Leo says goodbye (and good riddance) to UHI

  • Niall Hunter, Editor

New Health Minister Leo Varadkar has got off to a competent start, nearly a month since taking over from the often hapless James Reilly.

It's not that Mr Varadkar has done or said anything particularly radical. It's just that, unlike his predecessor, he has obeyed what should be a cardinal rule of politics, but usually isn't - try not to make promises you can't possibly keep.

The new Minister has apparently been following the minimalist advice on acting given by British playwright Noel Coward: 'Speak clearly and don't bump into the furniture'.

For an ambitious politician reluctantly trapped in 'Angola' for the next 18 months or so before presumably moving up to more prestigious heights, that's probably very good mission statement.

While he has a reputation for plain-speaking and for being reform-minded, his aim in Hawkins House seems to be to try to change things as pragmatically as possible without scaring the bejesus out of the public or undermining already low morale in a deeply flawed health system.

Nobody ever lost many votes by keeping expectations low and making statements akin to the Pope saying he thinks sin is a bad idea.

Leo has made the right noises about issues such as doctors' pay, the need to resource primary care, high skill levels of health staff, the cuts in the health budget and the old chestnut that '99% of the time' things go well in the health service.

By the way, on what research exactly is that percentage based? Given recent safety scandals, estimates of the level of adverse medical incidents in Ireland and chronic under-resourcing of services in recent years, it may well be an overly-optimistic figure. But at least it sounds good.

Varadkar may well get mired in the inevitable crisis that will undoubtedly appear out of nowhere in the months to come, but his long-fingering of the confusing, somewhat scary and largely unloved universal health insurance (UHI) project is unlikely to cause much moaning and gnashing of teeth.

In saying that UHI is unlikely to be introduced until after 2019, Leo is not just long-fingering this grand plan - he is placing it in a sealed lead container and burying it deep at the bottom of the garden.

And good riddance, most people will way, although one has to ask the question when exactly will proper access for all regardless of income to a wide range of health services actually materialise in this country.

James Reilly's plan to end the two-tier system of access to hospital and other services was admirable, but his means of achieving this were dubious, eg letting insurance companies run the system and failing to convince the public that costs could be controlled, while promising Byzantine new levels of bureaucracy to replace the HSE.

While we have now apparently seen the end of universal health insurance, will we ever see the beginning of universal health care?

In the meantime, most people would agree wholeheartedly with the new Minister that it is a far better idea to concentrate on introducing free GP care at the point of entry for the entire population in the shorter term.

So far, the plan to extend free GP visits to the entire population has been a complete mess and has, ironically, been a focus of much of public and political criticism, even though it is a concept that is actually highly popular with the public.

Most would agree that it is a disgrace that in a developed country like Ireland, a visit to a GP is almost a financial luxury for such a high percentage of the population. In most other European countries, easy access to this basic and highly important level of care is taken for granted.

Leo Varadkar will have to overcome the considerable resistance of the organised medical profession to the plans to date for free GP care, and there will definitely be some very tricky negotiations ahead.

While GP groups have quite rightly pointed out that general practice has been decimated by income cuts and will need considerable financial resources to deliver a more universal primary care system, one cannot avoid the impression that a hard core of the profession is reluctant to let go of the current two-tiered health system, in GP or hospital care.

And with the economy improving and more people likely to be able to afford private care, for some vested interests, the imperative to retain this system will become stronger.

With this, the prospect of universal healthcare, even under an alternative insurance system perhaps run by the State rather than the commercial marketplace,will become less and less likely.

Leo will have his work cut out to deliver a deal for GPs that will allow for the introduction of free care first for under sixes, then the elderly, then older school children, and then the entire population.

It may well take years to introduce free GP care, never mind universal healthcare.

However, it would be a good start in making our health system more equitable and efficient.

How the Minister is going to fix our inequitable and inefficient hospital system in the absence of UHI or any major public funding boost for the foreseeable future is another matter.

But Leo may not be around long enough as Health Minister to resolve that particular issue.

Varadkar long-fingers UHI

What James didn't do and what Leo must do

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