app leo varadkar

From the Irish Daily Mail, 8 March 2015:

Minister James Reilly may have got his plain packaging proposal for cigarettes over the line, but it’s not such plain sailing with his plan to give free GP care to all children under six years of age, now handled by current Health Minister Leo Varadkar (above).

And with good reason. The Government’s hasty proposal, announced in last year’s Budget, appears to have been not sufficiently thought out and now, after repeated warnings, a majority of doctors surveyed say that they will not enforce the measure. The GPs make a strong case against this plan, especially when the whole health service is already overstretched, and when the scarce resources that we do have would be better used for the really needy.

Granted, the doctors are also thinking of their own interests, as all professional groups do, and clearly they don’t want to have to take on an extra work load, but their broader point is surely very valid. Why are we introducing a new free health care facility, which was not even requested by the public, when we are cutting resources from other more acute areas where there is actually a serious and urgent demand?

Should we really be putting badly needed funding into any kind of free healthcare, regardless of income, when we have patients lying on trollies and long waiting lists for existing ailments?

According to the National Association of General Practitioners (NAGP) 93 per cent of GPs surveyed have said that they will not take part in the scheme for the under sixes and the NAGP has accused Health Minister Leo Varadkar, who is usually so sure-footed, of being ‘out of touch on the issue’ after Varadkar had expressed confidence that most GPs would sign up for the scheme.

In fairness to the new Health Minister who, unlike other politicians, seems to understand the reality of the public finances, he has inherited this scheme, just as he inherited his party’s equally ambitious plan, now long-fingered, to roll out universal health care. However, in the teeth of GP resistance to this, Varadkar has been too complacent.

Since all GPs are actually self-employed, he said that it was up to them individually to decide what to do. They would ‘see the benefits of the additional resources and better outcomes that would arise as a result of the scheme’ said the Minister, somewhat vaguely.

But his medical colleagues feel very differently and anyone listening this week to NAGP Chairman Andy Jordan would have heard just how compelling and persuasive is their case. This scheme will add to the burdens in doctor’s surgeries and divert attention from the genuinely sick. Nor will it stop people from needlessly going to A&E departments.

The €25m that the HSE has set aside for the scheme has been described by the NAGP as ‘morally reprehensible’ since the funding will not go to those with the greatest medical need. Indeed, the NAGP believes the scheme will actually increase inequality in the health system because it is unfair to older children with chronic conditions.

The Government’s argument that people will not necessarily use a GP more because it is free simply does not stack up. People will always use something more if it is free: this is human nature. Of course, they will. Worse still, Minister Alex White said of the scheme that it was ‘generally recognised as unreasonable to expect an individual to make a good decision on what is necessary and what is unnecessary care.’ This seems to exempt parents from any judgement or responsibility on their children’s health and offers carte blanche for everybody to see the doctor on everything!

The Minister gave a similar exemption in terms of parents’ long term responsibility. ‘The early identification of health issues at a younger age can mitigate or reduce the impact of ill-health later in life. We should bear this in mind when it is reported that almost one in four children in Ireland are either over-weight or obese, which is likely to lead to significant health issues later in life.’

Indeed. But why not educate parents about childhood obesity instead of fatalistically accepting such a phenomenon and using the doctor’s surgery to sort it out? Is this the way to build a health service? If more people took responsibility for their health, and their children’s health, there would be more resources for those who are really sick.

But the big question here is this: why is the State once again paying benefits to the affluent? What is it with the pattern in this country of giving benefits not just to those who genuinely cannot afford to pay, but to everyone- and so adding to the drain on the State’s coffers?  We have seen this before with child benefits and with entitlements to the elderly – such as medical cards for the over 70s – before they were clawed back.

What is so wrong with means testing? Other countries have learned from experience and are pulling back from universality, but we seem to be pushing ruinously in the other direction.

After all, it is not as if we are a super wealthy country which can afford such a ‘benefits for all’ philosophy. Instead, we should ask where our sense of priority and justice is that we would take medical care from the confirmed sick and elderly and give it to the very young and generally healthy – and also to the wealthy? The Government argues that the €25m will not come from existing health funding, but it’s coming from somewhere, so could such funding not have gone to somewhere more needy?

Of course, universal health care, of which this children’s initiative is to form a part, is a noble aspiration, but one wonders if it isn’t just another feel-good policy, not properly costed, but designed to boost the popularity of the Government and increase its chances of being re-elected. With the current talk of another round of social partnership, and even benchmarking, it looks like the Troika-imposed discipline has truly gone and the Government is simply going to cave in on the public finances, as Irish Governments so often do.

Of course parents will take all the free GP care they can get for their young children. That’s the nature of things. But where’s the fairness in one parent from the ‘squeezed middle’ bracket in our society having to pay the standard €50/€60 to have their eight-year-old seen by their GP while another parent who earns a huge salary gets their five-year old looked at for free?

One of the trotted-out arguments against means testing is that it is expensive and too laborious to carry out. Perhaps so, but that’s not a valid enough argument to just bin such a plan. It has to be less expensive than handing out benefits to everybody.

Why not do a once-off means test on a family or individual, and use it for all the State payments? The Revenue makes such assessments after all.

The reality, however, is that means testing is used in this country for some things, but not for others. The Department of Social Welfare, for example, means tests for almost all its benefits (especially if you are self-employed) as does the Department of Education for education grants. This is as it should be, so that those who deserve it receive it, and those who don’t need it don’t get it.

This should apply across the board – whether you are five or 55.