One cannot be too critical of paying patients. They pay for, expect and generally get a reasonable service. I assume they also help subsidise the public health service. Ireland's approach to health care is based on a public-private mix, which is not bad if managed properly. I have already referred to the problems in the private system in the United States. I cannot imagine what happens to a person with no health insurance there. Having watched the television series "ER" on occasion, I am glad we have several players in the market.