Tuesday, 3 June 2008

Indecent and Uncivilised; Healthcare for the Elite

Originally penned for the latest edition of Left Tribune

The Dublin demonstration on March 29th in support of decent public healthcare brought yet another outlet to a national anger felt at Ireland’s crippled health system. Dermot Looney looks at the history of Irish healthcare and the political issues which place public opinion very firmly on the left.

There are simply no issues in politics that touch us as personally and emotively as health. All of us have been patients to varying degrees. Many of us have been deeply involved as family members, professionals or others in the vast array of services and institutions that comprise Irish healthcare. Matters of death and life, pain and recovery and suffering and wellness affect us innately. The strings of conscience and empathy are pulled for all as shared experiences of illness and treatment strike universal chords.

Therefore, it is not surprising to have seen and heard the unprecedented levels of personal testimony across the airwaves and in print from those most affected by deficiencies in Irish healthcare in recent times. Emergent from a history of bit-part residualism and dominated by today’s self-serving neoliberal agenda, it is no wonder that people in Ireland are becoming increasingly enraged at the failure to provide a world class public health system.

Ireland’s experience with healthcare in the modern age has been borne out of traditions of poverty and exclusion, along with the unseemly alliance of liberal economics with the pre-eminence of the Catholic hierarchy. An unconnected system of voluntary religious-based institutions dominated from the first semblance of public healthcare for the ‘deserving poor’ under the workhouse systems to recent times. Initial attempts to socialise medicine were mere pipe dreams against the hegemony of subsidiarity in Irish social policy.

Halfway through the twentieth century, just a couple of years after Nye Bevan could successfully launch a comprehensive National Health Service across the Irish Sea that was universal, paid for through general taxation and free at the point of access, a mild effort by a fellow socialist towards a much narrower universalist provision for mothers and their children in the Republic of Ireland was met with a vicious response from the hierarchy and medical profession.

Noel Browne’s attempts to follow up his successful campaign against the scourge of tuberculosis with the Mother and Child Scheme ended in defeat for his proposals. But his exposé of the role of the Church and Irish Medical Association in the aftermath showed that, despite governmental efforts to take onboard public healthcare more seriously with the formation of a Department of Health in 1947, true power continued to lie in the hands of wealthy doctors and powerful clerics.

Shamefully, the initial support for the scheme from the Labour Party members in government was soon withdrawn in the face of pressure from institutions and individuals of the deepest conservatism. The scandal also played a part in the downfall of the Clann na Poblachta party and instilled a fear factor for those pursuing progressive health policies for a generation.

Health reforms have come and gone, with the 1980’s being a key time for cuts in beds and care due to a series of regressive budgets. The economic prosperity of the late 1990’s should have brought about a sea change in the provision of a healthcare policy that in secondary (hospital) care is ostensibly universal and free. But instead of the extension and expansion of provision at both primary and secondary levels, and in mental health and other key sectors, the record of successive Fianna Fáil-led administrations has been one of politically-motivated sham. Support for their private sector friends and an outright refusal to extend medical card cover for the less well-off have been just two of the moral outrages led by these governments.

Understandably and correctly, much of the focus of the widespread criticism has been on the scandalous levels of incompetence and repeated ‘systems failures’ – a term devised, no doubt, to make administrators and healthcare professionals sound more like machines than members of government-devised teams and structures. There has also been an enormous emphasis from media, patients groups and professionals on hospital cleanliness, an issue which 10 years ago would have seemed one truly at the micro-level.

It is crucial for Labour and the left to address issues such as these not only in terms of competence, but as a result of a series of political decisions by the most avowedly right-wing Irish government in the last 50 years. Chronic underfunding in a number of key areas – not least recruitment – as well as a political decision to effectively outsource the administration of healthcare to the HSE, a highly centralised body with no real public accountability, were a result of governmental policy. The unapologetic neoliberalism of the Progressive Democrats made an easy bedfellow for the conservative dodgery of Fianna Fáil.

But, significantly for Labour and the left, the economic thrust of health provision in terms of the privatisation agenda has also been a source of enormous opposition across the country. For now, it certainly seems that public opinion is very firmly on the left; supportive of public health and not the need for outsourcing our sick people to private profiteers.

An already-unacceptable two-tier system which forced those lucky enough to afford it to take out private health insurance has been exacerbated to the point that it could now be argued that not having private insurance is now a sign of poverty in itself. The campaign for a system that is both public and decent recognises the need for improvements in competence to be based on and accompanied by a commitment to public healthcare, not a system which, fancy language and specious arguments notwithstanding, continues to reward those who happen to be very rich. It seems the concentration of power has remained in the hands of elites all along; be it the Church hierarchy, conservative doctors or, increasingly, the healthcare capitalists.

Nye Bevan, the visionary socialist behind the British NHS, wrote in his book In Place of Fear that “no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.” Such an appalling vista exists in one of the supposed wealthiest countries in the world. If we are to rediscover our civility and compassion as a society, retaining the morality of public and universal healthcare will be at the forefront of the campaign for change.