Can Europe help us fix our public health service?

Long waiting lists for elective surgery, overworked A & E departments and in-patients having to be accommodated for long periods on hospital trolleys are the kind of stories we keep hearing about in relation to the Irish public health service. Of course these things are unacceptable. But bad as they are, a letter to the editor of the Irish Times on May 27^th 2012, from a GP, has described a situation that should be made a criminal offence when and if a culprit can be identified.

The letter indicates a level of inequality that simply should not exist in any country, developed or otherwise. It illustrates that ability to pay and not need is the criterion for hospital treatment here in Ireland. Read it here.

There are also the inadequate care services in Ireland for those who suffer from Cystic Fibrosis, despite the fact that we are among the countries with the highest incidence of this condition. These have been well documented on many occasions by Orla Tinsley.

The letter above prompted me to do some research. I was able to locate a report on European health services that seems detailed and is up-to-date. It’s from a Swedish benchmarking group called the Health Consumer Powerhouse, it’s called “Euro Health Consumer Index 2012”, it’s by Arne Björnberg, Ph.D., and it can be accessed here in .PDF format.

While inequality of the type highlighted in the letter to the Irish Times as it relates to Ireland is not dealt with specifically in the report, it does examine the issues of waiting lists and the cost of health care on a per capita basis in a total of 34 countries, the majority of them within the EU. In relation to Ireland, two graphs stand out. The one for waiting list times shows Ireland six places away from being the worst out of the total of 34. At the best end of the list lie Switzerland, Belgium, Germany, The Netherlands, Denmark, France, Austria, Finland and Sweden, with the lowest waiting times. But here’s the thing: In the graph that shows healthcare spend per capita, Ireland is right up there near the top along with Denmark, Germany, Belgium, Austria, The Netherlands, Switzerland, Norway and Luxemburg.

The author of the report has the following to say about waiting times:

“2.3 Major non-acute operations < 90 days

What is the interval between diagnosis and treatment for a basket of coronary bypass / PTCA and hip/knee joint? It is difficult to avoid the observation that for countries, which do have official waiting time statistics (Ireland, Sweden, UK etc), this is in itself a not very flattering circumstance. Countries such as Germany, where waiting times tend to vary in the 2 – 3 weeks range, have never felt the urge to produce waiting time data, for principally the same type of reason that Madrid has less snow-ploughs than Helsinki”.

A fair comment, but one is still left with the belief that pure inequality, as opposed to typical waiting times, is unique to Ireland, at least within the EU. This is supported by anecdotal evidence from people who have experienced public healthcare in France, Belgium, The Netherlands and Germany.

Once again one is prompted to ask why there is such an antipathy to the EU on the part of the radical left wing here in Ireland. If they were real Socialists they would, surely, embrace Europe as an exemplar of equality and anti-discrimination, and not as something to be viewed with suspicion. If they were doing their jobs on behalf of the users of health services in Ireland they would be beating a path to Brussels to highlight the woeful inequalities that have been described here, and getting all available help to remedy the situation.

Vote YES on Thursday

Predictions about the effect the referendum on the Fiscal Compact this coming Thursday will have on austerity in Ireland are meaningless.

Those who are trying to convince voters that it will have any bearing at all on household charges, septic tank inspection fees, water rates or anything else of that nature are either dangerously delusional or shockingly dishonest.

What is objectively true is that Germany (Bunds [German government bonds] approaching negative yields), Finland, The Netherlands, Austria (unemployment: 4%) have taken control of their finances and are all in favour of the fiscal compact. They simply want other countries to agree to it so that when stimulus measures are put in place for the EU as a whole there will be no free riders. It's hard to blame them for that.

And they're the countries I want to be aligned with in the EU - not the ones that allow UK and US commentators to put us into awful acronyms like PIIGS.

http://www.solarwave.ie/

What's the Irish left got against the EU?

It would seem that a large part of the left wing in Ireland is really, when all is said and done, against the idea of Ireland belonging to the European Union. 

Last week I took the left leaning members of the opposition to task for not making a lot more of the proposals that have been put forward by the Germans and the French for a Tobin tax. My point, which I do not seem to have done enough to get across, was that it was preferable to work with the EU on measures to raise revenue for economic stimulation instead of simply opposing fiscal discipline, as they have been doing. After all, a transaction tax on stocks and bond dealing should be close to the heart of any Socialist, and money borrowed, even for spending in the hope (and it would be a hope – borrowing and spending are not of themselves a guarantee of success) of generating growth, has to be paid back. In any event borrowing, as we know to our costs since the onset of the Great Financial Crisis, is dodgy under any circumstances.

Now I read in the Irish Times that Sinn Fein, in particular, has campaigned against every EU treaty that has been agreed to by Ireland over the last 25 years. Joe Higgins has always given the strong impression of a man that only agreed to become a member of the European Parliament so that he could work to undermine it from within. A new survey has also found that even a large percentage of traditional Labour party voters, 41%, intends to vote against the treaty, despite the strong endorsement of it from all Labour ministers in the current coalition government.

So what’s with the Irish left and the EU? In the UK, it’s the Conservatives who have the most Euro sceptic members, and the Labour Party is the one that is committed to taking a full part in Europe. In France, the newly elected President, Francois Hollande, a Socialist, might have used rhetoric in his election that will cause him to look for growth measures to go with the Fiscal Pact, but a Euro sceptic he most certainly is not. And Angela Merkel and her party, while supporting balanced budgets, are not afraid to put forward measures that will arouse the ire of capitalism (and should therefore expect to be embraced by Socialism), a good example being the aforementioned Tobin tax.

Perhaps opposition to Europe is a means our Socialists have decided on in order to differentiate themselves from other parties. This might have its attractions in providing a quick fix to gain electoral support in a deep recession, when voters are casting around for anything and everything that represents the status quo so that it can be punished, but it is not in the best interest of the country, nor, I would propose, even in the long term electoral best interests of the politicians concerned.

Another reason to vote Yes

Francois Hollande

Socialist Francois Hollande has become the latest president of the Fifth French Republic. Much has been made of his apparent attitude to the EU Fiscal Treaty, about which we in Ireland will have a referendum vote at the end of this month. 

At this stage it is impossible to know how much of M. Hollande’s words represented electioneering rhetoric and how much will result in solid changes to the treaty, but there is reason to believe that, while the austerity aspects of the treaty will not change, they might now be accompanied by measures aimed at stimulating the economy of Europe.

This represents just one more reason for Ireland to vote Yes in the referendum. It was always a good idea to confirm our position as members in good standing of both the EU and the Euro zone, and voting Yes is the means to achieve that under current circumstances. Now we have an added incentive – as members that are fully committed to fiscal responsibility, which is what the treaty is about, we can take full advantage of whatever economic stimulus is brought into being by the influence of France under its new leadership.

How a referendum can be anti-democratic

Winston Churchill is quoted as saying that 

“…democracy is the worst form of government - except for all the others that have been tried.”

And democracy can indeed be frustrating. It’s difficult sometimes to understand why the majority cannot see things your way and vote in the candidates that you think will serve us best in parliament. 

Referenda are, or at least should be, the ultimate item in the toolbox for the pursuit of true democracy. The Rolls Royce in the exercise of the right of every adult citizen of a country to have his or her say on the outcome of a proposal that will effect everybody. 

We are facing an important referendum in Ireland on May 31st next, on whether or not we will sign up to the European Union Fiscal Treaty provisions. 

While the idea of a referendum if attractive to anyone who is in favour of democracy, this one, and others in the past, have brought forward at least the suspicion that in practice such plebiscites can fall more than a little short of the democratic ideal. This has been discussed here before: Democracy and a referendum on fiscal union in Ireland. Here it was argued that as, on occasion, less than half the people who are eligible to vote in referenda actually do so, the majority are in fact saying they not want referenda at all and are happy to let others make these decisions. Unfortunately this can open the door for well organised groups that have separate agendas.

I now believe this situation has the potential to get even worse. The coming referendum is shaping up to be positively anti-democratic. This situation will arise because of two things: strong evidence from opinion polls that nearly half the voters are prepared to admit that they do not understand the treaty provisions, and the decision of the Irish Congress of Trade Unions to instruct its members how to vote on the question. The admitted lack of understanding feeds into the idea that people are prepared to let others make the decision on their behalf - if not they would do whatever it takes to gain sufficient knowledge of the issues. The trade union involvement is more insidious. It suggests that, if enough of the people who vote are both trade union members and among those who do not understand the treaty provisions, the outcome could depend on the attitude to the treaty of policy makers in the trade union movement. 

The problem is that these people do not have a mandate from the public at large. They have not put themselves up for election in front of anyone other than their own members. To put it another way - what’s the difference between abrogating, in practice if not in theory, a national decision to the leaders of trade unions on the one hand, and allowing the democratically elected members of Dail Eireann to bring forward a result after a full and transparent debate on the matter in the parliament of the country, on the other? Could the answer have something to do with the subverting of democracy?

OMG! A new referendum

There is a growing expectation that there will have to be a referendum in Ireland on EU treaty change, to allow for shared decision making on budgets and taxation by the countries within the Euro zone, which is known as fiscal union. Up to now the Euro zone has only had monetary union, which has meant that member countries have ceded their powers to set interest rates or regulate the money supply to the European Central Bank, but were left free to decide on such matters as taxation rates and whether or not the national budget should be balanced.

For some, like the current government, the need for a new referendum is unwelcome news. It is likely to be divisive and there is no guarantee it will be passed. Because of the attitude of certain of our Euro zone partners, most notably Germany and France, it is looking likely that Ireland’s not agreeing to fiscal union could create serious issues about the actual survival of the Euro as a hard currency and / or the part that Ireland might play in a re-designed European single currency system.

Readers of Stack Six will be aware that we follow an enthusiastic European line here. It is not too much to claim that the development of the European Union and Ireland’s place in it have been the most significant macro events that have occurred during this writer’s lifetime, having been born just a few short years after the end of World War II.

It is easy now to forget the changes that were forced upon the Irish Republic as a condition of entry to what was then known as the Common Market, and which evolved into the European Union. Some examples include: the end of the rule that meant that women had to resign from all Civil Service and many other jobs on getting married; the repeal of legalised discrimination that existed against gays; an end to corporal punishment in schools; a ban on capital punishment; and a general requirement to abide by the anti-discrimination measures of the Treaty of Rome, which set the whole thing off.

Even the NCT car test, which has contributed, along with a zero tolerance for drunk driving, to a halving of the annual rate of road deaths in Ireland since it was introduced in January 2000 [the actual reduction between 1999 (413 deaths) and 2010 (211 deaths), is 49%], was only established in Ireland because of an EU directive. It is easy to argue that we would have moved with the times in regard to these matters anyway but our history does not give any scope for comfort in this regard – we needed that external stimulus.

All relationships suffer from time to time. Those that are worth keeping are also the ones that are worth working on when difficulties arise. Ireland’s membership of the EU falls squarely into this category. An important element of our association with Europe, and a highly desirable facility in its own right, is our use of the Euro as the unit of currency. It has given us significant trade benefits, a defense against speculative attack on what would be our own ‘soft’ currency if we were not part of a currency bloc, very low mortgage rates, elimination of currency exchange costs and risk for travelers and businesses in the rest of the Eurozone, pricing transparency for same, and an additional incentive for US and other foreign direct investment into Ireland.

All of that is worth holding onto.

Ireland is not Greece

Mario Draghi, the new president of the European Central Bank, having taken over from Jean-Claude Trichet, has put the current debate about the possibility of Ireland getting a discount on the financial responsibilities it has assumed for the debts of its banks nicely into context.

We are indebted to Laura Noonan of the Irish Independent for asking the question, at Draghi’s first regular monthly press conference as ECB president, as to whether or not the Greek example, where banks with exposure to Greek sovereign debt have been persuaded to take a write-down of 50%, could be used as a precedent for Ireland. His answer was as follows:

“One has to keep in mind that the Greek situation is exceptional and unique - and unique. The sovereign signature, in spite of the recent turmoil, remains a pillar of financial stability, in the Euro zone and in the rest of the world. We are confident that the Irish government could comply with the measures announced, and the Irish government itself said it will do whatever it takes. So one has no reason to doubt about the commitment of the government”

In other words, Ireland has the opportunity to make a serious and very valuable contribution to resolving the current crisis in the Euro zone, and in so doing reassume its position as a member of the core, committed group of European Union member states. It can do this by reinforcing the value that has always been placed on a guarantee by a sovereign state, and in this case one that also happens to be part of the Euro zone. Greece’s misfortune is not that it does not want to do this; it is that it cannot.

Those of the Irish political opposition who are calling for a unilateral default by the government, whether it’s on Anglo Irish bank bonds or on Irish sovereign debt, either do not understand the consequences of what they call for or, much worse, are prepared to cause serious if not fatal damage to the European project, of which the Euro currency is a major component. Theirs is a desire to achieve a short term gain at a cost that represents extremely serious long-term damage. This damage is not even related to the regard or otherwise in which we would be held by our fellow Europeans, but rather to what would result from a grave setback to, or failure of, the European Union. See this previous StackSix entry to get a sense of the material significance of the EU to Ireland.

The historical, political and philosophical importance of it goes much, much deeper than that.

Also see this Financial Times article on "Why it's worth keeping the EU dream alive". Then read the comments for a lively debate on the issue.

The Euro zone rescue deal - "them and us"

The announcement of the Euro zone rescue package, which included a 50% loss on Greek bonds for those banks that held them, led to a number of reactions here in Ireland. One was from Mr. Peter Brown of the Irish Institute of Financial Trading, who said, on the RTE news on Thursday 27th. October:

“If they’re that keen on keeping the Euro intact, Ireland needs a deal”.

Who are “they”, in this context? The ECB? Angela Merkel and Nicholas Sarkozy? The European Commission? Ireland is a member of the ECB and the EU Commission. France and Germany are our comrade states in the entity that has given us massive social, equality and consumer legislation improvements at home and free access to a market of over half a Billion consumers, not to mention significant capital transfers through the EU Common Agricultural Policy and the Structural and Cohesion funds.

Our membership of the Euro zone provides us with protection from speculative raids on what would otherwise be our local currency, such as that which cost the Bank of England an estimated £3.4 billion in 1992. As a result of Irish government attempts to protect the Punt at the time, interest rates on Irish mortgages reached a staggering 16% at one stage.

We have vitally important price stability through the determined and consistent actions of the ECB, although we undo some of that by our own inflationary actions here at home. Our most recent crisis has shown that use of the Euro gives us access to technical and monetary assistance from those other member states, such as Germany, The Netherlands, Finland and France, that have the discipline and experience to be able to deal with low interest rates and increases in the money supply, and to impose adequate regulation on their financial institutions. Our recent property related bubble and its subsequent bursting has shown that we in Ireland are still only in the learning mode with regard to these matters.

An important consideration for travellers is that the Euro gives us the convenience of a common currency as well as valuable transparency in pricing throughout those states that use it.

And being in the Euro zone is yet another asset to go along with our educated workforce, our status as the only English speaking state in the zone and our competitive corporation tax rate to help us attract Foreign Direct Investment (FDI).

In a nutshell, when Mr. Brown talks about “them” he really means us - in order to make good on the implication of his remark, Ireland would have to be prepared to leave the Euro zone and, in so doing, jeopardise the whole EU project. In the light of the benefits we have and can continue to expect from remaining in, this would constitute the greatest example that can be imagined of cutting off one’s nose to spite one’s face.

A Greek silver lining

It seems possible that the US dollar might have reversed its long slide in value against the Euro. Greece, a Eurozone member, is in the news because of public unrest against austerity measures, after seriously blotting its copybook previously by falsifying data sent to the European Central Bank (ECB) and other authorities. This has adversely affected the Euro because of worries that a constituent country might be setting itself up for default on its sovereign debt.

But, of course, a lower rate of exchange for the European currency is a good thing. It makes European exports to the world’s largest consumer economy, the USA, easier. It makes imports, not just from the US but from many other countries, such as China, whose currency is pegged to the dollar, less attractive.

A decline in the Euro against Sterling will discourage shopping trips to Newry and will mean that Irish consumers will spend more at home.

Notwithstanding the perfidy of the Greek Department of Finance, there is little real fear that Greece will, or will be allowed to, default on its commitments to the extent that the whole European monetary system is irrevocably damaged. In the meantime it is possible that Hellenic fiscal management misdemeanours might have provided something of a silver lining for the other members of the Euro club.