In liberal discourse, choice is a healing concept. But choices are often driven by snobbery and enable inequality.
The holy grail of parental choice has spawned an education system that segregates children into demographic and cultural ghettos. Likewise, our two-tier healthcare system follows the money, not the patient, on the altar of choice. Half of the population indulges in unnecessary diagnostics and procedures, choosing their advisor like a fine restaurant. The other is waiting for lists. The worse the public system, the more the private sector thrives.
Still, counselors make the news and are treated like patient advocates rather than stakeholders protecting their band-aid.
It is for this reason that the predictable opposition to the new Sláintecare consultant contract pushed through by Health Department Secretary General Robert Watt should be met with a firm hand. The contract limits the ability of private practices to connect to the public system. It says consultants are welcome in their private practice on their own time and in their own facilities – but not in public hospitals. It’s only fair.
Obstetricians are most upset. Since Mount Carmel closed in 2014, there has not been a separate private maternity hospital.
This means that the contract puts an end to private maternity care once and for all.
Instead of defending their right to wealth, obstetricians have proclaimed the sacred “choice” to seek an exemption. The heads of Rotunda Hospital and the National Maternity Hospital argue this week that their middle-class clients must be given the “choice” of paying them €5,000 to have a baby delivered in a public hospital, even though they are giving birth to the same baby for free could bring .
The mothers involved usually pay an insurance company, which covers the cost of hospitalization in a single room (if available), and a good portion of the doctor’s fee can be reclaimed from the insurance company. With these benefits, why not see the doctor in his carpeted rooms instead of a public clinic with Hoi Polloi?
Many expectant mothers pay for private health insurance in such a way that they can choose their own doctor. But neither the state nor any taxpaying mother who can’t afford insurance is obligated to subsidize this luxury of choice. Why do you think there is no private maternity hospital?
This private fee is earned on the back of public infrastructure paid from public funds.
The head of Rotunda Hospital, Professor Fergal Malone, ominously declared that the change would have “serious implications” for obstetrics. It will also have a serious impact on his income.
Professor Shane Higgins, head of the National Maternity Hospital, spoke of the continuity of care. Everyone clings to the right to vote and repeats the liberal slogan.
I received continuous care throughout all of my three pregnancies in the public system. I was with the midwives of the parish on Holles Street. The midwives work in teams caring for a cohort of women. I met them all on different dates, so it didn’t matter who delivered the baby: I knew and adored them all.
The clinics were efficient and I never had to wait for appointments. They even made house appointments. It was totally free and an amazing service. I never needed the care of an obstetrician because my babies and I were healthy. If continuity of care is so important to obstetricians’ clients, why not change the maternity system so that doctors who need to see sick or at-risk mothers work in the same way as community midwives?
Why can’t every woman in the country have a steady supply and not just those rich enough to pay for it? Are doctors even hearing the class they are arguing for? Will liberal women journalists hear it, or will they hear “suffrage” and respond as they have been politically conditioned to it?
Higgins tries to present this as a women’s rights issue, since only women are denied the all-important choice in medical care. But it’s not discrimination. It is a model of how healthcare should work. A hospital. A list. All together.
What matters most is not the choice but a healthy baby and mother.
So is there better medical care in private obstetrics? Private patients may think so, but the answer is no.
The main work comparing private and public maternity care was done by Trinity College health economists Professor Pat Moran and Charles Normand. Her research shows that private patients are twice as likely to have a cesarean section as public patients – with no evidence of better outcomes.
And before you say “elderly mothers,” there was no evidence of a higher risk of being a private patient.
Caesarean sections are more expensive and require longer hospital stays, which incur even more fees. But here, too, the sanctity of “choice” comes into play. Incisions should only be made when medically necessary. With recovery rates longer than natural childbirth, it is utterly bizarre that incapacitating women by performing twice the number of dissections in private practice could be considered superior care. It costs more, financially and physically.
Professor Normand was consulted as an expert witness when a private practice sued the Province of British Columbia in Canada for its right to charge fees for aspects of private maternity care. The government won the case. Therefore, Irish evidence is used to support public maternity care in Canada against private interests.
In times like these, you must remember that it was doctors against socialized medicine that brought down the mother-child scheme – not the bishops.
If the choice is important, then we make one. What better Christmas present than a public contract that provides excellent care for Ireland’s mothers-to-be – all mothers.
https://www.independent.ie/opinion/every-woman-needs-continuity-of-care-in-pregnancy-not-just-those-who-can-afford-it-42241843.html Every woman needs ongoing care during pregnancy, not just those who can afford it