People with health insurance can often wonder what the point of having it is. What benefits does it really have when you’re often processed through the public system, or present yourself at the coalface of public hospitals and wards, not private ones? When it feels like you have to jump through flaming hoops just to figure out how to get money back for GP visits or physiotherapy, what good is it? But like most safety nets, you only ever realise how important it is when something goes wrong. In my experience, health insurance is simply a payment to skip queues.
The news last week that more than 4,300 people are waiting more than three months for a colonoscopy is shocking. This is a record level, an increase of more than 1,000 patients since the start of the year. Colonoscopies are vital for detecting colorectal cancer, and given that they're not the most pleasant experience, and much more invasive that a simple scan, no individual will flippantly request one. So all these thousands of people waiting for this test are doing so because they feel like something is wrong. According to the Irish Cancer Society, private patients can get a colonoscopy in 12 days. Having private health insurance is paying to skip a queue, a queue that should not be there.
Languishing on a waiting list
Bowel cancer is second most common cause of cancer death in
Ireland
. Around 2,500 people in Ireland are diagnosed every year. I was diagnosed with stage three bowel cancer last year after a routine colonoscopy, a test I waited for 3½ weeks to get after I was referred. I dread to think what would have happened if I had been languishing on a waiting list for months on end. The symptoms I had weren’t dramatic – significant enough to suggest something was wrong, perhaps IBS or colitis – but the results were very dramatic indeed. Thousands of people have nothing untoward show up, but it is unacceptable that thousands of people could be waiting for a routine examination while a cancer goes undetected. Staging is also crucial when it comes to detection. So it is equally unacceptable that someone could be waiting for a test right now as their undetected cancer tips over from an early stage to a later one. The Irish Cancer Society estimates that by the end of 2016, more than 7,000 people could be waiting over three months for colonoscopy.
The HSE originally had a target that all patients should have a colonoscopy within 13 weeks of being referred. Knowing they weren’t going to meet this target, in the 2016 National Service Plan, it was revised to 70 per cent of patients. That is not good enough. Revising targets and accepting delays is playing with people’s lives and potentially diminishing their survival outcomes. Support from the health service is the most basic level of support when it comes to cancer treatment. Who else are patients meant to turn to?
I had health insurance, meaning some of my procedures were and are carried out privately. I paid to skip the queue because I can afford it. Why should I get more immediate care than someone who can’t afford it? And considering the system seems to be under so much strain already, what would happen if Minister for Health Leo Varadkar’s ideological drive to get people to take out private health insurance actually succeeded? If private care becomes as overcrowded as public care, then what? While the last government was trademarked by its lurching from crisis to crisis while telling the public everything was getting better, abandoning any real vision or action for the health system was perhaps its greatest error. Even the universal health insurance plan was unceremoniously dumped. What followed was not just stagnation, but rising waiting lists, and of course the most obvious metric of failure – people on trolleys.
The numbers on people on trolleys is perhaps the simplest, most obvious, and visually blatant indicator of a broken system, but it is merely the choppy waves atop a polluted sea. The Tory-like rhetoric of private health insurance from the Department of Health is no comfort to those who can't afford it, nor to those who know the failings within our mediocre health system. What is the HSE doing to combat colonoscopy waiting lists, apart from firefighting by occasionally shoving some public patients into private facilities to clear the backlog? That is crisis-management, it is not a solution. The patients will keep coming.
Big business
There is a big difference between universal health insurance and universal health care. They are not the same, and have been criticised by the
Irish Medical Organisation
as such. Allowing the delivery and quality of healthcare to be determined by private insurance companies is, of course, typical
Fine Gael
, where big business, profit and private interests must be at the heart of everything. This is the last government’s real legacy – an obsession with focusing on financial models, not social ones.
The HSE features a collage of crises, and colonoscopy waiting lists are just one. Patients queue, doctors and nurses do their best, GPs refer. The entities not doing their jobs are the HSE and those in charge of sorting it out. I hope they can live with that, because many cancer patients aren’t so lucky.