Joe Higgins (Dublin West, Socialist Party) | Oireachtas source

Providing adequate resources for a health service that would comprehensively cater for the entire population of this State should be a key priority for any government. Successive governments have failed dismally to do this, however.

During the economic crisis in Irish capitalism in the course of the 1980s, savage cuts were inflicted on our health services. Thousands of beds were cut from public hospitals despite the fact that even at that stage health spending here lagged far behind comparable countries in Europe. We now have a second major assault on our health services in the wake of the collapse of the property bubble and following the disastrous decision to bail out bankers and bondholders on the backs of working class people. This austerity is taking billions from the pockets of ordinary people, creating huge unemployment problems and dramatically affecting the central taxation income. In response to its disastrous policy the Government piles disaster upon disaster, with a major attack on our health services.

The Government currently boasts of having taken tens of thousands of jobs out of public services, including many thousands from the health service itself. The effects of that are being shown up quite brutally around the country with the huge stress and strain on front-line workers in our health services. Fine Gael's policy on future health funding and organisation, based on what is called universal health insurance, has dictated Government policy in this regard. Five years ago, I analysed that Fine Gael policy called Fair Care, and my analysis stands the test of time. According to Fine Gael, Fair Care would represent the most fundamental reform of the health system since the foundation of the State. The new policy, however, involves a huge surge in the privatisation and marketing of health care. It essentially hands the running of health services over to private insurance companies.

The Fine Gael document, Fair Care, states that Ireland has two administrative systems for health: one public, the HSE; and one private, the insurance companies. Over time, it states, these two systems will become one run by the insurance companies. That gives the game away. The document is replete with the ideology and terminology of market capitalism. For example, it states that health providers will be paid for how many patients they treat. In addition, it states that patients will be a source of income rather than a cost, just as they are in private hospitals today.

The document further states that a Fine Gael government would encourage insurance companies from other European countries that have experience of implementing social insurance models to enter the Irish market. Therefore, our health service is to become a market for competing private insurance companies. While claiming that this Fine Gael policy will be based on a not-for-profit ethos, in reality it will involve cut-throat competition for profit in the health system. Profit-based private insurance companies will control the entire hospital budget. Therefore, public hospitals will be turned into autonomous units to compete with other hospitals, including private ones, for so-called business from these companies.

Just like the banks and developers that crashed this economy after a greed-fest that lasted years, private insurance companies are driven to maximise profits for their shareholders. Fine Gael's policy, which is now accepted by the Government, would give such companies inordinate power over patient care. It is clear, therefore, that in order to squeeze more profit out of the system they would, to cut costs, put relentless pressure on hospitals and others who provide health care.

As a result, hospitals, doctors, nurses, administrative staff etc., would be forced into a vicious competition driven by the commercial imperatives of the insurance companies. This would inevitably distort what should be the basic criteria relating to proper health care, namely, protecting the health and well-being of the patient and having compassion for those who are ill. That is the reality.

Fine Gael has stated that it relied heavily on the Dutch model when developing its own model. Since Fine Gael's FairCare policy document was introduced, the Dutch model has been shown to be extremely prone to both crisis and ongoing difficulties. The IMPACT trade union, which organises thousands of workers in the public health service, compiled a study, the author of which stated that in the Netherlands "a system of competing private insurers has created an inequitable and inefficient system of funding, different tiers of entitlement, rising hospital deficits, and even bankrupt hospitals" and that "financial incentives to discharge patients early has also led to one of the highest hospital readmission rates in Europe because more people experience post-discharge complications". Patients experienced such complications because they were turfed out of hospital early in order that the insurance companies might save money and make further profits.

It is an incredible betrayal on the part of the Labour Party that it has swallowed - lock, stock and barrel - the Fine Gael privatisation programme relating to the health service. That programme will not only exacerbate the problems I have outlined, it will also provide for a massive new austerity tax on those people who pay their central taxes - PAYE, VAT etc. - and look to the public health service when they require care. Those individuals will be obliged to pay an additional tax which some commentators estimate will run to €1,600 per annum if the Fine Gael policy is put into effect. Again, this involves taking the route of taxing working people further rather than making the choice - which could already have been made during this period of austerity - to, for example, tax major corporations. Such corporations pay tax at a rate that is among the lowest in Europe. If we take a rate of corporation tax of 8% as opposed to the headline rate of 12.5%, then based on the figures for 2010 every extra percentage point would have amounted to an additional €525 million for the Exchequer. In addition, a tax could have been imposed in respect of the huge increase in wealth that has been recorded among the extremely well off in our society in the past five years. The resulting income from such taxes could have been invested in job creation and would have increased the State's tax take even further. It could also have been invested in the health service and used to provide universal health care. Such health care would have been paid for from general taxation and would have been of a very high standard. If what I have suggested had been done, control of the health service would have been taken away from private insurance companies and the other parties that currently control it and placed in the hands of the front-line health workers who keep our hospitals and the service itself going.

On the basis of a democratic transformation of our health service such as that to which I refer and the provision of proper funding, we could deliver a service that would be supreme in terms of the level of care provided, desired outcomes for patients and the elimination of stress and worry for people as a result of the disappearance of waiting lists. In addition, many of the difficulties being experienced at present would be removed as a result of health workers and care workers in general being placed at the very centre of the administration of the system.

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