Waiting till Godot knows when

The surprise at the inaccuracy of waiting lists is, well a surprise. Whatever about public waiting times, try asking the HSE, or any public or voluntary hospital, what the waiting times are for private patients. You will not get an answer. Frame the questions carefully – the answer is only as informative as the crafting of the question.

Ask HIQA. Ditto. They will tell you their assumption is that the information they get from the HSE is inclusive, complete, etc, blah blah. Although HIQA has covered waiting times in its reports, it has never, ever, sought to look at differences in access, as between public and private. Yet, one can infer that HIQA does regard access as a rather important part of “quality” (no doubt a mid-Mediterranean Syrian refugee would agree, as would someone years “waiting” in “direct provision” here).

Public and voluntary hospitals are staffed by salaried public servants. Uniquely amongst these, consultants – some, not all – collect fees from private patients, and these have separate access, almost certainly quicker. The dogs in the street know this, but given the difference isn’t measured, we don’t “know” it as fact, and so have no need to acknowledge it, far less to address it.

The discipline of Public Health Medicine has a lot to answer for too, unfortunately. 

When Departments of Public Health were set up in the old Health Boards, their Heads reported to the CEO’s. Public health research into, or reports on whether or not possession of private health insurance is an independent determinant of health, or highlighting public/private differences in access to public hospitals, wouldn’t have been welcome, and didn’t happen. At one stage, a TD, at a health board meeting, asked its CEO about this matter. The response was that this was a private matter between consultants and their private patients. There was even an expenditure of money on legal advice to defend this position (Bernard Allen TD, Sean Hurley CEO Southern Health Board). That’s about as close as it got.
One would think that unions, so vocal in defence of the ordinary citizen, would have addressed this. No; in fact, many run group VHI and other schemes for their members.

We, the half of the population with private health insurance, are all complicit. We know full well that access to specialist care, either outpatient or inpatient, would take an unknowably long time were we medical card holders, whereas we will be “seen”, usually promptly, as a result of our “serum VHI” levels. And we shrug at any talk about universal healthcare; it might cost more, and drag us down, so let’s just leave it. Rather be looked after by a named Doctor in their “rooms” than examined by God-knows-who in “outpatients”. Bit of a conversation-stopper when you’re not sure who you’re talking too, if you know what I mean. Enough said.

People often buy private health insurance out of fear (Nolan & Wiley). Fear that access to hospital care will be otherwise dangerously delayed. So, poor public confidence in public healthcare is a good thing for private medicine. Utterances over the years, most particularly by the IHCA, reinforce this perception. Public bad, private good, if it wasn’t for us, sure it would be even worse.

No, it’s not the consultants’ fault; they had a contract to die for and why wouldn’t they defend it, despite its perverse economic disincentives wrt public care?

Discussions about all of this, when they occur – in Hawkins House, on TV, at conferences – occur between people virtually all of whom have private health insurance. It’s like men discussing women’s health.

The two-tier public hospital system we have is an international curiosity. Although we like to think of ourselves as amongst the more advanced European nations – those with the enlightened social programmes, and a well-informed citizenry satisfied to fund them – we operate a hospital system that Trump and Co would approve of heartily. Perhaps that is what Irish people want. I wouldn’t know. We’ve never been asked. And anyway, I’ve no solid data on any differences there are in access to public hospital care, between public and private patients. Ignorance is bliss.

Meanwhile, trolleys in A&E? – Cowardly politicians, squirrel-herding managers, wonderful doctors and nurses, more money needed etc – the usual banter and badinage. This too will pass, until the next time. Every Minister for Health is allowed to set whatever policy he/she wants for the people of Ireland, so toxic and Black-Hawk-Down is the portfolio. The time before last, the crowd that “got in” had promised “Universal Health Insurance” – well their prospective Minister had anyway. But that was then, this is now. That was before, this is since. The weak wait a long time in politics.

Healthcare heroes needed; apply within.

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Don’t Pay the Tillman, he won’t get you to the other side

It’s only after watching and listening to Seth Barrett Tillman (had never heard of him, but that’s OK – nor he of me, I’m sure) on RTE a couple of times in last days, that I realised how bad things have gotten, and how much worse they can get, even – gulp – here in Ireland. First, may as well do the emoting, the venting. Trump has encouraged these creatures out from under the rocks, out from the dark caves, where they’ve been glowering and seething, waiting for the opportunity. Or Trump is the manifestation of this dark force – not Caligula, rather his horse (or the ass thereof).

OK, that’s done. Systolic settling, diastolic dodgy still.

The USA is life, liberty and the pursuit of happiness. This hasn’t stopped it from being a beacon, welcoming the huddled masses etc, for yonks. But there has always been that tension. Personal autonomy (AKA looking after #1 and the Devil take the hindmost) and distributive justice (AKA we’re all in this together). The MéFéiners seem to adore the successful (ie wealthy +/- famous) and regard success as evidence of virtue, and see poverty and welfare as proof of vice. It’s a nice, straightforward, easily understood view of the world. And just as a couch potato can be a rabid supporter of an NFL team, a trailer-park, piss-poor (check out the derivation of the description) white guy can be an enthusiastic supporter of Trump. Logic doesn’t follow, irony is loosed and lost, and words mean what Humpty wants them to mean at any particular time.

Back to Seth (way back). The first things that strike are the hard-heartedness, the arrogance, the – well no point beating around the bush – the fascism. Shall we say the quality of his mercy is definitely strain’d. He has that Kellyanne Conway (I cannot be the only human to think she resembles a cast-member of The Walking Dead) habit – perhaps more accurately, method – of weaving insult and alt-truth into answers, not so much productive of a sweet-and-sour as a sour-and-glower flavour to the discourse. Diversion; why is it that so many wealthy white Americans seem so angry, so defensive, so gun-totin’ gung-ho (I appear to live a hyphenated life).

Anyway, the observation what I is leading up to, though trying not to end sentences with prepositions. Working with your international neighbours, through the UN, trade agreements, diplomacy etc, is evidence of a commitment to some kind of international distributive justice, some notion that all people are, well human beings. But, of course, when the slitherers come out (no, stop – rephrase) OK when the MéFéiners hold sway, then things change, and Seth can mock the very notion that America has to do anything at all in the world other than what it wants for itself. Like Trump said, just take the oil; to Hell with them all. And as for his “ancient truths”; methinks he means he who has the lump hammer gets the last slice of pizza.

Irony? Well, I did see the Kippah and the beard. Sad, sad; like that old joke; knock knock who’s there Jesus Jesus who ah how quickly people forget. Etc.

Bay of shamrock, bowl of Pigs

Castro gone. President Higgins sad. In this Trumpalist new world, some reacted in “not my president” style, though Michael D surely knows a thing or two about Cuba. Of course, eisenhower-and-batistaexperience, knowledge, fact, not universally accepted currency any more in a “post-truth” world. Ancient history – Cuba under Batista, an American fiefdom, mobster playground – irrelevant now, in a age of geopolitical creationism.

Perhaps Fidel’s guilt should include Guantanamo Bay – right on his doorstep, and after “human rights” had been invented; how could he turn a blind eye?! The USA, indignant at Castro’s demise, Luke’s pharisee. Senator Ronan Mullen, of that caste. We hope to invade DC, then kowtow again on St Patrick’s Day. Inward investment may follow, a casino or two, perhaps a fruit company. Bananas to spare here.

Really Trying Episode

20161102_095531It’s all a bit confusing. So Duffy was wrong to refer to the threatened Garda strike as illegal and perhaps tantamount to mutiny. But the GRA were fine in denying that what was planned by them in the first place, was a strike. And on RTE yesterday, Duffy’s efforts to explain the context of his remarks are brushed off, whereas the GRA Ciaran O’Neill’s stuttering defence of their plan as “individual” actions, is virtually unchallenged. Regardless of where you stand on the pay dispute, it would be helpful if RTE was not diving headfirst into tabloidisation, in a journalistic equivalent to AIB trying to catch up with Anglo Irish in power-hosing loans out across the counter. Disappointing. Go for a walk.

d’espair

There’s no such thing as “Islamic State”. It is the voice that shouts “Jump!” to the man on the ledge. The late night sucker-punch. The bottle hurled by a soccer hooligan. The ambulance chase. The videoing of crash victims. The courage inside the balaclava. Modern media unleash prurience, remote-control violence outs base instincts. The suicide-bomber enters The Matrix (where there’s a serious shortage of virgin dozens). Drones wash Pontius Pilate’s hands. During the Cold War, a handful had access to the red button, now everyone has, and there is always someone pushing one somewhere. Internet Trolls shit-stir immune. Beheadings are Hollywood. Yet, as always, the Emperor has no clothes; the caliph is in the altogether. Faceless prophet, naked lieutenant.

Latvia’s Cinderella second before Luxembourg takes over

The Greek crisis disturbs and perturbs the whole world. It is in a spin, and a slower one at that. To correct for this, an extra second will be allowed elapse tonight, extending Latvia’s 6-month EU presidency by a precious instant. Hands up all who knew that this European Union of equal partners has been led since January by our brothers and sisters in Riga? Well how about hands up who knew Luxembourg is in the chair from tomorrow? Mmmm. Perhaps we have all missed Ms Merkel regularly deferring to, referring to, through-the-chairing and acknowledging Laimdota Straujuma since January. Come to think of it, Tsipras hasn’t brought up too many points of order with Straujuma either.

Don’t suppose this EU, all-for-one-and-one-for-all, six-monthly first among equals thingy is a cod? Nah, Luxembourg will restore order; “through the chair, please, Germany, through the Chair and thanking you”! There will be no more second fiddle. Time will tell though.

Across from the GPO, Clerys falls without a shot fired

And still no stirrings. No sign of revolution. Whatever happened to the supposed spirit of 1916? Were there no genes passed on, or have they skipped this generation? How will we ever parade next year, celebrating what? Down our main thoroughfare, past its casinos, burger joints, bookies, junkies, and Clerys so recently cunningly captured.

There are so many sad aspects to Ciarán Hancock’s article on Clerys in the Business and Innovation section of today’s Irish Times. He sets out in laudable detail the stealth, planning and ruthlessness of the moves that took down Clerys. There is no comment on morality. It was legal, and that’s what matters. It was “business”. “Innovation”. Maybe Ms Foley and Co should actually get medals, awards, dinners held in their honour; sure doesn’t Denis O’Brien get lashings of them? Perhaps she is the hero of all this; the world is divided between wildebeest and lions and we should hail the hunter and what odds the prey separated from the pack and slaughtered. Sure, doesn’t it keep the herd strong to lose its, well, losers?

I thought perhaps the article, though not deemed worthy of the front page of the IT, would draw editorial comment. Nope, not a sausage. Maybe it’s just me. Perhaps old men merely rail, Lear-like, daft and doting, uncomprehending, out of touch with the new, real Ireland, where people adore and idolise the only thing that matters – wealth. We only hate O’Brien because we’re not him. Or perchance we just feel helpless.

I have seen the faces of those Clerys workers. Hidden, from my gaze at least, are those behind the entities that are OCS (in all its forms), Gordon Brothers, Natrium, D2 Private and Cheyne Capital (I may have seen Ms Doyle’s smug-shot somewhere on the net). But Hancock, in his piece, sets out how between them all, entirely legal, sneaky, cowardly manoeuvres were carefully planned and executed, military-style, culminating in shocked staff shown the door at a moment’s notice. Naturally, KPMG were involved; they can’t lose for winning.

Yes of course, our leaders gave out. Mr Kenny, the longest-serving and most fully institutionalised member of the Dáil, tut-tutted and then carried on giving people good-natured clatters on the back and maiming both logic and language when forced to speak. Mr Martin, the last FF princeling still standing, pressed that well-worn button delivering altar-boy sincerity and worldly-wise sad indignation, then shut up. And Ms Burton, from the party that’s actually supposed to care about this sort of thing, was, well Fr-Ted-irritated kinda, for a while. Mr Adams was annoyed too, though one would have thought the kind of stealth and planning of the Clerys operation might have roused in him a kind of Northern-Bank street respeck.

To whom can we turn? Is this country lost?