Fifty years after the defeat of Dr Noel Browne's proposals for free care for mothers and children, the Irish healthcare system fails to achieve the standards of care, access and equity that many states take for granted. This has been made abundantly clear in the series States of Health which reported this week on healthcare in seven other states. The debate suspended 50 years ago needs to resume today. Nothing less than fundamental reform is required to achieve an equitable, comprehensive healthcare system.
There is more than one possible route for reform. The opposition is presenting a strong case for compulsory health insurance, while the Government's health strategy is expected to propose retaining a tax-funded system.
A well-informed national debate is essential to tease out the implications of any proposed reform but the ultimate objectives for reform are quite clear. Ireland's two-tier, under-funded health system has no place in a wealthy, modern European state.
In the twilight of this Government, the electorate demands better. Surveys have shown that 95 per cent of the population wants the Government to spend more on health, 74 per cent would sacrifice tax cuts for a better health service and 65 per cent include healthcare in the top three issues which will influence their vote in the forthcoming election.
Although spending on health and its associated social services has doubled since 1996, it has only just attained the EU average. Decades of under-investment have left a legacy of deficiency in trained personnel, beds, clinics, hospitals, equipment and in the nation's health.
If we wish to emulate the standards of healthcare of our European neighbours, which they have built up over decades, Ireland has no alternative but to invest more heavily in health. Our national income now exceeds the European average and can sustain this. Not only should health spending take precedence over tax cuts but new taxes may have to be contemplated to fund it. How we spend on health is of equal importance to how much we spend.
Ireland remains highly unusual in Europe in charging most patients for visits to their family doctor and in discriminating between private and public patients in both access and quality of care in state-funded hospitals. Discrimination is deep-seated and insidious as Dr John McManus revealed in a lecture this week on research in his general practice. Public patients and women with coronary heart disease are far less likely to have their condition investigated and treated adequately.
Piecemeal tactics like the Progressive Democrats' proposals for a guarantee of private treatment after three months for patients on public waiting lists or the Independent Hospitals Association's proposal reported today to treat public patients in private hospitals, while superficially attractive, fail to address the apartheid at the centre of Irish healthcare.
Gradual privatisation of the two-tier system would increase the incomes of some doctors and the developers of private hospitals at the ultimate expense of public hospitals, which employ most of the doctors who staff private hospitals. The Government's health strategy expected next month will need to present a more visionary blueprint for reform.