Derek Scally: In fairness, our health system is ill

We have many linguistic quirks in Ireland: some are a habit, others as psychologically revealing as a poker tell. Many are both.

There’s the evergreen “sorry” which by now is a long way from its apologetic origins and may even mean the exact opposite. “I suppose” is now tossed into sentences to give a softer, subjective hue to factual observations and assertions. There’s an entire column to be written on sentences starting with “so”, but even that pervasive American import cannot compete with “in fairness” and “to be fair”.

For every statement an Irish person makes, you can be sure that someone is waiting to step in with their “in fairness”.

Sometimes this “fair” intervention offers additional perspective and information, or encourages someone to see things from another perspective. But the wish to demonstrate empathy – or to signal empathy – can tip things into a very Irish what aboutist cul-de-sac.

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Mention that Ireland's health system is not good and that, by European comparison, Irish people pay more for less, you may get nods of agreement

A classic “in fairness” trap is Ireland’s ongoing struggle with its Catholic legacy. Critics of Irish clericalism and its terrible consequences are countered with “in fairness, the nuns gave me a great education”. Denying that both positions are fair, or working to eradicate the other’s validity, is Ireland’s contribution to cancel culture.

Mention that Ireland’s health system is not good and that, by European comparison, Irish people pay more for less, you may get nods of agreement. Or you may get: “In fairness, the nurses and doctors do their best,” or “To be fair, my aunt got great treatment once she got in.” But playing one remark off the other – using personal experience to counteract facts – is part of the problem, not the solution.

The facts are clear: Ireland’s health system is ill. It was placed 22nd out of 35 countries in the 2018 Euro Health Consumer Index report, one place above Montenegro. Despite its nurses working longer hours, Ireland has Europe’s worst access times. This, by definition, defeats the purpose of having a public health system.

The HSE can, no doubt, provide dazzling statistics citing Ireland’s stellar healthcare outcomes in certain fields. But this is irrelevant if you die waiting. The reality of 21st century Irish healthcare is neo-tribal-liberalism: you buy your way to the top of the queue with private insurance or get bumped up the waiting list via personal contacts or TD intervention. Too often it isn’t about how sick you are, it is about what you can pay or who you know.

Let’s remember Suzy Long, who died of bowel cancer aged 41 in 2007 because of a seven-month public health wait for a colonoscopy. A private patient with the same condition was seen in three days. Where is the fairness in that for her husband and two children?

There are many more Suzys out there, dying daily on Irish waiting lists or because of smear test and other systematic failures. The dying are sympathised with, paraded in the media, but ultimately forgotten because they are fatal embarrassments. They contradict our virtuous self-image as a caring, compassionate people.

We fail those who die and those who live. Young people with autism or other conditions are failed when our public health system cannot provide the early intervention that could transform the rest of their lives. With an Orwellian slant on our republican promise, we Irish cherish all our children equally, but we cherish even more those whose parents can pay for treatment.

The 2018 Euro Health Consumer Index report cuts through the noise to ask a simple question: “If countries with limited means can achieve virtual absence of waiting lists, what excuse can there be for countries such as Ireland... to keep having waiting list problems?”

The excuses – and they are excuses – are many and complex. No one disputes that the Irish health system resembles a Las Vegas casino run by Franz Kafka, where the house always wins. Nor should anyone underestimate the challenge of reforming a system that can never be shut down for a root-branch overhaul.

Challenging the norm

But a key impediment to actual systemic change, though, is calling out “in fairness” about things that are anything but fair. Doing that means challenging the Irish cultural norm of viewing everything – even systemic issues – through a personal lens.

While people overcome waiting lists themselves through ad hoc action and personal contacts, the systemic issue of chronic waiting lists are normalised and sustained by fear. Anyone who calls out the dysfunctional system and its performance may be framed – by the “to be fair” crowd – as attacking the hard-working people inside the system.

Pedants who lob 'in fairness' into structural debates on health, education, planning, transport, climate are blocking people's access to basic dignity

A century after the Irish republican fight for freedom and the foundation of the State, Ireland has become a progressive, liberal and diverse society. Yet, like tenant farmers under British rule, most Irish citizens feel powerless to change – or quietly accept – dominating State systems, allegedly acting on their behalf, that provide only arbitrary access to basic, universal services.

The centenary of independence is a years-long celebration of Irish Republic ideals and the resulting freedom. But, to follow the logic of the republican theorist Philip Pettit, people who beg for access to basic rights – in private, in court or on Liveline – are not free.

Pedants who lob “in fairness” into structural debates on health, education, planning, transport, climate are blocking people’s access to basic dignity.

Curtailing others’ freedom is not what most Irish people sign up for when they go to the ballot box. Over and over again, though, in fairness, that is what they elect.

Derek Scally is Irish Times Berlin correspondent and author of The Best Catholics in the World