Madam, - Dr Orla Hardiman (Opinion & Analysis, July 3rd) argues that the system of reducing waiting-lists through the National Treatment Purchase Fund (NTPF) is not ideal. She also dislikes the idea of hospitals set up to make profit. However, she fails to recognise that the only reason for setting up the NTPF was the failure of the public system in this country. Before this system can be improved two facts need to be accepted:
1. The public system has failed, largely due to the civil servants in the health boards (now the Health Service Executive) and especially those in the Department of Health. Successive generations of civil servants have failed to deliver a proper health service, and the failure is compounded by procrastinating politicians.
The major Dublin hospitals are grossly overcrowded. Many county hospitals have been left in a state of limbo, half-closed and half-open. Medical consultants' loyalties have been split by working in public and private hospitals simultaneously. The public system and the Irish mentality are not compatible.
2. The two-tier system of private and public patients should be abandoned. Anyone who is sick should be called a patient and treated equally.
In my opinion, the Irish people would be much better served by a fee-per-item system funded by insurance companies such as the VHI, by government insurance as in Canada, or a mixture of both. Such a combination is being implemented in the State of Massachusetts at the moment, where legislation has been introduced so that 95 per cent of the uninsured will have cover by 2009 (New England Journal of Medicine, May 18th, 2006).
If 95 per cent of patients in this country were covered by medical insurance, hospitals could be run on a business basis. This would not be difficult as 50 per cent of the population is already covered by private insurance and 30 per cent by the medical card system, leaving only 20 per cent to obtain insurance from business incentives or qualify for government cover. This would get rid of the nonsense of hospitals having budgets, which encourage managers to reduce the number of patients being admitted so they can live within the budget.
If hospitals had to earn their money by working on a fee-per-item basis there would be no waiting lists and everyone would receive treatment on an equal basis. - Yours, etc,
PETER GAFFNEY, General Surgeon, Shanakiel Hospital, Cork.
Madam, - Your readers need no assistance from me in discerning whether the letter from the Tánaiste in last Friday's edition constitutes a robust defence of her political record or a tissue of unrealities, indicative of the bunker mentality that has now become the hallmark of this exhausted and discredited administration. Her direct charges, however, cannot go unanswered. In raising the case of Mrs Breda O'Gorman in the Dáil, I am accused of both ignoring the realities of the health service and of engaging in "easy politics".
While I am as anxious as anyone to engage in serious policy debate about the health service, the Labour Party will never concede that cases such as that of Mrs O'Gorman, which the Tánaiste rightly refers to as complex, can be excluded from our consideration. Quite the opposite. How we treat the complex and the difficult cases will always be a measure both of the system and of our community. The thousands of families like the O'Gormans, whose devotion to and care for their wife and mother is humbling, and their neighbours and friends will likewise, rightly, measure us against that standard.
As Leader of the Labour Party, I have a public duty to hold the Government to account. So infrequently does the Dáil sit, that the opportunity of a leader's question is not to be taken lightly, and I did not lightly choose to use the last such opportunity before the recess to raise the case of Mrs O'Gorman. I did so only because, after three months of unsuccessful representations on her behalf, I have come to share, in some small measure, the desperation of her family at the delay in obtaining relief for her from quite unrelenting pain.
The Tánaiste's allegation that my doing so amounts to "easy politics" is base, and beneath her. - Yours, etc,
PAT RABBITTE TD, Leader of The Labour Party, Leinster House, Dublin 2.