According to the official documents produced by the Irish Government’s Department of Finance yesterday, the budget announced by Michael McGrath and Paschal Donoghue yesterday will provide, next year, 22.2billion euros for spending on the Department of Health. 820million euros of this will be capital spending: Building new hospitals and medical centres, and buying new equipment. The rest, about 21.4billion euros, will go on day to day spending. Wages. Medicines. Running costs. Grants to people, like Medical Cards and GP cards.
This is an astonishing amount of money. It represents over a quarter of all Government spending. No other department comes close. The only department which gets more is the Department of Social Protection, which doles out unemployment benefit, pensions, fuel allowances, and all the rest: That will come in at just over 23billion euros. Education, coming in third, gets just 9billion euros.
The UK, by contrast, spends just about a fifth of its budget on the National Health Service. As a share of Government spending, Ireland spends a good 5% more than Britain does on health. And yet, Britons tend to pay less (the NHS is free at the point of delivery, unlike here) than we do.
What’s more, health spending has increased dramatically over the last ten years. The opposition parties, of course, tend not to mention this. But in 2011, a decade ago, Health Spending was just 18billion euros. Over the last decade, health spending in Ireland has increased by more than 20%. And yet, has the health service gotten appreciably better?
It’s worth asking that question because of this, frankly, absurd argument made yesterday, by the leader of the Labour Party:
Labour leader Alan Kelly said: "I'm sure the majority of people in this country will give up any modest tax change. If Adam and 172 other children waiting for scoliosis procedures can have them. That's what I believe." | @PTHosford reportshttps://t.co/mal0jsP8JE
— Irish Examiner (@irishexaminer) October 13, 2021
It’s worth noting here that the tax cuts announced in the budget amounted to just over one billion euros. Toss all of that into health spending, and you get less than a 5% increase on the total amount spent in any one year. Would that immediately go to reducing Scoliosis waiting lists? Unlikely.
The issues in the Irish Health Service are not financial. Compared to other countries around the world, we pour money into our health sector.
Indeed, if we go back to 2014, we will see that right in the middle of the decade, Ireland was spending 5% more of its national budget on health than any other EU country:
Ireland spends the largest share of government expenditure on health of any country in the EU, according to new figures. Government expenditure on unemployment, as a percentage of overall spending, is also the highest in Europe, while spending on old age is the lowest.
Health accounted for 19.9 per cent of general government spending in 2014, compared to an EU average of 15 per cent.
Of course, spending has only increased since then.
The problem is not money. It is, and ever has been, what we choose to spend the money on. And voters are not blameless.
We spend money, for example, providing medical cards to elderly people who, frankly, can afford to pay for their own healthcare. We provide free GP care to children whose parents can afford the cost of an appointment. From yesterday, we provide free contraception to young women. We provide free drugs to people who can afford them. All of this adds up, and takes away from the opportunity to invest in scoliosis, or other severe ailments.
The opposition would have you believe (and so, frankly, when they increase spending, would the Government) that money is the issue. But it is not. We are spending more than enough on Irish healthcare to provide a good service. The issue is that we are spending that money in politically popular, but inefficient, ways.
There has been much talk, at various times, over the last decade, about how the country needs a party led by somebody like Michael O’Leary to come in and fix things. The truth is that if the Irish healthcare system was run on a Ryanair model, it would almost certainly be more efficient. But it would not become more efficient without shifting how money is spent. Lots of goodies for the voters would go (in the same way that Ryanair, for example, ditched lots of goodies for passengers). We’re happy to accept a no-frills airline. But if past is any indication, attempts at a no-frills health system would see Mr. O’Leary shown the door by an angry public.
Many of the problems in Ireland can be laid, whether we like it or not, at the foot of voters. The state of the healthcare system is item one on that list. Until people stop voting for goodies for themselves, instead of care for those who need it, politicians like Alan Kelly will get away with pretending that he could fix Irish healthcare with just a few more euros.