Wrote most of this recently in hospital on my iPhone where I had the time as nothing else to do but observe the health system at work and participate in it!

I am one of the 25% of the population who has neither a medical card nor private health insurance.

I don’t believe in private health care or paying insurance for it. I never have. I have been chronically ill for many years and had a medical card until 9 years ago. I have written before regarding the extra costs of having a disability and health is one of them. I am not interested in having some private company manage my care and tell me what I can and can’t have. I want equal access for all to health, no postcode (ahem Eircode!) lotteries, am in favour of  of centres of excellence and no discrimination against people with disabilities in accessing acute health care. (Not Dead yet!)   I already pay for health care through my taxes and additional charges and and I realise and am grateful to others who pay for my access through their taxes, direct and indirect. I am able to pay the hospital charge for this stay in hospital and know that for others in the 25% it would be a difficult expense to deal with.  The same with my monthly medication expenses which even if I was privately insured would not be covered by a premium but there is a limit through the Drug Payment Scheme on what I pay – unless the medications are not covered by that scheme which I know is becoming an issue for many.

Often the commentariat on this 25% is that we can’t afford insurance rather than we won’t pay for it or that indeed we already pay for the system and expect to receive care.  Consumer and financial journalists (many seen as campaigning advocates) only see us as the ‘uninsured’ which is not accurate at all given everyone is legally entitled to access to the health service (though not primary or community care). Their pieces on health insurance create notions of panic if prices rise or people opt out of the system rather than campaign for a better system for everyone. The belief is also created that those using the system for the uninsured are not receiving or entitled to good care.

My experience of public health care (hospital based) is really positive – once you are in the system that is. In my recent admission I was fortunate to have the support of doctors who made decisions, communicated information clearly and it was clear that anyone no matter their income or social status would have received the same service.

I’ve been treated according to my need and matters are usually expedited should I require it.  Granted I attend one of the major teaching hospitals in the state but despite the crowds and the fact many outside Dublin attend also I’ve had generally a very positive experience with multiple specialities as both an in and out patient.  Unfortunately if it is not an emergency one has to wait – and it might become an emergency in the mean time.  And I have had to chase things up as an outpatient and am lucky that I am able to do so.

I’m prepared to pay more for access for all to an equitable well run health service. I earn a good wage and can afford to do so. However I don’t want to pay for health insurance to a private company who will only want me if I have an added premium either paid by me or the state. And for whom I might quickly become a liability. If I was to join a private health scheme at present I would have to wait five years before I could access treatment due to my pre existing conditions.  We need to talk about universal health care vs universal health insurance and we have to clearly define what that is.  It must include community health and social care and allied care including physiotherapy, dietetics and occupational therapy and mental health supports.

Recently whilst waiting for a public  outpatients appointment I observed a couple arrive. They indicated to the receptionist that the consultant who they had been seeing privately had asked them to attend the clinic at short notice. The receptionist didn’t know who they were and was not expecting them. After obtaining their details she asked them to take a seat. The woman looked at the rest of us (yes it was ‘a look’) and asked if it was there that they should sit and she was told yes. Fifteen minutes later the woman returned to the desk to ask if the receptionist knew they were private patients of Mr X. Again the receptionist retained her composure and said yes and she indicated that this made no difference here and it was a public clinic.  The woman said that she just wanted to check and said that they had found a quieter spot to sit around the corner and hoped they would not be forgotten about. At this stage others around me who had been waiting for their appointments for some time were copping on that she was 1) trying to jump the queue 2) laying it on thick that she and her husband were different to ‘us’.  By the implacable courtesy of the receptionist it was clear that this was not the first time she had dealt with such attitudes.

While I understand going to see a consultant can often be stressful, especially if unplanned surgery is involved, the two tier health system provides attitudes like these where some patients believe that they should have easier access than others because they pay extra for it.

But some say that private healthcare is about choice and also alleviating pressure on ‘the system’.  That’s bullshit really – it’s about an expense many can’t afford for a system we should all be able to access without prejudice and without profit.

We ALL pay for healthcare in one form or another. And We ALL should have the expectation that our health needs should be met in the same way as everyone else’s.

Minister Varadkar’s recent piece on the state of the health service has depressed many and I fear it will extend further the notion  that healthcare in Ireland can never be fixed and that privatisation is the only way to go.

Primary care and community supports in the areas of chronic conditions, disability and mental health should be as good as the hospital based care I and others have received. Sadly I know that not to be the case. Rather than campaigning to keep the ailing local hospital open and providing all services perhaps politicians and other campaigners and indeed the general public should change their focus to a holistic vision of a healthy society and how it can be organised and achieved.

My final point for the moment is in praise of those working in healthcare and the much maligned HSE.  As both an out and inpatient I was frequently moved by the kindness of all involved from physios, nurses, catering staff, doctors and radiographers.  Many think the compassion has gone out of much of Irish life but I constantly experienced caring and reassurance from almost everyone I met in the past months.  I also saw a system where people worked together to improve outcomes, afford choice and maintain dignity for those involved. And I also observed advocacy and kindness from other patients for those in the beds next to them which as someone wisely pointed out  are the forgotten pieces in the care jigsaw.  There is much wrong with the health system in this country but we don’t talk enough about what is right and what should be expected and received.  I can speak up for myself and my recent experiences have made me think about those who cannot speak up for themselves as I detailed here.

I’m off to send to send a thank you card or two to people who cared for me recently and to continue to work on coping with an extended period of leave for recovery and indeed finding my voice and learning to breathe again.  I hope that we do have conversations and questioning of healthcare in Ireland that extends beyond trolley watches and hospital closures and election manifestos – everyone deserves better than that.