Draft Copy:

published to coincide with the

all party talks – 15.10.10

2010
‘Wasters’ – a commentary on Ch. 4: ‘The Sickness of the HSE’


Concluding Paragraph:
“There is still time to get it
right and Minister for Health
Mary Harney is the one person
that can set things to rights for
she is a Minister without a
party, she can do as she
chooses and present the case
for the introduction of the
Health Tax to Finance Minister
Brian Lenihan knowing that it
represents a global solution
not only to the budgetary crisis
but also to the crisis in health.
And to cap it all a major
flagship project in Dublin
Docklands which could exceed
the International Financial
Services Centre in terms of its The Case for:
economic spin offs. All that is
1) Funding the HSE from a combination of a
required for this to happen is
political courage and the desire 10% Health Tax and Medical Insurance,
to do the right thing. The including Social Welfare Recipients and
courage is there but what
workers currently outside the tax net;
about the desire to do the right
thing simply because it is the 2) The GAA taking over Quinn Health; and
right thing to do?” 3) A Flagship Hospital & Cyber Campus in
the DDDA authority area.

By Paul Cassidy (M.Sc: Regional & Resources
Planning). Paul@pdfwebpublishing.com
2|Page

Introduction

I’ve previously reviewed and commented on chapter three of ‘Wasters’, which FAS my main concern
being that the axe falls on the waste and not the capacities; the waste being the junketeer management
and commercial trainers as opposed to the Community Employment Schemes and inhouse training
facilities. Although Shane Ross is highly respected and has been a consistent and reliable critic of the
excesses of the social partnership process and of public service waste he is driven by a neo-liberal free
market agenda. The concern being that he may well see ‘Wasters’, as his wrecking ball opening the way
for a fully privatised health system funded by universal private insurance, as is the gist of Fine Gael’s
Faircare plan. So my intention here is to make comment and propose an alternative means of funding a
mixed public/private health system. The Ross-Webb critique is, as the title of the book suggests, driven
by an expose on waste and incompetence and they pull no punches where the HSE is concerned. But it
begs the question as to whether there is a viable means of maintaining a public health system which
compliments and integrates with the needs of private medical insurance. So to begin, a commentary on
Chapter 4 ‘The Sickness of the HSE’; followed by an alternative taxation model based on a ten percent
tax on social welfare recipients and on all workers not subscribing to medical insurance; and in addition
the introduction of a major new medical insurance player to fill the gap left by Quinn Health, namely the
GAA.

Wasters on ‘The Sickness of Health’.

The chapter commences with a rather dry and redundant review of some miscellaneous visa card
expenses based on who ate where for how much and who went where in what class carriage; a tad on
the petty side but it does open into a more substantive critique. Ross has a good turn of phrase and
geographic metaphors feature: Brian Cowen (former Health Minister, Finance Minister and current
Taoiseach)likened the Department of Health and Children (Hawkins House) to ‘Angola’, (P101, Para 4),
after he had left it of course; Ross compares the HSE to ‘Tonga’, or ‘Andorra’, (P80, Para 2) in terms of
staffing levels of 140,000 (P84, Para 3); and maintains that the current governmental budgetary debacle
would ‘do Robert Mugabe proud ‘ (P100, Para4). Minister Harney made an innovative addition to this
phraseology of despair by describing the HSE’s Executives as ‘Serial bunglers’. Referring to the
management of its property portfolio in terms of the timely disposal of assets the authors refer to the
HSE as ‘moving like treacle’, the upshot of which is a backlog of redundant now unmarketable properties
which must be secured into the future at substantial cost.

Russian Dolls and PPARS: As to the abortive transition from Health Boards to HSE it seems the
Department of Health and Children handling of the transition was purposely designed to minimise
change. Consequently we have a Russian doll merger – out of site out of mind – with all eleven health
boards discreetly tucked inside the ‘Mother of all Dolls’: the HSE. It seems reasonable that the
Department of Health and Children (the latter part is not intended as a reference to the staff) would
have assumed the role of pay-master general where the HSE is concerned including the function of
budgetary over sight but this is not the case. No doubt if it had the thousands of ghost workers which
3|Page

PPARS appears to have exposed would have simply disappeared off the pay role obviating the need for
redundancies; which no doubt is why PPARS could not be delivered and why Deloitte Consultants were
effectively paid not to solve the problem. And if you don’t believe that’s possible then plainly you’re
either not Irish or not Irish enough.

The HSE’s payroll and banking system is plainly a confused and deranged behemoth with massive
duplication and waste no doubt designed to shield the appalling fact that many of those on the pay role
are likely to be ghost workers who either do not exist in the first place or are at home watching back
issue of Halls Pictorial Weekly. The elaborate PPARS (Personnel Payroll and Related Systems) debacle
despite failing in its task of systematising the HSE payroll cost the tax payer a staggering €400M
regardless, just like the evoting debacle. Why? No doubt those charged with the task were made see the
merit of leaving sleeping dogs lie; as indeed was the case with Minister Martin and Minister Harney;
although in fairness her misgivings are likely to be ideological rather than political. But therein lies the
problem the potential symmetry between the Ministers and the authors critique; the view that being
the product of a politically corrupt culture the best bet for the health services is privatisation thus
disassociating it from the political contagion that caused the crisis in the first instance. A simpler
alternative might be for the Minister to get her own ‘Department of Angola’, to reign-in said errant ‘Son
of Angola’, by becoming its hands-on paymaster and budgetary overseer. What else would the
Department of Health be doing if not that unless everyone had effectively given up or been bought off,
including the Minister.

After the Everest like PPARS debacle everything else seems diminutive: Unions demarcating, getting it
wrong and being told so by the Labour Courts; poor procurement policy and staff planning; lousy
handling of property portfolios and leases; utterly incompetent budgeting and financial control;
inherited duplication from the old health boards which simply morphed into miniature Russian dolls
within the new ‘Mother of all Dolls’, the HSE itself. Yes, you guessed it, the HSE has 11 legal teams, 11 PR
departments and 11 procurement and IT departments (P.81, Para.3); and so on and so ridiculously
forth.

Administration and the Old Boys: In terms of the administrative end of things some 16% of the 110,000
‘active’, staff are admin. Fine Gael’s Dr. James Reilly refers to the HSE’s inhouse consultants as engaging
in ‘Industrious futility’ (p.91, Para 2): 760 highly paid professionals furiously writing reports supposedly
for the heck of it with no net savings to the tax payer in terms of cutting back on external consultancy
bills. The Department of Health and Children could plainly justify its existence if it acted as paymaster,
budget setter and comptroller general over the HSE; while the HSE’s own internal legal, consulting and
PR staff might justify their existence by saving on the enormous external consulting costs the HSE incurs.
The problem seems to be a head to head between long established institutionalised functions within the
HSE and Department of Health and a paradigm shift towards privatisaiton which management seems
intent on imposing. So are the authors right in suggesting that duplication is coming from within when it
could just as easily be said to be coming from without? Well if you duplicate the role of an existing
4|Page

member of staff by outsourcing whose fault is that? Surely much of the duplication is arising from
managements attempts at imposing a culture of privatisation on a public service body.

The authors point to the roll of Summerhill College Sligo, attended by David Drumm (CEO of the HSE),
Dermot Mannion (former CEO of Aer Lingus) and Michael Fingleton (disgraced former CEO of
Nationwide Building Society) suggesting something of an insider old boys network; and also to the
culture of ‘under-performance’, related bonuses (P99). And it would seem that the latest nominee for
the post of CEO of the HSE, like Drumm, has been selected for his political acumen more than his
expertise or integrity which is of course the very problem which needs addressing: the political flea
circus which health has become. So if this appointment goes ahead we’ve five more years of the same
old. The real expert (Professor Tom Keane) demanded wait for it – not a superannuated bonus or annual
expenses paid trips to Florida – but a moratorium on staffing levels and budgetary guarantees, which of
course disqualified him: undue zeal and virtue shall be prosecuted. So instead we’re getting former
acting head of a flopped floatation, Eircom’s Cathal McGee. Is failure the agenda?

Medical Consultants & Executive Salaries: Now as I don’t wish to further demoralise staff at the HSE or
wade into matters beyond my competency it’s worth noting that medical consultants pay is close
enough to what many would regard as an acceptable cap at €222,000; assuming that that sum buys the
person concerned lock, stock and barrel where the public health system is concerned. The issue where
medical consultants are concerned appears to be their expectation that the health services be organised
round their need to clear a million a year from a combined public/private practice so as to cover medical
insurance and other costs as well as producing an executive salary. This has as much to do with the
ethos of corporate medicine that has crept into the health services as anything else. The reality is that
outside of major hospitals and centres of expertise medical consultants should be paid as tied public
health surgeons, working under the hospital’s medical insurance cover, with very limited if any focus on
private practice. Of course those hospitals will also be catering to the medically insured but that’s the
hospitals bonus not the surgeons, consultations aside. These are not backwoods men who hacked their
way to the top of the political system , they’re highly qualified and skilled medical technicians who work
under very challenging conditions and they are worth 200K plus assuming that’s it and the hospital or
health care region concerned has their undivided attention at that. That understanding alone should
make smaller local hospitals viable. As for larger hospitals and centres of expertise perhaps more
generous work practices can apply as hospital complex managers seek to maximise service potentials.

HSE executive salaries are also are not excessive given the context assuming bonuses are done away
with and replaced with Christmas hampers, complimentary memberships, match tickets etc. Rather than
rewarding executives for performing duties they’ve already been handsomely paid for in the first place
they should have their contracts terminated by the Minister for failing to deliver on targets. Bonuses
arise from companies trading on the markets at times of success as a means of cutting the executives in
on windfall profits; or so the theory went, now it’s just people in board rooms stuffing money into one
and others pockets.
5|Page

Non-Medical Staff: Last a by no means least are the non-medical staff which get no mention from Ross
and Webb. I worked as a Kitchen Porter for over a decade with all that-that entailed and my impression
of hospital toilets is that toilets in fast food joints are maintained to a far higher standard than toilets in
Irish hospitals. The impression one gets from modern Irish hospitals is that non-medical staff feel like
they have ‘walk-on’, roles on the set of ‘Dr.House’, while the key cast go vamping up and down anima
charged corridors waiting to be snapped up by passing Bollywood directors. Clearly it requires a degree
of humility and diligence to be a porter, janitor or attendant, when you’re rubbing shoulders with some
of the State’s most highly paid workers but that is life. A job is a job and assuming unionised pay and
conditions, opportunities for up-skilling and career moves, then how can it be so bad? When the
glamour is stripped back everyone is working under vulnerable circumstances and hygiene is of
paramount importance. If ‘Health’, had a God of its own it would surely be hygiene, a fact the Religious
Sisters of yore understood well and any of us treated in their hospitals can recall to this day the
immaculately kept corridors, foyers, toilets and waiting rooms polished to the last.

No doubt there are contract issues a stake due to the privatisation of cleaning services, which are
demoralising workers. If so that needs to be changed. We do not need a two tier workforce in our
hospitals and that coming back to bite us on the ass as ebola. Everyone must be in a union and feel
satisfied with the terms of their employment even out sourced labour, if that is the system, but it must
be unionised labour regardless. And then of course the unions have to be responsible about the degree
of control which that fact gives them. Bur gurus like Ross and Webb have to be aware that organising
110,000 workers plus in a work place where hundreds of thousands come and go on a daily basis in
upsetting circumstances is not going to be without incident or misunderstanding. It’s a constant
challenge to all concerned and generally speaking the all the staff concerned maintain a very
professional and friendly rapport.

Building in Choice: Health Tax and or Medical Insurance

The principle concern with the critique being offered in ‘Wasters’, is that its a veritable neo-liberal
wrecking ball designed to weaken public confidence in a key public service. But the real opportunity the
authors are exploiting is not the ‘Waste’, it’s the political failure to describe a viable funding mechanism
for health; and that is a simple enough proposition at the back of it all assuming the right mix of tax and
medical insurance inputs. So far Fine Gael have been the only ones to nail their colours to the mast with
their plan for a system based on universal medical health cover: Faircare. Fianna Fail and the left in
general have simply avoided the issue believing instead that they can keep inventing new ways of taxing
round the problem.

Health services need to be delivered as open access entitlements in a way which other more selective
social supports needn’t. Take children’s allowance for instance. One can easily argue that it ought to be
targeted at child poverty through the Social Welfare and Health systems via District Health Nurses and
Social Welfare Means Assessors; but that In the case of child disability a more universal approach is
needed regardless of means because child disability is too big a burden for any individual household to
6|Page

to carry alone regardless of means. In terms of health everyone needs to be given access based on
secured entitlement while allowing those who chose to obtain cover via their medical insurance the
freedom to do so. The securing of that entitlement is the issue which needs to be discussed here. So the
issue is how to create an open access health system with a secure budget.

It may be a bit of a misnomer to equate medical insurance with ‘private care’, in a mixed public/private
system because generally speaking it does not amount to that; what it does ensure is more attention; if
it didn’t why would anyone pay for it in the first place? ‘Public’ patients need to consider that medical
insurance subsidises the costs of public hospitals, underpinning budgets, expertise and resources; and
that the degree of separation between public and private is often slim to non-existent. Obviously
Medical Consultants will send more minions hoofing round the wards after the medically insured and
they’re likely to be the first into the next available private room but that’s it. But by virtue of the same
motive, the insured often are the last let home, whether they like it or not , and exposed to higher risk
as a consequence: ‘Woe betide the laying hen in the hands of mucker men’. The real merit of a mixed
public-private system is the potential it creates for secure budgets from which to plan services on an
ongoing basis rather than having a billion more this year and a billion less next.

Establishing a Tax Base for Health: We are being told that Health costs are exorbitant and I’m not sure
about that. The real issue isn’t whether health costs ten billion or fourteen billion, its establishing a
guaranteed ring fenced tax base from which to plan annual budgets and services. One of the products of
uncertainty is waste. Apocalyptic announcements of massive spending cuts seem like scare tactics
intended to fuel neo-liberal marketeers ambitious to make off with the honey pot. Those interested in
defending the mixed public-private system we currently have need to speak up fast and state their case
because if the Government succeeds in creating all party support for its four year budget plan we will be
presented with a done deal where the privatisation of health is concerned. And let’s be clear Fianna Fail
and Fine Gael both support privatisation; Fine Gael by saying so and Fianna Fail by doing so; pulling the
legs out from under the public system by not introducing a health tax. Those interested in defending the
ethos of public services need to accept the reality of a mixed public/private health system, like the one
we have, but funded from a combination of health tax and medical insurance. They also need to accept
the fact that Labour are the only party who have the will or the capacity to defend public health. Clearly
Sinn Fein and others would if they could - and O’Caolain has outline proposals for same - but the reality
is the government hasn’t even seen fit to include SF in pre-budget discussions. There is a love hate
relationship between Fianna Fail and Sinn Fein and they seem set to either tie the knot or destroy each
other. ‘Merge and be done with it’, I say.

A Mandatory Health Tax for the Uninsured: Any proposal as radical as imposing a mandatory health tax
for workers without medical insurance is a major departure for taxation policy in this state although its
common place in Europe. Clearly it will impact on those on social welfare and in low income jobs as they
are least likely to hold medical insurance. But many may choose to retain medical health insurance
through periods of unemployment to maintain their policy while many self employed or contract based
high income earners may prefer to pay a health tax as a means of guaranteeing health cover through
7|Page

valley periods; and some may choose to pay both, so as to have the best of both worlds. By enlarge
though it would mean deducting health tax at source both from social welfare payments and from
uninsured workers. The introduction of such a system would require reciprocal concessions towards the
public in terms of maintaining an efficient, comprehensive and geographically accessible health service
which in rural Ireland means maintaining a network of local hospitals on a county by county basis; the
distinction between a hospital and a clinic being the availability of beds.

There are those who are suggesting reducing social welfare and the minimum wage given that they are
relatively generous by UK and EU standards. I take the view expressed by Michael Noonan TD (Fine Gael
Shadow Spokesperson for Health) that taking more and more money out of the economy is a recipe for
disaster. What we need to do is circulate our diminishing money supply more efficiently introducing
taxes to secure service entitlements rather than erode them. As unemployment approaches the half
million mark and the total welfare bill creeps towards €25Billion/annum the State is going to have to
manage the spend and the best option would be to introduce a 10% health tax that extends a public
health care package to all concerned . Such a tax would yield €2.5Billion/annum. A similar tax on
workers currently outside the tax net – and there are perhaps as many as half a million or more – would
exceed the sum generated from taxing welfare generating a total sum of as much as €6Billion/annum.
Extend that tax net to everyone without medical insurance and the total health tax take will certainly
exceed €6Billion. So as far as ninety plus percent of the population is concerned they ought to be
offered the simple choice of either paying health tax or opting for medical insurance instead. Obviously
the more you earn the better value medical insurance will be while the less you earn the better value
health tax will be. There will always be those outside the health tax net, including domestic dependents
and asylum seekers, but I would propose making health universally accessible regardless as the percent
of the population which is unemployed and without welfare or assistance is small; ten percent of
nothing is afterall nothing or maybe it’s a token ‘Gate fee’.

In terms of private medical insurance the purist left need to accept that people who have the means to
choose medical insurance are entitled to do so; and that insured patients end up subsidising the public
health system which tends to surcharge insurers to cover public costs. Although I’ve since had to cancel
my medical insurance I did attend for surgery when insured for a minor operation. I was told that the
benefit of being insured was that I’d be the first on the table that morning. I was near enough the last as
it turned out. One thirtysomething hypertense male with a mass of cysts on his head was waiting with
me so nervously that the nurse made a judgement call, nodded my way, and took him into the surgery
ahead. The alternative being that he collapsed and we discretely dumped him down the disposal shoot.
While I’m sure the theatre nurse made the correct judgement call I now have occasional memorial cysts
on my head to remind me of my good deed. My medical insurers were charged over €700 for a minor
procedure and I had to cancel the insurance next year as I could no longer afford it. So who benefited
most in that situation? Now multiply that a hundred thousand fold and you get the picture. The
ideological sensibilities of the left on this matter are utterly unconvincing. We have a mixed
public/private health system and that is a good thing. If there are those who can afford the Blackrock
Clinic then good for them and all concerned but many a wealthy man has been bleed dry before his
8|Page

death presuming upon the notion that money could buy health; and they are as entitled to their
delusions as the consultants are to their fees. So lets live and let live and let the less well off the value of
what’s being offered .

Whereas the Social Partnership Process drove disparities through Pro-Rata pay deals rewarding the well
paid more that the lower paid Health Tax effectively gives the lower paid the same for less. A person
receiving €100/week may consider his €10 health tax money well spent and an incentive towards
temperance compared to a person earning €1000/week and paying €100 who may in turn consider that
value having large family. For others medical insurance will make more sense. So this is extremely good
value for social dependents and larger family units typically more dependent on the health system in the
first instance. Furthermore health tax will create a sense of ownership and entitlement for all
concerned.

A New Major Irish Medical Health Insurer: The collapse of the Quinn Group represents a real crisis for
the private health insurance model in Ireland. The solution could be very simple: get the GAA to take
over Quinn Health Insurance. Minister Harney has her work cut out for her on this one and does not
need another false start. We need a guaranteed, straight out of the box, sure fired winner. Is there any
organisation in this country to match the social and geographic reach of the GAA; that amounts to a
tenth of its manpower and membership; that can match, its popularity, draw and goodwill; its resources
and facilities; not to mention its revenues? The new Croke Park Stadium has been paid off a decade in
advance; hundreds of millions banked; a guaranteed revenue stream from matches; and larger revenues
still from the conference and function facilities at Croke Park. The GAA would make an ideal medical
health insurer and could even trade as a cooperative offering discounted rates to GAA members further
deepening their cultural influence.

The Gaelic Athletic Association could easily plan a new hospital and sports complex for its members
perhaps in Dublin Docklands as an anchor tenant in a major campus targeted at ‘Cyber Corporates’,
trading electronic goods and services online. Prestigious Cyber Corporates like Google, Facebook and
Ebay already have bases in Ireland and the Government is talking to more. They need also to talk to
online software sales giant like Digital-River, communications providers like Skype and online bankers
like Paypal. The opportunities are vast; with 21% VAT on sales foreign VAT receipts of €2.1 billion arise
from every €21Billion in digital sales not to mention Corporation Tax, PAYE, Rates and spin offs. Michal
McDowell TD once planned to convert the docklands into an exclusive location for the super wealthy
even suggesting the privatisation of the port tunnel and the moving of Dublin’s port facilities to
Drogheda, Dundalk and Arklow, laying the seed for the Authorities subsequent financial collapse. The
GAA could turn that vision inside out making it into an everymans campus accessible by port tunnel,
light rail and sea. Corporate clients could enjoy a cosmopolitan port setting with health plans and a
private hospital for staff on campus. The Government could lay on schooling from kindergarden,
through national school and secondary for employees ensuring reasonable labour costs. The project
could rival London’s Olympics in terms of the scale of investment and activity. And the Minister can rest
assured that if the GAA cannot sell health insurance in this country though its membership base then
9|Page

the medical insurance model is fundamentally flawed. Other locations for such a project could be
identified but the DDDA location will maximise synergies and spin offs to the tax payer – which is all of
us.

Reinvigorating our mixed public/private model through the introduction of an ‘either, or’, choice
between health tax and medical insurance would solve the governments budgetary problems in one fell
swoop. The tax revenues from the cyber campus would further inflate government tax revenues also
bailing out a key government agency that would otherwise require transfers. No need to impose four
years of hair shirt budgets on an incumbent government or to declare a state of national emergency and
effectively suspend democracy.

The Alternative: Killing the Goose the Laid the Golden Egg

We more or less know the alternative to introducing health tax for the medically uninsured. To date the
government have taxed: private health insurance, life assurance, house insurance, are planning the
reintroduction of domestic rates and of water charges, not to mention bin charges. They are allowing
the banks to drive the interest rates higher both on mortgages and current interest. Current account
interest rates in Ireland now exceed credit card rates with rates as high as 25% applying to current
account overdrafts. No doubt that list is not comprehensive. Most of the people paying these
exorbitant interest rates are now in negative equity and can no longer afford repairs to their properties
with Unions still advising apprentices that they are worth €25/hour.

In Ireland there is a tendency to keep returning to the ‘Golden Goose’, till it’s eggless, legless and
pegless and then to weep buckets at the funeral. Still all agree that this is the way forward. The Unions
and IBEC are signing off the same hymn sheet because they both share the same self fostered delusion
of a mythological benign, rule abiding, ‘Middle Class’, when in reality the so called middle and working
classes effectively merged in economic, cultural and consumer terms a decade ago to form a broad
‘Middle Mass’, with a ‘Dependent Class’, beneath and an ‘Executive, Business Class’, above. This fact has
apparently gone unnoticed, though we sit on the same ‘Land of Leather’, suites, eating breakfast in the
same Ikea kitchens; watching the same flat screen TVs; same computer screens, same programmes,
same music, videos and software; same Facebook, Twitter, Google and Ebay. The national conversation
switches seamlessly from football to rugby to soccer, to swine flue or whatever as though society had
become a mass of starlings mysteriously synchronising in mid-flight. And still we are lectured regularly
about ‘The Workers’, ‘Middle Irelanders’, the ‘Poor’, and the ‘Social Elite’, those at the top, responsible
for it all as if getting rid of the apex of the pyramid would make the rest of it more structurally sound.
This is all nonsense. Utter nonsense. Our world has changed illusively while we were trying to figure out
mobile phones, the IT cyberverse, the retail revolution, and how to assemble our flat pack kitchens. We
look back and believe we are seeing the same social landscape because we have after-all just looked
away. It is time to take our heads out of the sand and recognise that we have woke up somewhere else
socially, culturally and politically speaking and that it is not as challenging a landscape as we are making
it out to be. It is quite easy to identify your position in this new socio-economic landscape simply by
10 | P a g e

establishing whether domestic household means come mainly from: social welfare, wages or executive
salaries and profits.

Targeting the mythological ‘Middle Class’, is punishing mortgage holders and that includes households
across the entire social spectrum. It is simply an indiscriminate attack on the idea of home ownership
based on the belief that it is the one anchor that will hold in a storm. But will it hold? The famous French
anarchist writer Piere Joseph Proudhon once said ‘Property is Theft’, well the Irish people may well say
‘Property is Ruin’, and if the government proceeds to burden mortgage holders any further that
‘Property is Ruin and Damnation’. What will targeting and toppling the mythical ‘Middle Cass’, achieve: a
changing of the guard or a cascade failure? We do not need to speculate because the cascade failure has
already commenced and is easily charted.

Charting the Cascade Failure: The first item on the list of ‘Can no longer affords’, is medical health
insurance leading causing failure in the medical insurance business and forcing a major rationalisation of
health. With the Quinn Group in receivership and Quinn Health in limbo the entire medical insurance
model is in jeopardy. The Ministers response is to announce massive cutbacks perhaps over a billion in
cutbacks in a situation where revenues from medical insurance are sure to be in decline. The
Government’s decision to tax medical insurance policies further compounded the problem. If they had
just taxed the policy holder it might have worked but they taxed the spouse and dependants also
resulting in many family policies not being renewed; a stark decision for a parent in a situation where
the alternative is ‘Faith’, in an underfunded and shrinking public service.

In terms of repossessions we hear the Sheriff’s Office has been busy raiding family homes and making
away with the family furnishings for resale at mass auctions which are promoted ridiculously as an
indicator of renewed consumer spend. Can anyone fail to have noticed the dearth of SUV s and four
wheel drives on the road? There was a time you lived in dread of going to the local country shop for the
sheer volume of SUV’s and four wheel drives you’d have to drive in on the ditch for along the way, not
to mention kids mindlessly performing wheelies on quads and boy racers tracking doughnuts into the
road in a James Deane revival which is addicting a generation of youth to danger.

So no health insurance and the repo-man has been and gone: what next? The Credit Unions will
obviously be the next victim of the cascade collapse for the simple reason that it is the one loan
mortgage holders can afford not to pay. While the credit card can be maxed out and ignored the bank
account is key to maintaining mortgage payments and with current account interest rates matching
credit card rates and punitive charges of up to 25% there is little option but to keep that wolf from the
door for as long as possible. So logically mortgage holders who also have Credit Union loans will
renegotiate or cease paying the Credit Union. As members rather the customers they are on a stronger
footing in terms of default and will be advised accordingly by Citizens Advice.

The Government budgetary plans amount to nine more ways of skinning a comatosed cat. The Credit
Union will go up against the wall before the next budget if they proceed an event which will impact
heavily on local economies and local politics. This is Fianna Fail in ‘Hari Kari’ mode. Following on the
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collapse of the Credit Unions more cries for bail outs from the by now state owned commercial banks
which will be hit with by an increasing tide of mortgage holders deferring payment, seeking
moratoriums, loan extensions and revalutations. Irish banks net worth will fall to such a level that
Michael Branson will likely buy the lot on a whim and rebrand the country ‘Virgin Ireland’. Maybe that’s
a good idea? – a fresh start.

Accompanying all of that a surge of health card and disability applications; disserted wives allowance;
single parents; a soaring divorce rate; hundreds of thousands of households added to the housing
register and so forth putting the relevant departments under impossible pressure. More and more
people will emigrate simply closing the doors on their Celtic Tiger homes and leaving for good. Insurance
costs and claims will go through the roof at first car insurance, then household insurance, medical and
life assurance. How many men would kill themselves to save their wife and family the ignominy of
homelessness; how many would deliberately injure themselves to make a claim? My life assurance
policy permits me to commit suicide – Zurich Life. At some point some incensed householders will start
paying gangland figures for hits on the local Sheriff and his staff. People will drive commercial vehicles
through the frontages of Fianna Fail constituency offices in sheer rage before the repo man comes. No
foreign power will intervene knowing the form of the people and of the IRA on whom opportunity will
not be lost. The Army Council will reconvene. AK47’s are as cheap, as easy to use and as effective as
ever. Plus they make a lot of noise which tends to shut a lot of people up; ‘The barking iron’, as its
aficionado’s affectionately call it.

Conclusion

A few weeks ago the Governor of the Central Bank, Patrick Honohan (the highest paid public servant in
the state) was interviewed by Vincent Browne in relation to the Anglo bailout, amongst other things,
and as to whether it had been necessary or not. He said that it had not been necessary and that he had
said so in note 160 something of a report he had written. He said so with all the roguish charm of those
fly by night street jewellery sellers you used to see on Henry Street, dodging the cops between sales. He
apparently thought the fact that the tax payer had been stung for €34Billion (plus) amusing. At the time
I had advocated that the commercial banks be bailed out via domestic mortgage debt to give home
owners a break and ensure they commit to their mortgages because there is hundreds of millions of
vulnerable domestic debt out there, a potential fiscal Tsunami which would dwarf the collapse in the
commercial sector. I plagued Green Party Chairperson Dan Boyle and Fianna Fail on Facebook at the
time, but my efforts didn’t even merit a response. The social media being merely another poodle they
trot out to please the crowd. As events transpired I was right, the money would have been far better off
channelled via mortgages either as very generous interest allowance or as once off payments to
mortgage accounts which the government already has records of. My proposal would have saved the
commercial banks and indebted a generation of mortgage holders to Fianna Fail and the Greens for life;
a trick Fianna Fail played with the upwardly mobile working class in the nineties when Padraigh Flynn
was Minister for the Environment.
There is no guile (John 1: 47) behind this proposal just as there was none in the first instance. It is so
simple that it can be restated in a single sentence: Introduce a mandatory health tax of 10% for all those
without medical health insurance; get the GAA to take over Quinn Health and develop a flagship private
hospital in Dublin Docklands as part of a cyber campus designed to maximise foreign VAT receipts.
That’s it nothing else needs to be done except for the Social Partners to sit down to an honest review of
the excesses of the social partnership process, including the need for a rational review of Irelands civil
administration. There is no reason why health could not become self financing if every worker and
welfare recipient in the State paid their share either in health tax or insurance freeing government
finances from the veritable millstone. This is Pro-Rata in reverse, giving the little guy the boon deal.

There are two simple reasons as to why none of the political parties have fielded this idea:

1. Political parties driven by neo-liberal free market aspirations to privatise health want to see a
system level failure in the delivery of public health so as to justify breaking it up. That includes
the PD Minister for Health and Children, Mary Harney TD; Fianna Fail who borrowed the PD
coat till it wore out during the Celtic Tiger years; and Fine Gael and their FairCare proposals
which are exclusively insurance based.
2. None of the parties on the Labour Left end of the political spectrum have dared suggested
introducing Health Tax, despite the many precedents in Europe, for fear of being politically
outflanked by the ever populist ever clever Fianna Fail. There are those who are ideologically
opposed to the notion of private health insurance on principle despite the fact that the Irish
Health system is ideally suited to a mixed public-private system funded jointly by health tax and
medical insurance.

The social gregariousness of the Irish and their astute political acumen makes them great mixers and
ideally suited to a mixed system; we are a culturally and socially pliable lot and can get along in all kinds
of adverse circumstances. The system we have works by enlarge but is lacking the certainty of a
guaranteed tax and insurance base plus the proper financial control and oversight which ought to be
coming from the Department of Health and Children. Surely there would have been no need for the
PPARS debacle had the Department being doing its job as paymaster and budgetary overseer. As for the
level of duplication within the HSE arising from the ‘Russian Doll’, style merger of the Health Boards into
the HSE and the growing culture of outsourcing the answer is plainly to redeploy staff to where they are
needed in Hawkins House for one and to stop outsourcing work which can be done internally.

Not withstanding the wider arguments for civil service reforms that must be addressed by the social
partners (most notable of which is the excesses created by the pro-rata pay deals) there is a single
solution to this years budgetary problems and that is to apply a ten percent health tax to all those who
do not hold medical insurance and to allow people make that choice for themselves be they social
welfare recipients, low paid, self employed or executive workers. And in addition to invite the GAA to
take over Quinn Health on the basis that another false start would risk the collapsing the medical
insurance business in Ireland. The GAA and Dublin Docklands Development Authority could team up to
develop a flagship docklands renewal project involving a major new private hospital and a campus for
13 | P a g e

cyber corporates , like Google, Facebook and other social media players, software providers and online
bankers like Paypal.

In global terms the resulting revenues are easily guesstimated. With social welfare payments mounting
towards €25Billion/annum a 10% tax would produce €2.5Billion. Assuming that there are at least as
many low paid workers as social welfare recipients, in the region of half a million, one would expect an
additional €2.5B plus. Extending health tax cover to all other workers or self-employed who do not hold
medical insurance is likely to yield as much again bringing the total tax take towards €8Billion. Beyond
that there are the additional medical insurance inputs that would arise from the introduction of a major
new health insurer into the fray. The GAA could literally ‘enculturate’, the notion of medical health
insurance as a ‘civic good’, into rural and provincial Ireland in particular in a way that no other health
provider could making them compatible with the VHI’s urban base.

But who are the ‘Naysayers’, likely to be? A curious lot no doubt. There’ll be a raft of neo-liberal critics
who’ll cry foul as they witness the prospect of the HSE’s €10Billion property folio coming on the marker
at bargain basement prices turn sour. There’ll be a cacophony of social voices decrying the move: some
will protest on leftist ideological grounds - people opposed to the notion of medical insurance on
principle; others by reason of religious or clientelist sentiment will feel it their duty to defend the
vulnerable despite the Irish social welfare system being the most generous in the EU and remember
social dependents without welfare cannot be taxed and therefore will not be charged; and of course
well will have the usual voluminous rhetoric from those who just do rhetoric as a kind of aerobic
exercise.

Let nobody underestimate the seriousness of this moment in Irish political life. Fianna Fail have so far
got all the judgement calls wrong including their ill-fated expansion into the north which now threatens
funding for the third level sector in northern Ireland precipitating more social unrest. If one were told
someone was plotting a revolution one could well believe it so synchronised is the fall but it is just as
likely to be a product of collective bad judgement and the madness that is Ireland.

There is still time to get it right and Minister for Health Mary Harney is the one person that can set
things to rights for she is a Minister without a party, she can do as she chooses and present the case for
the introduction of the Health Tax to Finance Minister Brian Lenihan knowing that it represents a global
solution not only to the budgetary crisis but also to the crisis in health. And to cap it all a major flagship
project in Dublin Docklands which could exceed the International Financial Services Centre in terms of
its economic spin offs. All that is required for this to happen is political courage and the desire to do the
right thing. The courage is there but what about the desire to do the right thing simply because it is the
right thing to do?