Peter Mathews (Dublin South, Independent) | Oireachtas source

I thank the Minister for attending the debate. I acknowledge the contributions to date of my parliamentary peers on both sides of the House.

The objective here is to mend a system and create a new stage or platform for caring for the people of Ireland, of all ages and genders and regardless of background, wealth or lack of it. Even the title of the concept in the programme for Government, universal health insurance, is interesting. Let us parse that title. We like the concept of universality; it has an aura of equality about it. "Health", which is the middle of the label, is important. "Insurance" is good. It reduces risk and helps to protect against the calamitous unseen or unexpected. The quick, kerb-side reaction to the definition is that we should opt for it.

The framing of concepts is now displacing the substance of a concept or idea. That is dangerous. We must use our second line of thinking, as Daniel Kahneman calls it in his great book, Thinking, Fast and Slow, which will become a classic if it is not already. He cites an example involving postgraduates of the Harvard Medical School, men and women who by definition will be quite bright. One does not get through Harvard Medical School if one is dull or slow-witted. One might not be perfect, but one is at least bright intellectually. The experiment, conducted in the realm of presentation of ideas and concepts, asked the control group of postgraduate doctors to consider a medical management situation for a certain illness. The medical course of management of the disease was presented to the control group, which was divided into two, as having a 90% survival rate within two months. Alternatively, the same group was told that the medical management course had a 10% mortality rate within two months. In arriving at the decision of what medical management course to opt for, the information is the same in substance but the framing is different. We must be careful with this White Paper. I am not picking holes or looking for problems, but simply stating that we must look into the corners of what is involved.

The contributions of Deputy Higgins and Deputy Shortall are worthy of consideration. Insurance is an interesting industry. Underwriters charge premia, which they receive up-front. It is immediate cash to cover risks and events that are back-loaded over time. Only experience shows what will be required. In the meantime the reservoir of cash which they receive is a reservoir for investment. As Deputy Higgins said, it can go into pork bellies, cornflakes, oil, engineering, shares or whatever. That is the reserve which is put aside to cover the costs of the delivery of medical services to babies, teenagers, mothers, fathers, single people and grandparents as they get sick. It is therefore important to examine the physics of what one is addressing. If one measures the physics of a situation, wha t is involved in concrete realities, one can get a better idea of what are the costing requirements. Who is likely to get sick and when, and with what disorder or diseases?

As Deputy Shortall correctly said, we are now moving conceptually from a direct system of responsibility for delivering what is ultimately a vocational service involving doctors, nurses, auxiliaries and so forth. It is vocational. The people involved are not in it for profiteering; they will not move careers, as others do in secular occupations in the competitive marketplace and in the secular production and delivery of goods and services. It is essentially about looking after people's physical health and well-being, psychologically, psychiatrically and so forth.

Let us examine what is happening in this country in the realm of the vocational delivery of medical services. The up-to-date situation was outlined on the radio a few days ago. Young GPs are leaving this country in waves because the work conditions are impossibly demanding and the reasonable remuneration has failed. The same is true for nurses and trainee nurses. According to the interview on the radio, and it was not a sensational conversation, more than half of the trainee nurses are taking on second jobs to meet the bills and the cost of living until they qualify. After they qualify they are getting out of this country, because the atmosphere is shocking. The patient lists must be attended to and they do so to the best of their ability, but they are exhausted. One girl who was interviewed had worked for ten weeks without a day off. She has a patient list and said she regrets it. She knows the people they are looking after in the hospital are sons, daughters, mothers, fathers, sisters or brothers and their condition requires that the people providing the service be alert to little nuanced changes in their well-being. If one is exhausted, one cannot do that, even if one tries. One is bleary-eyed. That is wrong.

Another practical aspect to the concept of free GP care for children under six, and it surprises me that nobody has mentioned it, is that when a young family presents to the GP with a child under six, there are usually other children in tow. They might be under or over six. I am aware from the GPs I know that it becomes a family consultation, not a consultation for a child under six years of age. It can take up to an hour, because the mother has a complaint and the doctors, being mainly decent human beings, will deal with it. In the marine environment there is a flag of convenience for shipping goods back and forth; now there is the child of convenience for the family to come to the GP for their medical. That is not fair on the GPs, although I have not heard anybody talk about it. Has the Minister?

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