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Dear Minister for Health/Simon…

Simon. Is it okay to be so familiar with you? Simon, you give the impression of being entirely interested in improving the health system in Ireland. However, I guess that presiding over such a large organisation of over 100,000 staff has to be very challenging.

I am writing, Simon, because it just seems that, with each successive and well-meaning Minister for Health, small significant changes are made but overall, things seem to get steadily worse. Noel Browne and his new TB hospitals made an enormous impact. Harney and her smokeless fuel caused a great improvement for kids with asthma in Dublin (although, I note, this measure occurred when she held the environment brief). Martin and his attack on smoking in workplaces has been a world-leading initiative with positive health results.

On the other hand, old people have never been more afraid to go to emergency departments and queues have never been so long for public patients. The sense of chaos and waste has never been so acutely felt. Nurses are demoralised and doctors too. At the same time, expectations have never been so high but surely, for €14 billion, we should be able to do better — a lot better.

Simon. Do you like Netflix? I was looking at 13TH, a documentary about the fact that the US has 5 per cent of the world’s population and yet has 25 per cent of the world’s prisoners. Incredible! That 1:3 blacks will be incarcerated in their lifetime, while only 1:17 of whites will be incarcerated. That blacks make up 6.5 per cent of the population, yet make up 40.2 per cent of the prison population. That 90 per cent of these are there because of plea bargains and therefore never had a trial. Repeat: 90 per cent never had a trial. It is being called an ‘economic system to create free workers’. The 13th amendment says that all men will be free from being forced to work, except those who are criminalised. So let’s arrest the ‘poor negro’ with petty offences and plea bargain with him, telling him that he can get 20 years if he goes to trial or two years if he admits guilt. Then force him to work for prison profit.

If it is wrong for doctors to be unduly influenced by pharmacies, then it is wrong for politicians to be unduly influenced by rich moguls and powerful lobbies

So why am I talking to you about these things? Because systems and cultures are very hard to change — and they resist change. This documentary is suggesting that when slavery became unpopular, it changed to leasing of black workers, which later mutated to the second-class citizens of America, who were targeted by the KKK, and then later again it mutated to mass incarceration of black US citizens. The documentary suggests that the treatment of black people in the US only changes the way in which they are mistreated, but not the fact that they are treated badly.

Behind all these systems is the ongoing need to industrialise prisons in the US for free or cheap labour and having the effect of racial abuse. In this country, we are heading towards industrialising health, so that large companies run pharmacies, large GP practices and large hospital dynasties, creating profit for investors who have the influence and the money to be heard disproportionately by the politicians.

This is called ‘lobbying’ when it is, in fact, pressure by the rich at the expense of the less well-off. Lobbying tends to work against democratic values. If it is wrong for doctors to be unduly influenced by pharmacies, then it is wrong for politicians to be unduly influenced by rich moguls and powerful lobbies.

The blacks in America have been repeatedly asked to wait for genuine equality a while longer, while at the same time the US contains, from the 1970s, the largest prison population in the world. We in Ireland are asked to wait for the next health minister, and then after that to wait for the next health minister, to deliver an equitable, fair and efficient health system.

But the more things change and even get better, the more they get worse, with longer waiting lists and people terrified of using emergency departments. A waiting list is a shadow term for ‘not being treated’. Minister, Simon, we all have the right to basic and timely healthcare. Justice delayed is justice denied. Health delayed is health denied.

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