“You couldn’t make it up”, they say, when something ridiculous is reported in the media.
As ridiculous government decisions go, one would struggle to find anything more ridiculous than the decision in 2018 to pay GP’s €450 per patient for early pregnancy abortions (requiring an average of 4 GP visits), at the same time as other GP’s are paid €250 per patient for managing a pregnancy to birth (requiring an average of 10 GP visits). That is roughly €110 a visit for prescribing the abortion pill, and €25 per visit for managing a pregnancy over a period of 9 months.
But the journalists at the time did not report it and then say “You couldn’t make it up”; for the most part they did not report it, they said nothing at all. Self-appointed cheerleaders for the new abortion regime, the journalists wanted to ensure sufficient uptake by the GP’s to ensure the new regime’s viability. A blatant bribe to GP’s, in order to achieve this result, was hardly something that journalists could defend, so they did and said nothing. An example of twenty-first century Irish mainstream journalism at its shameful worst.
The bribery worked. As of May 2021, according to a recent reply to a parliamentary question from Carol Nolan TD, 398 GP’s here had signed up for the provision of abortion services. According to the Irish College of General Practitioners (ICGP), a total of just under 3500 GP’s are currently in practice, which suggests that more than 11% of these GP’s are now contracted to provide abortions.
What is harder to understand is the silence of the other 89% of GP’s, at the manifest injustice of the two payment systems. Perhaps they are making their voices heard within the ICGP, or within their own Unions, but (with the abortion regime up for review by the Oireachtas this year) one would have expected more GP’s to speak out publicly. Many GP’s, to their credit, have conscientious objections to abortion and are never going to participate in what they regard as a travesty of good medical practice. They must feel particularly aggrieved that, under this new regime, colleagues are paid more than four times what they themselves are paid per visit.
What would a fair system of payment be, without putting a further burden on taxpayers who already contribute so much by way of taxation to our health services? The following proposal would, if implemented, be budget-neutral, and it would be fair, in that it would not be based on value judgements favouring either side. Many of us who are pro-life, this writer included, deeply resent any of our taxes being spent on abortions which we abhor, but that is what a majority voted for in 2018, and we as democrats must accept that, until such time as we can persuade a majority back to our point of view. But there is no way we should accept abortionists being paid more than pro-life GP’s, and this proposal will rectify this.
Based on 2020 data (55,959 live births and 6,455 early abortions), and average GP payments of €250 for births and €450 for abortions, the total state budget for 2020 under these headings was about €16.9 million – €2.9m for abortions and €14m for births. Based on averages of 4 visits for abortions and 10 visits for births, the total number of visits in 2020 was about 585,400. Combining these totals (€16.9m and 585,400 visits) yields an average payment of slightly less than €29 per visit. Let us round this up to €30.
This is the proposal: Pay all GP’s €30 per visit, whether they are aborting babies or helping bring them to birth. Those aborting babies would receive €120 for 4 visits under this proposal, the pro-life GP’s would receive €300 for 10 visits. Neither side is receiving more favourable treatment. The overall budget is unaffected. Of course, the GP’s providing the abortions would receive far less than they are receiving currently, but what they are receiving currently is ridiculously unfair.
One final point. Abortion rates here in the last two years have varied greatly by county. This has happened in other countries too, and the general pattern has been that areas with greater population density have higher abortion rates. But in Ireland we have a system where the woman presenting for an abortion receives no mandatory counselling, it depends entirely on the attitude of her GP, and this might also be a factor in regional variation. In most counties, no more than one or two GP practices provide abortions. A county where the GP’s dispense with counselling might, for that very reason, have a higher abortion rate than a neighbouring county, where the GP takes the trouble to listen to the woman’s concerns and perhaps outlines alternatives to abortions. If the payment is far more when the woman proceeds with an abortion, than when she proceeds with her pregnancy, a GP might have a vested interest in dispensing with counselling, so as to receive a higher payment for less work. Equalising the payment per visit would remove any such temptation, and might bring our abortion rates down.
As things stand, unfortunately, the state’s financial arrangements with GP’s are such as to encourage abortions and discourage births. Which, in a country with a rapidly declining birth rate, and leaving aside all considerations of morality, is bordering on the insane.