The IMO in favour of universal health coverage

Pride Fighter

donegalfella wrote: »

This post has been deleted.

In time this era will be known as the era of Obama, Brown and Aubrey. Providing the latter two can get elected.

It is of comfort that sane moderates are fighting back against neo-liberalism and people want their interests served, the common good. Not the needs of big business.

Amhran Nua

opinion guy wrote: »

Which would be ?

Privatisation.

tallaght01 wrote: »

I don't care if you take my word for it.

Suit yourself, although clearly you care enough to start arguing about it on the internet, make the claim and back it up. At the end of the day, total public health expenditure has risen from €3.6 billion in 1997 to over €12.3 billion in 2006, an increase of more than 236%, if you exclude the billion euro insurance market. Inflation over that period might optimistically be said to have been in the 30%-40% region. I appreciate that a lot of improvements have been made, but I also feel that a great many inefficiencies have crept into the system and become congenital.

Would anyone like to argue against that?

Attempting to resolve these inefficiencies (such as introducing a Singapore-style patient electronic health record system, and then reaping the benefits of it) within the public sphere is an exercise in futility and industrial action, which further endangers the lives of patients.

Therefore the best way to deal with them in a short timeframe is, in fact, privatisation, which might not suit everyone's tastes, but it appears the Dutch have the best handle on it so far - all objections (thus far unsupported) to their method have been general and broad. One final advantage is that the billions acquired from the sale of these facilities can be pumped directly back into them to improve the equipment and assets available by an impressive amount, so not a quick smash and grab like FG, but use the proceeds of the sale to get the latest and greatest for the hospitals, which will make them even more appealing to buyers.

Permabear

This post has been deleted.

opinion guy

Amhran Nua wrote: »

Privatisation.


Suit yourself, although clearly you care enough to start arguing about it on the internet, make the claim and back it up. At the end of the day, total public health expenditure has risen from €3.6 billion in 1997 to over €12.3 billion in 2006, an increase of more than 236%, if you exclude the billion euro insurance market. Inflation over that period might optimistically be said to have been in the 30%-40% region. I appreciate that a lot of improvements have been made, but I also feel that a great many inefficiencies have crept into the system and become congenital.

Would anyone like to argue against that?

Yes. Inefficiencies havn'et crept in - they were always there. They are routed in the management structures of the hosptials. Thats waht needs changing. you don't need privatisation to do that.

Attempting to resolve these inefficiencies (such as introducing a Singapore-style patient electronic health record system, and then reaping the benefits of it) within the public sphere is an exercise in futility and industrial action, which further endangers the lives of patients.

I don't know what this singapore business is about - I'm guessing a national health record or someitnhg ? Many problems with this. For one thing -its illegal here. It would breach data protection laws. For another - the hospitals here, thru years of infrastructure underfunding, have appalling IT systems. Most records are still kept on charts. MAny x-ray depts are still film based. (Incidentally, computerising x-rays alone woudl VASTLY improve the efficienes of the public hospitls )

Therefore the best way to deal with them in a short timeframe is, in fact, privatisation, which might not suit everyone's tastes, but it appears the Dutch have the best handle on it so far - all objections (thus far unsupported) to their method have been general and broad.

NO it isn't. Tallaght01 has provided you with compeling arugments againt that and you haven't even heard a word he has said. Honeslty uou're complete lack of ability to listen to an expert just makes you come across as arrogant and someone who won't listen. I for one, won't be voting for you.

One final advantage is that the billions acquired from the sale of these facilities can be pumped directly back into them to improve the equipment and assets available by an impressive amount, so not a quick smash and grab like FG, but use the proceeds of the sale to get the latest and greatest for the hospitals, which will make them even more appealing to buyers.

You've said this a few times. What billions from selling what ?

tallaght01

opinion guy wrote: »

NO it isn't. Tallaght01 has provided you with compeling arugments againt that and you haven't even heard a word he has said. Honeslty uou're complete lack of ability to listen to an expert just makes you come across as arrogant and someone who won't listen. I for one, won't be voting for you.

While I wouldn't regard myself as an expert at all, I do have significant experience, as my specialty is public health (as well as a bit of paediatrics), and I'm also involved in public health research, and I'm just finishing a masters in public health. But I realise this is a highly complex issue, and posting links about increasing expenditure, while not following the money, has made me bow out of this argument, and retire to P.ie.

The increased expenditure argument is an interesting one, and lots of countries have had the same problems. But it really doesn't relate to inefficiency, except in a small way.

But that discussion is not for here :P

Amhran Nua

opinion guy wrote: »

Yes. Inefficiencies havn'et crept in - they were always there. They are routed in the management structures of the hosptials. Thats waht needs changing. you don't need privatisation to do that.

Remind us again, what was the last nurses strike over? As for inefficiency:

The HSE is frequently portrayed by the Irish media as an inefficient, top-heavy, bloated and excessively bureaucratic organisation defined by cronyism, budget overruns and an excessively "manager-oriented" culture where middle management and consultants' demands are prioritised over adequate service provision.[4][5] Additionally, the organisation has been involved in a number of serious health scandals, relating to cancer misdiagnoses.[6] [7] The HSE has also been the subject of criticism for cutbacks, service cancellations and overall stinginess.

The organisation was the subject of an Irish high court ruling in September 2008 stating it was in breach of contract over a reduction in payments made to pharmacists for dispensing drugs under various State schemes. If repayments are mandated, the HSE faces a bill of over €50 million.[8]

In late September 2008, the HSE was also criticised for not anticipating costs and deteriorating economic circumstances, which it claims as the cause of the cancellation of a Flu vaccination scheme for people aged over 50, with the Irish Medical organisation accusing the HSE of "incompetence and acting irresponsibly".[9]

In March 2010 it emerged that 58,000 X-Ray radiographs had not been reviewed by a consultant radiologist. [10]

In the same month, the Irish Medical Organisation stated that patients awaiting a HSE medical card were waiting up to six months to receive their card, and that their health was being put at risk as they could not afford medicines that they would have otherwise obtained had they received their card. [11]

Still, I guess some people would argue that black was white if it suited their interests.

opinion guy wrote: »

I don't know what this singapore business is about

And yet you still feel able to comment on it?

opinion guy wrote: »

I'm guessing a national health record or someitnhg ? Many problems with this. For one thing -its illegal here. It would breach data protection laws. For another - the hospitals here, thru years of infrastructure underfunding, have appalling IT systems.

It would not be illegal, just the computerisation of existing systems and the centralisation of patient records. Cuts admin down to nothing. As for underfunded IT depts, that has already been dealt with in the proposal.

opinion guy wrote: »

NO it isn't. Tallaght01 has provided you with compeling arugments againt that and you haven't even heard a word he has said. Honeslty uou're complete lack of ability to listen to an expert just makes you come across as arrogant and someone who won't listen. I for one, won't be voting for you.

Yeah, I think that the support-free level of discussion you tend to indulge in, complete with giant bold red underlined text, isn't going to be turning anyone off to be honest. One might even be forgiven for calling it arrogant and condescending. I wouldn't of course.

opinion guy wrote: »

You've said this a few times. What billions from selling what ?

What exactly do you think privatisation entails? Its the selling of public infrastructure/services to private interests. In exchange for which you receive money. Given the annual budget of the health services in Ireland, a sum of well in excess of €10 billion would not be unrealistic, which then gets put straight back into the facilities which have just been privatised. Its a remarkable deal, like buying a house for 300k, and then the previous owner turns around and puts that 300k into fitting the house out with the latest mod cons for you. Which should only push the price up even higher, since every cent spent gets directly reinvested.

Jane5

AN, the last nurses strike was about wanting to work less hours-as they were already rostered on for nights, weekends, and public holidays regularly, and those sorts of working conditions should necessarily have rewards of some sort attached to them, not to mention the deleterious effect of exhaustion on patient care.

I think, to be honest, that your arguments and obvious lack of knowledge regarding an awful lot of what you're talking about make a very valid point in themselves-that perhaps politicians should not be in charge of the funding and administration of specialised areas such as healthcare ad education, when they clearly do not understand many of the issues involved, and are so unaware of this lack of understanding that they do not even admit to it or see it as a hindrance in the carrying out of their duties.

I personally always thought that one of the old school CNMs would have been an excellent choice for Minister for Health. You know, straight off the wards, one of the ones that the SHOs both trust and fear in equal measures? They are, sadly, a dying breed.

Amhran Nua

Jane5 wrote: »

I think, to be honest, that your arguments and obvious lack of knowledge regarding an awful lot of what you're talking about make a very valid point in themselves

Since you demonstrably didn't even read the arguments that were being put forward in the thread, I'll take that under advisement.

Jane5

In fact-we have a big problem in Ireland in that respect. None of the Ministers for various departments have any real experience in the areas they are dealing with.

The Minister for Health should not be a lawyer who never even practiced.

The Minister for Finance should not be just a lawyer.

The health portfolio should not be trusted to anyone who is not a senior nurse or doctor who has significant experience on the frontlines and who is able to demonstrate to a satisfactory degree an awareness of the issues and an understanding of the workings of the system.

The Min for Fin should be ideally an economist, with a qualification in sociology or social policy.

The Minister for Education should be either a teacher with many years experience, or a principal with same.

Cabinet reshuffles should not be this picking a job out of a hat nonsense that they currently are. People should be recruited to these very responsible positions based on their qualifications and experience, and minimum criteria should be set out for each Ministerial position.

The status quo is not working, and is damaging the country beyond any hope of repair.

tallaght01

Amhran Nua wrote: »

Since you demonstrably didn't even read the arguments that were being put forward in the thread, I'll take that under advisement.

See Jane, you didn't agree with him, therefore you mustn't have read the arguments LOL


I'll defo be voting for Amhran Nua when I get back to Ireland. Spread the word amongst your colleagues. This is what will save our health service :pac:

Jane5

AN, because I didn't trawl through each tedious point and respond does not mean I didn't read it.

The Tallaght debacle, well, interesting you should comment on that!

That hospital, with its workload, required a minimum of 18 fulltime consultant radiologists to function safely. It had SIX. The consultants wrote to the DoH in detail about this problem, many many times over the years, I have seen this in the newspapers.

Not ONE new consultant was appointed. They were not listened to. And then Harney has the audacity to say that she was being blamed for "medical mishaps"
??????????????????????????????????????????????????????????????

Understaffing as a result of underfunding which is under DIRECT control of the DoH and Dept of Finance is NOT a medical mishap. It is a Government mishap.

Good example though, AN. Keep 'em coming.

Amhran Nua

tallaght01 wrote: »

See Jane, you didn't agree with him, therefore you mustn't have read the arguments LOL

It was a reference to this comment.

tallaght01 wrote: »

I'll defo be voting for Amhran Nua when I get back to Ireland. Spread the word amongst your colleagues. This is what will save our health service :pac:

Yes, and you're going to take your show on the road to p.ie as well, which will teach boards for giving you an infraction for personal abuse. Veiled threats only set people against you, when they otherwise might have been willing to find common ground.

K-9

Jane5 wrote: »

In fact-we have a big problem in Ireland in that respect. None of the Ministers for various departments have any real experience in the areas they are dealing with.

The Minister for Health should not be a lawyer who never even practiced.

The Minister for Finance should not be just a lawyer.

The health portfolio should not be trusted to anyone who is not a senior nurse or doctor who has significant experience on the frontlines and who is able to demonstrate to a satisfactory degree an awareness of the issues and an understanding of the workings of the system.

The Min for Fin should be ideally an economist, with a qualification in sociology or social policy.

The Minister for Education should be either a teacher with many years experience, or a principal with same.

Cabinet reshuffles should not be this picking a job out of a hat nonsense that they currently are. People should be recruited to these very responsible positions based on their qualifications and experience, and minimum criteria should be set out for each Ministerial position.

The status quo is not working, and is damaging the country beyond any hope of repair.

Probably some truth in that point but an Economist in Finance would be a nightmare! The best one we ever had, McSharry, didn't have a Leaving Cert.

Jane5

Why do you think, AN, that privatisation under government control will be any better than public service under government control?

They are not capable of managing ANY complex system. Whether it is public or private. Their capabilities and understanding of relevant issues has to be called into question. A radical overhaul of the way we elect politicians and appoint people into positions of responsibility and power has to occur.

Jane5

K-9 wrote: »

Probably some truth in that point but an Economist in Finance would be a nightmare! The best one we ever had, McSharry, didn't have a Leaving Cert.

Heh

This is why there should be minimum criteria set out for all Ministerial appointments, just like there are for regular jobs that entail responsibility. It costs a mammoth amount of taxpayer money to employ these guys and pay their large pensions to them while they are still holding office???????? so we should make sure we get value for our money. No less is expected of other workers.

Amhran Nua

Jane5 wrote: »

In fact-we have a big problem in Ireland in that respect. None of the Ministers for various departments have any real experience in the areas they are dealing with.

We actually floated that very idea among the people in AN, didn't go down too well for various reasons. You can find the discussion on the forum.

Jane5 wrote: »

AN, because I didn't trawl through each tedious point and respond does not mean I didn't read it.

You didn't even read the ones you did respond to.

Jane5 wrote: »

The Tallaght debacle, well, interesting you should comment on that!

You can find further details in the linked article. We are also talking about reforming the government as well, so no worries on that front.

tallaght01

Amhran Nua wrote: »

It was a reference to this comment.


Yes, and you're going to take your show on the road to p.ie as well, which will teach boards for giving you an infraction for personal abuse. Veiled threats only set people against you, when they otherwise might have been willing to find common ground.

I don't give a mickey about someone waving coloured cards at me on the internet, and I don't veil threats. If I was going to give you a kick up the hole I'd just tell you Though I don't remember ever having a funny coloured card waved at me for threatening anyone, but i could be wrong.

Look, I think your party was borne out of frustration. But you've had 3 experienced practicing medics on here, all committed to the public service exclusively, trying to tell you why your policies won't work. A new party should be looking to embrace these views. Defending the indefensible is the same old.

If you really want to have a hardcore, evidence-based discussion on health systems, the come over to p.ie and start a thread, and I'll defo engage with you, as long as you've done a lot of reading (health service journal etc and other peer reviewed publications, and WHO reports, as well as your political think-tank stuff).

I love that subject and am always happy to discuss. Just not here.

Jane5

AN, I read them. I don't happen to agree with you, and am talking about slightly different aspects of what you are, but I assure you, they were read.

Well, if your political party is talking about reforming the Government, then good on you. What are your ideas around that, proposals, etc?

Amhran Nua

tallaght01 wrote: »

Look, I think your party was borne out of frustration. But you've had 3 experienced practicing medics on here, all committed to the public service exclusively, trying to tell you why your policies won't work. A new party should be looking to embrace these views. Defending the indefensible is the same old.

And I've been attempting to get to the core of the objections, which amount to the concept that private healthcare doesn't provide the same level of care for marginal patients as it does for everyone else. I've yet to see any evidence of that within this thread. I've also raised an important point about institutional inertia and top heavy cruft in the health service, which privatisation is the most direct solution to - in addition, we have the multi billion euro direct investment benefits to Ireland's medical facilities and infrastructure, at zero cost to the taxpayer.

Its a hard argument to counter.

tallaght01 wrote: »

I love that subject and am always happy to discuss. Just not here.

I don't understand what's wrong with here.

Amhran Nua

Jane5 wrote: »

Well, if your political party is talking about reforming the Government, then good on you. What are your ideas around that, proposals, etc?

Here is an overview of what we're looking at doing:

The proposed amendment to the Irish electoral system
The amendment to the Irish electoral system would mean increased powers being devolved to local authorities and councils, directly elected mayors with executive powers, the consolidation of several local authorities to reduce administration overheads (paying close attention to the divide between rural and urban so that larger areas don't overwhelm smaller areas) without reducing services, and giving Mayors increased responsibilities to improve accountability.

There will also be an emphasis on more direct democracy at the regional level to allow people to vote for regional issues themselves without having to concern TDs.

Half of the members of the Dáil will be elected directly from their constituencies. Then the other half are elected from the list of the parties on the basis of each constituency. This means that each voter will have two votes in the elections to the Dáil. The first vote allows voters to elect their local representatives to the Dáil and decides which candidates are sent to Dáil from the constituencies. The second vote is cast for a party list and it is this second vote that will determine the relative strengths of the parties represented in the Dáil.

Seats will only be distributed among the parties that have gained more than 3% of the second votes. Each of these parties will be allocated seats in the Dáil in proportion to the number of votes it has received.

In addition to this, there will be certain circumstances in which some candidates win what are known as an overhang seat when the seats are being distributed. This is very similar to the German electoral system.

Lastly, the membership of the Seanad will be adjusted to give directly constituency-elected representatives an input into the national running of the country, with limited powers of legislation and amendment.

Further Policies

* The Seanad, Dail and the Councils count as separate offices.
* No person who has held one of the three can hold one of the other 2 within 5 years.
* There will be a three term limit for TDs.
* The practice in Councils where a seat becomes vacated and co-opting occurs and it goes to the next of kin or a Party Member will be replaced with a by-election.
* Where corruption has been proven, pension entitlements will be revoked.
* All party donations will be subject to full disclosure and auditing, and made relevant to activiy within each political party.
* Expenses and allowances will likewise be reviewed and subject to full auditing.
* The possibility of recall referendums will be investigated.
* Legislation will be implemented to mandate that no relation to a sitting or previous public representative can run for office or be appointed to committees on the basis of that relationship. Here is a list of the family related politicians in the Dáil, including all major party political leaders. For a job as important as the leadership of the country, we need the best people, not the best connected.
* The removal of special benefits to sections of society to pursue a career in politics.
* Tribunals will be given special investigative and criminal prosecution powers in order to combat corruption.

Basically making sure TDs focus on the national level, getting rid of the parish pump, removing the dynasties that have given us the likes of Cowen and Lenihan, giving local authorities more power, zero tolerance on corruption, and a lot of other ideas that are under discussion and haven't yet made it to policy level. We've already had a few of our ideas lifted by both FG and FF, albeit badly in the latter case.

Jane5

Hmmm.....
Sounds like a start.

And what would your position be on:

1) Sitting TDs/ministers receiving ministerial pensions after serving only a few years, being nowhere near retirement age, and still working at the job they are supposedly receiving a pension for.

2) Sitting TDs/ministers occupying permanent teaching/other posts within the public service while serving in the Dail for years, thereby keeping a teacher who would be available to teach from taking up those permanent positions.

opinion guy

Amhran Nua wrote: »

And yet you still feel able to comment on it?

You're demonstrating with every post serious deficiencies in understanding of the Irish Health care system in its current state, yet you apparently feel able to "fix" it.

It would not be illegal, just the computerisation of existing systems and the centralisation of patient records. Cuts admin down to nothing. As for underfunded IT depts, that has already been dealt with in the proposal.

See this is exactly what I'm talking about. You have this nice idea - but you lack the understanding of what the problems are in implementing it. Centralisation of medical records as the law stands would be in breech of the data protection act. THis is because each hosptial owns the information and file of each patient that attends their. This in turn means they are obliged to protect that information and not to sahre it with outside organisations.....including other hosptials. If you are a patient in one hospital and they want your records from your old hosptial, a doctor has to contact medical records in the old hosptial, have the patient sign a form, fax it over, and then wait for the info to be faxed back.

This is all a matter of law. To implement a national medical database, you would either have to have everyone sign a release form for every hosptial in the country (never going to happen), or change the data protection act (itself not so simple an act).
All of this is to say nothing of the massive IT funding required

What exactly do you think privatisation entails? Its the selling of public infrastructure/services to private interests. In exchange for which you receive money. Given the annual budget of the health services in Ireland, a sum of well in excess of €10 billion would not be unrealistic, which then gets put straight back into the facilities which have just been privatised. Its a remarkable deal, like buying a house for 300k, and then the previous owner turns around and puts that 300k into fitting the house out with the latest mod cons for you. Which should only push the price up even higher, since every cent spent gets directly reinvested.

Total fantasy. I seriously, SERIOUSLY doubt you'd find anyone to buy most of the countries hosptials (the newer ones maybe but no way not the older ones). Most of them are simply not fit for purpose. If I were a venture capitalist I'd put money in building a new hosptial here, I wouldn't touch any plan to buy an old one.

Amhran Nua wrote: »

And I've been attempting to get to the core of the objections, which amount to the concept that private healthcare doesn't provide the same level of care for marginal patients as it does for everyone else. I've yet to see any evidence of that within this thread.

No no. You have ignored the complexity of the service which you don't understsnd that peoepl are trying to point out to you.

I've also raised an important point about institutional inertia and top heavy cruft in the health service, which privatisation is the most direct solution to - in addition, we have the multi billion euro direct investment benefits to Ireland's medical facilities and infrastructure, at zero cost to the taxpayer.

Its a hard argument to counter.


I don't understand what's wrong with here.

The most direct solution is to fire a vast portion of the HSE managements structure. Replace them with a lower number of people who are actually qualified to run hospitals. Oh and lets not forget shooting Mary Harney from a cannon (better aim her towards Holland I guess :P)