Euthanasia in Ireland

I140519_184537_1168815oTextCS_62291243The GMS card review is in full swing..


One Dublin GP reports that half his elderly patients are having their medical cards reviewed. While their original cards were reported as being valid until 2016 and beyond, many have been surprised by a sudden notice from the HSE that their cards are to be reviewed at the end of May, or June. It is essential to realise that losing their Medical cards will not only disqualify them from free Primary Health care at the G.P. Surgery, but will generally push them back on the Drug Refund scheme, where many will have to pay €144.00 per month for their medicines. Many will not be able to afford this.

They will also lose a raft of other benefits that come with the medical card, including social and community supports from the HSE, and various allowances and tax exemptions.

Furthermore, many elderly patients are not able to cope with the pressing demands of this bureaucracy. Many are suffering from cognitive impairment, and a sudden form in the door causes incredible stress for them.

A few fairly random examples of (real) patients so contacted are


81 year old woman, suffering recurrent strokes. Lives alone. Manages with home help, and meals on wheels, with the assistance of the Public Health Nurse and Occupational Therapy. Will not be able to afford any services or medicines. Will not be able to maintain an independent lifestyle
80 year old woman, in subsidised accommodation. Medicines cost in excess of €500 euro a month. Suffers from hypertension, insulin dependant diabetes, stroke, glaucoma, blind in one eye, osteoarthritis. €7.00 over threshold.
80 year old man, early dementia, anxiety state, lives at home, chronic obstructive airways disease, barely coping with social welfare inputs.
88 year old woman in heart failure , with dementia, temporal arteritis, macular degeneration and kidney failure.
86 year old man with atrial fibrillation, incapacitated from osteoarthritis.
87 year old woman with dementia, osteoarthritis, asthma.
89 year old woman post stroke, in atrial fibrillation. Grossly incapacitated, and needs ongoing help
83 year old woman with advanced rheumatoid arthritis and depression.
79 year old woman, incapacitated post bowel cancer , in renal failure, with hypertension.
And  on and on – there are literally thousands of these

Make no mistake what is going on here

This is done in order to buy cheap votes in middle class Dublin. This is done in order to provide medical cards to the largely healthy children of the top income earners in our society. For this pupose the HSE are sacrificing the Sick, the Old and the Infirm.

These moves will definitely shorten these peoples lives lives and speed them to an early grave (another economic benefit, for the state no doubt).

This is  euthanasia by stealth.

These people do not deserve this.

Please Please pass this message on.

Please add your comments in the comment box (above),

and please do not let this uncaring state get away with this preposterous injustice.


Bulldozing Health

Listen to no-one. March on a mantra. Dictatorial government. If you are going down the cul-de-sac, the best policy is to accelerate. Whatever you do, do not lose face, do not re-consider, do not apply any logic or reason. What matters here are ephemeral promises. Catch phrases. “Free health care”, “working smarter”, “money follows the patient”(or not),”UHI”, “Dutch model” etc etc

Then instead of actually delivering those promises, what you actually do is take medical services from the sick and the dying, from the poor and the aged, and you give them to the children of the top earners in society. Children, who by and large don’t need those services, and certainly don’t need them as much as the sick and the dying do.

This week the cabinet gave the nod to the Under-6 scheme without anyone batting an eyelid. There is either no-one in there with the intellectual capacity to see what is going on, or they are all so caught up in their own egos and mantras, that they have blinded themselves to the destruction that they are about to cause.

Two issues are being confused. One is Universal Health Insurance. The second is a free scheme for the Under 6s. These are not the same thing, although many commentators see the latter as a forerunner, or model, for UHI. This is not the case, as the Under 6 scheme is taxation based health care, and the money comes out if the Exchequer. The people who will pay for this are the people who are losing their current medical cards. The people who will benefit from it are wealthier, and less in need than the people who are losing their medical cards. This is a middle class scheme, that is neither founded in logic or in benefaction.

This is all about cynical politics. It is all about electioneering, and it is the depths to which our politicians have sunk. National Health care is a noble aspiration when you can afford it. If you can’t afford it, as in Ireland at the moment, then it robs the poor to subsidise the rich. It takes scarce resources and distributes  them upwards, as opposed to using them where they are most needed. It really is hard not to be cynical.

Going Dutch? Pay for yourself!

Dutch Courage

Dutch Courage

When James Reilly, introduced the idea of the Dutch system in 2008, it was hailed as a panacea for all our ills (literally). For less than the Irish pay in health care (9-10% depending on how you measure it) we could have a single tier system of health care, with no need to maintain any private health care. This is an noble aspiration. All the better since we were assured that the Dutch System was the ideal – equitable, efficient and definitely cheaper than ours. Alas all has not stayed on promise. Dutch families on modest income (€50,000) are paying up to 25% of their gross income on maintaining a health system (1).

A family with a combined income of under €50,000 a year was paying almost €11,500 in health costs in 2012, or 23.5 per cent of income, according to the analysis by the Dutch Health Performance Report for its government. Almost €6,000 of this was for health insurance premiums while the remaining €5,000 related to exceptional medical expenses.”

“Currently, the Netherlands is the biggest spender in Europe and the second (after the US) among the OECD countries.” (2)

This is in one of the richest countries in Europe! There were reports going around that the Minister for Public Expenditure, Brendan Howlin, got a grasp of the facts he said that UHI would bankrupt the country. Clearly an opinion with basis.

Wonderful if it can be achieved, but what chaos there is going to be if the current system is dismantled and a void is left. This is the way General Practice is going now.



Health Warning in General Practice

alexwhiteLabour_large Alex White. Junior Minister for Health, Responsible for Primary care.

G.P.s, impotent in their negotiations with the Government, because of the strictures of the Competition Act, have seen their income eroded by the draconian FEMPI cuts to the tune of 40% in many cases. It is becoming difficult to attract young doctors to this aging profession, as practices become insolvent,  older doctors just get fed up and withdraw,  and younger doctors flee to England, Australia and Canada, where they have some prospects of building a life.

The response to this from the Department of Health, is the production of an non-negotiated contract, that provides free health (for children) to the upper 55% income strata, and the withdrawal of medical cards from older children, the sick and the dying. In true totalitarian  fervour, the contract contains clauses, allowing the HSE to access any patient records, to cancel contracts at will, and forbidding the doctors from ever criticising the HSE. No resourcing for this contract has been even proposed, though there are occasional statements saying that it will be in line with current GMS payments – i.e €70 per child per year, for 24 hour care, 365 days a year.

There is little doubt that if this proposal is accepted and launched, the surgeries of this country would be overrun, with “the worried well” . Data from the U.K. shows that frequency of visiting will increase for this cohort, by a figure of  3 to 5 times, ultimately drowning the General Practice service, and thereby sending sicker people in their droves to the A&E departments. One of the most worrying features in this ongoing situation, is the complete air of unreality that exists in the Government. That the Dept of Health officials can really believe they can sit in their offices and design a system from the ground up, in spreadsheets, and graphs, without once engaging the providers of the services is unbelievable. It is akin to designing a building, without talking to architects or builders or the end users.

James Reilly, Minister for Health, throws out aphorisms and catch phrases, like “the money follows the patient” while destroying the cost base of the primary care  services. The real issue here is that politicians are  constrained by false beliefs and their own propaganda.

  • They believe that giving free health care to the wealthier voters is an election winner. This is a re-run of the “Over-70” fiasco, and will ultimately transfer resources from the ill to the well, from the old to the young, from the poor to the rich. It constitutes all that is bad in Irish politics. It makes for cheap electioneering and lousy allocation of resources.
  • They believe that the National Health Service in England provides better care at primary care level. This is against all the evidence. It can take up to three weeks to get seen in a G.P. setting in England. Irish G.P.s offer a same day service , by and large. English G.P.s spend much of their time chasing quotas. There are many surveys that show a large degree of satisfaction with Irish General Practice, and no evidence that there is a better service in the NHS.
  • They believe that they can legislate a National Health Service without putting in the infrastructure. Ireland benefits from the fact that General Practitioners have provided their own facilities, by and large. No real allowance in any of the proposals is made for capitalising those assets, as the State moves to nationalise the health service. Ultimately these assets will be lost to the health services, as they are sold off as unviable enterprises.
  • They believe that Government can conscript G.P.s  into a poor and underfunded service, by the pincer movements of the Competition Act, and the FEMPI cuts. The aim is to operate a system whereby state enforcement can apply without the hinderance of negotiating rights. G.P.s are already voting with their feet (if young) or their pensions (if older). The contempt for the G.P. in the Department of Health is itself taking a heavy toll.

All this is doubly sad, because the concept of a service free for all is very appealing to G.P.s who are only too aware of the constraints of private medicine. Unfortunately this experiment is akin to Stalinist socialist planning. Looks fine on a spreadsheet, but is not in the real world. Catch phrases at elections, are not the basis of good policy. We could be watching a train wreck in slow motion.

Doctors reiterate opposition to proposed new GP contract – Health News | Irish Medical News | The Irish Times – Mon, Mar 24, 2014.

The scandalous inequity of “Free Health Care” Irish Style

English: Brown Thomas department store in Dubl...

English: Brown Thomas department store in Dublin Ireland (Photo credit: Wikipedia)

I notice that the new range of “Little Lady” products has arrived in Brown Thomas’s premier store. Young ladies aged from two to five can buy, for instance,  a Marie Chantal dress for a mere €160.00. No doubt the Government’s generosity will help to some degree, as the lucky ladies whose parents are able to take them to the Brown Thomas store, will soon, by government mandate, be eligible for Free Health Care.

Thanks to our bankrupted government, which believes that the best way to achieve social reform is to distribute its paltry purse upwards, the richest families in the State will be eligible once again for the state’s largesse, in a re-run of the failed Over-70’s policy. In the political sound-bite fest that is Irish Health Care, there can be no better sound-bite than “free health care for children under five”. Stories about people who cannot afford to take their children to the doctor validate the pressing need for relief for the people who are just above the GMS (State health-scheme) income threshold and below the able-to-pay category. The Government’s solution is to give free health care to all under fives.

The first lie is that there is any such thing  as “free health care”. Health care has to be paid for, and the people who are paying for this bounty, are the very people it was meant to help.

Like all universal benefits in Ireland, including free schooling, free universities, children’s allowances, this new benefit is a transfer of state funds from the poor to the rich. Instead of targeting the money at the very people who need it, the marginalised are being made to share these scarce resources because of the dogma that universal benefit is somewhat on a higher moral plane than helping the distressed directly. Furthermore, many of the marginalised will actually lose benefit because their older children will be excluded from benefits they previously enjoyed in order to fund this particular policy.

The current GMS system covers between 40 -45% of all under fives at the moment, so this new scheme is solely for the benefit of the top 55% of the population. Accepted that a small number of these will be in the marginalised categories, a large number of these will be children from the comfortable backgrounds of the leafy suburbs, and private schools.

Against this, the government have a policy of restricting medical cards, and are trying to cut back 35,000 cards. Many of these will be “marginalised” people who have children older than five years of age, unable to benefit from the largesse of this political cynicism.

Further budgeting is withdrawing the “discretionary cards” given to sick and dying people, who are also being denied access to free health care to accommodate this ideological, illogical political stroke.

It is  a disgrace that the left-wing parties in this country have so little insight to the effect of this sound-bite dogma will have on the very marginalised and very sick that they purport to champion.  It is no wonder that they are floundering at the polls.

In a country wracked with austerity, the Government, has managed to make equity the basis of inequality!

The Consultation

Health care systems

Health care systems (Photo credit: Wikipedia)

As yet, every E.U. citizen has entitlements to be treated for a nominal amount in the public hospitals (unless paradoxically you have private Health insurance !!, when you are not). About 45% of the Irish population are entitled to free G.P. Care and free hospital care, and about 50% of our population have private health insurance. Health expenditure is tax-deductible, and there are a range of schemes that allow tax efficient spending on health.

Providers of health care, can be Government employed, or independent. However, all providers will be working within specific frameworks for delivery, and will have several  agendas themselves. All providers will have a ‘product’ offering, and will have an interest (and I do not mean an exclusively monitory) in the service they supply, which may be very far removed from the interest of the patient. Providers also have a knowledge advantage (which is why people go to them in the first place) but that knowledge is never either complete or comprehensive.

In institutions and hospitals, there may be many agendas, from budgeting, research, staffing, local policies, Department of Health or HSE policies influencing a consultation. In Primary Care, many similar issues arise, and there is also the fact that in Ireland GPs are effectively independent SMEs, with their own funding requirements.

So when a hypothetical patient decides to engage with her doctor, or other health provider, she ends up in a conversation with the provider, the third party coverer, the Government, the service proposal, the knowledge base, and their own financial position. All these factors play a role in the conversation, and the outcome is very much a compromise between all factors.

No country can afford an endless resource in Health, and Ireland, in the middle of an appalling financial crisis, can certainly not afford to offer an unlimited amount of services, especially unvalidated ones.

There has historically been an extraordinary disconnect between what is offered and what is delivered in Ireland. In 2001 The Primary Care initiative set out to offer comprehensive care for all at a General Practice Level. Despite a lot of launches and booklets, it never got off the ground. Currently the Government are proposing free GP care for all, at the same time as they are drastically reducing funding to the sector. GPs already involved in the Priamary Care Teams are withdrawing their support, due to reduction in funding.

The populist slogans of the politicians are are a thousand miles away from the practical delivery of comprehensive GP Care.