No doubt a great many GPs will welcome the promised issue of 200,000 medical cards. Last year we paid out €300 million to just 2,000 practices for medical treatment given to medical card holders, writes Kevin Myers.
God alone knows - and I do mean that Solitary Divine Personage - how much GPs earned otherwise, because theirs is a cash business.
A quick tap on the chest, a "breathe deeply, please", a thoughtful hmmm, a swift prescription for flavoured chalk, and a, "That'll be €40, please". And then into the piggy-bank marked "Holiday Home in the Dordogne", with a full declaration to the Revenue Commissioners being as likely as one to the North Korean government.
Perhaps that's why people are relatively sanguine about the prospect of the number of medical card holders being increased by 20 per cent: at least that way, payments to GPs are regulated, and therefore taxed. And we're so used to paying out vast Niagaras of money, relatively purposelessly, to one set of professionals, lawyers, for the tribunals - some of which can actually last all of FOUR HOURS A DAY - that payment of money for health can, surely, only be a good thing.
And in a world of infinite resources, where doctors and nurses grow on trees, where medicines are extracted from a vast open-cast mine, and where hospitals are self-seeding, like dandelions, the issue of another 200,000 medical cards would of course be a wondrous thing. Indeed, the only question is: Why only 200,000? Why not four million, to encompass the entire population? We all know the answer to that, but it's one we prefer not to discuss too much in public. Indeed, the tendency is simply to ignore the real truth, because it is just too ghastly for words. It is that we are running out of GPs. We have not enough doctors to meet our present requirements, never mind our future needs, with our population set to increase by 25 per cent in the next five years.
With the feminisation of the medical profession, our supply of GPs is going in the opposite direction. As this column reported two months ago - to no response whatsoever - the Irish Medical Journal recently printed a terrifying report by two women doctors. The vista they painted was of Denningesque awfulness - so awful, I suspect, that people simply wish to ignore it, rather as in the first-class salon of the Titanic they ignored that unmannerly bang, and the vulgar gush of water.
The authors sent questionnaires to 200 women who had graduated from GP training courses, 1995-2001. Only 134 (67 per cent) replied. Of those, 13 per cent were no longer in general practice, which means that 16 graduates who had taken incredibly precious places in medical school had abandoned medicine almost upon graduating. A further one third were only working part-time. Over 40 per cent said they hoped to work office-only hours, and nearly one in 10 declared they would never work non-social hours, come what may.
Worst of all, only one in 10 declared they wanted to remain full-time GPs. And the picture could be far graver, because one third of all women graduates didn't reply at all. They could have left the medical profession entirely. And consider this: three quarters of all current GP trainees in Ireland are women.
In such circumstances, the issue of 200,000 vouchers for free medical treatment is just another Red Cow Roundabout solution to an Irish problem. Ignore reality, just solve hypothetical problems using hypothetical resources in a hypothetical world; and if you want to know how well that works when put into practice, listen to AA Roadwatch, and the broken, strangled tones of grief and despair with which the words "Red Cow Roundabout" are uttered.
Here is the position. We haven't got enough GPs as it is. We can't issue medical cards to another 200,000 people, because the system can't take it - not least because people with access to anything that's free will avail of it far more than people who have to pay. Every sniffle, every sneeze, every mucile emission will prompt medical card holders to rush off to the surgery, when the rest of us fee-payers will let our body do the curing - as, generally speaking it will.
It's not a uniquely Irish problem: all over Europe, medical systems are imploding under the weight of expectation created within the populations they are treating. But in Ireland, the situation is far worse. We have no medical system as such, but a series of largely unconnected historical events called hospitals, founded by rival religious orders, and which are now linked to the Department of Health. You might just as well create a Department of Car Showrooms and pretend it has unity of purpose and geographical intent.
The crisis exists from top to bottom in our medical non-system. How are we dealing with our central problem, lack of personnel? Well, simply: by looting doctors and nurses from the developing world, even as we impose an equality agenda on our medical school intake which judges applicants more by their teenage academic qualifications than their long-term intent. Since teenage girls are smarter than teenage boys, they get the places; but 10 years down the line, we now know that most female medical graduates will not be working as full-time GPs, or even as doctors at all.
Our medical system is holed beneath the water-line. So by all means wander through steerage, giving out another 200,000 medical cards: and just see if we can't hit that next iceberg as well, but this time on the port side.