Hawking healthcare for votes is irresponsible
WITH just under two weeks to go until the general election, auction politics are in full swing. Fianna
Fail is bringing back the SSIA for first-time buyers — and hang the fact that it will stall home buying now and push up house prices down the line. Sinn Fein is building houses for all. And just about every party is promising better public services and more money in your pocket.
It’s almost like the good old days of the Charlie McCreevy budgets, which were like public holidays where there was one for everyone in the audience and we all partied like it was 1999. To mention servicing the national debt or balancing the books would almost seem churlish at this stage — like a disgruntled guest at a wedding who queries the cost of the ice sculptures or the flock of rare pink doves that everyone else is oohing and ahhing over.
And among all this wonderful largesse, free access to GP care has found itself on the auction block as a vote-catcher. Fine Gael and Labour want free visits for all children under the age of 18. Sinn Fein are offering two free visits a year — and almost every party is sagely talking about how you don’t have to pay to see a GP in other enlightened OECD countries and our children deserve no less than that. That they fail to note that those countries are also missing out on our endless waiting lists for outpatient appointments and elective surgeries, or hundreds of people lying on trolleys in emergency departments during the entirely predictable annual winter surge, seems unimportant.
So let me point out, for the politicians down the back, that comparing bits of our health service to other health services without seeing the big picture shows a staggering lack of understanding about how health care should be delivered. If we want to make comparisons, we should compare the value of funding different initiatives within our own health service, to decide where that money is best spent.
Health care is an expensive and scarce resource. If you are going to roll out new access to a cohort of people, it should be targeted. So, you operate the rules of triage and you prioritise those with greatest need first. The sickest. The oldest. The most vulnerable.
The under-18 free GP initiative is the opposite of that. The vast majority of under 18-year-olds are in rude health. Half of them already have a medical card. So let’s call a spade a spade and say this money is being spent on healthy, middleclass kids — which may go some way to explain why Fine Gael is so keen on it.
That patient cohort currently doesn’t even come to the doctor much. But making visits free will incentivise them to do so. We are basically engineering increased attendances of people with minor illnesses in a system that’s already struggling to cope with major ones.
People say: “Money shouldn’t be a barrier to seeking treatment if you’re sick.”
But in all surveys, only a tiny proportion of patients say money would prevent them from attending a doctor if they were actually unwell. So this money is being spent, when parents aren’t even looking for it.
The unspoken truth is money was a loose filter that meant people didn’t attend GPs with sniffles, cuts and scrapes — they came when they were properly ill.
If the under-sixes card has taught us anything, it’s that if you give ex-private patients a free medical card, they will increase their attendances by a multiple. And capacity in general practice is simply not there for that to happen.
If there’s extra money available to spend on health, that would be welcome.
But spend it properly — on clearing the waiting lists of children waiting on scoliosis surgery.
Or the elective hip and knee surgery lists that old people languish for years on while getting progressively worse. Provide nurses so children’s chemo isn’t cancelled. Or upgrade our ambulance service so people with chest pain don’t wait an hour before anyone gets to them.
Or, if a new government wants to extend medical cards, then raise the threshold for qualification to take in working families who are just above that level and are struggling to pay their way and get little support.
Or bring people with certain health conditions, who may have to attend frequently and spend a huge amount of money of medications and visits, into the net.
But this blatant votebuying at the expense of the health budget isn’t on.
The mismanagement of our health service budget makes me, and indeed you, sick. We prioritise what will give politicians a soundbite ahead of what is needed by patients. Procurement experts say the National Children’s Hospital may actually end up costing €2.4bn. That is a genuine scandal of epic proportions.
Our current budget should be sufficient to provide decent healthcare, but it isn’t because we are spending the money on the wrong things.
Making a balls of general practice, the one bit of the health service that worked well, is a big deal.
General practice was the only area that operated without a waiting list and the only area that didn’t run a two-tier system; public and private patients were treated the same.
Government health policy is destroying that. Overloading an already over-stretched service will result in waiting lists and in doctors’ surgeries closing their books to new patients — as we are already seeing. And the crippling, unsustainable workload means as doctors retire, they are not being replaced. Overall primary care may look better on paper but, in reality, it is getting worse. And it was all so predictable.
Universal access to primary care is a laudable aspiration. But in our disastrously mismanaged system, it’s not our first priority. Clear the waiting lists and the trolleys before you start giving the healthy and wealthy a freebie. Hawking healthcare to buy votes is at best craven and irresponsible. At worst it’s a matter of life and death.