The nagging pain in the right shoulder has persisted since last March.  Deciding, after eleven months, it was not going to go away, I went to see the doctor.  The €50 consultation fee included the chance to go to the pharmacy down the street and to return ten minutes later with vaccine for the doctor to administer.  The vaccine cost €12.89 – an odd amount.  He suggested a course of physiotherapy and, if that didn’t work, an appointment with a specialist.  I wondered how much my health insurance would cover.  The pain killers were not as painful as the vaccine, just €8.53.

Sometimes cash on the nail is the only option.  Arriving in the state in January 1999, when health insurance was limited to emergency cover for the first six months, the few pounds in my savings were quickly wiped out.  It was May 1999 and the third visit to the doctor in the space of a few weeks; the ear pains had returned, bringing with them vertigo and nausea.  He looked stern.  “I think there may be fluid that needs to be drained.  You need to see a consultant and quickly; I mean within a couple of weeks.  There is a danger of a perforated eardrum and permanent hearing loss”.  He scribbled a telephone number on a piece of paper.

Dialling the number brought a brisk and efficient secretary.  “You want a public appointment?  There would be dates during the second week in August”.

She must have sensed the inaudible groan.  “If you’re happy to pay, there’s an appointment on Thursday week at 10.15”.

It cost £150 for the consultation, plus another £500-£600 for the day surgery.  It used up most of the money in my building society savings account, but seemed preferable to losing hearing.

Medical care here is a commercial activity.  In 2008, a lipoma close to the spine was causing discomfort.  Day surgery was proposed, though this time the health insurance would pay.  The chief encounter at the reception area of the hospital concerned details of the insurance cover – this was clearly a business transaction.

Without cash or insurance cover, appointments can take months under the public health provision.  We persist with the belief that the market will provide an equitable and efficient health system when it is patently obvious it cannot do so.  Money paid to insurance companies and used for administration and advertising would be better devoted to health care.  Doctors compelled to regard patients as customers and driven to keeping an eye on the bottom line would prefer to be concentrating on clinical practice rather than commercial economics.

The free market is an excellent mechanism in many circumstances, but when it comes to health care the basic requirements for its operation simply do not exist.  At the most elementary, how many people go up and down the street to see which doctor is charging least?

There need to be fundamental questions about the philosophy underlying our system, yet the prospective party of government is proposing further privatisation of a system that is already failing.