Last week while at the MacGill Summer School in Donegal, Minister for Health, Leo Varadkar hinted that the Government may have bitten off more than it could chew with the proposed roll out of Universal Health Insurance (UHI) by 2019, or even beyond.
What I found particularly frustrating with his predecessor, James Reilly's idealism is that he placed such an emphasis on redressing the two tiered system, where those who currently have health insurance would no longer have a greater right to queue skip under UHI, that he continually sidestepped questions about the quality or efficiency of the ‘one queue for all’ set up. Namely that the Public system could not efficiently service the queues of patients it already had, before adding a further 46% of the population to the same system.
Those who never had health insurance seemed to be under the misapprehension that UHI was a ‘free to all service’, as opposed to ‘free at the point of use service’, and I believe that it was this misapprehension that distorted the apparent groundswell of support for the policy of UHI. In reality there was always going to be a huge cost involved in implementing such a project. Firstly the cost of adequately funding the existing Public system, the increase in medical professionals required, and the further cost of up scaling that model to deal with a further 46% of the population, who until such time had access to the Private System. This cost would have to be funded by the tax payer through general PAYE taxation or a specific taxation mechanism such as increased Universal Social Charge (USC) or Pay Related Social Insurance (PRSI).
A large number of people who seemed to think UHI would benefit them, failed to understand that it would also cost them. More than that, the cost would most likely be much larger than the premiums currently paid by customers with Private Health Insurance.
Where Minister Varadkar’s deserved huge credit, in contrast to his predecessor, is that he has made great efforts to take his time in understanding the successes, failings and issues currently faced by all stakeholders in the Health System and on foot of such study, communicated very clearly to the public the problem with the UHI proposal, something his predecessor also failed to do. Minister Varadkar stated that if UHI was up and running, you would indeed have equality of care rather than a two tier system, but that system would see many people moving from a fast queue to a slow queue. He also rightly stated that it would not be fair to bring about UHI until such time as the Public System is brought up to par with the current alternatives.
This in essence is the problem with UHI. Asking 46% of the population to pay more than the cost of their current private health cover for a inferior service, to say nothing about blindly leading the other 54% of the population (who currently don’t pay for health insurance) down a path of a utopian promise while failing to inform them, that it was actually going to cost them more than they themselves deem they can afford. How have I come to that conclusion? Simple, if they could afford UHI they could certainly afford Private Health Insurance, because based on all suggested costing models, private health insurance is cheaper. So long as that remains the case, any government will have a hard time convicing any informed citizen of the case for UHI.
Irish Health Insurance