Here is what fudge reads like. "This Government will introduce Universal Health Insurance with equal access to care for all. Under this system there will be no discrimination between patients on the grounds of income or insurance status. The two-tier system of unequal access to hospital care will end." It is also what a false promise reads like.
These are the opening sentences of the health section of the Programme for Government negotiated between Labour and Fine Gael in March 2011. This week the false promise of universal health insurance was abandoned and the fudge was exposed. More than seven years of Fine Gael policy-making in the health area has just been flushed away.
On April 29th, 2009, Fine Gael launched a "radical new health care policy" called FareCare. Universal health insurance was the central tenet of this plan. At the launch of that document Enda Kenny said the policy derived from a special party commission chaired by the former leader Alan Dukes which had been asked to develop a policy that would transform the health service "within a five-year time frame".
Kenny promised that “in its first 30 days in Government, Fine Gael will work with all the major stakeholders in the health service to agree an implementation plan so that the proven Dutch system of UHI is best adapted to Irish circumstances”.
This health policy document, while sounding radical, was vague on implementation and very vague on costings. That part of the 2011 Fine Gael election manifesto dealing with health merely summarised the key points of this policy document. The proposal was also shaved down into sound bites and formed the fourth plank of the “Five Point Plan”, which became Enda Kenny’s mantra for that campaign.
Fine Gael clearly saw health as a key differentiating policy for them in the 2011 election. They spent much money on large billboards and press adverts showing a resolute Enda Kenny with a hospital trolley in the background over the strap line “I will end the scandal of patients on trolleys.”
After the election when Fine Gael and Labour sat down to agree a Programme for Government the result was the paragraph quoted at the top of this column. This week on RTÉ radio Róisín Shortall TD, now joint leader of the Social Democrats, who was then on the Labour Party front bench, revealed that this text was a fudge designed to camouflage the differing Labour and Fine Gael positions on how the health services would be organised and funded. When Mary Wilson pointed out to her that the word fudge suggested that something was being long-fingered and whether she meant it was a compromise, Shortall stuck to the word fudge.
No viable plan
Shortall says that within four months of going into the
Department of Health
as a junior minister she knew that there was not a viable plan to implement universal health insurance. Notwithstanding this, the Government persisted with the charade that this policy was affordable for another 4½ years.
On April 1st, 2014, the Government launched a White Paper on Universal Health Insurance. At that launch Kenny spoke of how the publication of the White Paper “sent a very clear message that the Government intended to deliver on that promise of change”. In response to those who said implementing universal health insurance could not be afforded during a recession, Kenny said: “I respectfully disagree. Because real reform only ever happens at a time of crisis.”
He said that the model of universal health insurance being proposed was “based on an examination of UHI systems in a number of other countries”. However, the White Paper included no projected costings. Originally universal health insurance had been promised for 2016 but when launching the white paper Kenny and the then minister, James Reilly, pushed the intended implementation date out to 2019. When Leo Varadkar became Minister for Health less than three months later he quickly announced that even that 2019 deadline was too ambitious.
Cannot be afforded
This week it was pushed off into the never never. For months Varadkar has had access to a study from the Economic and Social Research Institute showing that universal health insurance was not implementable in
Ireland
. The report set out that it could cost up to €2 billion more than we currently pay for our health service. When the finalised ESRI report was published this week Varadkar was forced to acknowledge that universal health insurance as proposed could not be afforded “now or any time into the future”.
The universal health insurance proposal was a rare instance of dramatic policy making by a party in opposition. The problem with it was that while it sounded like grand scale health reform it was never properly costed until now.
It is worth remembering this sorry saga in the next few months, when all the parties will come at us with pre-election grand schemes and multi-point plans across a range of policy areas.