Reforming and then sustaining public-health systems has become one of the greatest challenges facing governments across the western world.
The project is more often than not an ideological battleground, although the characteristic conservatism of Irish politics means that may be one maze Health Minister James Reilly might not have to negotiate in his efforts to establish an universal health-insurance scheme.
The project is always, and probably always will be, one of the great consumers of public resources. Despite all of these obstacles, an efficient, one-tier, easily accessed health system is a prize worth fighting for.
It is even one worthy of co-operation between all political parties, medical, and social interests involved because it is one of the criteria by which a society is judged. For some people it is more, it is a life or death issue. For many others, it defines the quality of life they can hope to enjoy.
Sometimes it is even more than that; it can be an expression of intent and national defiance. Britain’s often criticised but stoutly defended NHS was established immediately after the Second World War but the idea was first expressed in the Beveridge Report of 1942 — the very moment Britain was preparing for a Nazi invasion. Just over 20 years ago, Bill Clinton’s Health Security Act failed despite the efforts of Hillary Clinton. Even today, US courts are grappling with that act’s successor — Obamacare.
Politicians, invariably only while in opposition, have exploited the issue to undermine their opponents but to no other great advantage. In most instances, the consequences are that health systems remain less than they might be and those most affected — sick people, often of scant enough means — are the victims.
Enda Kenny’s Coalition is already three years in office and the first steps of the next stage in plans — hopes might be a better word — to introduce a universal health-insurance scheme have been taken. Mr Reilly has an outline of what he might propose, but that has already, predictably, been challenged by his colleagues in Cabinet.
They have been joined by Fianna Fáil health spokesman Billy Kelleher, who has warned of the costs involved in a country where nearly half the population enjoy a medical card. At this stage, that seems more like taking advantage of a situation for a bit of schoolyard points scoring, a bit like telling Henry Ford his car will be too expensive even before he has put the wheels on, before he has put the seats in, or decided what colour — other than black — it might be.
There are any number of ways to describe the failings in our health system but not so many ways to fix it. This project, this issue that will sooner or later touch every family in the country, deserves the constructive support of all in public life. The situation in our hospitals, for carers, for local health services, for mental health services, is so pressing that a moratorium, a kind of political ceasefire, should be declared until a final plan is proposed. Then the debate can begin.
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