On the doctrine of inevitability

The News Letter had an interesting article a short while back, reporting remarks by Alex Easton in respect of a border poll and the Irish reunification debate. It is not clear in which context he made his comments, but the headline is that he speculates that nationalists will “inevitably” lose a border poll, and recites a few other well-known tropes. I am not a nationalist, but I feel that his comments reflect beliefs prevalent within unionism around how people like me will vote if or when the big day comes, so I thought it worth spending a little time addressing them. 

The first thing to talk about is the word “inevitable”. Politicians of all shades here seem to feel that history and events are on their side, without ever stopping to consider that both sides cannot be right on this at the same time. Unionist politicians argue that their position is safe because, no matter what, middle class people of an ostensibly nationalist background will vote for the union to protect the block grant and their public sector job. On the other hand, nationalist politicians and activists have argued for many decades that the eventual collapse of the northern state is inevitable on the basis that it is an artificial, unsustainable entity (whatever that means) and because of ongoing demographic change. Recently, they have taken to arguing that the brexit process will hasten this collapse.

This inevitability doctrine lies beneath the hastily-assembled policy veneer that tribally-oriented politicians here wrap up their constitutional ideology in. It carries with it a significant implication, which is that there is no need to make any compromises, face any uncomfortable choices, or do any other work to create or maintain their desired position.

This is why Unionism, despite being holed well below the waterline at 43% of the vote, believes it is taking no risks by dragging the majority of Northern Ireland’s citizens out of the EU, guessing – or perhaps, more accurately, gambling – that those who do not vote for Unionist parties will back staying in the UK union over the option to stay in the EU via reunification. For similar reasons, Sinn Féin makes no effort to address its own toxicity, particularly in terms of its historic association with the Provisional IRA, or its unwillingness to show flexibility on a range of issues, such as the matter of how Irishmen who served the RIC/RUC or British Army should be commemorated, or what should be done with the statue of Nazi collaborator Séan Russell in Dublin.

The second aspect here is the rather flimsy list of benefits that Alex seems to think will turn the trick whenever the border poll arrives. 

First in the list is the claim that, in Ireland, the Fire Brigade charges a fee to attend a private residence in the event of a fire. This is, of course, true, although Alex chose to omit that there are provisions for those who cannot afford the fee, and that the cost of this fee is generally covered by home insurance, which most people would quite reasonably be expected to have in place to cover the damage. He chose not to explain in any great detail why “stick with the union because we’ll use your taxes to pay for the fire brigade when your house catches fire” might be the kind of compelling message that turns wavering border poll voters. I’m not sure that it is. 

The other three points relate to healthcare. Specifically, free prescriptions, free ambulances and free GP access. In some ways, Alex is onto something with this line of argument, because “free” access to healthcare is something that resonates with people here. In an Irish Times article a few weeks ago, Colum Eastwood alluded to the fact that this was a major source of difficulty for the pro-reunification camp. There is real, and legitimate, fear around what could happen to “free” healthcare in the event of reunification.

But I think that if Alex thinks that this seals the deal, he may have another think coming, especially if people begin to question the system that operates here. This is a system which is riven with inequality and is falling apart. For whatever reason, it has proven impervious to political efforts to improve it. 

Lengthy waiting lists have been a fact of life for the best part of a decade now. At present, there is a two year wait for elective surgery. I have heard, anecdotally, of lengthy delays to see oncologists and diabetes specialists. Alex touts free ambulances, but more than once I’ve seen stories in the papers about ambulance coverage being spotty, with high rates of sickness/stress-related absenteeism, and even stories where politicians have had to intervene to get an ambulance out to someone in need. That’s setting aside the fact that A&E wards have had to sound the alarm over overloading during recent winters. He also talks of free GP care in an environment where, depending on your postcode, you could be waiting weeks to see your doctor.

Counter-intuitively, the system that prevails in Northern Ireland actually accomplishes the opposite of what it sets out to achieve in terms of equality. By design, not accident, it effectively subsidises the private sector, as NHS-trained clinicians are allowed to do private work, and use NHS facilities and staff to arrange such work, in facilities that are either operated by the private sector to earn public revenue, or are operated as charities which pay no tax on their receipts. These arrangements are not some Tory perversion of the system, but are aspects that were built in by the Labour government of the 1940s, who had to bribe doctors with generous arrangements to take part. Pushing people into private care and extending waiting lists serves to preserve the illusion of healthcare which is free at the point of delivery. The irony is that this works perfectly well for people who have enough money to afford private insurance or to come up with the money for the fees, who get the benefit of fast-tracked access. Others are reduced to taking out loans or remortgaging their homes, and when those options are not available they are left to suffer.

I am struggling to understand how the system in Ireland could be much worse than this. The poorest third of the population in Ireland receive free healthcare. The next third up from that receive free GP access, so only one-third has to pay to see the GP. Having to pay £50 to see a GP is a pain compared with it being free, but provided charges are not being levied on those who are on lower incomes or are chronically sick, elderly or otherwise vulnerable, I really don’t see it as being a big ask. Hospital charges and other fees are capped, with the promise of further enhancements to come.

Don’t get me wrong. I am not trying to trivialise the fact that healthcare costs can deepen poverty and inequality. I think people should receive healthcare quickly, and on the basis of need, not ability to pay. Nobody should ever face having to make a decision between spending money on their health versus other necessities; nobody should ever face losing their home. It is abhorrent to me that there are lengthy waiting lists and that people are having to scrape together money to pay for private procedures. But I think we need to have an honest conversation with ourselves about what we need to do to solve this. I don’t pretend to have the  answers, but I strongly believe that the healthcare debate in this country is hamstrung by a kind of cultural and ideological exceptionalism, rather like gun control in the US. Addressing this and giving the politicians the flexibility they need to make the really tough calls would be a good place to start.

Returning to Alex’s attempted defence of the Union. If the best Unionism can do to sell it is to promise that the state will pay for the fire brigade when your house burns down, or that the state will pay for a pain-relieving operation after making you wait two years, it can be assured that there is nothing at all inevitable about how people in Northern Ireland’s unaligned centre ground are going to vote. If Unionism wants to save the union, it better get to work on coming up with some tangible benefits that target swing voters, and fast.