Are the Irish people happy with way things are in this country?

Interesting OP. I've increasingly noticed that non-Irish people tend to go back to their home country for healthcare if they have a serious problem.

It seems the default for Americans and most Europeans, recently I spoke with a Chinese man who went home for his cancer treatments while continuing to live in Ireland.

When people with the option vote with their feet to get treated elsewhere it's evidence that our health system is relatively poor.

What happens usually isn't "corruption" it's at worst clientelism or constituency service. No money changed hands, she didn't buy influence. She used her elected representative to represent her.

Anyone can call their local TD and ask them to figure something out for them. That's part of what they do as public reps. They're not acting as gate keepers, they're just capable of making a formal representation on behalf of a constituent. Usually they don't even have any special access. It's just a case of raising an issue.

TD can and will advocate on behalf of their constituents - that's a big part of Irish (and other) democracies and isn't in anyway corruption.

If she was on a waiting list for that long, she's also entitled to use the NTPF (National Treatment Purchase Fund) to accass a private hospital or EU cross border treatment options.

The local TD's office lifted phone, called the hospital, asked what the hell is going on. He or she most certainly isn't deciding who gets treatment.

That isn't corruption.

Irish people will also tend to contact their representatives very quickly if they're having any issue with the public services. They often can help find information, ensure rights are upheld and so on.

It's nothing whatsoever to do with buying influence, nepotism or corruption.

Aspects of the health system work well, other aspects are ridiculous. The A&E mess it totally unacceptable and isn't being resolved.

Waiting lists?

You know 40% or thereabouts don’t turn up for appointments?

That’s what’s stoppInt the real people in need from accessing the help they need.

Ignorant self important people who couldn’t be bothered to ring and cancel appointments.

I know of one old lady who used to call the local TD to come around and change her light bulbs and fix the sink - and what's worse he did it!

LeinsterDub wrote: »

Our health is fundamentally broken. It's the worst of all worlds. Some what public some what private. We are spending massively on it too. If we went with the NHS model it would be unlikely to be more expensive.

https://www.google.ie/amp/s/www.rte.ie/amp/923592/

Isn’t the NHS in just as much turmoil?

EdgeCase wrote: »

What happens usually isn't "corruption" it's at worst clientelism or constituency service. No money changed hands, she didn't buy influence. She used her elected representative to represent her.
..

I disagree. Money need not change hands by way of a sack with 'swag' written on it. Positions and favours for friends and family go a long way. Favouring one person or company, over another because it benefits you personally, in some way, is corruption. Be it state or council contracts or planning permission etc.
You are describing people asking politicians to represent them, that's what they are supposed to be doing.

Matt Barrett wrote: »

I disagree. Money need not change hands by way of a sack with 'swag' written on it. Positions and favours for friends and family go a long way. Favouring one person or company, over another because it benefits you personally, in some way, is corruption. Be it state or council contracts or planning permission etc.
You are describing people asking politicians to represent them, that's what they are supposed to be doing.

Petitions in favour of family and friends aren't on, but there are actually arguments about constituency service here going too far too i.e. clientelism.

We've two issues:

1. TDs can set themselves up as the local 'fixer' and that can create issues where they create an impression that they're getting people things that they are already entitled to. I've seen plenty of things where people were thankful to TDs who put a phone call in that they / anyone could have put in to find out some information or because they helped them fill in a form.

2. TDs can become so locally focused that major issues of national policy become totally distorted. We see that a lot here with health. Try reforming the local hospital system for example and centralising acute services into specialist centres and you'll have small towns going crazy demanding that they have services that are extremely difficult and even dangerous to support on a small scale.

I've always thought that Ireland could do with a version of a "mixed member" system where you'd a % of TDs elected from bigger constituencies that take in whole regions as well as the local ones.
This is what they do in Germany to counterbalance the tendency for everything to focus on local. You need a balance between everything being local and a need for some kind of serious national debate on issues.

Ireland's PR-STV voting system is also starting to come into its own in the last few decades. For the early decades of the state, it weirdly managed to have a two-party system in a structure that should have really eliminated that. Now, at least you're seeing a situation developing where the government is far more about consensus building in the Dail. A lot of legislation is being started in cross-party committees and there's much more of a need to bring everyone on board to do things than there was in the past.

That's definitely not doing us any harm as I think the days of FF / FG politics ruling the roost are long gone and you're actually now getting something that's genuinely proportional, which is really always how the system was supposed to work.

It's largely down to an incompetent system that's been allowed to just spiral out of control for quite a long time. It is absolutely not a badly funded system, but it just creates endless bottlenecks and problems that shouldn't happen in the first place.

One of the things that has always shocked me about the Irish hospital system for example is that there's nobody really coordinating your care. If you've a complex problem, you're often bounced from consultant to consultant as if they're not colleagues at all. There's no single point of contact and your GP's often not really in the loop either.

I know I've relatives in the public system getting extremely good care for cancer, and access to drugs that would be unavailable elsewhere (seriously expensive stuff) but, they're often just left kind of to fend for themselves and nearly manage their own case.

You'd think there'd be some kind of individual assigned to manage your care i.e. a "Super GP" type role in a hospital, but there isn't. So you're left battling with administrators and bureaucracies and trying to endlessly chase things up.

Another example is a relative of mine who has bilateral cataracts (i.e. two eyes) and they put each eye on a different waiting list !?!?!
I mean how does that even make sense? The outcome will be worse due to the gap between the two operations and all the pre-op assessments now need to be done twice. It both causes the patient a load of inconvenience and costs the HSE more.

We also had the experience of my grandmother being called in for appointments, and waiting around for hours and hours (as an immune-compromised cancer patient with a very bad leg and back) and then you'd discover that they either just wanted to meet her her for a chat, or on two occasions had lost her file and had no idea why they'd called her in in the first place. It was a BIG deal to drag her into hospital for the day and exposed her to all sorts of risks of infection and so on. These things could have been handled by a GP, a community nurse or over the phone. Yet, they just kept dragging her in again and again.

I don't think we actually have healthcare "system". We have hospitals, doctors and nurses and nobody really coordinating anything properly.

I just always get the impression it's a bunch of usually well intentioned people running around in circles and management isn't management, but rather it's unthinking administration and bureaucracy.

I would agree with the OP, the system is a spectacular disaster and an absolute joke. It's largely down to complete and utter incompetence of the system rather than corruption and it does need to be declared a national emergency and put beyond politics.

I would advocate that there's a national crisis healthcare committee set up in the Dail on a cross party basis and that it be given powers to drive reform, investigate, hold organisations to account and so on until the mess is cleaned up.

EdgeCase wrote: »

Petitions in favour of family and friends aren't on, but there are actually arguments about constituency service here going too far too i.e. clientelism.

We've two issues:

1. TDs can set themselves up as the local 'fixer' and that can create issues where they create an impression that they're getting people things that they are already entitled to. I've seen plenty of things where people were thankful to TDs who put a phone call in that they / anyone could have put in to find out some information or because they helped them fill in a form.

2. TDs can become so locally focused that major issues of national policy become totally distorted. We see that a lot here with health. Try reforming the local hospital system for example and centralising acute services into specialist centres and you'll have small towns going crazy demanding that they have services that are extremely difficult and even dangerous to support on a small scale.

I've always thought that Ireland could do with a version of a "mixed member" system where you'd a % of TDs elected from bigger constituencies that take in whole regions as well as the local ones.
This is what they do in Germany to counterbalance the tendency for everything to focus on local. You need a balance between everything being local and a need for some kind of serious national debate on issues.

Ireland's PR-STV voting system is also starting to come into its own in the last few decades. For the early decades of the state, it weirdly managed to have a two-party system in a structure that should have really eliminated that. Now, at least you're seeing a situation developing where the government is far more about consensus building in the Dail. A lot of legislation is being started in cross-party committees and there's much more of a need to bring everyone on board to do things than there was in the past.

That's definitely not doing us any harm as I think the days of FF / FG politics ruling the roost are long gone and you're actually now getting something that's genuinely proportional, which is really always how the system was supposed to work.

Have you told them? the fact they are in cahoots, is political protectionism and nothing to do with governance.

It was put forward we don't really have corruption because money is seldom seen to change hands. I was saying hard cash need not change hands for it to be corruption. Board appointments, contracts etc. etc.

Putting in a call to inquire on delays or issues to the correct authority, is part of their job. It's when they benefit personally, that it crosses the line.

Sceptic Orwellian wrote: »

One of the most important systems in any nation is its public healthcare system, without it and when it comes to things like managing chronic conditions, people who can contribute to the economy but don't have the means to access other forms of care, be it private or overseas, will end up simply not working and quite possibly disabled because of the potential complications. So not only will the individual suffer, but the State will lose out as well.

The reform must come sooner rather than later.

Yeah, it undoubtedly does have profound impacts and if the A&E and other continuous crises aren't dealt with, it will impact foreign direct investment as it's a significant infrastructural snag.

I would wonder about how this feeds into areas like people being on long-term disability benefit due to perhaps inadequate access to services like mental health, which is generally abysmal in the public system. For example, if you were on a low paid job and dependent on the HSE, and got cataracts, in the current system you could end up losing your sight entirely in the waiting list and probably end up registered as legally blind, which is ludicrous and extremely expensive if someone's still of working age.

They would eventually get to you, but that could end your career.

I know, for me anyway, healthcare is probably my biggest concern when it comes to any election. The problem is that I don't really see any great alternatives being proposed. FG had notions of a single tier public health system being rolled out and seem to have done absolutely nothing to achieve that and FF presided over a complete fiasco of a system for years. So, it doesn't leave me with all that many good options.

I also think that there's an attitudinal problem in Ireland when it comes to healthcare because it's two tier.

The two-tier system effectively morphed out of the old 19th century poor law hospital system where public health was seen as a charitable thing, not a public service. Those same charities (mostly, but not exclusively religious) formed the basis of what is now our public health system while those who could pay for insurance, are in a quasi-separate system.

That apartheid also has resulted in a situation where the most influential people don't really see how bad the public system is, as most will only have fleeting experiences of it. There are some exceptions, like maternity services which are increasingly totally public, but there are a lot of issues with how things are structured.

If the NHS screws up, everyone's impacted - from the cleaning lady to the solicitor who uses their services. In Ireland, the cleaning lady gets in line and the solicitor disappears of to some private hospital and thinks everything's lovely. That means that political pressure doesn't come on in the way it might otherwise do.

Also, the % of people with private insurance in Ireland is quite high, 46% are covered by private insurance of some sort. So, almost half the population don't interact with the public system very much at all and I think there's still a mentality that public healthcare is a 'charity' rather than a paid-for public service funded by social insurance contributions.

Well, Sinn Fein has certain other legacy issues that put me off quite a bit and Labour managed to somehow destroy themselves during the last government, despite having pushed through some quite progressive policies that FG took credit for - especially things like marriage equality, which was something FG were never very progressive on until they noticed that public opinion was in favour of it.

Labour really needs to get its act together and make itself an decent alternative again. They really allowed themselves to become the 'mud flap' for the last government.

Well, the main proposal for a single-tier Irish healthcare system has been a universal cover using mandatory insurance model that would be funded using public and private payment to cover the bills.

Quite a few European public systems work on the basis of universal insurance, rather than the NHS model of direct state provision, and it might work, but I would just hope it didn't turn into a worst of both worlds.

All I know is the current system really can't go on.

Sceptic Orwellian wrote: »

One thing that I do not quite understand, is Vhi state-owned or privatized?

It's a state owned company, much like the ESB or Irish Rail.
However, they opened the market to bring in other players. So, it behaves like a commercial company, even though it's state owned.

VHI could have provided the basis for a single tier healthcare system using a continental style state owned type insurance model, much like some of the French systems.

It's been around since 1957.

There's a concept of 'community rating' in the Irish health insurance system and also a number of balancing systems that require insurers to cross subsidise each other depending on their risk loading e.g. VHI might have more older / sicker customers and some of the new entrants have relatively low risk portfolios so there are balancing structures there to even that loading out.

Franz Von Peppercorn wrote: »

We have one of the highest marginal rates of taxation in the world. And it comes in at the lowest level.

Blaming the tax payer is victim blaming.

Also, if people could trust the public system, they wouldn't need all of this private insurance. Effectively we're being taxed twice for health. Paying rather a lot for a service than most of us end up paying for separately anyway.

Well, as it stands a lot of the public hospitals are effectively private trust anyway, other than direct-owned HSE hospitals, many of the acute 'public hospitals' are actually owned by religious organisations or charities. They're just publicly funded.

What worries me a bit though is that there's an assumption that the market would remove the overspends and the bureaucracy, as the money would follow the patient and the patients would shop around, thus shaking out the inefficient providers.

The opposite could also end up being the case, and costs could be driven up.

EdgeCase wrote: »

Also, if people could trust the public system, they wouldn't need all of this private insurance. Effectively we're being taxed twice for health. Paying rather a lot for a service than most of us end up paying for separately anyway.

Yes. I pay higher marginal and as much tax in total percentage as I did in the U.K. I fund my own health care. Trust me I’d like the NHS system. If it could work here.