John Collison on why Ireland can't do infrastructure

I suspect it was put together quickly, and then went viral, and with that, she no longer had full control over it. In fairness, though, she owes nobody any obligation to correct anything. It's an opinion piece, and as a way of starting a debate it has done its job. I happen to disagree with the angle she’s taking, but I definitely agree with her that there’s a fundamental problem with how this country delivers infrastructure, and it is being masked by a “we’re rich” narrative based mainly on windfall income from corporation tax - much like our fundamental problems were masked by windfall income from residential stamp duty back in the late 2000s. It's like we just don't learn. I have my own opinions on the reasons for this, but they’re off topic.

My only complaint was that I’d like to have been told the how the vertical axis of that graph was calculated.

The Premature State: Why Ireland Can’t Build Itself

David McWilliams interviews Sinead O’Sullivan here about her recent SubStack. He also mentions about the ‘nitpickers’ who try to detract from her argument by nitpicking over data points etc. He claims those nitpickers are employed here in government, tax-funded roles and to agree with her points would undermine their very comfortable positions.

So, in the interests of transparency, @KrisW1001 you were nitpicking over her data points. Are you paid by the state in a role that would be undermined if her argument was correct?

I was not "nitpicking". I was asking the most basic question anyone should ask whenever they see a graph or other "numbers" being used to advance an argument: "where are these numbers from, and how have they been calculated?" Unsourced data is indistinguishable from lies, and anyone can insert a chart into an article.

I won't accept bogus data in support of any argument, even one I might believe in: facts are not optional. I'd advise you to take the same line, and question even those whose opinions you share. A strong argument will survive it.

Regarding my personal life, I debated just telling you to go f off for yourself , but that might have left you thinking you'd been "right". No, sadly for the conspiracy narrative, I work in private industry, in a field unconnected with civil infrastructure or any Government-funded activities. My interest here is as a citizen. When I did work in an infrastructure-related field, years ago, none of it was in this country.

So now, tell us all where your living comes from…

@Podge_irl The GPs figure is wrong, but not significantly wrong. There are 5200 GPs in Ireland, based on figures from the Irish College of GPs (their membership of 4400 is 85% of all practicing GPs). Against that, we have a population of around 5.58 million, so it’s about 0.9 GPs per thousand persons.

It wasn’t always this way, which is why I suspect you reacted the way you did to the figures.. I was the same, which is why I dug into it. The low number today is due to two factors: first is rapid population growth, and the second is the erosion of pay and conditions for GPs. It’s great that you don’t have to pay for kids to go to the doctor anymore, but it’s not so great that the GPs get a pittance for it: Children are paid at a flat-rate per year that (if I remember right) is about double the rate for the 18-60 cohort on the medical card scheme. Now anyone with a kid can tell you that a child needs to the doctor far more often than an adult, and far more than twice as often. When you add the induced demand factor of making kids’ GP visits free, GPs have had a massive drop in both available capacity and in income. General Practice is a self-employment in Ireland, so a good income is essential for the survival of a practice, but these cuts have forced many young GPs to leave, or just not set up practice here at all after graduation. It took my own doctor nearly a year to find a junior GP to work with them, and that’s in a well-resourced, progressive urban practice.

Just to be clear, I’m not defending the idea that everyone should have to pay €70 (€56 after tax rebate) to go to the doctor with a sick child, but this was a change that dramatically increased demand while also dramatically cutting remuneration. For a better idea of how to do it, I once had to visit the doctor in the Czech Republic, and there the system works on a nominal fee basis (equivalent to around a fiver here) per visit, a fee that the doctor can waive for patients that they know can’t pay. The fee doesn’t make much difference to the practice revenue, but it does deter the people who will march their kid to the surgery every time they sneeze or scrape their knee - my GP reckons that if they could get just ten patients on their GMS list to cop on a bit, they’d have at least an extra two appointment slots a week for other patients.

I think there’s a miscount between countries, and that some figures could be counting all generalist medical doctors, which would include non-consultant hospital doctors, Emergency Department Doctors and suchlike, but for Ireland the narrower definition of a generalist who runs public surgeries (“a GP”) was used.

Eurostat appears to be using the broader definition, and it results in this chart:

(From this 2025 publication - Medical workforce in the EU: an ageing profession - News articles - Eurostat )

That’s not to say we don’t have a dysfunctional health service. We definitely do. It’s something of a surprise to learn that we have the same number of medical staff give or take as countries with far better service provision. For me, the private/public split in specialist care is messing with wait times and quality of service. It’s not right either to say it’s the private model that messes things up, given that all GP primary care is private in Ireland, with the State directly reimbursing doctors for handling medical card patients, and we have historically had a very good GP system (as good as countries where it’s all public). Hospital care is neither fish nor fowl here, and that’s why it’s so badly broken: there are two parallel accounting and auditing processes within hospitals - one for the government, one for the insurers, and it’s a total waste of effort.