Heart beat: I read this morning that the Health Insurance Authority (HIA) is proposing to levy €21 million which is to be transferred to the VHI, under the risk equalisation scheme.
This baffles me. We constantly hear that we need competition in the insurance industry and the lack of such competition is a main factor in high insurance premiums. I can think of no way more calculated to drive companies out of this wonderland environment than this daft and, in my humble opinion, immoral practice. I will be told that this has to do with "community rating".
This is another sacred cow, to be protected from the real world. Insurance is about covering risk, and health risks for the young are less than for the elderly. I believe the idea that all levels of risk pay the same premium is simply untenable. It does not hold for any other kind of insurance. Why should it hold for your health?
The VHI has been almost a monopoly since 1957, nearly 50 years. This is plenty of time for ordinary insurance principles to work. You pay less when you are younger; you pay more as you grow older and more likely to become ill. There could be an age ceiling, eg 70 years at which premiums would be pegged. At 70 years you get a medical card which entitles you to everything. The problem is that everything is not available.
The problem is the whole health service is dysfunctional. The problem is the Minister does not appear to know or is unwilling to say whether she is responsible for the public sector or the private sector or both.
As the public ship founders, it appears to those taking to the boats of private insurance that these same boats can be relied upon to deliver them safely. Sadly this premise is not a given. It depends on what is wrong with you and where you are. A private system that deals with the quick and acute problems, but not with the chronic illnesses, is not acceptable as a part solution or in the interests of access and equity.
I would not like it thought that I am against the private delivery of healthcare. I am all for it. I believe the whole service should be privatised, with those who can pay purchasing their own insurance. The State would then purchase insurance for those who cannot meet the cost.
I do not underestimate the difficulties in this but the status quo is not an option. There is a middle way - the transfer of public hospitals to regulated private ownership. This would involve manpower regulation, the exigencies of the marketplace and economies of scale. It would also involve the private sector accepting responsibility for the delivery of a comprehensive service, including liaison with the bodies responsible for training doctors, nurses and paramedics. It would also require the acceptance by the private sector of an element of regulation in the public interest.
In such a scenario, it is in the best interests of everyone that the private insurance market thrives and gives value for money. It will not do so inhibited by antiquated rules and by punishing newcomers for their success. Should Michael O'Leary subsidise Aer Lingus? Rather I would think Ryanair revitalised Aer Lingus, and I think Bupa rejuvenated the VHI.
They should not be penalised for what they are required to do. In time their population of customers will age and the swings and roundabouts of commerce will pertain. We have had enough monopoly. It does not help the consumer, the taxpayer and the plain ordinary citizen. It is regressive and against the common interest. Let the companies justify their existence by their products and their capability.
I am not too sanguine about the possibility of real change, but I would welcome a pleasant surprise. The Minister should not worry unduly. If the whole system implodes, it certainly won't be her fault. She can take solace from the experience in her department regarding the pension deductions from the elderly nursing home patients. Ministers Hear No, Speak NO, and See No were not responsible. Sure they didn't know what the lads in the department were doing. Toss one of the department lads to the wolves and the punters will forget about it soon enough. These boys may not be real brass monkeys but they surely have brass necks. All sorts of nice things are due to happen. We are due to see a reduction in the numbers of patients on trolleys by the end of March.
There is wide acceptance that the health service is as I experienced almost throughout my working life. I suspect our national malaise goes far deeper than that. I think our goals and aspirations are askew and we drift with little planning and few ideals. Our money has been squandered. We deserve better than this, but we must work for it, not just to leave it to others.
Maurice Neligan is a cardiac surgeon.