Draft Copy: published to coincide with the all party talks – 15.10.


‘Wasters’ – a commentary on Ch. 4: ‘The Sickness of the HSE’
Concluding Paragraph: “There is still time to get it right and Minister for Health Mary Harney is the one person that can set things to rights for she is a Minister without a party, she can do as she chooses and present the case for the introduction of the Health Tax to Finance Minister Brian Lenihan knowing that it represents a global solution not only to the budgetary crisis but also to the crisis in health. And to cap it all a major flagship project in Dublin Docklands which could exceed the International Financial Services Centre in terms of its economic spin offs. All that is required for this to happen is political courage and the desire to do the right thing. The courage is there but what about the desire to do the right thing simply because it is the right thing to do?”

The Case for: 1) Funding the HSE from a combination of a 10% Health Tax and Medical Insurance, including Social Welfare Recipients and workers currently outside the tax net; 2) The GAA taking over Quinn Health; and 3) A Flagship Hospital & Cyber Campus in the DDDA authority area. By Paul Cassidy (M.Sc: Regional & Resources Planning). Paul@pdfwebpublishing.com


2|Page Introduction I’ve previously reviewed and commented on chapter three of ‘Wasters’, which FAS my main concern being that the axe falls on the waste and not the capacities; the waste being the junketeer management and commercial trainers as opposed to the Community Employment Schemes and inhouse training facilities. Although Shane Ross is highly respected and has been a consistent and reliable critic of the excesses of the social partnership process and of public service waste he is driven by a neo-liberal free market agenda. The concern being that he may well see ‘Wasters’, as his wrecking ball opening the way for a fully privatised health system funded by universal private insurance, as is the gist of Fine Gael’s Faircare plan. So my intention here is to make comment and propose an alternative means of funding a mixed public/private health system. The Ross-Webb critique is, as the title of the book suggests, driven by an expose on waste and incompetence and they pull no punches where the HSE is concerned. But it begs the question as to whether there is a viable means of maintaining a public health system which compliments and integrates with the needs of private medical insurance. So to begin, a commentary on Chapter 4 ‘The Sickness of the HSE’; followed by an alternative taxation model based on a ten percent tax on social welfare recipients and on all workers not subscribing to medical insurance; and in addition the introduction of a major new medical insurance player to fill the gap left by Quinn Health, namely the GAA. Wasters on ‘The Sickness of Health’. The chapter commences with a rather dry and redundant review of some miscellaneous visa card expenses based on who ate where for how much and who went where in what class carriage; a tad on the petty side but it does open into a more substantive critique. Ross has a good turn of phrase and geographic metaphors feature: Brian Cowen (former Health Minister, Finance Minister and current Taoiseach)likened the Department of Health and Children (Hawkins House) to ‘Angola’, (P101, Para 4), after he had left it of course; Ross compares the HSE to ‘Tonga’, or ‘Andorra’, (P80, Para 2) in terms of staffing levels of 140,000 (P84, Para 3); and maintains that the current governmental budgetary debacle would ‘do Robert Mugabe proud ‘ (P100, Para4). Minister Harney made an innovative addition to this phraseology of despair by describing the HSE’s Executives as ‘Serial bunglers’. Referring to the management of its property portfolio in terms of the timely disposal of assets the authors refer to the HSE as ‘moving like treacle’, the upshot of which is a backlog of redundant now unmarketable properties which must be secured into the future at substantial cost. Russian Dolls and PPARS: As to the abortive transition from Health Boards to HSE it seems the Department of Health and Children handling of the transition was purposely designed to minimise change. Consequently we have a Russian doll merger – out of site out of mind – with all eleven health boards discreetly tucked inside the ‘Mother of all Dolls’: the HSE. It seems reasonable that the Department of Health and Children (the latter part is not intended as a reference to the staff) would have assumed the role of pay-master general where the HSE is concerned including the function of budgetary over sight but this is not the case. No doubt if it had the thousands of ghost workers which

3|Page PPARS appears to have exposed would have simply disappeared off the pay role obviating the need for redundancies; which no doubt is why PPARS could not be delivered and why Deloitte Consultants were effectively paid not to solve the problem. And if you don’t believe that’s possible then plainly you’re either not Irish or not Irish enough. The HSE’s payroll and banking system is plainly a confused and deranged behemoth with massive duplication and waste no doubt designed to shield the appalling fact that many of those on the pay role are likely to be ghost workers who either do not exist in the first place or are at home watching back issue of Halls Pictorial Weekly. The elaborate PPARS (Personnel Payroll and Related Systems) debacle despite failing in its task of systematising the HSE payroll cost the tax payer a staggering €400M regardless, just like the evoting debacle. Why? No doubt those charged with the task were made see the merit of leaving sleeping dogs lie; as indeed was the case with Minister Martin and Minister Harney; although in fairness her misgivings are likely to be ideological rather than political. But therein lies the problem the potential symmetry between the Ministers and the authors critique; the view that being the product of a politically corrupt culture the best bet for the health services is privatisation thus disassociating it from the political contagion that caused the crisis in the first instance. A simpler alternative might be for the Minister to get her own ‘Department of Angola’, to reign-in said errant ‘Son of Angola’, by becoming its hands-on paymaster and budgetary overseer. What else would the Department of Health be doing if not that unless everyone had effectively given up or been bought off, including the Minister. After the Everest like PPARS debacle everything else seems diminutive: Unions demarcating, getting it wrong and being told so by the Labour Courts; poor procurement policy and staff planning; lousy handling of property portfolios and leases; utterly incompetent budgeting and financial control; inherited duplication from the old health boards which simply morphed into miniature Russian dolls within the new ‘Mother of all Dolls’, the HSE itself. Yes, you guessed it, the HSE has 11 legal teams, 11 PR departments and 11 procurement and IT departments (P.81, Para.3); and so on and so ridiculously forth. Administration and the Old Boys: In terms of the administrative end of things some 16% of the 110,000 ‘active’, staff are admin. Fine Gael’s Dr. James Reilly refers to the HSE’s inhouse consultants as engaging in ‘Industrious futility’ (p.91, Para 2): 760 highly paid professionals furiously writing reports supposedly for the heck of it with no net savings to the tax payer in terms of cutting back on external consultancy bills. The Department of Health and Children could plainly justify its existence if it acted as paymaster, budget setter and comptroller general over the HSE; while the HSE’s own internal legal, consulting and PR staff might justify their existence by saving on the enormous external consulting costs the HSE incurs. The problem seems to be a head to head between long established institutionalised functions within the HSE and Department of Health and a paradigm shift towards privatisaiton which management seems intent on imposing. So are the authors right in suggesting that duplication is coming from within when it could just as easily be said to be coming from without? Well if you duplicate the role of an existing

4|Page member of staff by outsourcing whose fault is that? Surely much of the duplication is arising from managements attempts at imposing a culture of privatisation on a public service body. The authors point to the roll of Summerhill College Sligo, attended by David Drumm (CEO of the HSE), Dermot Mannion (former CEO of Aer Lingus) and Michael Fingleton (disgraced former CEO of Nationwide Building Society) suggesting something of an insider old boys network; and also to the culture of ‘under-performance’, related bonuses (P99). And it would seem that the latest nominee for the post of CEO of the HSE, like Drumm, has been selected for his political acumen more than his expertise or integrity which is of course the very problem which needs addressing: the political flea circus which health has become. So if this appointment goes ahead we’ve five more years of the same old. The real expert (Professor Tom Keane) demanded wait for it – not a superannuated bonus or annual expenses paid trips to Florida – but a moratorium on staffing levels and budgetary guarantees, which of course disqualified him: undue zeal and virtue shall be prosecuted. So instead we’re getting former acting head of a flopped floatation, Eircom’s Cathal McGee. Is failure the agenda? Medical Consultants & Executive Salaries: Now as I don’t wish to further demoralise staff at the HSE or wade into matters beyond my competency it’s worth noting that medical consultants pay is close enough to what many would regard as an acceptable cap at €222,000; assuming that that sum buys the person concerned lock, stock and barrel where the public health system is concerned. The issue where medical consultants are concerned appears to be their expectation that the health services be organised round their need to clear a million a year from a combined public/private practice so as to cover medical insurance and other costs as well as producing an executive salary. This has as much to do with the ethos of corporate medicine that has crept into the health services as anything else. The reality is that outside of major hospitals and centres of expertise medical consultants should be paid as tied public health surgeons, working under the hospital’s medical insurance cover, with very limited if any focus on private practice. Of course those hospitals will also be catering to the medically insured but that’s the hospitals bonus not the surgeons, consultations aside. These are not backwoods men who hacked their way to the top of the political system , they’re highly qualified and skilled medical technicians who work under very challenging conditions and they are worth 200K plus assuming that’s it and the hospital or health care region concerned has their undivided attention at that. That understanding alone should make smaller local hospitals viable. As for larger hospitals and centres of expertise perhaps more generous work practices can apply as hospital complex managers seek to maximise service potentials. HSE executive salaries are also are not excessive given the context assuming bonuses are done away with and replaced with Christmas hampers, complimentary memberships, match tickets etc. Rather than rewarding executives for performing duties they’ve already been handsomely paid for in the first place they should have their contracts terminated by the Minister for failing to deliver on targets. Bonuses arise from companies trading on the markets at times of success as a means of cutting the executives in on windfall profits; or so the theory went, now it’s just people in board rooms stuffing money into one and others pockets.

5|Page Non-Medical Staff: Last a by no means least are the non-medical staff which get no mention from Ross and Webb. I worked as a Kitchen Porter for over a decade with all that-that entailed and my impression of hospital toilets is that toilets in fast food joints are maintained to a far higher standard than toilets in Irish hospitals. The impression one gets from modern Irish hospitals is that non-medical staff feel like they have ‘walk-on’, roles on the set of ‘Dr.House’, while the key cast go vamping up and down anima charged corridors waiting to be snapped up by passing Bollywood directors. Clearly it requires a degree of humility and diligence to be a porter, janitor or attendant, when you’re rubbing shoulders with some of the State’s most highly paid workers but that is life. A job is a job and assuming unionised pay and conditions, opportunities for up-skilling and career moves, then how can it be so bad? When the glamour is stripped back everyone is working under vulnerable circumstances and hygiene is of paramount importance. If ‘Health’, had a God of its own it would surely be hygiene, a fact the Religious Sisters of yore understood well and any of us treated in their hospitals can recall to this day the immaculately kept corridors, foyers, toilets and waiting rooms polished to the last. No doubt there are contract issues a stake due to the privatisation of cleaning services, which are demoralising workers. If so that needs to be changed. We do not need a two tier workforce in our hospitals and that coming back to bite us on the ass as ebola. Everyone must be in a union and feel satisfied with the terms of their employment even out sourced labour, if that is the system, but it must be unionised labour regardless. And then of course the unions have to be responsible about the degree of control which that fact gives them. Bur gurus like Ross and Webb have to be aware that organising 110,000 workers plus in a work place where hundreds of thousands come and go on a daily basis in upsetting circumstances is not going to be without incident or misunderstanding. It’s a constant challenge to all concerned and generally speaking the all the staff concerned maintain a very professional and friendly rapport. Building in Choice: Health Tax and or Medical Insurance The principle concern with the critique being offered in ‘Wasters’, is that its a veritable neo-liberal wrecking ball designed to weaken public confidence in a key public service. But the real opportunity the authors are exploiting is not the ‘Waste’, it’s the political failure to describe a viable funding mechanism for health; and that is a simple enough proposition at the back of it all assuming the right mix of tax and medical insurance inputs. So far Fine Gael have been the only ones to nail their colours to the mast with their plan for a system based on universal medical health cover: Faircare. Fianna Fail and the left in general have simply avoided the issue believing instead that they can keep inventing new ways of taxing round the problem. Health services need to be delivered as open access entitlements in a way which other more selective social supports needn’t. Take children’s allowance for instance. One can easily argue that it ought to be targeted at child poverty through the Social Welfare and Health systems via District Health Nurses and Social Welfare Means Assessors; but that In the case of child disability a more universal approach is needed regardless of means because child disability is too big a burden for any individual household to

6|Page to carry alone regardless of means. In terms of health everyone needs to be given access based on secured entitlement while allowing those who chose to obtain cover via their medical insurance the freedom to do so. The securing of that entitlement is the issue which needs to be discussed here. So the issue is how to create an open access health system with a secure budget. It may be a bit of a misnomer to equate medical insurance with ‘private care’, in a mixed public/private system because generally speaking it does not amount to that; what it does ensure is more attention; if it didn’t why would anyone pay for it in the first place? ‘Public’ patients need to consider that medical insurance subsidises the costs of public hospitals, underpinning budgets, expertise and resources; and that the degree of separation between public and private is often slim to non-existent. Obviously Medical Consultants will send more minions hoofing round the wards after the medically insured and they’re likely to be the first into the next available private room but that’s it. But by virtue of the same motive, the insured often are the last let home, whether they like it or not , and exposed to higher risk as a consequence: ‘Woe betide the laying hen in the hands of mucker men’. The real merit of a mixed public-private system is the potential it creates for secure budgets from which to plan services on an ongoing basis rather than having a billion more this year and a billion less next. Establishing a Tax Base for Health: We are being told that Health costs are exorbitant and I’m not sure about that. The real issue isn’t whether health costs ten billion or fourteen billion, its establishing a guaranteed ring fenced tax base from which to plan annual budgets and services. One of the products of uncertainty is waste. Apocalyptic announcements of massive spending cuts seem like scare tactics intended to fuel neo-liberal marketeers ambitious to make off with the honey pot. Those interested in defending the mixed public-private system we currently have need to speak up fast and state their case because if the Government succeeds in creating all party support for its four year budget plan we will be presented with a done deal where the privatisation of health is concerned. And let’s be clear Fianna Fail and Fine Gael both support privatisation; Fine Gael by saying so and Fianna Fail by doing so; pulling the legs out from under the public system by not introducing a health tax. Those interested in defending the ethos of public services need to accept the reality of a mixed public/private health system, like the one we have, but funded from a combination of health tax and medical insurance. They also need to accept the fact that Labour are the only party who have the will or the capacity to defend public health. Clearly Sinn Fein and others would if they could - and O’Caolain has outline proposals for same - but the reality is the government hasn’t even seen fit to include SF in pre-budget discussions. There is a love hate relationship between Fianna Fail and Sinn Fein and they seem set to either tie the knot or destroy each other. ‘Merge and be done with it’, I say. A Mandatory Health Tax for the Uninsured: Any proposal as radical as imposing a mandatory health tax for workers without medical insurance is a major departure for taxation policy in this state although its common place in Europe. Clearly it will impact on those on social welfare and in low income jobs as they are least likely to hold medical insurance. But many may choose to retain medical health insurance through periods of unemployment to maintain their policy while many self employed or contract based high income earners may prefer to pay a health tax as a means of guaranteeing health cover through

7|Page valley periods; and some may choose to pay both, so as to have the best of both worlds. By enlarge though it would mean deducting health tax at source both from social welfare payments and from uninsured workers. The introduction of such a system would require reciprocal concessions towards the public in terms of maintaining an efficient, comprehensive and geographically accessible health service which in rural Ireland means maintaining a network of local hospitals on a county by county basis; the distinction between a hospital and a clinic being the availability of beds. There are those who are suggesting reducing social welfare and the minimum wage given that they are relatively generous by UK and EU standards. I take the view expressed by Michael Noonan TD (Fine Gael Shadow Spokesperson for Health) that taking more and more money out of the economy is a recipe for disaster. What we need to do is circulate our diminishing money supply more efficiently introducing taxes to secure service entitlements rather than erode them. As unemployment approaches the half million mark and the total welfare bill creeps towards €25Billion/annum the State is going to have to manage the spend and the best option would be to introduce a 10% health tax that extends a public health care package to all concerned . Such a tax would yield €2.5Billion/annum. A similar tax on workers currently outside the tax net – and there are perhaps as many as half a million or more – would exceed the sum generated from taxing welfare generating a total sum of as much as €6Billion/annum. Extend that tax net to everyone without medical insurance and the total health tax take will certainly exceed €6Billion. So as far as ninety plus percent of the population is concerned they ought to be offered the simple choice of either paying health tax or opting for medical insurance instead. Obviously the more you earn the better value medical insurance will be while the less you earn the better value health tax will be. There will always be those outside the health tax net, including domestic dependents and asylum seekers, but I would propose making health universally accessible regardless as the percent of the population which is unemployed and without welfare or assistance is small; ten percent of nothing is afterall nothing or maybe it’s a token ‘Gate fee’. In terms of private medical insurance the purist left need to accept that people who have the means to choose medical insurance are entitled to do so; and that insured patients end up subsidising the public health system which tends to surcharge insurers to cover public costs. Although I’ve since had to cancel my medical insurance I did attend for surgery when insured for a minor operation. I was told that the benefit of being insured was that I’d be the first on the table that morning. I was near enough the last as it turned out. One thirtysomething hypertense male with a mass of cysts on his head was waiting with me so nervously that the nurse made a judgement call, nodded my way, and took him into the surgery ahead. The alternative being that he collapsed and we discretely dumped him down the disposal shoot. While I’m sure the theatre nurse made the correct judgement call I now have occasional memorial cysts on my head to remind me of my good deed. My medical insurers were charged over €700 for a minor procedure and I had to cancel the insurance next year as I could no longer afford it. So who benefited most in that situation? Now multiply that a hundred thousand fold and you get the picture. The ideological sensibilities of the left on this matter are utterly unconvincing. We have a mixed public/private health system and that is a good thing. If there are those who can afford the Blackrock Clinic then good for them and all concerned but many a wealthy man has been bleed dry before his

8|Page death presuming upon the notion that money could buy health; and they are as entitled to their delusions as the consultants are to their fees. So lets live and let live and let the less well off the value of what’s being offered . Whereas the Social Partnership Process drove disparities through Pro-Rata pay deals rewarding the well paid more that the lower paid Health Tax effectively gives the lower paid the same for less. A person receiving €100/week may consider his €10 health tax money well spent and an incentive towards temperance compared to a person earning €1000/week and paying €100 who may in turn consider that value having large family. For others medical insurance will make more sense. So this is extremely good value for social dependents and larger family units typically more dependent on the health system in the first instance. Furthermore health tax will create a sense of ownership and entitlement for all concerned. A New Major Irish Medical Health Insurer: The collapse of the Quinn Group represents a real crisis for the private health insurance model in Ireland. The solution could be very simple: get the GAA to take over Quinn Health Insurance. Minister Harney has her work cut out for her on this one and does not need another false start. We need a guaranteed, straight out of the box, sure fired winner. Is there any organisation in this country to match the social and geographic reach of the GAA; that amounts to a tenth of its manpower and membership; that can match, its popularity, draw and goodwill; its resources and facilities; not to mention its revenues? The new Croke Park Stadium has been paid off a decade in advance; hundreds of millions banked; a guaranteed revenue stream from matches; and larger revenues still from the conference and function facilities at Croke Park. The GAA would make an ideal medical health insurer and could even trade as a cooperative offering discounted rates to GAA members further deepening their cultural influence. The Gaelic Athletic Association could easily plan a new hospital and sports complex for its members perhaps in Dublin Docklands as an anchor tenant in a major campus targeted at ‘Cyber Corporates’, trading electronic goods and services online. Prestigious Cyber Corporates like Google, Facebook and Ebay already have bases in Ireland and the Government is talking to more. They need also to talk to online software sales giant like Digital-River, communications providers like Skype and online bankers like Paypal. The opportunities are vast; with 21% VAT on sales foreign VAT receipts of €2.1 billion arise from every €21Billion in digital sales not to mention Corporation Tax, PAYE, Rates and spin offs. Michal McDowell TD once planned to convert the docklands into an exclusive location for the super wealthy even suggesting the privatisation of the port tunnel and the moving of Dublin’s port facilities to Drogheda, Dundalk and Arklow, laying the seed for the Authorities subsequent financial collapse. The GAA could turn that vision inside out making it into an everymans campus accessible by port tunnel, light rail and sea. Corporate clients could enjoy a cosmopolitan port setting with health plans and a private hospital for staff on campus. The Government could lay on schooling from kindergarden, through national school and secondary for employees ensuring reasonable labour costs. The project could rival London’s Olympics in terms of the scale of investment and activity. And the Minister can rest assured that if the GAA cannot sell health insurance in this country though its membership base then

9|Page the medical insurance model is fundamentally flawed. Other locations for such a project could be identified but the DDDA location will maximise synergies and spin offs to the tax payer – which is all of us. Reinvigorating our mixed public/private model through the introduction of an ‘either, or’, choice between health tax and medical insurance would solve the governments budgetary problems in one fell swoop. The tax revenues from the cyber campus would further inflate government tax revenues also bailing out a key government agency that would otherwise require transfers. No need to impose four years of hair shirt budgets on an incumbent government or to declare a state of national emergency and effectively suspend democracy. The Alternative: Killing the Goose the Laid the Golden Egg We more or less know the alternative to introducing health tax for the medically uninsured. To date the government have taxed: private health insurance, life assurance, house insurance, are planning the reintroduction of domestic rates and of water charges, not to mention bin charges. They are allowing the banks to drive the interest rates higher both on mortgages and current interest. Current account interest rates in Ireland now exceed credit card rates with rates as high as 25% applying to current account overdrafts. No doubt that list is not comprehensive. Most of the people paying these exorbitant interest rates are now in negative equity and can no longer afford repairs to their properties with Unions still advising apprentices that they are worth €25/hour. In Ireland there is a tendency to keep returning to the ‘Golden Goose’, till it’s eggless, legless and pegless and then to weep buckets at the funeral. Still all agree that this is the way forward. The Unions and IBEC are signing off the same hymn sheet because they both share the same self fostered delusion of a mythological benign, rule abiding, ‘Middle Class’, when in reality the so called middle and working classes effectively merged in economic, cultural and consumer terms a decade ago to form a broad ‘Middle Mass’, with a ‘Dependent Class’, beneath and an ‘Executive, Business Class’, above. This fact has apparently gone unnoticed, though we sit on the same ‘Land of Leather’, suites, eating breakfast in the same Ikea kitchens; watching the same flat screen TVs; same computer screens, same programmes, same music, videos and software; same Facebook, Twitter, Google and Ebay. The national conversation switches seamlessly from football to rugby to soccer, to swine flue or whatever as though society had become a mass of starlings mysteriously synchronising in mid-flight. And still we are lectured regularly about ‘The Workers’, ‘Middle Irelanders’, the ‘Poor’, and the ‘Social Elite’, those at the top, responsible for it all as if getting rid of the apex of the pyramid would make the rest of it more structurally sound. This is all nonsense. Utter nonsense. Our world has changed illusively while we were trying to figure out mobile phones, the IT cyberverse, the retail revolution, and how to assemble our flat pack kitchens. We look back and believe we are seeing the same social landscape because we have after-all just looked away. It is time to take our heads out of the sand and recognise that we have woke up somewhere else socially, culturally and politically speaking and that it is not as challenging a landscape as we are making it out to be. It is quite easy to identify your position in this new socio-economic landscape simply by

10 | P a g e establishing whether domestic household means come mainly from: social welfare, wages or executive salaries and profits. Targeting the mythological ‘Middle Class’, is punishing mortgage holders and that includes households across the entire social spectrum. It is simply an indiscriminate attack on the idea of home ownership based on the belief that it is the one anchor that will hold in a storm. But will it hold? The famous French anarchist writer Piere Joseph Proudhon once said ‘Property is Theft’, well the Irish people may well say ‘Property is Ruin’, and if the government proceeds to burden mortgage holders any further that ‘Property is Ruin and Damnation’. What will targeting and toppling the mythical ‘Middle Cass’, achieve: a changing of the guard or a cascade failure? We do not need to speculate because the cascade failure has already commenced and is easily charted. Charting the Cascade Failure: The first item on the list of ‘Can no longer affords’, is medical health insurance leading causing failure in the medical insurance business and forcing a major rationalisation of health. With the Quinn Group in receivership and Quinn Health in limbo the entire medical insurance model is in jeopardy. The Ministers response is to announce massive cutbacks perhaps over a billion in cutbacks in a situation where revenues from medical insurance are sure to be in decline. The Government’s decision to tax medical insurance policies further compounded the problem. If they had just taxed the policy holder it might have worked but they taxed the spouse and dependants also resulting in many family policies not being renewed; a stark decision for a parent in a situation where the alternative is ‘Faith’, in an underfunded and shrinking public service. In terms of repossessions we hear the Sheriff’s Office has been busy raiding family homes and making away with the family furnishings for resale at mass auctions which are promoted ridiculously as an indicator of renewed consumer spend. Can anyone fail to have noticed the dearth of SUV s and four wheel drives on the road? There was a time you lived in dread of going to the local country shop for the sheer volume of SUV’s and four wheel drives you’d have to drive in on the ditch for along the way, not to mention kids mindlessly performing wheelies on quads and boy racers tracking doughnuts into the road in a James Deane revival which is addicting a generation of youth to danger. So no health insurance and the repo-man has been and gone: what next? The Credit Unions will obviously be the next victim of the cascade collapse for the simple reason that it is the one loan mortgage holders can afford not to pay. While the credit card can be maxed out and ignored the bank account is key to maintaining mortgage payments and with current account interest rates matching credit card rates and punitive charges of up to 25% there is little option but to keep that wolf from the door for as long as possible. So logically mortgage holders who also have Credit Union loans will renegotiate or cease paying the Credit Union. As members rather the customers they are on a stronger footing in terms of default and will be advised accordingly by Citizens Advice. The Government budgetary plans amount to nine more ways of skinning a comatosed cat. The Credit Union will go up against the wall before the next budget if they proceed an event which will impact heavily on local economies and local politics. This is Fianna Fail in ‘Hari Kari’ mode. Following on the

11 | P a g e collapse of the Credit Unions more cries for bail outs from the by now state owned commercial banks which will be hit with by an increasing tide of mortgage holders deferring payment, seeking moratoriums, loan extensions and revalutations. Irish banks net worth will fall to such a level that Michael Branson will likely buy the lot on a whim and rebrand the country ‘Virgin Ireland’. Maybe that’s a good idea? – a fresh start. Accompanying all of that a surge of health card and disability applications; disserted wives allowance; single parents; a soaring divorce rate; hundreds of thousands of households added to the housing register and so forth putting the relevant departments under impossible pressure. More and more people will emigrate simply closing the doors on their Celtic Tiger homes and leaving for good. Insurance costs and claims will go through the roof at first car insurance, then household insurance, medical and life assurance. How many men would kill themselves to save their wife and family the ignominy of homelessness; how many would deliberately injure themselves to make a claim? My life assurance policy permits me to commit suicide – Zurich Life. At some point some incensed householders will start paying gangland figures for hits on the local Sheriff and his staff. People will drive commercial vehicles through the frontages of Fianna Fail constituency offices in sheer rage before the repo man comes. No foreign power will intervene knowing the form of the people and of the IRA on whom opportunity will not be lost. The Army Council will reconvene. AK47’s are as cheap, as easy to use and as effective as ever. Plus they make a lot of noise which tends to shut a lot of people up; ‘The barking iron’, as its aficionado’s affectionately call it. Conclusion A few weeks ago the Governor of the Central Bank, Patrick Honohan (the highest paid public servant in the state) was interviewed by Vincent Browne in relation to the Anglo bailout, amongst other things, and as to whether it had been necessary or not. He said that it had not been necessary and that he had said so in note 160 something of a report he had written. He said so with all the roguish charm of those fly by night street jewellery sellers you used to see on Henry Street, dodging the cops between sales. He apparently thought the fact that the tax payer had been stung for €34Billion (plus) amusing. At the time I had advocated that the commercial banks be bailed out via domestic mortgage debt to give home owners a break and ensure they commit to their mortgages because there is hundreds of millions of vulnerable domestic debt out there, a potential fiscal Tsunami which would dwarf the collapse in the commercial sector. I plagued Green Party Chairperson Dan Boyle and Fianna Fail on Facebook at the time, but my efforts didn’t even merit a response. The social media being merely another poodle they trot out to please the crowd. As events transpired I was right, the money would have been far better off channelled via mortgages either as very generous interest allowance or as once off payments to mortgage accounts which the government already has records of. My proposal would have saved the commercial banks and indebted a generation of mortgage holders to Fianna Fail and the Greens for life; a trick Fianna Fail played with the upwardly mobile working class in the nineties when Padraigh Flynn was Minister for the Environment.

There is no guile (John 1: 47) behind this proposal just as there was none in the first instance. It is so simple that it can be restated in a single sentence: Introduce a mandatory health tax of 10% for all those without medical health insurance; get the GAA to take over Quinn Health and develop a flagship private hospital in Dublin Docklands as part of a cyber campus designed to maximise foreign VAT receipts. That’s it nothing else needs to be done except for the Social Partners to sit down to an honest review of the excesses of the social partnership process, including the need for a rational review of Irelands civil administration. There is no reason why health could not become self financing if every worker and welfare recipient in the State paid their share either in health tax or insurance freeing government finances from the veritable millstone. This is Pro-Rata in reverse, giving the little guy the boon deal. There are two simple reasons as to why none of the political parties have fielded this idea: 1. Political parties driven by neo-liberal free market aspirations to privatise health want to see a system level failure in the delivery of public health so as to justify breaking it up. That includes the PD Minister for Health and Children, Mary Harney TD; Fianna Fail who borrowed the PD coat till it wore out during the Celtic Tiger years; and Fine Gael and their FairCare proposals which are exclusively insurance based. 2. None of the parties on the Labour Left end of the political spectrum have dared suggested introducing Health Tax, despite the many precedents in Europe, for fear of being politically outflanked by the ever populist ever clever Fianna Fail. There are those who are ideologically opposed to the notion of private health insurance on principle despite the fact that the Irish Health system is ideally suited to a mixed public-private system funded jointly by health tax and medical insurance. The social gregariousness of the Irish and their astute political acumen makes them great mixers and ideally suited to a mixed system; we are a culturally and socially pliable lot and can get along in all kinds of adverse circumstances. The system we have works by enlarge but is lacking the certainty of a guaranteed tax and insurance base plus the proper financial control and oversight which ought to be coming from the Department of Health and Children. Surely there would have been no need for the PPARS debacle had the Department being doing its job as paymaster and budgetary overseer. As for the level of duplication within the HSE arising from the ‘Russian Doll’, style merger of the Health Boards into the HSE and the growing culture of outsourcing the answer is plainly to redeploy staff to where they are needed in Hawkins House for one and to stop outsourcing work which can be done internally. Not withstanding the wider arguments for civil service reforms that must be addressed by the social partners (most notable of which is the excesses created by the pro-rata pay deals) there is a single solution to this years budgetary problems and that is to apply a ten percent health tax to all those who do not hold medical insurance and to allow people make that choice for themselves be they social welfare recipients, low paid, self employed or executive workers. And in addition to invite the GAA to take over Quinn Health on the basis that another false start would risk the collapsing the medical insurance business in Ireland. The GAA and Dublin Docklands Development Authority could team up to develop a flagship docklands renewal project involving a major new private hospital and a campus for

13 | P a g e cyber corporates , like Google, Facebook and other social media players, software providers and online bankers like Paypal. In global terms the resulting revenues are easily guesstimated. With social welfare payments mounting towards €25Billion/annum a 10% tax would produce €2.5Billion. Assuming that there are at least as many low paid workers as social welfare recipients, in the region of half a million, one would expect an additional €2.5B plus. Extending health tax cover to all other workers or self-employed who do not hold medical insurance is likely to yield as much again bringing the total tax take towards €8Billion. Beyond that there are the additional medical insurance inputs that would arise from the introduction of a major new health insurer into the fray. The GAA could literally ‘enculturate’, the notion of medical health insurance as a ‘civic good’, into rural and provincial Ireland in particular in a way that no other health provider could making them compatible with the VHI’s urban base. But who are the ‘Naysayers’, likely to be? A curious lot no doubt. There’ll be a raft of neo-liberal critics who’ll cry foul as they witness the prospect of the HSE’s €10Billion property folio coming on the marker at bargain basement prices turn sour. There’ll be a cacophony of social voices decrying the move: some will protest on leftist ideological grounds - people opposed to the notion of medical insurance on principle; others by reason of religious or clientelist sentiment will feel it their duty to defend the vulnerable despite the Irish social welfare system being the most generous in the EU and remember social dependents without welfare cannot be taxed and therefore will not be charged; and of course well will have the usual voluminous rhetoric from those who just do rhetoric as a kind of aerobic exercise. Let nobody underestimate the seriousness of this moment in Irish political life. Fianna Fail have so far got all the judgement calls wrong including their ill-fated expansion into the north which now threatens funding for the third level sector in northern Ireland precipitating more social unrest. If one were told someone was plotting a revolution one could well believe it so synchronised is the fall but it is just as likely to be a product of collective bad judgement and the madness that is Ireland. There is still time to get it right and Minister for Health Mary Harney is the one person that can set things to rights for she is a Minister without a party, she can do as she chooses and present the case for the introduction of the Health Tax to Finance Minister Brian Lenihan knowing that it represents a global solution not only to the budgetary crisis but also to the crisis in health. And to cap it all a major flagship project in Dublin Docklands which could exceed the International Financial Services Centre in terms of its economic spin offs. All that is required for this to happen is political courage and the desire to do the right thing. The courage is there but what about the desire to do the right thing simply because it is the right thing to do?

Sign up to vote on this title
UsefulNot useful