During his radio show on Monday 6th October, Stephen Nolan was in familiar territory — challenging SDLP leader Claire Hanna about her speech at the party’s weekend conference. When talk turned to the SDLP’s vision of a New Ireland, Nolan reached for one of the oldest clichés in the book: the idea that healthcare in the Republic of Ireland is “extortionate” and unaffordable.
Then, in the same breath, he admitted that he didn’t really have a clue how the health service in the Republic actually works.
And that, in a nutshell, is the problem.
For years, sections of Northern Ireland’s media – and particularly those resistant to constitutional change – have parroted this line about the “cost of healthcare in the South” without ever checking the facts. The claim is presented as a self-evident truth, when in reality it’s a half-remembered talking point from decades past. It’s lazy journalism, and it badly skews public debate.
The truth is that the Republic has been steadily moving towards universal healthcare through the Sláintecare reform programme – a ten-year plan to create a single-tier health service where access is based on need, not income. Since its launch in 2017, more than €1.2 billion has been invested in reform, with free GP care being expanded to all citizens by 2026, and inpatient and emergency department charges abolished. Prescription costs are capped at €15 per month for medical card holders and €80 per month for everyone else under the Drugs Payment Scheme.
So no, most people in the Republic do not “pay through the nose” for care. Private insurance is still common, but increasingly as a choice for speed or comfort, not necessity. And if that sounds familiar, it’s because that’s exactly what many people in Northern Ireland now find themselves doing.
Here in the North, the principle of care “free at the point of access” is fading fast. Over 340,000 people are waiting for a first outpatient appointment — roughly one in six of the population. Many patients face waits of two to four years for surgery. Private cataract operations, knee and hip replacements have quadrupled in the past year as those who can afford it go private. The Department of Health has even launched a Waiting List Reimbursement Scheme, allowing patients to reclaim money spent on private care — including in the Republic — because the system here can’t deliver on time. Last week’s publication of waiting times for cancer treatment here should be a wake-up call for all of us. The Irish News called them “shameful”.
It’s an irony rarely acknowledged in our debate: while Northern Ireland’s NHS is quietly sliding toward a two-tier model — free in theory but pay-to-access in practice — the Republic of Ireland, through Sláintecare, is steadily moving in the opposite direction, towards universal free care.
That contrast is clear when you look at the direction of travel:
- In Northern Ireland: the NHS remains publicly funded, but chronic underinvestment and abysmal management mean more people are forced to pay privately to get treated.
- In the Republic: patient charges are being abolished, GP care is being made universal, and investment is shifting toward community-based, accessible public care.
So when commentators like Nolan dismiss the idea of a New Ireland on the basis of “healthcare costs”, the question isn’t what it would cost in Dublin — it’s what it already costs in Belfast. We now have a de facto pay-to-be-treated model in Northern Ireland, but without the honesty to admit it.
The myth of expensive Southern healthcare persists for three reasons: it’s politically convenient, it’s rarely challenged, and it relies on selective comparison. Critics quote the cost of a GP visit in Dublin without mentioning the hundreds or thousands being spent privately in Belfast to avoid multi-year waits. Not a day goes past when my social media feeds are not bombarded by advertisements for one of our local private medical providers! Meanwhile, Sláintecare is pushing Ireland toward universality, while Northern Ireland drifts away from it.
If we’re going to have a genuine debate about a New Ireland – or about healthcare anywhere on this island – then let’s ground it in data, not fear. Let’s compare what people are actually paying north and south, and ask where the real value and fairness lie.
Because the uncomfortable truth is this: it’s Northern Ireland, not the Republic, where people are increasingly paying through the nose for healthcare.
If the public debate about Ireland’s future is to mean anything, it has to be based on facts, not myths. The next time Stephen Nolan admits he doesn’t have a clue — perhaps someone should take him up on it, and explain how healthcare actually works beyond the soundbite.
Eugene Reid is a keen observer of all things business and politics. A former elected representative who has had a career working across the private, public and voluntary sectors! Bringing a unique perspective from a diverse and varied background.
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