So what if James Reilly is the next health minister?
James Reilly has been rewarded for his staunch defence of Enda Kenny in the recent heave by being made Deputy Leader and re-appointed to the front bench in health. So what does Fine Gael’s James Reilly stand for and what will Fine Gael’s health policy mean to the Irish people?
It is not always that easy to tell what James Reilly actually stands for, although it is much more obvious what he’s against. He’s against much of current health policy. He is very critical of the Minister of Health and her policies. He is often dogged in his criticisms of the HSE, their failures, the scandals, the misdiagnoses, long waits on trolleys and for out patient appointments, the failure to invest in primary care.
As a GP with surgeries ‘in Lusk and Donabate’, he’s ‘involved in the development of a new town centre in Lusk to provide medical facilities’ (according to his own website) so quite clearly he is a believer in the entrepreneurial aspect of primary care and in Ireland’s complicated public and private mix of healthcare.
He’s very good at chasing the government on the story of the day whether it is head shops or children in care. He is intent on being the next minister for health and if Fine Gael is the majority party in the next government, that’s where he might well be. He is very ambitious. He is just three years in Dail Eireann, elected in 2007 for Dublin North when he successfully won Fianna Fail’s Jim Glennon’s seat. And once elected to Dáil Eireann, he was instantly made health spokesperson.
Reilly cut his teeth in medical politics – and there is no world not political than that – he was president of the Irish Medical Organisation (IMO) before he was elected a TD and notably Reilly was head of the GP section of the IMO in 2001/2 when they negotiated the extraordinarily high rate for new over 70 year olds.
James Reilly has been instrumental in developing Fine Gael’s FairCare policy. Influenced by Reilly, Enda Kenny set up a Health Commission chaired by Alan Dukes in 2008 that recommended the Faircare policy. Faircare commits to getting rid of the two tier health system by introducing a mandatory health insurance system – so that everyone will be insured.
According to their proposals, people who currently pay private health insurance will pay the same, those with medical cards will be paid for by government, while those without either will have to pay a sum which Reilly says is €200 a year and for that they will get free GP visits, drugs and hospital care.
Faircare was launched April 2009. Since then Reilly, Enda Kenny and Frances Fitzgerald have been busy touring the country selling it to the Fine Gael supporters. Faircare commits Fine Gael to a form of universal health insurance modelled on the Dutch system. And there are three stages to be introduced over a five year period. These include:
- ‘Maximising what we have’ – beefing up primary care and ‘slashing hospital waiting lists’
- ‘Money follows the patient’ and the continued development of primary care
- Free GP care and universal health insurance
So is there anything new in FairCare? The Labour party have been recommending social health insurance since 2001 but their model differs to the Fine Gael one as they envisage one not-for-profit insurer where as the Fine Gael proposal is based on profitable private insurers competing for business.
Lots of Faircare is current policy such as increasing efficiencies in the system, reducing waiting times, building up primary care. Their proposal on ‘money follows the patient’ is inevitable no matter who is in charge and is already being built into the health system, albeit slowly.
It is the universal nature of Faircare so that services will be provided free at the point of delivery to all citizens and access based on need not ability to pay that is the significant development for Fine Gael. A year ago, when they published the policy Fine Gael said more detail would follow. But unfortunately, most of the detail remains illusive.
There are no specific costings except a constant reiteration that no one will have to pay more. And to justify the no additional cost element, they talk about 10% efficiencies, reducing 5,000 HSE staff, increased competition that will drive down costs….
Yet currently the HSE is savings 100s of millions of euros in efficiencies. And where do 5,000 HSE staff go to? Fine Gael say through redeployment, redundancies and to the insurers – is that realistic? Currently the HSE is busy redeploying and pushing redundancies and will private, profitable insurers really want HSE staff, maybe five or 50 but not 5,000.
The Faircare policy says that competition will drive down costs. Yet in Holland where their model is based, the reform took about 20 years to get to the start line and has just been in place since 2006. And while there were reduced costs due to competing private providers in first two years, the costs have gone back up by 10% in 2007 and 2008.
Also government has had to hire about 500 extra staff to regulate the insurance industry, which also costs money and again there is no detail as to whether this will be a new body or given to an existing body.
For such huge change people need to believe it will happen. For it to happen people will need to see real gains quickly. Fine Gael say five years is the timeframe but their own commission recommended a ten year time frame. And their policy talks about setting up “a Universal Health Insurance (UHI) commission in its first 30 days in Government” where they will work the detail with “all the major stakeholders in the health service to agree an implementation plan so that the proven Dutch system of UHI is best adapted to Irish circumstances.”
The international experience is that it would take more than 30 days to get all that done. Also it will totally depend on who they are in government with, the size of the parties and therefore the power. Also currently a Resource Allocation Working Group set up by Minister Harney is due to report and that will influence how the Department of Health proceeds in this area in the years and decades ahead. Unofficially the Resource Allocation Working Group is due to report next week and that they are not coming down specifically in favour of universal/social health insurance. More on this anon.