MICHAEL WOLSEY: Why Sláintecare is not a cure for all the ills of our health service
Unfortunately the policy is a bad one. It is aimed at providing a hospital service similar to that operated in the UK. But the British system does not work well; its health service is far from healthy.
If you want proof, just look north of the border. Northern Ireland’s hospitals have lengthy waiting lists. They have coped badly with the Covid crisis, often shutting wards and sometimes entire hospitals, and calling in the British army to assist overworked medical staff.
I could counter this with a list of deficiencies from the Irish system but I am not playing king of the castle. My point is simply that the UK’s National Health Service, once the envy of the world, is no longer a good model to follow.
It was set up after World War Two, by the Labour government of Clement Attlee, at a time when people in Britain paid for all their own health care. The rich got the best treatment and the poor had to rely on charity.
Atlee’s dynamic health minister, Aneurin Bevan, swept in a system based on the socialist principle of ‘from each according to his means, to each according to his needs’. It was paid for only by taxation and free to all users, even the very wealthy.
From the outset this proved impractical. A row over the imposition of token prescription charges split the Labour Party and brought down Atlee’s government. The re-elected Conservatives did not dare abandon the hugely popular NHS, but the service would never again be entirely free. Funding has not kept pace with population growth or the huge cost of marvellous, modern medical technology. Taxpayers are just not prepared to foot the bill.
Before Bevan gave birth to the NHS, Ireland’s health system was much like Britain’s. Since then we have gone on our own rather shambolic way, extending free medicine here and bolting on private insurance there. We have medical cards for some people and everyone is entitled to free treatment in public hospitals, if they wait long enough.
They can shorten the wait by paying for private treatment. Their payments subsidise the public hospitals but their health care is, in turn, subsidised by allowing doctors who practise private medicine to operate from those hospitals.
For better or worse, our system is now nothing like the British one and we should not try to turn it into the NHS, which itself is no longer working well.
If we want to copy another country, we should look at Germany. Its system delivers better results than ours but its broad structures are not so very different. It, too, mixes private and public health care, using the same staff and, in most cases, the same hospitals and clinics.
The big difference is that all German residents must have health insurance. It is provided by ‘insurance funds’ set up for that purpose alone, strictly regulated and price-controlled.
For people earning less than €63,000 (not a bad annual salary, even by German standards) the insurance is paid for by employers, employees and the government, via tax concessions.
If you earn more, you can top up your benefit with insurance bought from a private company. This will get hospital patients a private ward, probably a nicer ward, and sometimes their choice of doctor.
Germans can also opt for entirely private treatment in facilities built and financed by private companies, but this is so expensive only the very wealthy choose to do it.
Everyone else is in the same boat, although some are travelling first-class.
Everyone ends up getting the same level of care in the same hospital. If you can afford it, and choose to spend your money that way , you can have the deluxe package, but the difference won’t be huge.
Since the money spent on the German hospital system comes from insurance funds, not taxation, it is ring-fenced and does not go up or down with the economy or at the whim of governments.
This could be a German solution to an Irish problem, a more workable model for Sláintecare and one that could be introduced in stages. The present model has hit problems. Before pushing on down the rocky road we should at least consider a different route.