#Open journalism No news is bad news

Your contributions will help us continue to deliver the stories that are important to you

Support The Journal
Dublin: 5°C Sunday 28 February 2021

Justin Bieber could teach our government a thing or two about healthcare

We should follow the singer’s lead and call for a quality public healthcare system, writes Julien Mercille.

Julien Mercille

DID YOU KNOW that Justin Bieber would be a better Health Minister than Simon Harris, Leo Varadkar or James Reilly?

That’s because Bieber is a public healthcare system advocate, whereas the three Fine Gael ministers have pushed for a more privatised system.

At the tender age of 16, Rolling Stone magazine asked Bieber if he wanted to become an American citizen (he’s Canadian). He told them, “no way”, because of the bad US healthcare system, which is the most privatised among Western countries.

“You guys are evil,” he told the magazine. “Canada’s the best country in the world. We go to the doctor and we don’t need to worry about paying him, but here, your whole life, you’re broke because of medical bills.

My bodyguard’s baby was premature, and now he has to pay for it. In Canada, if your baby’s premature, he stays in the hospital as long as he needs to, and then you go home.

Now 22, mature Bieber still supports public healthcare. Last Christmas, he tweeted to his 82 million followers to support Britain’s NHS by buying the CD made by an NHS Choir instead of his own CD.



And it worked: the NHS Choir became Britain’s No 1 Christmas song.

Unfortunately, the Programme for Government released last week, as well as previous Fine Gael plans, seek to bring more market and privatisation in our system:

  • Hospital groups will become “hospital trusts” with “greater autonomy”
  • Hospital managers and CEOs will require an MBA, ensuring they are business-minded
  • The HSE will be replaced by a Health Commission
  • Performance targets for hospitals will be established and monitored by a “Performance Management Unit”
  • “Activity-based funding” will be used to finance hospitals

Why are those reforms dangerous?

In a public system, hospitals are funded via bloc grants given to them by the government based on what they need to operate properly.

Under the new system, the link between hospitals and the government is broken, and a market is thereby created.

This is called establishing a “purchaser-provider split”. The providers of healthcare are hospitals and the purchasers are insurance companies and the government.

Making hospitals “autonomous” means that they can rely on the private sector both to raise funding and deliver health services. Financing hospitals via “activity-based funding” means that every procedure they deliver now has a specific price.

It creates a market in which health services from surgeries to medical tests can be bought and sold. It opens the door to outsourcing and private operators, which will jump on the opportunity to enter this lucrative sector.

Also, the fact that hospital group managers are now called CEOs should ring alarm bells: hospitals will be run like businesses that care about profits first, and health second.

When hospitals can’t reach their “financial performance targets”, a private company can take them over. Leo Varadkar said exactly this a few months ago:

Where hospitals consistently under perform in terms of clinical outcomes, patient experience and financial management, it should be open to the provider to transfer management of the hospital for a period of time to a private provider.

The problem with such reforms is that market-based and privatised systems are bad at three levels: they’re unequal in access, more expensive, and bad for patients. Only insurance companies and private healthcare companies benefit from that.

First, private systems are more unequal because they prioritise people who can pay over those who cannot.

Second, they’re more expensive. We always hear that markets are supposedly more efficient but that’s a big lie for healthcare. Privatised systems need to hire armies of bureaucrats and legal advisers to process all the billing and paperwork involved.

In a public system like Canada – where I’m from – I never saw a single pamphlet or flyer or bill posted to me because the government pays automatically when I go to see a GP or when I go to the hospital, reducing administrative waste.

Insurance companies also often oppose reimbursing patients. It makes sense for the firms: if they can prove they don’t have to pay because of a pre-condition or whatever, they save money. But it jacks up the costs in administrative and legal procedures.

Third, for-profit hospitals are bad for health. Some people can’t access them; they tend to provide care of lesser quality and mortality rates are higher in them because they dedicate fewer resources to doctors and nurses. There’s no surprise here: they want to cut their costs to boost their profits, so they cut in the services they give you.

Polls have shown that healthcare is the most important issue for Irish people.

However, if no action is taken to counter the government’s plans, the electorate is in for a massive disappointment. We should follow Bieber’s lead and call for a quality public healthcare system.

Julien Mercille is a lecturer at University College Dublin. Twitter: @JulienMercille.

About the author:

Read next: