The Celtic Tiber has been replaced by the Grey Panther as 15,000 older people converged on Dail Eireann (the Irish Parliament) from all over Ireland in protest at a Government decision to remove automatic entitlement to free health care services for over 70 year olds – despite the fact that the Government had already capitulated and more or less reversed the decision.  As the grey panthers were going home they were replaced by 15,000 students protesting a large increase in third level College fees.

With the Irish economy forecast to decline by 2.5% in 2008 and 4% in 2009, things can only get worse. The Government budget deficit is expected to exceed 8% of GDP next year, and unemployment is forecast to double. Although the Irish public sector Debt/GNP ration has declined to c. 25% in recent years, it has been replaced by private sector debt which has doubled from 100% of GNP in 2003 to 200% in 2008, with net private external liabilities rising from 12% to 67% of GNP.

Cross-posted from the European Tribune.

College student protests are the perennial of Irish political life and you know things are getting really serious when they don’t happen.  The 1960’s didn’t happen until the 1970’s in Ireland and I well remember the large student protests in the first two terms of the college year which petered out as the third term and the annual examinations heaved into view. However when the 1980 recession loomed I also recall being booed by the general student body as we emerged from the almost traditional student occupation of the College Administration block in protest against College fees.  Recessions have a way of forcing all but the most committed and altruistic students to focus on their exams and the jobs market instead.

However the mass mobilisation of the “grey vote” is new in Irish politics and has sent shivers through the Government Coalition.  One Government back-bench TD (Member of Parliament) has already resigned from Fianna Fail, and independent TDs who supported the Government have also signaled their intention to withdraw their support. Older people have long memories and, unlikely most younger voters, can vividly recall the much harder times in Ireland prior to the Celtic Tiger. They are not about to let themselves become the sacrificial lambs of the current depression.

The Irish Health service remains the touchstone for public discontent despite a tripling of public expenditure over the past 10 years.  The peculiar mix of Public and Private health care in the Irish system seems designed to maximise public discontent with both.  Unacceptable waiting lists for inadequate public services are matched only by the exorbitant fees charged for private health care.  Successive re-organisations of the public system have served only to increase the number of highly paid administrators exponentially whilst the Government has never successfully confronted the high profit margins associated with private health care and prescribed drugs provision.

The Minister for Health, Mary Harney, is almost the last surviving TD for the Progressive Democratic Party, almost the sole expression of American style free market neo-liberal economic and political ideologies in Ireland. However no new more efficient model of health care provision has emerged. When public administrators don’t administer efficiently, and “free markets” don’t result in any price competition it is clear that new models of leadership, management, and cost control are required.  The alternative is what we have now: forced cuts in the provision of services which we can no longer afford – either as taxpayers or consumers.

Part of the problem is that the Public and Private health care systems overlap, with consultant doctors often working in both, and private facilities often adjacent to public hospitals.  There is thus an incentive for those doctors to maintain waiting lists for public care at unacceptable levels, so that many patients are forced to go private in order to receive adequate care.  However the Government and the Health Service Executive (HSE) have also been spectacularly inept.  Thus there is no effective purchasing strategy designed to leverage the enormous volumes of medicines bought by the HSE from Global drug Companies.  We thus pay more for our medicines than almost anywhere else in the world, and our medical Consultants are amongst the highest paid in the world.

I don’t have a problem with private health care per se.  It is preferable for the wealthy to use their wealth on health care rather than on luxury goods, and they reduce the demand for public heath care services when they opt to do so.  However a Public Heath Care system must be kept entirely separate from a private one, and there is no place for private profit motives in such a system.  The sheer volume of public health care services provided should enable enormous economies of scale, and the separation from private health care would enable the development of a public service (as opposed to private profit) ethic within the system as a whole.

Perhaps it is time the EU played a greater role in the coordination of health care entitlements and in the promotion of best practice in health care provision.  The British, French and German systems may not be perfect, but they do seem to be up there with the best in the world.  The EU needs to have a greater involvement in concrete issues that effect people in their daily lives if it is to become to be seen as more than a supra-national, trans-government entity concerned with abstruse external, strategic, diplomatic and political issues.  It was always a bit difficult to argue the case that the Lisbon Treaty would have direct benefits for ordinary people.  

If we end up having to revamp the Lisbon Treaty, the inclusion of provisions for improved entitlements and more efficient public health care services would be a good place to start. Greater regulation and management of Global Financial systems would also be a priority. of course.  Isn’t it funny how quickly a Treaty designed to move the EU forward already seems inadequate to the task?  We live in interesting times.

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