Madam, – Fintan O’Toole’s proposal for a “one-tier system of social health insurance” (Opinion, January 11th) obscures more than it reveals.
The obvious question is what happens to the existing health insurers (VHI, Aviva and Quinn) when the social health insurance system is in place? If the social health insurance system is to be one-tier, then presumably these health insurers will be abolished; otherwise we just have a slightly modified form of the current structure. The conclusion then is that Mr. O’Toole is proposing a monopoly health insurer.
Not only will it be a monopoly; as I read the article, it will be compulsory, without it one can’t receive healthcare. Further, the word “social” would imply (again Mr O’Toole isn’t explicit) that this insurer would be a State agency. So every citizen will be legally obliged to contribute to a State monopoly which will decide whether or not one receives treatment for a particular condition. If this State monopoly decides that it won’t pay for your condition, then you have no alternative, you have nowhere else to go, apart from abroad. These reservations are not theoretical; this is precisely what happens under the monopoly healthcare system in Canada. I have a Canadian friend who was forced to go to London for essential cancer surgery because he was rejected by the monolithic Canadian system.
I believe this is a major issue in the context of the upcoming election.
Both Labour and Fine Gael are proposing radical restructuring of healthcare in this country. The problem is that the two parties appear to have very different, and incompatible, proposals. Labour appears to be proposing a monopolistic system similar to Fintan O’Toole’s. Fine Gael, on the other hand, seems to be proposing an open, diverse structure with multiple competing insurers, similar to the system in the Netherlands and Germany. In my view, this issue must be a prominent topic in the election campaign. It is too important to be left to post-election horse trading in the context of negotiation of a Programme for Government. – Yours, etc,