Open letter to Dr Varadkar regarding reform of the health service. Replace current system and funding with German model

stetascope

Dear Dr Varadkar,

I would like to offer you my advice for reform of the health service. I know it is a most difficult task for any minister. Most recent incumbents either tiptoe around the landmines of “Angola” to protect their political reputations or attempt to make piecemeal reforms – a process that usually ends in failure.

The process of reform requires the steely reform mindset of Napoleon or Julius Caesar, leaders who made reforms to administration systems, calendars and measurement systems that lived a long time after them. My suggestion is to reform Irish Healthcare by adopting a system similar to the German insurance model and privatise all the healthcare provision, funding and administration. The department of Health and HSE would shrink to be a department merely overseeing and directing government policy. To my mind the government has no more business providing healthcare service that is does providing intercity bus services, telephone services, or dare I say it, water service. Goods and services are usually provided much more efficiently by the private sector.

If you doubt this think about whether people would prefer to go into hospital as public or private patients. Which system will provide the better healthcare? In some cases the healthcare will be equally good in the public system as the private system but it is hit and miss and the funding method is not efficient. For instance if two patients are treated in a typical public hospital for identical procedures – one private and one public: The hospital will be paid by the health insurer for the private patient but will receive no extra funding for the public patient. Which patient would the hospital prefer to treat? So which patient stays on a waiting list?

Similarly If two patients go to the GP – one with a medical card and one private which will the doctor prefer to treat – the one for whom she will receive €50-60 or the one for whom she is paid a shrinking amount each year whether the patient comes in or not? Much as with hospitals the private GP system is subsidising the under resourced public one. This is unfair on private patients and practitioners and amounts to another tax.

The system of 2 or 3 tiers is very unfair. Medical card holders get much for free – even free Junior and Leaving Certificates for their children (I am not sure what that had to do with healthcare). Those who are unfortunate enough to be just above the very low limits for a medical card pay for everything expect GP visits. Those above that again pay for everything. Or they may pay for our so-called health insurance which will pay the hospital when they need to be admitted enabling them to beat the queue but pays little for other medical expenses. Perhaps if they paid for GP visits hosipital admissions would be fewer.

The lucrative nature of the medical card makes administration attempts to limit the number the norm. This process can be very cruel. Every year people with long term conditions and expensive drug needs have to reapply, filling in a long form with many financial questions. The application is usually refused first on income grounds and they are without a card for some months. Then the patient has to go to a doctor for a letter and maybe to a TD for representation to try and get the card back on medical grounds. It is a cruel and very inefficient system but I guess it does harass all apart from the persistent and desperate to give up their medical cards.

Our so-called medical insurance system is a joke. For insurance markets to work effectively pricing needs to be based on risk. But when Mary Harney, one of your predecessors, insisted on ‘community rating’ she demonstrated that government did not consider the health insurance market to be the same as other insurance markets, especially when dealing with the grey vote. Somehow it was not OK to ‘discriminate’ against older people who are often sick in the same way the younger less-experienced drivers are ‘discriminated’ against for motor insurance. The chickens are coming home to roost now with fewer young people taking up medical insurance.

The government is correct not to treat medical insurance as pure insurance. The wealthy pay more for car and house and life insurance because they have more to insure but not for Irish style health insurance. The current insurance model with one premium no matter your age, medical condition or income is not working and will never work for the whole system. Therefore a 2-tier model will inevitably remain as long as it remains a key method of funding. The German model where you pay a percentage of your income is a good option. At present much is funded publically so this is like an income tax. Therefore the funding is related to income. This also will charge older people more on average because they earn more on average than younger people. The amount paid would be about the same as USC so it could be reassigned for this purpose. Obviously you can then have competition in the market by allowing the insurance companies to charge slightly varying percentages and offer different extra benefits.

In addition to privatising the financial administration, all the health care providers should be privatised into hospital trusts or for-profit companies. They would be paid by the insurance companies for work done. Market principles would apply for staff costs, building etc. with all costs planned and budgeted as they are with most industries. The potential for government meddling with go. This will take a lot of pressure from individual patients and healthcare unions off you and your colleagues. Hospital managers will be able to manage healthcare provision dealing with patients, insurance companies and staff in the same way as most other businesses.

We also need to return sanity to medical education. How come when we have ginormous points for medicine, indicating strong interest from the best and brightest, that very few junior hospital doctors are Irish? Perhaps because the medical education system is not properly funded by government and has to prostitute itself and take in many overseas students at high fees to ‘subsidise’ the Irish students. Many of this small number of Irish students then take their subsidised education and go abroad after qualifying. Few come back so junior hospital positions are filled by foreigners, many with poor English.

The government should require subsidised medical students to work in Ireland for 3-5 years post training or be liable to pay the economic costs of fees. Sufficient Irish students should be given places in medical school to meet our future needs. Only after that should places be offered to overseas students. Also, medical education should become post-graduate. This may increase number of places without additional infrastructure and would also have the beneficial effect of increasing the status of science as a university subject.

The medical card system will become redundant under this scheme. If government feels the need to subsidise non-medical services to low income people a new system should be introduced.

Everyone should receive GP and medicine cover under the new system allowing the abolition of the current drug repayment schemes. Every patient should pay a nominal fee for doctor or dentist visits and a nominal fee for prescriptions, like that introduced recently for medical card holders.

This is only a start. It is clear that to reform the medical system a new approach is needed. Continuation of the current 2-tier system with government playing the role of main funder and main service provider will never be as good or efficient as a well-structured private model and will remain ‘Angola’ for politicians.

Yours sincerely,

New blog

I have transferred the blog ccccccc.org from blogger to wordpress because of google’s inflexibility. Older posts can still be found at http://cccccccorg.blogspot.ie/.

Improve your live and survive your camp articles are on http://surviveyourcamp.blogspot.ie/

Let the other person feel that it is their idea

If you want results, let other people come up with your ideas.

In the science fiction movie Inception, the businessman Mr Saito hires Dom Cobb, a skilled dream invader, to assemble a team to plant an idea in the mind of Robert Fischer, who is about inherit his father’s massive business empire. It is a simple idea. Saito wants Fischer to break up and sell his father’s empire. But the thought must be so deeply planted in his subconscious by having dreams within dreams within dreams that Fischer thinks it is his idea.

Mr Saito recognized that it is much better to let the other person think an idea is his or hers. Thankfully, most of us do not have to go to such extremes to achieve this, but the message is worth remembering. Most of us do not like other people ramming ideas down our throat. Even if the other party’s idea is very good, we may be reluctant to go with it because they will take the credit. In business many of us have come across “Not invented here” syndrome, where we get the impression that some part of our company is not enthusiastically behind an idea because we came up with it, not them. Bear this in mind when you are trying to convince someone to do something. Make subtle suggestions and let the other person think out the conclusion. This principle can be applied in business and personal matters.

Carnegie gives a few examples. In one a designer who made sketches of textiles and hairstyles had been trying to sell his designs to a stylist for years, with no success. Then he tried a different approach. He brought in unfinished sketches and asked the stylist to do him a favor. He asked him to look over the sketches and make suggestions as to how they should be finished.

The designer came back a few days later, got the sketches and finished them according to the suggestions. They were all accepted. The stylist accepted them since, because of his input, he felt they were his ideas.

Everybody likes to claim an idea is theirs. It makes them feel clever and important. If you are designing something, let your boss or a customer decide the color or some other feature so they can claim it as their own in some way.

Carnegie gives another example of application of the principle to personal life. A man wanted to go on a family vacation to historical sites in the Eastern United States while his wife wanted to visit scenic sites in the West. They could not do both. Instead of tackling the idea straight on, he spoke over the dinner table to their daughter, who had just learned some history in school. He asked her if she would like to visit some of the sites she had learned about in school. Of course she agreed. Then with no further discussion of vacation plans, his wife made the suggestion two days later that they should go East on holiday because it would be such a thrill for their daughter to visit the sites.

This approach also works well in politics. If you want something done, you might find it more effective to ignore your ego and let others steal your ideas. Carnegie gives the example of Colonel Edward House, an advisor to US president Woodrow Wilson. House learned that the best way to convert the president to an idea was to plant it in his mind casually and get him to think about it further himself. The first time he noticed this was when the president recycled one of House’s ideas as his own a few days after he had argued against it. House did not let him know it was his idea originally. He wanted results, so he let Wilson take credit for the idea.

If you want results, let other people come up with your ideas.

Sex is Energy

Channel your sexual energy into your desire. You
will be harnessing the most powerful force of nature.

The artist Beatrice Wood said that sex is energy. She lived to be 105 years old. Sexual energy is one of the most powerful forces in the universe. It drives people and animals to do things that they would otherwise not do. At its extreme, a male black widow spider or praying mantis is driven to sex even though afterwards he will end up as a meal for his mate.

Sex has three very powerful benefits – (1) procreation of the species, (2) a feeling of extreme happiness and well-being, (3) the power to achieve other things if properly channeled. Harnessing the power of sex is the 10th step on Hill’s Path to Riches. If you can channel your sexual energy into achieving your goal rather than satisfying your physical desires, you will be using great power.

Sexual power is strongest in young men. They seldom channel it properly, but when they do the results are incredible. Young men want to excel to make themselves look good for women. This is a response to an evolutionary urge to find a mate. Sometimes this energy is channeled poorly into criminality and driving cars too fast. But some young men do use the power to achieve greatness in business, the sciences and arts.

Look at how young some of the whiz kids of modern technology are. Mark Zuckerberg set up Facebook when a sophomore in Harvard. The company’s founding president was Sean Parker, originally of Napster, who already had an impressive record in innovation at age 25. Sean Parker’s father advised him to take risks in business before he had a family. Historically Mozart wrote music when very young. Einstein’s greatest discoveries were as a young man. If you are young, and especially male, channel some of your sexual energy into a goal and look at it take off.

Hill observed that most of the millionaires he interviewed achieved most between ages 40 and 60. This is probably still typical of business. Fifty seems to be a common age for entrepreneurs. At this age people have accumulated a lot of life experience and good contacts. They will know what they want and how to go about getting it. They are also more likely to channel sexual energy into the business than into physical sexual acts. They usually already have a family.

Men under 40 often dissipate most of their sexual energy by overindulging in the expression of sexuality. Sexual energy is also strong in women, and women can control it better than men. Many younger women are delaying relationships and marriage now and channeling much of their energy into their careers.

The desire for sexual expression is the strongest mind stimulus. Other stimuli include love, fame and financial gain, music and friendship. Humans engage in many more sexual acts compared to the number of offspring than any other creature, and engage in sex at all times – not just when the female is in season. Contraception is highly developed to allow sexual acts without offspring. This is because the feeling of happiness and well-being produced has created a market for risk-free indulgence in sex.

Advertisers use sexual imagery to sell their products. Designers strive to create work that evokes thoughts of sex. The power and energy of sex are so great that many political and religious leaders have tried to control it down through the years. Clergy in the Roman Catholic Church are unmarried men. But it is nearly impossible to put a cork on the bottle of sexual energy. The Catholic Church has experienced many sexual scandals recently because many of its priests were not able to control their sexual desires.

The trick is to learn to channel some of your sexual energy into your goal. I personally think of several women as my muses. They are women who if I were younger I would want to have a sexual relationship with. But now I think of them and it helps me channel my energy into my work.

You have to accept that you have sexual desires. They are probably the strongest desires you have. The more sexual desire you have, the more you can achieve in life. Just don’t let it destroy you. In recent years the economist and politician and potential candidate for the French presidency, Dominique Strauss-Kahn, was embroiled in a tawdry sexual scandal involving a chamber maid in New York. In the field of politics there is a fine line between having the sexual energy and animal magnetism that you need to be popular and over-expressing this sexual energy and becoming knocked down by scandal.

Bill Clinton is a very sexually attractive man and this animal magnetism made him the most popular US president of recent years. But it also gave his enemies a target to aim at. The charismatic president John F. Kennedy was also extremely sexual, if half the stories can be believed. But he lived in a time when the press was more easily controlled.

The best salesmen and saleswomen are highly sexual, with the same type of energy as Bill Clinton. This comes across with their hand shake, tone of voice, posture, emotions and personal grooming. They will always look their best. The best public speakers, lawyers and even clergymen have plenty of sexual energy. They will channel it into enthusiasm.

Acknowledge that you have sexual energy and be glad of it. It shows you are alive. In many societies sexuality is condemned, because of the bad outcomes that can come when people let their sexual desires run riot. But if you channel this sexual energy into your goals, you will have an unstoppable power.

Love, romance and sex can help channel your energy into worthwhile endeavors. Many people have achieved very well because of the support of their mate. The choice of mate remains the most important you will make in life. With the right person you can conquer the world. With the wrong person you will more than likely fail. When love, sex and romance are properly harnessed there is little that you cannot achieve.

The desire to please women remains one of the strongest motivating forces that there is for men. What is the point of achieving great things if you have no one to share them with? The woman who recognizes this desire in her man and allows him to impress her has nothing to fear from other women. The woman who restricts her man in his goals will lose him.

Channel your sexual energy into your desire. You will be harnessing the most powerful force of nature.