Madam, - I agree with many of the sentiments expressed by Dr Timothy Lynch of the Mater Hospital (August 17th).
Yes, Mary Harney's plans for private hospitals is a further move towards an American-type health system based largely on private provision and high-quality healthcare - as long as you can pay for it.
One of the major tax shelters at the moment, among the total costing the State €8.5 billion a year, is the tax write-off for developers of private hospitals. There are similar tax shelters for the development of nursing homes.
Consequently, the State is openly providing huge financial incentives, at taxpayers' expense, to deny a large number of these same taxpayers access to the private hospitals to which they are contributing! This is the case for over 50 per cent of the Irish population who are still solely dependant on the public health system.
These same taxpayers, depending on the public health system, already endure lengthy waiting-lists, and, it is questionable if they receive equality of care with citizens possessing private insurance.
The current move will expand and deepen this division between public and private, as Dr Lynch suggests. To compound this, the private hospitals are not best placed to provide some of the complex tests and procedures which require huge capital investment and are best provided as public rather than private services.
The most viable option for policy makers is not to expand the public/private divide in the health system, but virtually to abolish it with the introduction of universal social insurance. Under this system, all citizens would pay a proportion of gross income (possibly 5 to 7 per cent) and would automatically be entitled to health insurance to cover their health and social care. Those who are not at work, retired or ill, would still qualify for health insurance under this scheme.
The money raised would be ring-fenced specifically for health and social care and wouldn't have to compete for funds from general taxation. Public-only contracts for a large proportion of consultants would also improve the adequacy and quality of healthcare provision. This system would pool and concentrate all the resources of society into a well-funded public health system.
The same scheme could be used to provide geriatric, disability and mental health services. This would result in a situation whereby the necessary funding of health and social care would be guaranteed, and where necessary increases in spending would happen in a totally reformed and equitable health and social care environment.
This is not a hugely difficult policy option and has been in operation in France and Germany for many years.
It would be better for all Irish citizens if suggestions like the above were seriously considered by government. However, my fear is that an unsuspecting public will be spin-sold the private solution, with the carrot of shortening waiting-lists in public hospitals for public patients, and, sought-after care in new private hospitals. At first glance this looks good, but it is a socially and economically regressive policy choice. - Yours, etc,
TOM O'CONNOR, Lecturer in Economics and Social Care, Cork Institute of Technology, Bishopstown, Cork.