This week, indignant old men and women have led a wave of unprecedented social protest in the national media. Next week, the same old men and women will take their protest to the streets. The government may fall.
The primary issue may be medical cards but the core value at the heart of the matter is the entire concept of the universality of welfare entitlements. Universality has become the battle-ground. Joe Behan has powerfully articulated the core Irish values long since jettisoned by Fianna Fáil. We may be witnessing the death throes of the Progressive Democrats, but the cancer of their neo-liberal ideology has spread.
Ms Harney, in particular, seems hell bent on ensuring that Ireland will not have the opportunity to transform itself into any form of egalitarian state, operating a Nordic-type social model, before she departs the scene. She wishes to dismantle the last remnants of the Irish welfare state.
What has been particularly striking about the budget debate in general is the absence of any protest about increased taxation by the wealthier members in society – as noted in the recent TASC survey, there has been a shift to the left among ABC1’s. There is an acceptance that the wealthier must pay more tax – this is simply no longer in dispute. No one is protesting about the cut in the ceiling for tax relief on private pensions or the 2% levy for higher earners. Higher earners themselves would probably support even more progressive taxation if it was clear that good public services and universal education and health care would be provided. And the entire population seems to be unified in its outrage by, not just the threat to the universality of the medical card for the over 70’s, but also the application of the 1% levy to even the lowest earners.
Health care is the key battle ground in the universality war. For over a decade now, universality has been losing ground to ‘market justice’ and privatisation, despite growing evidence that the market system has failed in health care provision. For example, it is common knowledge in medical circles that many of the country’s private hospitals would not survive at all without the National Treatment Purchasing Fund (NTPF). And it is also well known that the NTPF is a gravy train for private hospitals. Ms Harney has a particular fondness for the NTPF, which has managed to escape any real scrutiny despite its massive budget.
The 2008 budget for NTPF is €100 million – the same amount of money that was to be saved by taking the medical card off the ‘ineligible’ over-70’s.
Reducing expenditure on the NTPF would have been one of several health care ‘cuts’ considered by the government, but cutting the medical card for over-70’s is what it chose. Above all else, bail out the boys. Maintain the illusion that the private hospital sector is efficient and cost effective, rather than invest in the public hospitals so that they can deal, in a timely manner, with the patients that were referred to them. And spin it so that it looks like the medical card money was only going to doctors for doing nothing anyway. In this analysis, spending money on GP’s is the same as wasting money. (On the contrary, the evidence in the medical literature is that expenditure on primary care offers the best value for money in health care – much more so than expenditure in the acute services). But do not, under any circumstances, dare to mention or to threaten the extravagant profligacy of NTPF money (€100 million) being doled out to the beloved private hospitals and investors.
It’s not as if all of the cases being dealt with by NTPF are exactly high priority – only 44% of those offered outpatient consultations on the NTPF bothered to take up the offer and only 17% required any surgery. The annual reports of the €100 million endowed NTPF are a complete disgrace, thick with unctuous self-congratulation but exceedingly thin on meaningful data. They make no attempt whatsoever to provide any information on value for money or any comparison with the cost of the same treatments if they had been carried out in the public hospitals. The sum of money involved in 2007 was €92 million and the number of in-patients treated was 22,000.
This year, the Regional Maternity Hospital, Limerick, will provide comprehensive maternity care to some 6,000 mothers of all levels of clinical complexity on a budget of a mere €18.5 million (and this includes the neonatal intensive care of many extremely preterm babies, some born as early as 24 weeks and the cost of whose care can amount to over €0.5 million per baby).
The maternity hospitals in this country continue to struggle to provide a decent level of care on very miserable budgets. And for the second year running, despite huge increases in the number of births (44% in a decade), not an extra red cent has been provided in the budget to improve them.
Will pregnant women have to descend on the Dáil, along with the pensioners, to pelt eggs at the ministers responsible before anything will be done? And pelt them they should. We have indulged and put up with this type of messing for far too long.
“This Budget serves no vested interest. Rather, it provides an opportunity for us all to pull together and play our part according to our means so that we can secure the gains which have been the achievement of the men and women of this country. It is, a Cheann Comhairle, no less than a call to patriotic action.”
This was Brian Lenihan, ending his budget speech on Tuesday and apparently trying to sound like Franklin D Roosevelt. What unmitigated blather. No vested interest served? Patriotic action? Please, give us a break.
Here’s Roosevelt himself, proclaiming his New Deal in his 1932 election campaign – “Throughout the nation men and women, forgotten in the political philosophy of the Government, look to us here for guidance and for more equitable opportunity to share in the distribution of national wealth… I pledge you, I pledge myself to a new deal for the American people… This is more than a political campaign. It is a call to arms.”
There are no FDR’s in this government.
Dr Gerry Burke, FRCOG, is a consultant obstetrician & gynaecologist in Limerick’s Regional and Maternity Hospitals. He is also a member of the Labour Party.
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