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.

In Britain the pendulum swings incessantly. Conservative governments consolidate — a spin doctor’s term for cut — and as soon as the Labour party is returned to power the money is found to undo some elements of the last round of Tory cuts to the symbolically important NHS.

An Irish version of that endless merry-go-round was seen this week when Health Minister Leo Varadkar announced a new medical card system, reversing some of the decisions made by his party colleague and predecessor, the last Minister for Health Dr James Reilly. Though this was a health initiative it was provoked by political necessity: the coalition’s need to respond to the local election drubbing provoked by the withdrawal, by the HSE, of up to 15,000 discretionary medical cards under the leadership of Dr Reilly, albeit in slightly different economic circumstances.

These changes are just the latest in a long line of programmes acting as bridge to the eventual introduction of a universal healthcare system. This ambition, which Mr Varadkar insists is as strong as it ever was, is mapped through the 2015 HSE service plan’s allocation of €25m for the introduction of free GP care for children under six, with another €12m for GP care for people over 70.

This measure was announced earlier this week along with others designed to revive a health service that suffered tremendous if unavoidable cutbacks in recent years. Even if the measures do not reverse all of those cuts — how could they? — and even if our economic situation is far from secure, it is very disappointing and wrong that only €35m of the promised €50m will be provided for mental health services. What other service could have 30% shortfall imposed on it? All of these details point to one thing — the gap between our expectations and our ability to satisfy them. We demand ever better services but ever lower taxes, ignoring the reality that you only get what you pay for. Something has to give.


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