama as a socialist — if not a communist — the services offered in some US states are so limited that they would cause a revolution even here.