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Do we pay too much tax for crappy services?
Comments
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The HSE is an excellent example of an inefficiently run public service, in fact it's a perfect microcosm of the worst aspects of public sector inefficiency:
Expensive, poor service delivery, lots of cushy numbers for overpaid staff poorly performing redundant tasks who cannot be fired.
Ironically but characteristically it combines this inefficiency with an often crushing workload on frontline staff who work hard performing the essential healthcare tasks and who basically keep the show on the road. A similar dichotomy can be found in much of the public sector and it explains why many public servants who work hard resent generalisations about it, however well founded, as "public sector bashing".
The health service also has a unique amount of profiteering by private interests, most visibly private consultants who take advantage of the two tier health system to the detriment of the public interest despite them experiencing first hand the negative effects of this in their public practice and career up to this point. This is a cultural blindspot within the medical profession where junior doctors bitch hard about their unconscionable working hours and conditions but wilfully refuse to join the dots between this and the two-tier system they hope to make a killing off as private consultants once they climb up the ladder.0 -
I hope for your own sake that you never have the misfortune for requiring the HSE. The HSE is an uter shambles, a corrupt, inept disgrace. If you gave someone a mandate on how to squander money and setup something so unfit for purpose they could not manage to create something as bad as the HSE.
4-5 year waiting lists, over paid useless staff. Scrap PRSI and privatise the HSE and let the private sector deliver it with insurance. We should be left to opt out of the HSE since it is worthless.
The US healthcare system is not the model we should be looking to aspire to.0 -
CrankyHaus wrote: »The HSE is an excellent example of an inefficiently run public service, in fact it's a perfect microcosm of the worst aspects of public sector inefficiency:
Expensive, poor service delivery, lots of cushy numbers for overpaid staff poorly performing redundant tasks who cannot be fired.
Ironically but characteristically it combines this inefficiency with an often crushing workload on frontline staff who work hard performing the essential healthcare tasks and who basically keep the show on the road. A similar dichotomy can be found in much of the public sector and it explains why many public servants who work hard resent generalisations about it, however well founded, as "public sector bashing".
The health service also has a unique amount of profiteering by private interests, most visibly private consultants who take advantage of the two tier health system to the detriment of the public interest despite them experiencing first hand the negative effects of this in their public practice and career up to this point. This is a cultural blindspot within the medical profession where junior doctors bitch hard about their unconscionable working hours and conditions but wilfully refuse to join the dots between this and the two-tier system they hope to make a killing off as private consultants once they climb up the ladder.
If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.0 -
I think everyone agrees the HSE needs reform, but to suggest the US model is the solution, where getting sick can literally bankrupt an individual, is laughable.
The US model is great for people who are rich. Not so much for the rest of society.0 -
I think everyone agrees the HSE needs reform, but to suggest the US model is the solution, where getting sick can literally bankrupt an individual, is laughable.
The US model is great for people who are rich. Not so much for the rest of society.
It's not even great for people who are rich, even if you have the better half of a million quid on the bank nobody is happy paying 10 grand + for simple medical procedures such as fixing a broken leg etc. The only people it's great for is the people running the insurance companies.0 -
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If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.
You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.
Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.
Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.
I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.
Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.0 -
If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.
I suspect you did not read my post in full.
Much of the problem with the HSE is in fact the private elements creating a two-tier system. This is not merely inefficient in itself. It also works against reform of the HSE, as those who have the most say (the rich and powerful) are protected from its failings by private insurance. Furthermore the long term policy of our parties of government, FG certainly and most likely FF, is towards an Insurance led system, so there is no appetite to sacrifice any political capital by reforming the HSE. Do not forget that the HSE was formed under Minister of Health Mary Harney (PD) in an FF-PD coalition.
The Insurance led model has some advantages but international comparisons show it tends towards higher costs, sometimes much higher when profiteering runs rampant (the US).
Of course to save public services from privatisation the services have to prove themselves worthy of saving by serving the public well or public opinion will side against them. Our public sector unions have been astonishingly incapable of realising this, with the result that more and more services have been ceded to the private sector to the satisfaction or at least apathy of the public who got sick to the back teeth of being treated like dirt by a self-serving platitude-spouting Labour Aristocracy.0 -
You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.
Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.
Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.
I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.
Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.
Private is again, not always the answer, nor is a state that is completely non unionised. One only has to look at the situation in the states where employees routinely get 10 days annual leave, have to work more than one job just to keep bread on the table and where there is abject poverty. These are not good things for anyone or society in general.
Take a look at the work of unions in the private sector here and you'll see employees rights are well protected.
https://www.rte.ie/news/business/2019/0710/1061284-compensation-paid-to-paddy-power-staff-over-breaks/
Tearing the HSE to the ground and starting from scratch isn't an option - whatever change is needed has to come with the co-operation of the unions.
"Let the consumer of healthcare pay" you say - we are all consumers of healthcare in one way or another.0 -
CrankyHaus wrote: »I suspect you did not read my post in full.
Much of the problem with the HSE is in fact the private elements creating a two-tier system. This is not merely inefficient in itself. It also works against reform of the HSE, as those who have the most say (the rich and powerful) are protected from its failings by private insurance. Furthermore the long term policy of our parties of government, FG certainly and most likely FF, is towards an Insurance led system, so there is no appetite to sacrifice any political capital by reforming the HSE. Do not forget that the HSE was formed under Minister of Health Mary Harney (PD) in an FF-PD coalition.
The Insurance led model has some advantages but international comparisons show it tends towards higher costs, sometimes much higher when profiteering runs rampant (the US).
Of course to save public services from privatisation the services have to prove themselves worthy of saving by serving the public well or public opinion will side against them. Our public sector unions have been astonishingly incapable of realising this, with the result that more and more services have been ceded to the private sector to the satisfaction or at least apathy of the public who got sick to the back teeth of being treated like dirt by a self-serving platitude-spouting Labour Aristocracy.
Actually, wasn't that Michael Martin? The current leader of FF?
The key thing about the HSE and any public service is that we lack the ability to reform it, in any way shape of fashion.
When the politician is the guy wielding the axe but also looking for your vote, what are they going to do? Put away the axe and look for your vote
It's an impossible position really but that is why we need strong leadership but I agree, the unions are a terrible influence on the public sector. They represent their members fine, but the manifestation is the public services we have to interact with daily. Generally poorly run, inefficient, expensive and working in an old fashioned archaic manner.0 -
Tearing the HSE to the ground and starting from scratch isn't an option - whatever change is needed has to come with the co-operation of the unions.
When are the Unions ever interested in change?
They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.
Unions were fine in the times before strong employment law, but in today's modern workplace, they are mostly out of date and hold the country to ransom.0 -
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When are the Unions ever interested in change?
They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.
Unions were fine in the times before strong employment law, but in today's modern workplace, they are mostly out of date and hold the country to ransom.
You've obviously missed the past 10 years or so. Plenty change has taken place. I am not saying it's been easy but unions are not against change. They want to protect their workers rights - granted going to far sometimes to do so.
Look at the link I've posted to see why you still need unions even in this age of "Strong Employment Law"0 -
Actually, wasn't that Michael Martin? The current leader of FF?
Michael Martin was Minister when the law establishing the HSE was passed but Harney was Minister when it was founded. I actually think that in long term health policy there was/is little difference between FF, The PDs, or FG: a slow drive towards an Insurance model with minimal sacrifice of political capital to fix the ailing public health system so that eventually few will mourn its demise. Beyond giving out some goodies to win votes Ministers of any party make minimal changes as it is seen as a career ender: whether that was Cowen describing it as "Angola" or Leo doing SFA there while giving constant press soundbites on other department's performance.0 -
You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.
Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.
Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.
I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.
Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.
You'll pay 200 a month, but then you or someone in your family are unfortunate enough to become ill with something and your 200 a month premium suddenly triples to 600 a month next year because you're high risk.
But you can't move insurer, because you have a pre-existing condition, and no other insurer will touch you, or they load your premium to account for your condition.
Then next year, the insurance company decide that your condition is no longer covered on the payment plan you are on, you need to upgrade to a higher package. So it goes from 600 a month to 800 a month.
You can't afford this, so you let your insurance lapse. Which means treatment stops. But then your son or daughter has a fall and breaks their leg, and you get a bill in the post for 30 grand that you now owe for the hospital fees and various consultant fees and use of equipment.
The American system is rubbish. Big Pharma and insurance companies have been lobbying against reform of their system for years, because it'll end up hitting their profits if they move closer toward a semi-socialist health model.0 -
You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.
Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.
Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.
I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.
Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.
Trade unions are a better option than private shareholders IMO.
We pay tax because as a society we feel pooling our money best serves everyone equally in regards to health and other matters. When you bring in privatisation you bring in inequality and society suffers as a result. Irish society isn't a business. You don't treat your family based on how much money they make.0 -
You've obviously missed the past 10 years or so. Plenty change has taken place.
Can you give us some examples of this change?I am not saying it's been easy but unions are not against change. They want to protect their workers rights - granted going to far sometimes to do so.
In my experience its the default position that Unions adopt in Ireland. Any change has to go through extensive negotiations and in exchange for more allowances or wage increases. Just look at the farce of Irish Rail train drivers refusing to give up their overtime and train new train drivers.0 -
CrankyHaus wrote: »Michael Martin was Minister when the law establishing the HSE was passed but Harney was Minister when it was founded. I actually think that in long term health policy there was/is little difference between FF, The PDs, or FG: a slow drive towards an Insurance model with minimal sacrifice of political capital to fix the ailing public health system so that eventually few will mourn its demise. Beyond giving out some goodies to win votes Ministers of any party make minimal changes as it is seen as a career ender: whether that was Cowen describing it as "Angola" or Leo doing SFA there while giving constant press soundbites on other department's performance.
I think the days of a political party or a Minister standing up and proclaiming to fix the HSE or the health service for all, are over.
Every politician realises that the HSE is just too big a job for anyone party to fix, it needs buy-in from the entire political establishment.
This is why Slaintecare was launched by a cross-party committee.
https://health.gov.ie/blog/publications/slaintecare-action-plan-2019/
However, to get real change, needs cross party leadership and the ability to let people go who are surplus to requirements. This needs maturity from all parties.0 -
Matt Barrett wrote: »Trade unions are a better option than private shareholders IMO.
We pay tax because as a society we feel pooling our money best serves everyone equally in regards to health and other matters. When you bring in privatisation you bring in inequality and society suffers as a result. Irish society isn't a business. You don't treat your family based on how much money they make.
Spinning two separate yarns as usual Matt.
Feelings have nothing to do with the reality of the situation.
Where is your 'purely accountancy driven cost assessment' when it comes on taking on public vested interests and the Trade Unions? Or do you think they are operating at maximum efficiency?
You are only interested in saving the taxpayer money so long as it's ideologically convenient and sacred cows are saved because privatisation is inherently bad? Am I right?
I also include the Irish Hospital Consultants Association in the Trade Union bracket by the way, arguably the most powerful 'Union' in the state, along with the National Association of General Practitioners. Do you think we get good value for money from their €252,000 annual salary?
As to the privatisation argument, some level of privitisation is good, as it relieves the public system. The more patients that can be treated by private doctors and hospitals means fewer people reliant on the public system. A hybrid system is what is best and what they have in places like Germany and Holland, where an insurance-driven model to delivering health care is optimal, with people unable to afford insurance being given subsidised insurance by the state.
We should look at this problem with an evidence-based approach, not dogma or misty-eyed ideology or 'feelings'.0 -
Can you give us some examples of this change?
In my experience its the default position that Unions adopt in Ireland. Any change has to go through extensive negotiations and in exchange for more allowances or wage increases. Just look at the farce of Irish Rail train drivers refusing to give up their overtime and train new train drivers.
I suspect it doesn't really matter what examples I give, you will most likely find an issue.
1. The biggest change within the public service in the past decade is the increase in standard working week. Strangely enough there was no pay rise associated with it, the opposite in fact.
2. The move of a large number of departments to a shared services model of HR and Payroll (Peoplepoint and the like) This is ongoing.
3. The increased provision of digital services to the public.
4. The centralised tendering and associated frameworks systems to increase efficiencies in procurement.
5. The merging and consolidation of a number of different bodies.
A few hundred other things as well.....
https://reformplan.per.gov.ie/2014/downloads/downloads.html
There are examples like Irish Rail, but that shouldnt be the standard that gets applied to all.0 -
Spinning two separate yarns as usual Matt.
Feelings have nothing to do with the reality of the situation.
Where is your 'purely accountancy driven cost assessment' when it comes on taking on public vested interests and the Trade Unions? Or do you think they are operating at maximum efficiency?
You are only interested in saving the taxpayer money so long as it's ideologically convenient and sacred cows are saved because privatisation is inherently bad? Am I right?
I also include the Irish Hospital Consultants Association in the Trade Union bracket by the way, arguably the most powerful 'Union' in the state, along with the National Association of General Practitioners. Do you think we get good value for money from their €252,000 annual salary?
As to the privatisation argument, some level of privitisation is good, as it relieves the public system. The more patients that can be treated by private doctors and hospitals means fewer people reliant on the public system. A hybrid system is what is best and what they have in places like Germany and Holland, where an insurance-driven model to delivering health care is optimal, with people unable to afford insurance being given subsidised insurance by the state.
We should look at this problem with an evidence-based approach, not dogma or misty-eyed ideology or 'feelings'.
Isn't that essentially the situation here give or take.0 -
When are the Unions ever interested in change?
They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.
swap in unions for taxpayers
then voters
then self employed
then professionals
then trades
then pensioners
the students
then the lower paid
then the unemployed
look just swap in people into the above codswallop and be done0 -
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I suspect it doesn't really matter what examples I give, you will most likely find an issue.
1. The biggest change within the public service in the past decade is the increase in standard working week. Strangely enough there was no pay rise associated with it, the opposite in fact.
2. The move of a large number of departments to a shared services model of HR and Payroll (Peoplepoint and the like) This is ongoing.
3. The increased provision of digital services to the public.
4. The centralised tendering and associated frameworks systems to increase efficiencies in procurement.
5. The merging and consolidation of a number of different bodies.
A few hundred other things as well.....
https://reformplan.per.gov.ie/2014/downloads/downloads.html
There are examples like Irish Rail, but that shouldnt be the standard that gets applied to all.
Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.
The fact now though is that the Unions want to go back to their 35 hour week.
https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961Public servants are to seek a shorter working week and the abolition of extra hours agreed during the financial crisis, in a move the Government estimates would cost more than €600 million.
So yea, not exactly a ringing endorsement of Trade Unions facilitating change.
Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.0 -
Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.
The fact now though is that the Unions want to go back to their 35 hour week.
https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961
So yea, not exactly a ringing endorsement of Trade Unions facilitating change.
Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.
lol
"change happened but the unions didnt propose it
also all those changes dont count"
listen, would u not.0 -
Isn't that essentially the situation here give or take.
No. We have a system where if you can afford private insurance you grab it, as otherwise, you will be waiting years for elective procedures. Many times these will be done in public hospitals anyway, it's just a method to skip a queue, or perhaps get a nice rebate if you have something done privately.
Otherwise its a mess, as there is no imposition on the HSE, the hospitals or any publicly funded health provider to up their game and offer services in a more efficient manner. The Dutch model, the money follows the patient, therefore the patient has a choice to what hospital to go to.
We have the youngest population in the EU yet have one of the worse outcomes in terms of spend per captia.
Money is not the issue, its the system itself is not fit for purpose and to fix or reform the system, eggs have to be broken, so to speak.
HSE overspent for last year is projected to be over €700 million. I can't find the link right now, but I heard that since 2012 or so, HSE overspent the guts of €3 Billion, the cost of a new Children's Hospital.0 -
Deleted User wrote: »lol
"change happened but the unions didnt propose it
also all those changes dont count"
listen, would u not.
The point I was making was thus:
A poster stated that Unions are not against change in an earlier post, yet as I demonstrated they clearly are. Change has to be forced onto them, usually, by negotiation but sometimes unilaterally in times of a crisis.0 -
As I said:Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.
The fact now though is that the Unions want to go back to their 35 hour week.
https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961
So yea, not exactly a ringing endorsement of Trade Unions facilitating change.
Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.
"I suspect it doesn't really matter what examples I give, you will most likely find an issue."
You asked me to give you examples of change. I gave numerous examples and linked you to a plethora of documentation around public service reform and documents that reviewed the success of that reform. These reports would contain the metrics and benchmarks you are looking for but look, it's much easier continue with an opinion not based on facts.0 -
The point I was making was thus:
A poster stated that Unions are not against change in an earlier post, yet as I demonstrated they clearly are. Change has to be forced onto them, usually, by negotiation but sometimes unilaterally in times of a crisis.
But surely if Unions are against change, there would be no change?
(Change is of course a very broad catch all)0 -
No. We have a system where if you can afford private insurance you grab it, as otherwise, you will be waiting years for elective procedures. Many times these will be done in public hospitals anyway, it's just a method to skip a queue, or perhaps get a nice rebate if you have something done privately.
Otherwise its a mess, as there is no imposition on the HSE, the hospitals or any publicly funded health provider to up their game and offer services in a more efficient manner. The Dutch model, the money follows the patient, therefore the patient has a choice to what hospital to go to.
We have the youngest population in the EU yet have one of the worse outcomes in terms of spend per captia.
Money is not the issue, its the system itself is not fit for purpose and to fix or reform the system, eggs have to be broken, so to speak.
HSE overspent for last year is projected to be over €700 million. I can't find the link right now, but I heard that since 2012 or so, HSE overspent the guts of €3 Billion, the cost of a new Children's Hospital.
I'm not disagreeing with you in general on the HSE and the fact that there is lots of room for improvement.0 -
As I said:
"I suspect it doesn't really matter what examples I give, you will most likely find an issue."
You asked me to give you examples of change. I gave numerous examples and linked you to a plethora of documentation around public service reform and documents that reviewed the success of that reform. These reports would contain the metrics and benchmarks you are looking for but look, it's much easier continue with an opinion not based on facts.
I asked for examples of change, that Unions would be interested in.
All I see there are examples of change hoisted on top Unions forced on by the Government.
The first example you gave about the increased working week, is at this time is being used as a threat to strikes unless that change is rowed back!
What is your opinion on that?0 -
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I asked for examples of change, that Unions would be interested in.
All I see there are examples of change hoisted on top Unions forced on by the Government.
The first example you gave about the increased working week, is at this time is being used as a threat to strikes unless that change is rowed back!
What is your opinion on that?
You asked for examples of change. I gave a small portion of them. If the unions werent "interested" in that change - it wouldn't have happened
Now you're moving the goalposts. That's grand.
It's a pointless debate.0
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