In the South we often look enviously at the British NHS.
From the injustice and inequality of our two tier system, from our GP waiting rooms where we will have paid €50 or €60 to see a doctor, we see how the NHS was at the center of the debate in the British General election campaign.
As efforts to push citizens in the South into the private health market are ratcheted up we see the growth of grassroots campaigns in support of the NHS. We have heard the emotive words of campaigners such as Harry Leslie Smith who called on the British people to stand up and defend the NHS.
Yes, we recognise that the NHS has its own problems. Under the Tories it has suffered from cut backs and attempts to pursue a privatisation agenda. And with the election of a majority Conservative government the future for the NHS is far from secure.
But for now the debate is quantitatively different.
NHS campaigners are fighting to keep what they already have – to retain something which many British people feel great pride in.
Here those of us who want to see a universal health system are fighting for something we have never had.
And the odds are stacked against us.
Against us stand the vested interests. The private health profiteers. The proponents of neoliberalism. The EU rules on spending and borrowing brought in by way of the Fiscal (Austerity) Treaty.
But there is too much at stake to let that stop us.
We all know people who have been let down and failed by the two tier health system.
We know people who cannot afford health insurance but have borrowed money to have a cancer test privately because the time they are expected to wait in the public system could put their lives at risk.
And we know people who can neither afford insurance nor to borrow for healthcare but who have to wait. Sometimes in pain. Sometimes in fear.
We have seen public patients with late diagnosis die where private patients survive.
An example of this was the high profile case of health campaigner Susie Long.
Her story of her seven month wait for a colonoscopy in the public health system in 2005.
Her late diagnosis.
Her encounter while undergoing chemotherapy with a private patient who had been referred for a colonoscopy at the same time as her but got it after 3 days.
There have been many other cases just like this.
So many ordinary people whose stories will never be told.
This is an inequality and injustice which many of us are simply not prepared to accept.
So how is it then that we do not have a more vocal public campaign for a national health service in Ireland?
It is back to how this debate is framed and how the dominant political ideology over recent years has seen a greater focus on putting money back in people’s pockets than on strengthening public services.
But for most people on low and middle incomes the pennies they put back in your pocket won’t buy you the healthcare you need. Remember Susie Long’s case occurred in the boom years of the Celtic Tiger.
We need to start discussing how we build a public health system and how we pay for it. And why a progressive tax system that asks those who have more to pay more is the fairest way to do this.
People’s greatest fears around paying more taxes are what that money will be used for. Sometimes the record has not been good – waste and excessive pay have undermined public confidence. But for many they are open to paying more tax if they are genuinely getting a better service for it.
A public health system would mean many people would not have to pay the exorbitant private health insurance costs which they feel they have to pay for at present.
Healthcare and the choice between public and private is a debate that goes to the heart of what kind of society we want to live in.
It is a debate between those who clearly see that the state must stand by the responsibilities which it has progressively adopted over the last two centuries and those who want to minimise the role of the state – a battle between those of us who believe the in the essential value of solidarity between citizens and those who don’t.
For many the United States stands as a forewarning on what you get when you go down the private health route. Gross inequality. Crippling healthcare costs. Healthcare costs pushing up the costs of living.
But it is worth looking to developing countries to understand how bad it can get when governments cut back on healthcare spending at the behest of those pursuing a neoliberal agenda.
In developing states we have seen how the absence of a developed public health service has impeded the ability to control epidemics such as Ebola with consequences for both citizens in those countries and globally.
The question of the IMF’s role in the Ebola outbreak in Sierra Leone is illustrative of the moral bankruptcy of that organization and neoliberalism as a whole. It is illustrative of its incompatibility with social justice. Structural adjustment programmes created the conditions that made it inevitable that the health system of Sierra Leone would not be able to cope with an outbreak of a contagious disease. Sierra Leone along with Liberia and Guinea were engaged in IMF structural adjustment programmes at the time of the Ebola outbreak – the constraints on public spending meant quiet incredibly that Liberia had only 60 doctors before the Ebola outbreak while Sierra Leone had only 136 with populations of four million and six million respectively. For more on this it is worth reading the Lancet Medical Journal’s article of February 2015 entitled “The International Monetary Fund and the Ebola Outbreak”.
While the experience of the countries affected by Ebola is extreme it is ultimately where the neoliberal and anti-public services agenda brings us.
Neoliberalism may seek to make us individually responsible for our well-being but it cannot change the essence of our interdependence.
In working for a universal health system the challenge now is to promote solidarity as a core value, essential to building a fairer society.
We need to counter individualism and consumerism and false freedoms (such as putting the money in your pocket to pay for your own healthcare) that have done so much to destroy societies, communities, lives and the environment.
It is time to recognise that public healthcare provision is a cornerstone of what a progressive state does for its citizens.
As Britain stands on the verge of discarding the great legacy of Aneurin Bevan and the post war Labour Government, in Ireland it is time to build an alliance of ordinary people, patients, healthcare professionals and political representatives to work towards building a universal public health system for all of Ireland.