Leo now stands at a major crossroads

Health Care Reform

[As published in the Sunday Independent on 14 September 2014]

Minister can avoid Reilly’s fate to be the face of health reform instead of re-election puppet.

There was a rich symbolism in the release of a video of former Health Minister James Reilly being drenched in the Ice-Bucket Challenge, in the same week that it emerged his own officials in the Department of Health had spent his entire three-year tenure there, freezing and drowning his attempts to reform our creaky, mediocre health service.

According to documents released under Freedom of Information, these officials advised that such reform was not feasible.

To put it politely, who runs the country? Taoiseach Enda Kenny and Ministers James Reilly and Leo Varadkar were elected on a platform in which they very specifically committed a new government to insurance-based health reform. The Labour Party had a broadly similar plan. The electorate overwhelmingly endorsed it. The programme for government enshrined a synthesised version of the programmes.

It now appears that the cliche about the civil service being the real government has more than a ring of truth to it. I have previously written about the dysfunctional interface at the heart of Irish government between rapidly-rotating technically inexpert ministers and institutionalised bureaucrats. One hoped that Dr Reilly with his professional background might have been able to tip this power balance.

The alarm bells started ringing for me when he announced that universal health insurance would come in a second term of government. It sounded a bit like post-dating a vow of fidelity to the later years of marriage. I feared he was being taken hostage by the bureaucrats.

In the end it wasn’t the promise to reform the health service which led to Minister Reilly being shuffled out of the sector (and I wish him well in his new responsibilities), but the wholly unsurprising political fall-out from the wholly unsurprising consequences of being forced to remove so much money from the public health service at a time when more people than ever needed it.

He was, in short, dealt terrible cards when he assumed office in a recession-ravaged country which had lost its economic sovereignty. The hypocrisy of backbenchers who voted for all the austerity budgets which crippled health then baying for his blood must have been hard to take. So how is new minister Leo Varadkar going to proceed? Will he use the great power of his ministry to tackle the bureaucrats and reform a health system which desperately needs reform, or will he instead use his year or so of office in the current Government as a pre-election political damage-control exercise? Will he prioritise the unbelievable waiting lists, cancelled operations and closed beds? Will he do something about the absurdly low doctor numbers here? Galway, where the Savita tragedy occurred, has the lowest number of obstetricians per woman in the developed world. Will this be a priority? The early indications are that it will not. He intends focussing on budgetary credibility. However, first impressions suggest he is going to do exactly what James Reilly would have had to do, ie ask for money.

These two politician doctors are an interesting compare-and-contrast study. While there is a superficial similarity between their curricula vitae (both general practitioners, both from medical families, both Fine Gael, both ‘gave up’ medicine to become politicians), there is also a very profound difference. Dr Leo seems to have made a fairly early decision that a career in medicine wasn’t necessarily for him. He joined Fine Gael while still a student and became a local councillor in his early 20s, while still a junior doctor. He did complete general practice training, but never worked in a career-level GP post.

Dr James Reilly on the other hand had a long and successful career as a prominent GP and as a GP representative. He was drawn to politics in mid-life because he wanted to reform our terribly-mediocre health system. Together with his party colleagues, he outlined an ambitious programme for fundamental health reform in his years in opposition following his election to the Dail in 2007.

He didn’t get the chance and now Dr Leo finds himself presiding over the same system which is still in desperate need of profoundly fundamental reform.

Leo Varadkar finds himself standing at a major crossroads at the outset of his tenure as Minister for Health. Two starkly different choices face him. We hope he will opt for bold reform. Powerful forces in his own party would however prefer that he use his time in Health to transform it into the a branch office of the Campaign to Re-Elect the Taoiseach.

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