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June 30, 2016

Making someone else pay

‘That is not America! It isn’t even Mexico! Can’t someone else do it?’

Dr Ruairi Hanley

In a scenario worthy of Homer Simpson, Dr Ruairi Hanley believes the philosophy that somebody else should always pay for our healthcare is simply… D’OH!

In a legendary episode of The Simpsons, Homer runs for election as Sanitation Commissioner for Springfield. Initially the campaign goes poorly, until our hero discovers a catchy new political slogan: ‘Can’t someone else do it?’

Homer expertly sums up this policy in a public speech on the subject of dog owners and their responsibilities for waste disposal: “Animals are crapping in our houses and we have to pick it up! Did we lose a war? That is not America! It isn’t even Mexico! Can’t someone else do it?” Needless to say, Homer wins the election by a landslide. Alas, his policies prove to be a disaster as the entire annual budget is spent in one month and Springfield becomes a giant garbage dump.

Unfortunately, here in Ireland we appear to have adopted a similar philosophy in response to our economic crisis. The basic, popular message from many of our politicians and commentators is simple: ‘Someone else must pay!’

Truly, our country is finding it hard to grasp the concept of personal responsibility for our actions.  We see this displayed in the national hysteria surrounding the €100 household charge.

I understand people living in local authority housing are exempt from this, as are those who are renting. Therefore, it is mostly those who borrowed substantial sums from banks to buy grossly overpriced houses who will be required to pay less than €2 a week to fund the local services that they take for granted. Apparently, this idea is completely unacceptable for many of our countrymen who presumably have decided that ‘someone else must pay’. Perhaps the tooth fairy might oblige.

Another good example of our national desire to make others financially accountable for our mistakes is demonstrated in the increasingly vocal calls for mortgage debt forgiveness.

In other words, those who did not walk into a bank demanding massive amounts of money at the height of the boom should now pay to bail out those who did.

Celtic Tiger years
Of course, it is now fashionable to blame financial institutions for reckless lending to innocent, naive citizens. This argument ignores the inconvenient fact that borrowing was not compulsory in this country during the Celtic Tiger years. The wonderful phrase, ‘the banks were throwing money at us’ falsely implies that no-one was actually demanding exorbitant loans.

I admit this analysis may sound harsh and I have a great deal of sympathy for those at risk of losing their homes. I hope that, for these people, some form of fair debt restructuring or long-term loan extension is developed, without engaging in the moral hazard of widespread, taxpayer-funded write-downs. Forgiveness must be tempered with fairness.

Unfortunately, the concept of ‘someone else must pay’ appears to have also crept into the field of healthcare. This was brought home to me recently when a GP colleague wrote an interesting letter to The Irish Times.

He outlined a case history of a patient who had lost his full medical card, and now had a doctor-visit card, meaning he had to spend €130 a month for medications that had previously been paid for by the State.

The author explained that his patient was not prepared to pay this money, and thus would suffer potentially nasty health consequences as a result of his untreated diabetes, hypertension, emphysema and obesity. My colleague suggested that this was incredibly short-sighted on behalf of the Exchequer, as they would spend far more treating this patient for the serious medical complications he would suffer in years to come.

My initial response on reading this letter was to nod approvingly in agreement. However, I could not help but notice the fact that the person referred to was a smoker and apparently had a history of alcohol-related liver disease.

Risk of stroke
It therefore seems reasonable to assume that he is probably paying roughly €9 a day for cigarettes, which would total €270 a month. This contributes directly to his health problems and an increased risk of stroke, heart attack and cancer. We can possibly add to this the amount he has spent on alcohol, which is difficult to determine.

When asked to partially finance the prescribed medications that are preventing him from suffering illness or premature death, this individual has decided that he will not do so. In essence, he believes that ‘someone else should pay’ for these wonderful, life-prolonging inventions, as he is “unable to afford them”. Yet, he seemingly continues to fork out more cash each month for nicotine-based products that are slowly killing him.

Now, I fully accept that cigarette smoking is ridiculously addictive and it can be very hard for lifelong users of these products to quit. I also recognise that many people have difficulties with alcohol misuse and dependency. Nonetheless, it never ceases to amaze me how some excess users of such products appear to have developed such a strong sense of entitlement to free healthcare paid for by others.

Politically incorrect
Of course, such an analysis is gloriously politically incorrect. The best solution is for the State (a.k.a. the taxpayer) to keep picking up the bill. Any suggestion that recipients of public health services should ever be required to pay a cent is an outrage worthy of a fascist.

Having carefully reflected on the matter, I therefore think there is only one answer for the problems in our health service, our economy and indeed our entire country. Someone else must pay.