Eurostat report that shows our Government spends a greater proportion of its income — 19.9% — on health than any other EU administration must shape the debate about honesty, the efficient use of resources, and waste in that vital but dishearteningly dysfunctional sector.
One of the paths towards self-realisation is considering how others might see us. By stripping away delusion and vanity, hubris and any unwarranted sense of victimhood, we can take the first steps towards life-changing reforms. That simple but rewarding process works for societies as well as for individuals.
The Our health service got more than Britain’s NHS — 17.3% — and about four times the ratio spent on health in Greece or Slovakia. These figures challenge the argument that the health service should get preferential treatment if extra funding becomes available. That our health outcomes are, broadly speaking, no more than the European average means that it’s time to stop throwing money at a problem rooted in inefficiency and waste until those bottomless-pit issues are resolved.
Health spending is not the only area where we seem an outlier. We spend 9.6% of state expenditure on old age, including pensions, but this is less than half the EU average of 21.4%. This seems a provocation to the increasingly powerful grey vote and will become a pressing point as the proportion of older people in society reaches new levels. We are also out of step on unemployment spending. We spend 6.5%, while the European average is 3%. A range of issues and services feed into this but the fact that we spend more than twice the average must raise questions. This reality also challenges the anti-austerity drum beaten so loudly by those politicians elected to the Dáil who refuse to take part in government.
The 19.9% spent on health is made up of many kinds of cost, but pay is the dominant one. As demands for pay increases grow, that cannot be ignored. It seems fair and rational that any increase be linked to new efficiencies and a significant reduction in waste — and they, unlike benchmarking, should be delivered before increases are offered. The focus must be on everything from the fabled HSE bureaucracy to legal and drugs costs and the productivity of HSE staff involved in elective surgery as frontline staff and services are stretched to breaking point. The level of consultants’ pay must be a factor, though their representatives argue that posts cannot be filled because Irish pay levels are too low, but that argument has been scuppered by another OECD report which, just two weeks ago, confirmed that this is a pretty low-tax economy.
The Eurostat figures focus on one layer of society but take no cognisance of how much it costs to buy a home, how transnational corporations pay so little tax, how their profits have grown, how rich people can legally avoid tax or how million-plus packages are almost everyday for industry leaders. That does not mean we can ignore them but, in the broader context, it must be recognised that a growing market economy driven by raw capitalism fuels discontent and wage demands in every sector irrespective of delivery or efficiency.
A three-pipe problem, as Sherlock might say.
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