Dr James Reilly, the embattled health minister, said last Friday in an RTÉ interview that he has a very “difficult job to do” but that he wouldn’t change the difficult choices and decisions he’s had to make, even if he were given such a chance.
Unfortunately, the minister is trying to do the impossible: squeezing an increasing number of square pegs (patients needs) into an increasingly diminishing number of holes (available funds).
Only politicians with absolutely no training or experience to run the biggest business in the state with over 100,000 employees and a budget of €13 billion would see any merit in such a futile exercise.
Since there is no chance that the politicians and bureaucrats will ever accept this, perhaps we should all be concentrating on what we can do ourselves to ensure the best possible outcome if we fall ill and need medical care.
Nearly everyone agrees that, once you get into the health care system, the treatment and care is very good. But non-life-threatening and elective treatments too often come with appalling delays.
There are now 340,000 people and counting on referral lists for outpatient departments; 16,600 people have been waiting four years for their first appointment. Another 113,000 people have been waiting a year for treatment (which includes hip replacements and other “elective” surgery).
With budgets tightening and the population ageing, if you are a younger person – say, anyone under 40 who intends to keep living in this country – start taking better care of yourself. Cut down on alcohol and cigarettes, lose weight and do more exercise. Encourage the entire family to eat less rubbish and exercise more. If you work in a hazardous environment, take extra care. Be conscious of the cost of an accident to you and your family. The same preventive measures should be taken by older people, of course, but the genetic causes of many illnesses and conditions can’t be avoided once you hit a certain age.
The bulk of the health care budget (the 20% to 30% of the €13 billion that doesn’t go on payroll costs) is already spent on the conditions and illnesses of older people in our society. And even if waiting lists were better managed, with older, more ill people always going to the top of every queue, the budget cuts are still going to be inadequate. We are an ageing population with less, not more money to spend.
Is affordable universal health insurance, devised, regulated and probably managed by the Department of Health mandarins, a reasonable prospect in the near future? I’m guessing that it won’t be. Top-grade health care is expensive to deliver in every society. Technology helps bring costs down, but even universal insurance systems in ageing, well-off countries (such as Holland) carry huge costs. In our bankrupt state, where both the government and individuals are hugely indebted, it will be nearly impossible to deliver in the near future.
Until then, there is still the option of private health insurance. Two million of us are still paying this way to beat the state queues and to get prompt diagnosis and treatment.
The cost of insurance has soared in recent years with high single- or double-digit increases. Popular family plans for two adults and two or three children costs can cost between €2,000 and €3,000 a year. An adult plan is typically between €800 and €1,000. About 66,000 dropped their insurance in 2011, most of them younger, healthier people, and this will also drive the price of premiums up.
However costly, health insurance is still community rated, meaning that all plans must be available to all buyers, regardless of age, but many are now being designed to be suitable for some and not for all. A young woman of child-bearing age might not get much benefit from a plan that doesn’t include extra maternity benefits; an older person, on the other hand, isn’t going to get much use out of a basic plan with sports-injury cover but doesn’t meet the full cost of orthopaedic treatment in the private hospitals.
Is €800 a year too expensive for someone who is unemployed, living on minimum wage or on a state pension? Yes, of course, though many of these people will be eligible for a medical card. What the card doesn’t do, however, is ensure prompt care.
Is €800 too expensive for an extended family of earners to pay for an older relative, or the €200 to €300 for a chronically ill child whose parents can no longer afford their policy?
Where there’s a will, there should be a way. Three or four working siblings should be able to afford to pay €15 or €20 each a month for their elderly relative’s health insurance plan (even if that person is entitled to a medical card) and far less for a child’s plan (which must be linked to an adult member).
If you are concerned about what is happening in the health service and you want to ensure the good health and health care of yourself and your loved ones, then you need to think strategically.
Improving what you can – your lifestyle choices – and then putting aside some money regularly for future treatment or insurance is the obvious thing to do. Being generous – if you can – with others who cannot afford to pay for their own treatment or insurance should also be a consideration.
A number of insurance brokers now specialise in finding the best cost plans, so shop around. (Check out healthinsurancesavings.ie, healthinsurance.ie and lyonsfinancial.ie and the Health Insurance Authority website www.hia.ie.) Health cash plans like www.hsf.ie are also worth investigating – a single premium covers the entire family and will pay tax-free cash benefits towards outpatient and hospital costs.