Do we pay too much tax for crappy services?

Chips Lovell · 17-07-2019 2:51pm

Franz Von Peppercorn II wrote: »

It’s totally disengenuous to add employer contributions there.

It's all coming from the same source. You could levy the whole lot from employees and its still ultimately coming from the employer, i.e. the cost of their labour is still the same. And it's all going into the same pot.

McGiver · 17-07-2019 10:28pm

Podge_irl wrote:

I don't think Ireland's services are particularly crap either. They are certainly not top notch but for the most part I would consider them reasonably middling. It is worth looking at examples such as the metro and bus projects ongoing at the moment to see how much people will demand better services and yet reject all efforts to bring them in in the face of the slightest inconvenience though.

How many European countries did you live and have experience with?

Irish public services are extremely slim and generally low quality, public transport in particular but not only that.

kippy · 17-07-2019 10:29pm

markodaly wrote: »

How do you come to that assertion?

Population of Ireland <<<<<< Population of Germany

McGiver · 17-07-2019 10:36pm

Geuze wrote:

France and Germany.

I don't know the French system, can ask mates, but I know the German one.

Germany has a mandated state health insurance for starters, secondly it's a universal healthcare unlike the US one, thirdly 80% is public/government funded (again unlike the US), thirdly 90% people use public mandated insurance and only 10% private insurance. And it's not a free competition of private healthcare providers as you may have suggested, it's overwhelmingly government driven. I'd be OK with this system, if course. The only thing that is "free" about it is that one is free to go for private insurance if they so wish and generally the consumer can visit any doctor/facility they want.

McGiver · 17-07-2019 11:18pm

Deleted User wrote:

Our services are shockingly poor, for that tax take, however. Any increase in tax take is used to buy votes by increasing pay as opposed to investing long term. Public service workers should NEVER be paid the same as their private sector equivalents. They get pension, leave, security that the private sector will never get. Instead we have governments benchmarking and often paying more than the equivalent.

Agree. I think Ireland is the only odd country in the EU where public sector pays are higher than the private ones. Maybe Greece was in a similar situation... Before it bankrupted.

McGiver · 17-07-2019 11:20pm

Geuze wrote:

You can't really blame workers for focussing on the 50% MTR after 35k approx.

It's a red herring. It's irrelevant and incorrect. The effective taxation is one of the lowest in Europe.

Podge_irl · 18-07-2019 7:52am

McGiver wrote: »

How many European countries did you live and have experience with?

Irish public services are extremely slim and generally low quality, public transport in particular but not only that.

4.

I'm not sure what makes Irish public services "extremely slim" in comparison to our near neighbours - what fundamental public services are we missing?

Geuze · 18-07-2019 3:30pm

McGiver wrote: »

I don't know the French system, can ask mates, but I know the German one.

Germany has a mandated state health insurance for starters, secondly it's a universal healthcare unlike the US one, thirdly 80% is public/government funded (again unlike the US), thirdly 90% people use public mandated insurance and only 10% private insurance. And it's not a free competition of private healthcare providers as you may have suggested, it's overwhelmingly government driven. I'd be OK with this system, if course. The only thing that is "free" about it is that one is free to go for private insurance if they so wish and generally the consumer can visit any doctor/facility they want.

AFAIK, in Germany there are various healthcare providers, e.g.

public hosps
not for profit hosps
for profit hosps

but that they all accept your insurance.

There are 200+ insurers, known as sickness funds, but the premia are fixed by the State.

AFAIK, the GP and consultants are not employed by the State?

Geuze · 18-07-2019 3:31pm

McGiver wrote: »

It's a red herring. It's irrelevant and incorrect. The effective taxation is one of the lowest in Europe.

Well, while we all know and agree that effective income tax rates are nowhere near 50%, many earners do focus on the 50% MTR on extra income over 35k.

McGiver · 18-07-2019 9:41pm

Geuze wrote:

Well, while we all know and agree that effective income tax rates are nowhere near 50%, many earners do focus on the 50% MTR on extra income over 35k.

Total tax rate is what counts. And it's one of the lowest in the EU. It's simply low.
However, I agree there could probably be more bands, two bands with such a steep cut off seem harsh but that's the issue here - it's just the optics... Are optics really that important? I think they aren't.

McGiver · 23-07-2019 11:43am

Podge_irl wrote:

I'm not sure what makes Irish public services "extremely slim" in comparison to our near neighbours - what fundamental public services are we missing?

It's not about missing that much rather than quality, extent and coverage.

Public transport - totally behind most of the EU. In Dublin, the capital, that's just awful, 2 tram lines (very recent), no tube, dart saves it somewhat, but overall poor - ask any foreigner living in Dublin. Compare with other EU capitals of a similar size. Outside of Dublin, much worse. The same goes for cycling infrastructure - poor. And railways too.

Healthcare - everyone knows this, just terrible. Literally all my foreign mates do their medical stuff to continental Europe, apart from Romanians and to some extent Poles (that's understandable check their EHCI scores). Reason - local healthcare is expensive (the bang for the buck), unreliable to get a really good quality and can be slow even with a private insurance. Many cases of fake doctors. The whole idea of putting patients on trolleys in hospitals is inhumane and just doesn't happen in most of the healthcare systems in the EU (where Ireland should belong) - the scale of the issue here is totally shocking.

Education - 92% of primary schooling outsourced to the Church - unthinkable in many EU countries (where I'm from this was mostly abolished in 1773 when the Jesuits lost the monopoly for providing education). I'm OK with religious organisations running private schools and people being free to choose them if they wish so, but the bulk education should be provided by the state (LAs) and/or private non-religious organisations. Similar goes for secondary schooling - the state allowing the Church run the show instead of taking the responsibility.

Emergency services including Gardai - slow to turn up and act

Law enforcement - quite toothless overall (cops don't have firearms), traffic rules enforcement weak

Water supply - water unsafe in many areas, unthinkable in a developed European country

Broadband?

Then the amount LAs provide overall (libraries, support services etc) is very limited, largely due to limited budgets (were cut by 22% during the recession an never restored), but there are other factors too.

Etc.

Is that sufficient?

The key point is that you need the experience with living abroad to be able to assess this issue in depth. For person who has been living in Ireland for decades and has no comparison the situation isn't that bad and has been actually steadily improving, albeit from a very low base. It's when you look at international, EU comparison where the issues start to become apparent and you notice the deficit vs the EU peers.

voluntary · 23-07-2019 2:06pm

McGiver wrote: »

Total tax rate is what counts. And it's one of the lowest in the EU. It's simply low.

Total tax rate for an 'average joe'? This may mean something for the budget planning, but not for employees/residents who are charged top rates of income tax and will relocate at first occassion or will never even settle down here and many high profile jobs go somewhere else.

McGiver · 23-07-2019 5:50pm

voluntary wrote:

Total tax rate for an 'average joe'? This may mean something for the budget planning, but not for employees/residents who are charged top rates of income tax and will relocate at first occassion or will never even settle down here and many high profile jobs go somewhere else.

Give me an example please. I can give you a similar one from the Germany, France, Austria, Finland, Sweden. You'll be surprised how little tax you pay.

What I admit is quite high VAT but the impact of it isn't that high, it hits low income people more actually and then Capital Gains tax that's a joke. But income taxes and social contributions are low compared to the EU peers.

voluntary · 24-07-2019 11:53pm

McGiver wrote: »

Give me an example please. I can give you a similar one from the Germany, France, Austria, Finland, Sweden. You'll be surprised how little tax you pay.

What I admit is quite high VAT but the impact of it isn't that high, it hits low income people more actually and then Capital Gains tax that's a joke. But income taxes and social contributions are low compared to the EU peers.

Not sure how accurate is this, but according to this table, Ireland is the 9th dearest country in terms of income tax in Europe
https://tradingeconomics.com/country-list/personal-income-tax-rate?continent=europe

Also, many (if not all) executive level individuals in publicly traded companies get most of their compensation in stock, so what they would look for is Capital Gains tax and Dividend tax. Both very high in Ireland.

Social contribution (PRSI) may not be very high, but again, what do you get for it? A 200 euros per week pension (comparing to 80-100% of the last salary in many other places), the most expensive childcare in the whole Europe and a stay-away-from public healthcare system?

McGiver · 27-07-2019 9:17am

voluntary wrote:

Not sure how accurate is this, but according to this table, Ireland is the 9th dearest country in terms of income tax in Europe

It's not accurate at all. It's just income tax and and not the total tax burden. Also, not sure where they got 48% from that's neither effective nor marginal tax rate.

voluntary wrote:

Also, many (if not all) executive level individuals in publicly traded companies get most of their compensation in stock, so what they would look for is Capital Gains tax and Dividend tax. Both very high in Ireland.

Well, we're talking about population as the whole or average Joe to reflect most population, so special cases like these are irrelevant if you want to discuss tax policy.

And I agree CGT is too high, no disagreement on that at all.

voluntary wrote:

Social contribution (PRSI) may not be very high, but again, what do you get for it? A 200 euros per week pension (comparing to 80-100% of the last salary in many other places), the most expensive childcare in the whole Europe and a stay-away-from public healthcare system?

Again, no disagreement - that's the bang for the buck argument I used. It's poor even for the relatively less money. But the PRSI is low so.

Now, childcare is private with no state or LA provision, but it's changing somewhat with more subsidies and regulations etc. So hard to blame this on government - it's a private business, the only thing we can say is that the government failed to take responsibility and tightly control it. Compare with Germany where it is tightly regulated and either provided by the LAs or private but under LA control, highly regulated and subsidised - kindergarten in Berlin costs approx 300/month!

Sorry, but I have to repeat myself again to dispel the myth - total tax burden in Ireland for an average Joe (which covers most of the population) is one of the lowest in the EU.

Page 10:
https://www.institutmolinari.org/IMG/pdf/taz-burden-eu-2018.pd

Now, in the report above, they calculate total tax burden based on Real Gross Average income, which includes taxes paid by the employers, so I have made a table to illustrate the taxes paid by employee only. No difference, Ireland is one of the lowest in the EU.

Notice how relatively low taxes paid by employee are in Sweden, whereas total tax approaches 50%, the rest is paid by the employer. Also 60% of tax paid by the employee is municipal (LA) and county tax, only 40% goes to the central government, which is a brilliant system how to keep money on the local level for public services etc. Also LAs set their income tax rates independently so there is a slight variation, this is somewhat similar to Switzerland.

micosoft · 26-08-2019 8:00am

McGiver wrote: »

It's not about missing that much rather than quality, extent and coverage.

Go on then. Great thing is that nearly every facet of government services are ranked by independent agencies these days. Will be good to see what is wrong.

McGiver wrote: »

Public transport - totally behind most of the EU. In Dublin, the capital, that's just awful, 2 tram lines (very recent), no tube, dart saves it somewhat, but overall poor - ask any foreigner living in Dublin. Compare with other EU capitals of a similar size. Outside of Dublin, much worse. The same goes for cycling infrastructure - poor. And railways too.

Compared to what equivalent sized and density European City? Subways work in high density cities. We simply don't have the density to justify. As a cyclist Dublin is a great city now - and I remember the bad days for cyclists. Evidence is the numbers cycling these days. Can it be improved? Sure but it's a medieval layout city so will take time to alter.

McGiver wrote: »

Healthcare - everyone knows this, just terrible. Literally all my foreign mates do their medical stuff to continental Europe, apart from Romanians and to some extent Poles (that's understandable check their EHCI scores). Reason - local healthcare is expensive (the bang for the buck), unreliable to get a really good quality and can be slow even with a private insurance. Many cases of fake doctors. The whole idea of putting patients on trolleys in hospitals is inhumane and just doesn't happen in most of the healthcare systems in the EU (where Ireland should belong) - the scale of the issue here is totally shocking.

Everybody? Do they? We are number 19 of healthcare and outcomes. Ahead of Denmark. 15th highest life expectancy despite our relationship with alcohol. In pretty much every metric we are doing well. Saying that it's cheaper to do X in Hungary or Poland is hardly convincing. And health news does not travel - during peak periods trolleys are used in every other country in Europe.

McGiver wrote: »

Education - 92% of primary schooling outsourced to the Church - unthinkable in many EU countries (where I'm from this was mostly abolished in 1773 when the Jesuits lost the monopoly for providing education). I'm OK with religious organisations running private schools and people being free to choose them if they wish so, but the bulk education should be provided by the state (LAs) and/or private non-religious organisations. Similar goes for secondary schooling - the state allowing the Church run the show instead of taking the responsibility.

Apart from the historical artefact that most schools are owned by the religious (which is being address - this isn't the 17th century when the state can just take things) what is so terribly wrong? Other than that we have consistently been in the top ten countries globally for education.

McGiver wrote: »

Emergency services including Gardai - slow to turn up and act

Law enforcement - quite toothless overall (cops don't have firearms), traffic rules enforcement weak

12th safest country in the World? We don't want or need armed police. 4th safest country in Europe for road safety.

McGiver wrote: »

Water supply - water unsafe in many areas, unthinkable in a developed European country

We have easily one of the safest potable water systems in the world. https://www.water.ie/water-supply/supply-and-service-update/
There are supply issues because the Irish people declined to pay for it which will eventually be fixed in a few years.

McGiver wrote: »

Broadband?

A function of our population density.

McGiver wrote: »

Then the amount LAs provide overall (libraries, support services etc) is very limited, largely due to limited budgets (were cut by 22% during the recession an never restored), but there are other factors too.

Not sure if you have a specific example? I would agree there are challenges as we raise standard of social care in certain areas but not massively at variance of our peers.

Etc.

McGiver wrote: »

Is that sufficient?

Not really. Before suggesting people "live abroad" you might actually appraise yourself of the facts. You have not called out a single service where Ireland is so short of our peer group that you could argue the service is substandard. I've actually lived abroad (I suspect in a broader spread of countries) and your experience is alien to me. Perhaps relying more on statistics rather than anecdotes? The chicken licken school of political commentary rarely gets results.

McGiver wrote: »

The key point is that you need the experience with living abroad to be able to assess this issue in depth. For person who has been living in Ireland for decades and has no comparison the situation isn't that bad and has been actually steadily improving, albeit from a very low base. It's when you look at international, EU comparison where the issues start to become apparent and you notice the deficit vs the EU peers.

The level and quality of services in Ireland ranks comfortably with our peers of the most wealthy countries in the World. Other explanations such as population density, historical decisions and cultural reasons explain the +- in our ranking. Grossly exaggerating "how bad it is" is actually unhelpful in improving a particular service as your opinion can easily be dismissed as the usual suspects of "x is the worst in the world" when clearly it is not.

McGiver · 26-08-2019 8:29am

micosoft wrote: »

The level and quality of services in Ireland ranks comfortably with our peers of the most wealthy countries in the World.

Furst, I wasn't sure sure if it was a joke or not - do you really believe this? Do you have any evidence for this? I just don't agree with this on fundamental level, having lived in several countries, Ireland is the most "low cost" and "small state" in terms of public services of all of them. You're basically suggesting that the services in Ireland is in the same league as in Germany, Austria, Sweden, Norway, Switzerland etc these are the countries you are talking about, and this just is imply not true.

You must be just looking at Dublin ignoring the hinterlands. But as I said even Dublin is poor compared to similar EU cities, in few aspects. Public transport is one of them.

And you are totally wrong on healthcare and trollies. Trollies don't happen in most Europe. Just doesn't happen. There's no way you can justify this as normal - it's absolutely not.

The WHO ranking you have given has nothing to do with outcomes, it's using synthetic indicators which don't affect you as the consumer, and it's measuring "health system performance", totally irrelevant for the end user. Also the paper itself says that it's using new indicators to asses "health system performance" instead of traditional ones such as life expectancy etc. Clearly not suited for our discussion.

Look at EHCI rankings which is using indicators directly affecting you as the consumer - Patient Rights and Information, Access to Care, Treatment Outcomes, Range and Reach of Services, Prevention and use of Pharmaceuticals. As expected, Ireland does quite poorly in EHCI.
https://healthpowerhouse.com/publications/

micosoft · 26-08-2019 12:38pm

McGiver wrote: »

Furst, I wasn't sure sure if it was a joke or not - do you really believe this? Do you have any evidence for this? I just don't agree with this on fundamental level, having lived in several countries, Ireland is the most "low cost" and "small state" in terms of public services of all of them. You're basically suggesting that the services in Ireland is in the same league as in Germany, Austria, Sweden, Norway, Switzerland etc these are the countries you are talking about, and this just is imply not true.

You must be just looking at Dublin ignoring the hinterlands. But as I said even Dublin is poor compared to similar EU cities, in few aspects. Public transport is one of them.

And you are totally wrong on healthcare and trollies. Trollies don't happen in most Europe. Just doesn't happen. There's no way you can justify this as normal - it's absolutely not.

The WHO ranking you have given has nothing to do with outcomes, it's using synthetic indicators which don't affect you as the consumer, and it's measuring "health system performance", totally irrelevant for the end user. Also the paper itself says that it's using new indicators to asses "health system performance" instead of traditional ones such as life expectancy etc. Clearly not suited for our discussion.

Look at EHCI rankings which is using indicators directly affecting you as the consumer - Patient Rights and Information, Access to Care, Treatment Outcomes, Range and Reach of Services, Prevention and use of Pharmaceuticals. As expected, Ireland does quite poorly in EHCI.
https://healthpowerhouse.com/publications/

Unlike you I provided links for every assertion I made. In other words I'm not saying - I'm stating that the evidence suggests that Ireland is similar to other EU nations and typically in the upper half if not quartile for state services. If you are saying that our public transport is not up to London's standard and our skiing is not up to Austrias, well, that's not a reasonable comparison. You've only just put forward a single fact in your diatribe of Irish services (which is around A&E services). But here too news does not travel borders. The UK has trolley issues.

I understand that what matters to you is "belief" but as I indicated it would be better to look at services - rate them based on evidence, and suggest solutions based on that taking into account the unique circumstances of Ireland (Island with low density population).

You made an assertion - that Public services in Ireland are extremely slim and comments like "totally behind most of the EU" or "terrible". For the most part it's actually inline or better than our peers in the EU which are the richest countries in the world and the most invested in public services. Being consistently in the top twenty of the world is ok by me.

McGiver · 26-08-2019 4:11pm

micosoft wrote: »

Unlike you I provided links for every assertion I made. In other words I'm not saying - I'm stating that the evidence suggests that Ireland is similar to other EU nations and typically in the upper half if not quartile for state services. If you are saying that our public transport is not up to London's standard and our skiing is not up to Austrias, well, that's not a reasonable comparison. You've only just put forward a single fact in your diatribe of Irish services (which is around A&E services). But here too news does not travel borders. The UK has trolley issues.

I understand that what matters to you is "belief" but as I indicated it would be better to look at services - rate them based on evidence, and suggest solutions based on that taking into account the unique circumstances of Ireland (Island with low density population).

You made an assertion - that Public services in Ireland are extremely slim and comments like "totally behind most of the EU" or "terrible". For the most part it's actually inline or better than our peers in the EU which are the richest countries in the world and the most invested in public services. Being consistently in the top twenty of the world is ok by me.

OK. So do you have a response on EHCI? Because the report you provided is a purely academic exercise with no value in this discussion. EHCI is a fairly authoriative and widely accepted report, and most importantly clearly measures indicators important for us, the public, the consumers.

I sort of expected you would mention UK with regards to trolleys, but I naturally exclude UK as I'm coming from a continental perspective and I don't think UK should be the country to evaluate Ireland against (even though I have a personal experience with the UK and do take it into account in comparison). NHS isn't the best public healthcare system in the world as the British believe. It has several areas of speacilisation where it excels due to the sheer amount of resources (including academia), but taken as a whole and overall it's a poor system and lags behind almost all Northern, Western and even Central European systems. I can point you to EHCI here as well where UK isn't doing that well as the Brits would like everyone to believe i.e. it's not even top 10 what to speak of number 1.

And I insist that trolleys aren't normal thing top half of the European healthcare systems and that the occurence of this issye in Ireland is certainly not an indicator of a successful "upper quartile" healthcare system. How can you maintain that HSE is first class public service is beyond me. I'd say that vast majority of lay people and experts agree on HSE being sub-standard in the "top league" at least, let's narrow it down to Western/Northern Europe.

And also, care to comment on whether your POV is a Dublin-centric or not? Are you assessing Ireland based on Dublin? That wouldn't be exactly accurate.

micosoft · 27-08-2019 8:39am

McGiver wrote: »

OK. So do you have a response on EHCI? Because the report you provided is a purely academic exercise with no value in this discussion. EHCI is a fairly authoriative and widely accepted report, and most importantly clearly measures indicators important for us, the public, the consumers.

I sort of expected you would mention UK with regards to trolleys, but I naturally exclude UK as I'm coming from a continental perspective and I don't think UK should be the country to evaluate Ireland against (even though I have a personal experience with the UK and do take it into account in comparison). NHS isn't the best public healthcare system in the world as the British believe. It has several areas of speacilisation where it excels due to the sheer amount of resources (including academia), but taken as a whole and overall it's a poor system and lags behind almost all Northern, Western and even Central European systems. I can point you to EHCI here as well where UK isn't doing that well as the Brits would like everyone to believe i.e. it's not even top 10 what to speak of number 1.

And I insist that trolleys aren't normal thing top half of the European healthcare systems and that the occurence of this issye in Ireland is certainly not an indicator of a successful "upper quartile" healthcare system. How can you maintain that HSE is first class public service is beyond me. I'd say that vast majority of lay people and experts agree on HSE being sub-standard in the "top league" at least, let's narrow it down to Western/Northern Europe.

And also, care to comment on whether your POV is a Dublin-centric or not? Are you assessing Ireland based on Dublin? That wouldn't be exactly accurate.

So you've excluded the NHS which is one of the oldest public health systems in Europe and for a variety of reasons the most comparable to Ireland. Any other countries you'd like to include from your data set? Poland for example? Of are you just cherry picking your data to be the best health services in Europe? As I stated, health news rarely travels borders (other than UK) but the idea of no issues elsewhere is perplexing and not plausible. There are issues in every EU country.

I also note that you've moved from "everything is ****" to focusing on A&E in Ireland. I specifically said the top 50% or in some cases the top quartile in delivering public services within the EU. You have changed to goal posts to health care among the top five countries on the planet (outside of Japan and South Korea).

I've already commented twice that Ireland has one of the lowest population densities in Europe. We aren't the Netherlands and have a preponderance of one off housing. That has an impact delivering any form of services but especially public transport. This was and continues to be a choice of the Irish electorate.

Again my point is, Ireland is up there with some of the best services in the world. Stating that Ireland is "totally behind most of the EU" or "terrible" is manifestly untrue. And the reason I say that is that you can then have a rational discussion about how you improve services based on data and not on anecdote.

McGiver · 27-08-2019 9:00am

micosoft wrote: »

McGiver wrote: »

OK. So do you have a response on EHCI? Because the report you provided is a purely academic exercise with no value in this discussion. EHCI is a fairly authoriative and widely accepted report, and most importantly clearly measures indicators important for us, the public, the consumers.

I sort of expected you would mention UK with regards to trolleys, but I naturally exclude UK as I'm coming from a continental perspective and I don't think UK should be the country to evaluate Ireland against (even though I have a personal experience with the UK and do take it into account in comparison). NHS isn't the best public healthcare system in the world as the British believe. It has several areas of speacilisation where it excels due to the sheer amount of resources (including academia), but taken as a whole and overall it's a poor system and lags behind almost all Northern, Western and even Central European systems. I can point you to EHCI here as well where UK isn't doing that well as the Brits would like everyone to believe i.e. it's not even top 10 what to speak of number 1.

And I insist that trolleys aren't normal thing top half of the European healthcare systems and that the occurence of this issye in Ireland is certainly not an indicator of a successful "upper quartile" healthcare system. How can you maintain that HSE is first class public service is beyond me. I'd say that vast majority of lay people and experts agree on HSE being sub-standard in the "top league" at least, let's narrow it down to Western/Northern Europe.

And also, care to comment on whether your POV is a Dublin-centric or not? Are you assessing Ireland based on Dublin? That wouldn't be exactly accurate.

So you've excluded the NHS which is one of the oldest public health systems in Europe and for a variety of reasons the most comparable to Ireland. Any other countries you'd like to include from your data set? Poland for example? Of are you just cherry picking your data to be the best health services in Europe? As I stated, health news rarely travels borders (other than UK) but the idea of no issues elsewhere is perplexing and not plausible. There are issues in every EU country.

I also note that you've moved from "everything is ****" to focusing on A&E in Ireland. I specifically said the top 50% or in some cases the top quartile in delivering public services within the EU. You have changed to goal posts to health care among the top five countries on the planet (outside of Japan and South Korea).

I've already commented twice that Ireland has one of the lowest population densities in Europe. We aren't the Netherlands and have a preponderance of one off housing. That has an impact delivering any form of services but especially public transport. This was and continues to be a choice of the Irish electorate.

Again my point is, Ireland is up there with some of the best services in the world. Stating that Ireland is "totally behind most of the EU" or "terrible" is manifestly untrue. And the reason I say that is that you can then have a rational discussion about how you improve services based on data and not on anecdote.

Still no reply on EHCI. Cherry picking is your random synthetic WHO report.
Also no reply if you are coming from Dublin centric POV.
Care to respond?

Finland, Norway, Sweden and Estonia have lower density than Ireland, the former three are also quite large so much more difficult to govern, yet their public services and governance are first class.

And I insist that NHS is not a good system to gauge health care system against. Look at France, Spain, Belgium, Austria, Netherlands, I won't even mention the Nordic countries because they are two leagues ahead.

Your goal of top 50% in the EU (which is 13/27 in other words) doesn't match with the Irish PR of "we're one of the best developed countries in multitude of indicators globally". You mentioned it repeatedly. So are you climbing down now?

beggars_bush · 27-08-2019 9:18am

The problem with the Irish health system is public consultants allowed to make money on private work in public hospitals

When they should be working to clear public waiting lists

If you want private care, use a private hospital

McGiver · 28-08-2019 8:04am

beggars_bush wrote: »

The problem with the Irish health system is public consultants allowed to make money on private work in public hospitals

When they should be working to clear public waiting lists

If you want private care, use a private hospital

Yes, the EHCI reports raise this issue as well, parallel economy (separate private practises of public doctors, under the table payments etc).

And also more importantly that waiting list is a wrong concept which only decreases accessibility and makes situation progressively worse (because it had in UK, Ireland, Sweden which all heavily rely on lists).

1.1.2 No correlation between accessibility to healthcare and money spent

It is inherently cheaper to run a healthcare system without waiting lists than having waiting lists! Contrary to popular belief, not least among healthcare politicians, waiting
lists do not save money – they cost money! Healthcare is basically a process industry. As any professional manager from such an industry would know, smooth procedures with a minimum of pause or interruption is key to keeping costs low!

In the EHCI 2017 there were some surprising newcomers among countries having no or minimal waiting lists in healthcare. Tiny Montenegro has achieved a similar improvement
to what Macedonia did in 2013 by introducing a national real time e-referral system. In 2018, only Switzerland scores “All Green” on Accessibility. Frequently, there is a negative bias in Patient Organisation responses on Waiting Times and a positive bias in officialnational data.
Serbia, having bought a license for the Macedonia system, is a bit slower in the implementation than their smaller neighbours, but is on course to eliminating waiting lists.
If countries with limited means can achieve virtual absence of waiting lists – what excuse can there be for countries such as Ireland, the UK, Sweden or Norway to keep having
waiting list problems?

j8wk2feszrnpao · 28-08-2019 1:43pm

beggars_bush wrote: »

If you want private care, use a private hospital

Why? Do you want consultants removed from the public system to just work in private ran hospitals? That's not going to help public waiting lists.

Midster · 31-08-2019 7:37pm

Just thought I’d jump in here. I live craughwell galway.

Our bin company used to take direct debits from us every month to take away our trash (fare enough,) but recently I received a letter from them saying from now on they want all there customers to pay a whole year in advance (which is crazy!!!.)

I mean it’s not like we have a choice to change what company takes our trash away or anything, they have a captive audience so to speak, and I’m just finding out, can basically charge any amount they want, or if it be weekly, monthly or yearly. And there’s absolutely nothing you can do about it.

I care for my partners autistic son, and my partner also has a long term disease so she can’t work either. I have to scrabble around now and find the money somehow and on benefits it isn’t an easy task at all.

The actual amount for the year hasn’t gone up, it’s the same, but when at the end of each week your emptying the loose change jar to by milk, how the hell we can afford a whole years payment, it’s ridiculous!!

If they haven’t put the money up but are now asking for yearly payments instead of monthly I can only presume its because they themselves are looking to expand there business into a new area, and they need a fat chunk of paper at the start of the year be able to get a loan from the bank big enough to do it.

Can’t do anything about it, I have to pay, I’m just sick to death of it.

The railway here has only one track so there’s like 3 trains a day, leaving at times of the day nobody needs to travel.
It’s as overpriced as hell to go anywhere anyway so nobody does.

The busses that go to Galway from here come from Dublin so there always late and also overpriced.

Were the hell is the sanity

beggars_bush · 03-09-2019 5:58pm

Midster wrote: »

Just thought I’d jump in here. I live craughwell galway.

Our bin company used to take direct debits from us every month to take away our trash (fare enough,) but recently I received a letter from them saying from now on they want all there customers to pay a whole year in advance (which is crazy!!!.)

I mean it’s not like we have a choice to change what company takes our trash away or anything, they have a captive audience so to speak, and I’m just finding out, can basically charge any amount they want, or if it be weekly, monthly or yearly. And there’s absolutely nothing you can do about it.

I care for my partners autistic son, and my partner also has a long term disease so she can’t work either. I have to scrabble around now and find the money somehow and on benefits it isn’t an easy task at all.

The actual amount for the year hasn’t gone up, it’s the same, but when at the end of each week your emptying the loose change jar to by milk, how the hell we can afford a whole years payment, it’s ridiculous!!

If they haven’t put the money up but are now asking for yearly payments instead of monthly I can only presume its because they themselves are looking to expand there business into a new area, and they need a fat chunk of paper at the start of the year be able to get a loan from the bank big enough to do it.

Can’t do anything about it, I have to pay, I’m just sick to death of it.

The railway here has only one track so there’s like 3 trains a day, leaving at times of the day nobody needs to travel.
It’s as overpriced as hell to go anywhere anyway so nobody does.

The busses that go to Galway from here come from Dublin so there always late and also overpriced.

Were the hell is the sanity

You can bring your recycling and rubbish to council centre for much less than the bin companies charge

We let our recycling build up (its all washed, stacked and separated, then go every few months.

James Brown · 04-09-2019 3:04pm

munstermagic11 wrote: »

Why? Do you want consultants removed from the public system to just work in private ran hospitals? That's not going to help public waiting lists.

Neither is consultants using the long waiting lists to drum up business for private clinics.

j8wk2feszrnpao · 04-09-2019 9:46pm

Matt Barrett wrote: »

Neither is consultants using the long waiting lists to drum up business for private clinics.

True, but it doesn't answer the question I asked.

James Brown · 05-09-2019 2:18pm

munstermagic11 wrote: »

True, but it doesn't answer the question I asked.

No I don't want consultants removed from hospitals :rolleyes:

They should not be able to dangle a private option over a patients head after giving them a wait time of several months in public.

Midster · 05-09-2019 2:46pm

The problem I see with hospitals is that they are completely inefficient, I’ve been in an Irish hospital twice since I’ve been here, once for a gaping wound on my hand that was extremely painful and didn’t get seen even for pain killers for over 8 hours, second time was because of a trapped nerve in my back, which was extremely painful and was calling out repeatedly to any nurse that would listen to please give me a pain killer but was still left there on a stretcher, in the hallway, writhing in agony for at least 4 hours before someone gave me a paracetamol, it was a joke. My partner has a long term illness that could actually eventually kill her and she refuses to go to hospital now, and she takes the terrible pain and toughs it out cause she doesn’t want to be waiting for 12 hours or more, like the last few visits.

Hospitals are supposed to be hassle, it’s why mums don’t take there kids there with grazed knees, but it’s ridiculous.

Nurses should be trained to the level that they can take care of the easy cases themselves, without a doctor. So the more serious cases can be seen faster.

McGiver · 05-09-2019 9:17pm

Midster wrote: »

The problem I see with hospitals is that they are completely inefficient, I’ve been in an Irish hospital twice since I’ve been here, once for a gaping wound on my hand that was extremely painful and didn’t get seen even for pain killers for over 8 hours, second time was because of a trapped nerve in my back, which was extremely painful and was calling out repeatedly to any nurse that would listen to please give me a pain killer but was still left there on a stretcher, in the hallway, writhing in agony for at least 4 hours before someone gave me a paracetamol, it was a joke. My partner has a long term illness that could actually eventually kill her and she refuses to go to hospital now, and she takes the terrible pain and toughs it out cause she doesn’t want to be waiting for 12 hours or more, like the last few visits.

Hospitals are supposed to be hassle, it’s why mums don’t take there kids there with grazed knees, but it’s ridiculous.

Nurses should be trained to the level that they can take care of the easy cases themselves, without a doctor. So the more serious cases can be seen faster.

Totally consistent with my experience, experience virtually everyone I know and the EHCI reports. Yet micosoft insists Irish services are in the first league comparable to Western & Northern Europe. Which is very rich.

It's not only the hospitals that are inefficient, the bigger issue is the HSE itself, the structure is so convoluted that it leads to massive ineffeciencies, corruption and waste. Ireland pays one of the highest per capita healthcare costs in OECD yet this is the result.

I had several personal shocking experiences with public Irish health care both from admin and medical point of view.

It escapes me how anyone can dispute this despite all the evidence.

By the way, Is there any efficient government agency in Ireland? Revenue PAYE probably.

jimmycrackcorm · 06-09-2019 3:17am

Midster wrote: »

The problem I see with hospitals is that they are completely inefficient, I’ve been in an Irish hospital twice since I’ve been here, once for a gaping wound on my hand that was extremely painful and didn’t get seen even for pain killers for over 8 hours, second time was because of a trapped nerve in my back, which was extremely painful and was calling out repeatedly to any nurse that would listen to please give me a pain killer but was still left there on a stretcher, in the hallway, writhing in agony for at least 4 hours before someone gave me a paracetamol, it was a joke. .

I don't mean to belittle your experience but a large part of the problem is people turning up to A&E instead of going to their GP first. Your GP would have at least given you pain medication.

j8wk2feszrnpao · 06-09-2019 8:50am

Matt Barrett wrote: »

No I don't want consultants removed from hospitals :rolleyes:

I didn't say you did. The question wasn't even directed at you. Relax.

McGiver · 06-09-2019 9:22am

jimmycrackcorm wrote: »

Midster wrote: »

The problem I see with hospitals is that they are completely inefficient, I’ve been in an Irish hospital twice since I’ve been here, once for a gaping wound on my hand that was extremely painful and didn’t get seen even for pain killers for over 8 hours, second time was because of a trapped nerve in my back, which was extremely painful and was calling out repeatedly to any nurse that would listen to please give me a pain killer but was still left there on a stretcher, in the hallway, writhing in agony for at least 4 hours before someone gave me a paracetamol, it was a joke. .

I don't mean to belittle your experience but a large part of the problem is people turning up to A&E instead of going to their GP first. Your GP would have at least given you pain medication.

This is an issue in all EU countries by the way. Maybe the degree of it is higher in Ireland but I have no data for that.

James Brown · 06-09-2019 2:06pm

munstermagic11 wrote: »

I didn't say you did. The question wasn't even directed at you. Relax.

It's not a yes or no solution. I'm pretty chill thanks.

Regarding people going to the A and E instead of the GP, that's for the A and E to sort out. Stop treating them they'll not come back.
If you wander into the A and E on a whim and get treated you'd be almost foolish not to avail of it as you fancy. Anyway I'd rather stick the pain and wait until the doctor opens than go to an A and E.

Podge_irl · 06-09-2019 2:21pm

Matt Barrett wrote: »

It's not a yes or no solution. I'm pretty chill thanks.

Regarding people going to the A and E instead of the GP, that's for the A and E to sort out. Stop treating them they'll not come back.
If you wander into the A and E on a whim and get treated you'd be almost foolish not to avail of it as you fancy. Anyway I'd rather stick the pain and wait until the doctor opens than go to an A and E.

Big believer in personal responsibility I see :rolleyes:

They can't not treat them and it is on people themselves to stop being either selfish, misguided or whatever it is that drives them to go to A&E when they shouldn't.

James Brown · 06-09-2019 2:28pm

Podge_irl wrote: »

Big believer in personal responsibility I see :rolleyes:

They can't not treat them and it is on people themselves to stop being either selfish, misguided or whatever it is that drives them to go to A&E when they shouldn't.

Can they not advise seeing a local GP as that's accident and emergency?
Well you wait on people to do whats best for the HSE over and above themselves. Let me know how you go.

Midster · 06-09-2019 3:31pm

jimmycrackcorm wrote: »

I don't mean to belittle your experience but a large part of the problem is people turning up to A&E instead of going to their GP first. Your GP would have at least given you pain medication.

The night before I went to hospital I was sitting on the sofa and had the same pain. Like very intense muscle spasms slowly building up then giving and burst of excruciating pain, I couldn’t move anywhere.
First thing we did was ring west doc, in an attempt to get it seen to rather than going to hospital, first of all they didn’t want to come out, but my partner rang them back and practically begged them to come so they did. They gave me an injection of some kind and everything stopped almost straight away.
That night I went to bed ok, and went to the toilet during the night ok, but when I woke up the next morning it was back with a vengeance more intense than before. My partner rang west doc again and they flatly refused to come out so my partner rang the ambulance.
I was dreading going there but I just thought if they were to give me another one of those injections that west doc had given me the night before maybe I would be alright and could wait then for the doctor, or maybe leave the hospital and make an appointment with my local gp.
They left me in the corridor screaming in agony for what felt like hours with no medication what so ever.
I begged every nurse that walked by and a couple of them did say they would go find a doctor but they disappeared, and never came back.
Finally a nurse did give me paracetamol, but it didn’t stop it.
After being there all day in complete agony the evening came and still nobody.
Long and short of it is that I never actually got to see a doctor at all, the pain eventually subsided and as soon as it did I got a lift home from a friend.

j8wk2feszrnpao · 07-09-2019 8:23am

Matt Barrett wrote: »

It's not a yes or no solution. I'm pretty chill thanks.

You don't come across that way.
Again, the question was directed at you.

Mongfinder General · 07-09-2019 8:45am

McGiver wrote: »

Totally consistent with my experience, experience virtually everyone I know and the EHCI reports. Yet micosoft insists Irish services are in the first league comparable to Western & Northern Europe. Which is very rich.

It's not only the hospitals that are inefficient, the bigger issue is the HSE itself, the structure is so convoluted that it leads to massive ineffeciencies, corruption and waste. Ireland pays one of the highest per capita healthcare costs in OECD yet this is the result.

I had several personal shocking experiences with public Irish health care both from admin and medical point of view.

It escapes me how anyone can dispute this despite all the evidence.

By the way, Is there any efficient government agency in Ireland? Revenue PAYE probably.

Revenue is efficient. Why? Because they have to be. They are in the business of making money. I work for a government agency. My job is very technical and esoteric. I'm sometimes asked to school colleagues a grade or two above me. And that's ok but recently I've begun to question my raison d'etre. You see there are people there on better salaries than me who "perform" menial tasks. Admin roles, secretarial roles, HR type roles. These are handy jobs. I spend days sometimes parsing legal texts while trying to problem solve and present a solution to my boss. Meanwhile, there's some jobs worth in charge of licking stamps and filling out forms. So, it's really not worth my while performing in my current role. I'm better off vegetating with the cabbages. And that's my goal now. The general attitude across the public sector is not too dissimilar. Take the handy number, do the bare minimum and achieve the optimum remuneration package for your output.
This is a true ineptocracy.

McGiver · 07-09-2019 9:26am

Mongfinder General wrote: »

McGiver wrote: »

Totally consistent with my experience, experience virtually everyone I know and the EHCI reports. Yet micosoft insists Irish services are in the first league comparable to Western & Northern Europe. Which is very rich.

It's not only the hospitals that are inefficient, the bigger issue is the HSE itself, the structure is so convoluted that it leads to massive ineffeciencies, corruption and waste. Ireland pays one of the highest per capita healthcare costs in OECD yet this is the result.

I had several personal shocking experiences with public Irish health care both from admin and medical point of view.

It escapes me how anyone can dispute this despite all the evidence.

By the way, Is there any efficient government agency in Ireland? Revenue PAYE probably.

Revenue is efficient. Why? Because they have to be. They are in the business of making money. I work for a government agency. My job is very technical and esoteric. I'm sometimes asked to school colleagues a grade or two above me. And that's ok but recently I've begun to question my raison d'etre. You see there are people there on better salaries than me who "perform" menial tasks. Admin roles, secretarial roles, HR type roles. These are handy jobs. I spend days sometimes parsing legal texts while trying to problem solve and present a solution to my boss. Meanwhile, there's some jobs worth in charge of licking stamps and filling out forms. So, it's really not worth my while performing in my current role. I'm better off vegetating with the cabbages. And that's my goal now. The general attitude across the public sector is not too dissimilar. Take the handy number, do the bare minimum and achieve the optimum remuneration package for your output.
This is a true ineptocracy.

I think this would be the case in most European civil services, to be be fair. But my observation is that the Irish government structures, organisation and management is overly convoluted. It's a cultural thing I guess.

Do we pay too much tax for crappy services?

Comments