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.

Ireland invited to join mile high club

It’s mortifying really. And with the whole world looking on. Will we never learn? If only we’d accept our ignorance and listen to our betters. It’s no wonder Mr Walsh from IAG had to get cross in front of that bold Oireachtas Transport Committee. He told us he’d only tell us once, and that if he had to come back, he’d be really annoyed and we wouldn’t like it.

And Mr Byrne from City Jet laid down the law too. We’re just plain stupid – gombeens – or at least the people we elected to look after our country and our things, they are. And Mr Barrington the Aer Lingus Chair says we’d be mad not to sell our Aer Lingus stake, and he should know, since he already does business with Mr Walsh and thinks he’s great.

It’s clear that Messrs Walsh, Byrne and Barrington are very eager for we Irish to sell our Aer Silverware. They are sure it will do us good. They have no personal interest, they only want us here in Ireland to be happy. And this they promise will make us happy. And we dither. Mortifying. They realise that grown-up decisions like this shouldn’t be in the hands of the governments of democratic republics. It must be very frustrating for them.

And Mr Worth speaking personally, and Deputy Rabbitte speaking personally, also want us to sell.

We’re just too stupid. We’re walking around the airplane, kicking the tyres, while the nice man is telling us it’s a snip, a bargain, are-we-mad-or-what, a-chance-like-this-won’t-come-again. Sigh. Soooooo embarrassing.

Galway Remand

At Galway Distinct Court today, a woman was reminded in custard following her appearance on several charges of blasphemale, incitement to hate dread and pubic disorder. Judge Allthedishes Mahogany remarked that while Growonya Whale was “great gas”, he was obliged to take a damn view of her antics. He granted her request for free lucozade. Given she had no visible means of supper and was of no faxed adobe, he opined he was left with no choice but to enslamate her until her next curt appearance. “No bodder, Yer Onher” consoled the defendant, “I’ll see you here again when you’re free”.

Ms Whale faces charges arising from her a disturban on Shop Street in the town of Galway. She was arrested while dancing outside Griffins bakery, wearing a priest’s collar, a burka, and nothing else, repeatedly shouting “I’m a Charlie’s Angel”. Several passersby approached Ban Garda Monica Sago to complain. Garda Sago outlined the complaints in court. Citizens had variously felt insulted, embarrassed, short-taken, threatened, intimidated, mortified, assailed by impure thoughts, religiously persecuted, discomfited, holocaust-denied, and generally plussed off. Judge Mahogany appeared non-pissed at the charges, remarking “sure it was only a bit of craic, wasn’t it?”? and “I haven’t a clue where to put that question mark”. The punctuation mark was remanded in quotation.

Ms Whale personally thanked all present for their presence. It was agreed, given her religious persuasion, that she would be provided with a compass while in jail, so as to know which direction was One.

Denis O’Brien buys Swedish Academy, looks headed for clean sweep of Nobel gongs

The continuing impression of Denis O’Brien is of a teddy bear seething with resentment, so hurt he’s not loved that he intends mauling everyone and everything in sight, out of spite. Why can’t I have my just desserts? “Denis O’Brien, multi-millionaire genius businessman and philanthropist, loved and admired by all and sundry”. From various factor 50 sanctuaries whose denizens have little interest in tribunal findings of corrupt payments, he sues everything that moves, dispenses lorry loads of what looks like conscience money, and his media empire metastasises through what’s left of Irish journalism. And still the loathing grows. Fetch me my lawyers, I feel another lawsuit coming on. Only kidding about Nobel. Anyway, Norway runs the peace prize. For now.

Let’s have a ReferEndaum

Politics has indeed been reformed, as promised. Well, re-formed anyway. We remember with a shudder Minister you-know Richard you-know Bruton you-know, traipsing the airwaves in support of the referendum proposal to abolish the Seanad. Proudly keeping the FG promise to radically you-know reduce you-know the number of politicians by 30% (so there’d be lesser, or fewer even). Of course 90% of the reduction would be made up of the 60 axed senators. The Dáil chicken involved in the breakfast of reform, the Seanad pig rather committed.

The Constituency Commission had been given a hospital pass in its terms of reference. Whereas Enda had personally suggested demolishing the unfinished estate of the Seanad, and was happy to  put it to a referendum, reducing the number of TDs was far too important to be put to the people. And sure, the Constitution says there has to be at least one TD per 20,000. Bingo. Even bango bongo.
So the Commission recommended reducing TD numbers by, wait for it, you-know, 8. From 166 to 158. And half the boundaries in the western world have to be redrawn even for that tiny change. Radical reform indeed. Another promise kept. Tick the box. Universal Healthcare? Mmmm, let’s give cards to red-headed 20-30 yearolds this year, OK? Maybe next year, to people born in March in uneven years. Tick.

Here in God’s own country in Galway West, we will still have 5 TDs, marking each other daily, our own little eternal cold war. Legislating now and again, when they’re let, but potholes always more important than holes in the ozone layer. Every filled pothole five times welcomed.

Enda lied of course. The longest serving member of the Dáil, institutionalised therein to a jaw dropping extent, content to insult the intelligence of the populace with cynical promises.

A referendum to see if we agreed with him that the Seanad should go. A Constituency Commission precluded from suggesting Dáil reforms that would require a referendum.

We need to be more like the Swiss. Lashings of referenda, even referendums. Trust politicians not. Involve the people. Honestly Enda, we don’t mind one bit voting  a half dozen times a year on things that matter to us. It’s called democracy. No, I’m not suggesting that FF or SF would be better. It’s just you very specifically promised reform, and a better democracy, and wilfully and cynically did the opposite.

Ansbacher Remediation offer from Sinn Féin

In a further twist, Sinn Féin President Gerry Adams has offered to arrange the shooting or banishment of all those named yesterday in the Dáil by Mary Lou McDonald. “And if any of the victims – and by that I mean any of the long-suffering and oppressed people on this island – have other names, no problem. Just tweet me and they’ll be taken care of too”. Adams commented that he felt it “smartalecky” for anyone to suggest that the £25M haul from the 2004 Northern Bank robbery in Belfast would more than cover any Revenue losses arising from offshore accounts, and further denied that he would personally have two pensions as a result. Nor would he name any of those involved under cover of Dáil privilege. “Dáil privilege doesn’t stop bullets” he explained.