Fixing our public health service

I had been looking forward to hearing President Barack Obama deliver his speech to the American Medical Association in Chicago to see how he would tackle this major issue that troubles the conscience of American society. Many critics had serious doubts about how soon the US President would try to get to grips with this important social issue in the context of an even more pressing political priority - fixing the US financial system.

Facing a sceptical audience of doctors, President Obama was his confident self. He used his powers of persuasion while at the same time he did not shy away from telling things that his listeners did not want to hear. His social and political credentials that make him the only world political leader that enjoys admiration and respect everywhere were evident when he stated:

"We are not a nation that accepts nearly 46 million uninsured men, women and children. We are not a nation that lets hardworking families go without coverage they deserve, or turns its back on those in need. We need to get this health care reform done." The usually Republican-leaning doctors gave Mr Obama a standing ovation when they heard this evidence of political vision.

Our health system too needs an overhaul. While our public health service is in some ways more generous to those in the lower strata of our society, it still needs urgent attention to ensure that we do not develop a two-tier health system - one for the rich that can afford private health care and the other for those who have to make do with what the state provides.

The symptoms of an unsustainable health system are all there - shortage of doctors, long waiting lists for life-enhancing surgery, frequent shortages of vital medicines at the government dispensary, and diagnostic medical equipment that frequently breaks down causing delays in the provision of critical medical tests.

Scarce, but critical, preventive screening for a population that generally has little appreciation of the importance of a healthy lifestyle is yet another symptom of a failing health system.

We may have a state-of-the-art hospital, but we cannot honestly say that we have a state-of-the-art public medical service. As our population ages and demands better health care, the human and financial capital in our hospitals is dangerously inadequate. Rationing of limited resources is becoming increasingly evident.

We have a good free public medical service for those needing urgent life-saving treatment. We should be proud of this. But we also need to be more ambitious for our people.

In the UK, for instance, the NHS has just introduced a preventive screening programme for those over 40 in order to identify hidden problems, advice on healthy lifestyles to reverse health threats to individuals, and prescribe preventive medication when this is likely to improve further health prospects of various people.

We should be aspiring to emulate such medical practices. But we need to remember that money does not grow on trees. To support the sustainability of our public health services we need to re-engineer the way of managing this service. The financing of our public health system needs to be deficit neutral to be viable.

Social priorities must remain paramount. Elderly people and those who cannot afford an adequate private health cover need to be protected through free public medical services. For the rest of us, we need to discuss honestly how we can finance the cost of running a universal medical service that provides good basic care to all those who need and want it.

There is enormous scope for improving the way we manage our national health services. We can start from basic fundamentals like the maintenance of patients' medical records, the management of our hospitals, and the employment of medical and paramedical staff. Similarly, a war on waste and abuse can reap results that will save us millions of euro every year.

As the cost of aging becomes overpowering, now is the time to start a debate on health services reform. But like President Obama, our politicians need to be guided by principles of social solidarity and economic pragmatism when they draw the blueprint for our public health plans.

johncassarwhite@yahoo.com