Friday, September 21, 2007

Criticism is healthy

Malcolm has found his mind coming back to Herr Christian Pauls, the German Ambassador in Dublin, and the small furore over his reported remarks.

Anyone coming late to the party might usefully refer to the report in the Irish Independent: the Irish Times is briefer and less detailed, but both seem to agree on the key points. It is a curiosity worthy of record that the fullest report (and an offensive illustrative photograph) seems to have appeared in the (London) Times: in itself Malcolm finds that telling, in all sorts of ways.

Pauls was speaking in German, and accepts he described the Celtic Tiger society as "a rougher, less caring one" (this was translated as a "coarser" society). He drew attention to Irish immigration policy (noting that Ireland had learned nothing from the German experience), the inadequacy of Irish health services (in particular the "chaotic" hospital waiting lists), and the sheer greed evident in Ireland (here pointing out that minor government ministers earned more than the German Chancellor, and that consultants regarded €200,000 jobs as "Mickey Mouse" money). His throw-away line about cars (that the average age of a car in Germany was nine years, while Dublin roads are full of recent registrations) seemed a particular point of resentment. There was also a dismissive comment about the position of the Catholic church.

Now that was Malcolm's take, and, to be frank, he recognised most of those points as common ground. However, inevitably, Dermot Ahern ordered a formal Foreign Affairs rebuke: but then (as Malcolm views things) Ahern is UCD, a Louthman, and a solicitor, three impediments to a sense of humour.

If one issue which should have torpedoed the Fianna Fáil General Election campaign, it was and is Health. Despite the prosperity enjoyed by a minority in the Tiger economy, the public squalor is general. Nowhere more so than in health.

Even now Ireland budgets 10% less than the EU15 average for health provision. In the last quarter century the population has increased by a quarter, but hospital beds are down by a third, to just 12,000. Head-for-head, Ireland has a quarter fewer doctors, and three-quarters fewer specialists than the same EU15 average.

Ireland (Health) 101:

The Irish population is sheeped-and-goated from square one. One is eligible for health service on the basis of having (or not having) a medical card. Those possessing the card are entitled to GP services, hospitals, prescribed drugs, dentistry and opticians, maternity care. To arrive at this desirable status, one needs to be 70+, or receiving benefit. Single-parent families (and pretty well everybody else) are subject to a means test. Something like a quarter of the population qualify for the card: this number seems to decline by two-thirds of one per cent annually. Producing such a card is, in addition, a social stigma.

So something like half the population are covered by private health insurance. In the main, such privileged individuals are still treated in the public hospitals, but jump the queues. Numbers on the waiting lists are difficult to ascertain, but are believed to amount to 1% of the total population, and are highly politically-sensitive. Here's the BMJ:
The Republic of Ireland's hospital waiting list system is "flawed, unequitable and in need of re-engineering," a leaked report from the Harvard Association has said.
The Irish government should "depoliticise" the waiting list and treat it purely as an ethical issue based on patients' medical needs, according to the report by the group of 50 Harvard graduates—all management specialists, but none of them working in the health service field...
The group was led by Professor Ray Kinsella, director of the Centre for Insurance Studies in the Graduate School of Business at University College Dublin. It found that surgical patients who had been categorised by a consultant as "routine" might be "left waiting indefinitely for years without a realistic expectation of treatment."
Mary Harney

The Minister for Health is Mary Harney (of the defunct Progressive Democrats), who has been in the post since 2004. This is the lady who commandeered a military aircraft to fly to open a friend's off-licence in Leitrim (and had to apologise because EU money was involved). It was her mother who, last year, jumped the queue (which included emergency cases) for hip surgery. Harney's stewardship means Irish health services are ranked 25th of the EU25+Switzerland.

Yet, Fianna Fáil transfers brought her back into the Dáil, and — boy, oh boy — did she need them. Her first-preference vote collapsed from over 20% to just 12.5%. So she remains enstooled.

Cui bono?

But not everyone is unhappy. Harney had forced BUPA out of the Irish health-insurance market by insisting on "risk equilisation". In effect, this meant that BUPA (which had been about a third cheaper) would be subsidising its main rival VHI (which is in the penumbra of state-control, and has more older subscribers) by around €161 million a year. So BUPA sold out to the Quinn Group, of which the Belfast Telegraph says:
The Quinn Group has grown from modest beginnings in 1973 to become a conglomerate with interests in the manufacture of building products and glass, insurance, packaging and property.
One of the most recent successes of the group has been its insurance arm, Quinn Direct, which in March posted the largest profit yet reported by an Irish non-life insurer. The Co Cavan based operation made a pre-tax profit of £158m in 2005, a growth of 52% on the previous year.
Not surprisingly, health insurance premiums in Ireland continue to increase by 10% a year.

The Quinn Group is the creation of Séan Quinn (Ireland's richest man, worth £2.3 billion, and rated 177th richest in the world). Mr Quinn has, it goes without saying, a healthy relationship with Bertie Ahern, whom he lends the odd helicopter.

There is even a curious story that Mr Quinn slipped his €6.5M a year retirement package past his company board just moments before (State secret) budget changes would have limited it to €5M.

All in all, then, Malcolm grits his teeth and joins Kevin Myers in urging promotion and respect for Herr Pauls. He got it right. Which is more than can be said for Mary Harney and her arch-liberalism. Sphere: Related Content

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