The biggest single problem with democracy as a system of government is that every single voter – the people with the ultimate power – has a conflict of interest. In the days when Kings ruled by decree, the broadly agreed contract between ruler and ruled was that the King would govern in the interests of the people, and not just in his own interest. This did not always work, because Kings wanted glory and riches for themselves. There was, after all, very little of benefit to the people of England by Richard the Lionheart’s decision to spend years of his reign on a hopeless crusade for Jerusalem. When autocracy worked reasonably well, by contrast, such as under the Medicis in Florence, conditions could be created for arts and culture and economics to boom.
But in a democracy, at least in theory, we are all rulers. And we are all charged, supposedly, with making the very best decisions for the country as a whole rather than just our own interests. If you went back to the ancient Greek idea of democracy, you’d find that the basic concept was that the voters, unlike autocratic rulers, could be trusted to put the interests of the whole state ahead of their own personal interests.
But that’s not how it works, and politicians know it:
More than 78,000 children aged six and seven are to be give free GP care in the coming weeks, the Irish Independent has learned.
Meanwhile, another 400,000 people will qualify through an easier means test. However, due to the pressures on GPs, this will be phased in over the coming months.
It will mean a saving of up to €70 a visit, although patients will still have to pay for medication.
If one was to look at the state of the Irish health service objectively, and identify the problem areas, then the cost of GP care for six- and seven-year-old children would barely make a list of the top 100 problems. We have waiting lists of up to five years for scoliosis treatment for children, for example. The service is so short of beds for the old that, as I reported yesterday, the state is offering €50m for the supply of just 20 extra beds in Limerick University Hospital. The HSE’s over-spend this year will be €1.6bn more than budgeted – at minimum.
Free GP care for children of that age is not going to solve any of those problems – and in fact it may create more problems than it solves. When GP care is free, you go to the GP more often. Irish doctors are already over-worked, and getting a GP appointment in some parts of the country is already exceedingly difficult. Adding more demand to a system that is struggling to meet supply is an act of utter recklessness.
But, it’s popular.
This brings me back to my opening sentence: Every single voter has conflicts of interest. In this case, politicians know well that the parents of 6 and 7 year old children care more about their own children, and their own household budgets, than they care for the overall health of the health service. What’s more, because the responsibility for decision making is so diffused and spread out in a democracy, each individual voter can tell themselves with a degree of truth that voting in their own interests and not the overall interests of the state is rational, and not the reason for the various problems afflicting the country. Thus can a voter favour more housing nationally, so long as it is not in his or her area.
On an individual basis this is of course perfectly rational. But it does strike me that Irish voters in particular seem to have a less pronounced sense of the national interest than voters in many other countries. Consider the example of the United States, where Joe Biden’s recently found unconstitutional plan to write off student debt provoked a storm of opposition from almost half the voters on the basis that such spending was reckless and bad for the country. Or consider the Netherlands, where plans to compulsory purchase farms have provoked a storm of opposition from urban as well as rural dwellers, on the basis that such a thing might not be in the national interest. You will find very few examples in Ireland, by contrast, of voters objecting to state spending splurges.
And that’s the bit of democracy, or at least Irish democracy, that does not work: For democracy to work as intended, voters need to accept responsibility, and blame, for their own decisions and for the consequences of the things the vote for. A direct consequence of free GP care for healthy six and seven year olds will be longer waiting lists for six and seven year olds who have scoliosis, or other conditions.
That’s a decision we are making as a country, and if you vote for it, then you’d best be prepared to shoulder your share of the consequences, and the blame.