# Are income tax rates really too high in Ireland



## ClubMan (12 Jan 2022)

I see several posters here and in other threads claiming "income tax is too high in Ireland". Is that really the case? This research seems to suggest that this may not be the case.





						Comparing Irish Income Taxation Rates with other EU Member States – Public Policy
					






					publicpolicy.ie


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## Horatio (12 Jan 2022)

I haven't read the article you linked but it may be the case that the value realisation / capital allocation decisions from the income tax take is poor rather than the tax take itself being the problem.


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## ClubMan (12 Jan 2022)

Horatio said:


> it may be the case that the value realisation / capital allocation decisions from the income tax take is poor rather than the tax take itself being the problem.


I have no idea what that means.


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## noproblem (12 Jan 2022)

A lot of people are not able to hold down a job and must/should be helped.
A lot of people chose not to work and are paid not to. 
A lot of the population are of an age where they collect money by means of a pension.
All children in this state are paid an allowance, it's given to the parent/parents. 
On top of the above cash, many more allowances are also handed out.

Most people paying high tax don't agree with paying all of the above.
Many people getting most of the above, think more people should be paying more.

 To pay the above requires a lot of tax-payers money. If it continues, more tax will be required.

Goverments will rise and fall on either giving, or taking. 

Are taxes too high now? For some, yes. For others? No.

Maybe we need a 3rd rate of tax?


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## Protocol (13 Jan 2022)

Effective income tax rates are not very high, no.

However, the entry point to the top marginal tax rate MTR is very low.

You reach 48.5% at about 36k, that is crazy.


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## Itchy (13 Jan 2022)

noproblem said:


> To pay the above requires a lot of tax-payers money. If it continues, more tax will be required.



Or less/more effective spending. I'd like to see the Comptroller and Auditor Generals annual report have more clout.



Protocol said:


> Effective income tax rates are not very high, no.
> 
> However, the entry point to the top marginal tax rate MTR is very low.
> 
> You reach 48.5% at about 36k, that is crazy.



Is this not a contradiction. The MTR just raises the effective rate. For example, you could say the effective rate at, say 40k is too high and should be reduced by raising the entry to the MTR to 40k? 

Effective tax rates - Single person


13k0%​15k1%​20k8%​30k14.8%​40k19.8%​50k25.5%​60k29.4%​70k32.1%​80k34.6%​90k36.5%​100k38.1%​

If you raise the entry to the MTR, you reduce the effective tax for those in between the bands.


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## Peanuts20 (13 Jan 2022)

You can't look at Income Tax in isolation, you have to look at the overall tax burden.

Firstly you have PRSI and USC and USC can be called what ever they want to call it but in essence, it is a tax on income.

Secondly you should look at consumption tax, VAT in Hungary is 27% as an example, 25% in Norway and Sweden.

Thirdly you have to look at other taxes, e.g. our property tax is amongst the lowest in Europe, it's a pittance in comparison to Local Council Tax in England. I lived in England for many years and the council tax on my modest 4 bed terraced house in Essex is 8 times what I pay for a 4 bed semi here. Throw in the free water here and I'm already €2k better off then if I lived in the UK

So there are pluses and minuses and the overall tax burden on individuals is what should be looked at, not just income tax


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## Purple (13 Jan 2022)

The rates aren't too high but the band at which the highest rate is paid is too low.
The income at which the lower rate is paid is too high.
Basically the base is way too narrow. Not only should income taxes be less progressive but non income related taxes are way too low and things like property tax should be much higher.


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## Carnmore (13 Jan 2022)

I don't think the rates are too high rather it's increasingly difficult to see what services I'm getting in return without having to pay an additional premium such as the Drugs Payment Scheme, GP/Hospital charges. 

If services were on a par with northern Europe I would happily pay a higher rate.

It seems to me that tax is increasingly spent on welfare, public sector pay, private sector contractors providing poor value (such as HAP, care provision, infrastructural projects) rather than service provision/delivery.


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## NoRegretsCoyote (14 Jan 2022)

Peanuts20 said:


> You can't look at Income Tax in isolation, you have to look at the overall tax burden.


But it's a thread about income taxes

I personally would have a gentler schedule so same average tax rate overall, with the lower rate kicking in earlier and higher rate a bit later.


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## Purple (14 Jan 2022)

Carnmore said:


> it's increasingly difficult to see what services I'm getting in return


When you flush the toilet does your poo go away?
Do the streetlights come on when it's dark?
Are there roads outside your house?
Are there emergency services you can call?
If you have children are there schools that they can go to?
Are there hospitals you can go to if you are sick?

There are loads of things we get but there is gross inefficiency in how the State delivers services and, in particular, how it regulates and interacts with the private sector. 

If we want Northern European levels of service we need serious structural reform to the State sector and the Unions won't let that happen. We also need much high taxes on low to mid level earners and that certainly won't happen.


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## ClubMan (14 Jan 2022)

Purple said:


> there is gross inefficiency in how the State delivers services and, in particular, how it regulates and interacts with the private sector.


My experience of a lifetime working in the private sector is that it's rarely a paragon of efficiency and common sense either. And that includes several US HQ'd publicly quoted multinationals where results are measured quarterly and by the markets. But it's a common trope to assume that such inefficiency is the sole domain of public services only.


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## DublinHead54 (14 Jan 2022)

ClubMan said:


> My experience of a lifetime working in the private sector is that it's rarely a paragon of efficiency and common sense either. And that includes several US HQ'd publicly quoted multinationals where results are measured quarterly and by the markets. But it's a common trope to assume that such inefficiency is the sole domain of public services only.



There is an infatuation with 'change' and paying huge sums to plan change across both public and private sectors. 

I think Tax Rates are unfairly high for younger people, especially in the current economic environment. I think people who are in essentially services that are lower paid deserve better tax breaks than those working in non-essential services with higher wages. Private salaries are rising due to competition and the tax take I imagine will grow given the low threshold to hit the top income tax level.


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## Purple (14 Jan 2022)

ClubMan said:


> My experience of a lifetime working in the private sector is that it's rarely a paragon of efficiency and common sense either. And that includes several US HQ'd publicly quoted multinationals where results are measured quarterly and by the markets. But it's a common trope to assume that such inefficiency is the sole domain of public services only.


I agree with you that the private sector is nothing special either but the services delivered by the State are more important so it's more important that they are delivered well and efficiently.


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## Purple (14 Jan 2022)

Dublinbay12 said:


> There is an infatuation with 'change' and paying huge sums to plan change across both public and private sectors.


I agree. LEAN methodology is a good driver for change. It empowers people at every level to make the thousands of small changes that add up to a big difference. When the high volume of low value changes are made the big structural problems become more visible and are easier to fix.


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## Purple (14 Jan 2022)

Dublinbay12 said:


> I think Tax Rates are unfairly high for younger people, especially in the current economic environment. I think people who are in essentially services that are lower paid deserve better tax breaks than those working in non-essential services with higher wages.


I think the issue is more that we still have too narrow a tax base with too much tax on labour. That creates an unequal society where those starting off are disadvantaged.


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## ClubMan (14 Jan 2022)

Purple said:


> I think the issue is more that we still have too narrow a tax base with too much tax on labour. That creates an unequal society where those starting off are disadvantaged.


But as another poster said earlier, this thread is specifically about income taxes/deductions.   

And the report that I linked to in my original post (split off from another thread) assesses the Irish income tax regime as generally fair - i.e. not onerous and very progressive.


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## Leo (14 Jan 2022)

Purple said:


> I agree with you that the private sector is nothing special either but the services delivered by the State are more important so it's more important that they are delivered well and efficiently.


On top of that, you generally don't get much in the way of choice when it comes to state services. If I want a product of the private sector, then I'll usually have choice and the more efficient company will often win that business by offering better value / quality. 

Lots of private sector companies, including the big quoted ones fail and go bust due to inefficiencies, we just throw more money at state inefficiency.


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## Purple (14 Jan 2022)

ClubMan said:


> And the report that I linked to in my original post (split off from another thread) assesses the Irish income tax regime as generally fair - i.e. not onerous and very progressive.


"Fair" is a relative term. Why is very progressive regarded as fair?


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## ClubMan (14 Jan 2022)

Purple said:


> "Fair" is a relative term. Why is very progressive regarded as fair?


Ok, maybe I should've quoted from the report's abstract for those who haven't read it.


> At average incomes and below, the Irish income tax burden is relatively low when compared to other EU Member States...
> 
> The Irish tax and welfare system is the most progressive and redistributive in the EU – in terms of offsetting household and market income inequalities.


Why would a progressive tax system *not* be fair? Surely those who earn more should pay more?


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## Purple (14 Jan 2022)

ClubMan said:


> Ok, maybe I should've quoted from the report's abstract for those who haven't read it.


Income inequality is only part of the picture. Household expenses and net wealth must also be taken into account. It is wrong that people with moderate incomes but no net wealth are having part of their income transferred  to people with lower gross incomes but vast net wealth.


ClubMan said:


> Why would a progressive tax system *not* be fair? Surely those who earn more should pay more?


I think a progressive system is fair, to a point. If, for example, people ended up only marginally better off working than they would be on welfare then it's not fair. If people who didn't work starved and those in high incomes only paid a very small more then it wouldn't be fair either.

So the answer to your question is "probably but it depends".


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## Carnmore (14 Jan 2022)

Purple said:


> When you flush the toilet does your poo go away?
> Do the streetlights come on when it's dark?
> Are there roads outside your house?
> Are there emergency services you can call?
> ...


All rhetorical questions but, as you know full well, that isn't what I mean .

Those are base-level prerequisites of any civilised society, again which you know full well.


Purple said:


> There are loads of things we get but there is gross inefficiency in how the State delivers services and, in particular, how it regulates and interacts with the private sector.


I know that 


Purple said:


> If we want Northern European levels of service we need serious structural reform to the State sector and the Unions won't let that happen.


I've repeatedly posted to this effect in posts which you've been an active participant in 


Purple said:


> We also need much high taxes on low to mid level earners and that certainly won't happen.


I already stated that I'd happily pay more tax.

I don't know what you hope to achieve by responses such as this apart from inane back and forthes, which is not debate


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## ClubMan (14 Jan 2022)

Carnmore said:


> Those are base-level prerequisites of any civilised society, again which you know full well.


Which still have to be paid for.


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## Carnmore (17 Jan 2022)

ClubMan said:


> Which still have to be paid for.


Obviously as they do anywhere else including the countries which have additional tangible public services rather than revenue being subsumed in to welfare and public sector pay


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## ClubMan (17 Jan 2022)

Carnmore said:


> Obviously as they do anywhere else including the countries which have additional tangible public services rather than revenue being subsumed in to welfare and public sector pay


How do you think that other countries pay for these items?


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## RetirementPlan (17 Jan 2022)

Carnmore said:


> Obviously as they do anywhere else including the countries which have additional tangible public services rather than revenue being subsumed in to welfare and public sector pay


That's a good trick - providing additional tangible public services without paying the people who provide those additional tangible public services.


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## Carnmore (17 Jan 2022)

ClubMan said:


> How do you think that other countries pay for these items?


Proportionately and getting their priorities right. In Ireland the only guarantees associated with the public sector is the wages of those employed by it getting paid whether the service is delivered or not.


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## Carnmore (17 Jan 2022)

RetirementPlan said:


> That's a good trick - providing additional tangible public services without paying the people who provide those additional tangible public services.


It's an even better trick to change the purpose of the public service to a wage-paying one rather than service delivery


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## Purple (17 Jan 2022)

Carnmore said:


> Proportionately and getting their priorities right. In Ireland the only guarantees associated with the public sector is the wages of those employed by it getting paid whether the service is delivered or not.


That's true but that doesn't necessarily mean they don't deliver the services. People are people, most of them want to do a good job. That applied in the State sector and in the private sector. The issue in both is getting the culture and structure right. That's harder in the State sector because there is no sanction on an organisation for being structurally incompetent. In the Private sector they go bust, in the State sector they close Wards. It's really hard in both to sack anyone for being bad at their job.


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## RetirementPlan (17 Jan 2022)

Carnmore said:


> It's an even better trick to change the purpose of the public service to a wage-paying one rather than service delivery


Let me know if you see that happening anywhere.


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## Carnmore (17 Jan 2022)

RetirementPlan said:


> Let me know if you see that happening anywhere.


In Ireland unless one is benefitting from it and in denial.

In the latter case, then it's all the governments'/senior management/too many administrators fault


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## Carnmore (17 Jan 2022)

Purple said:


> That's true but that doesn't necessarily mean they don't deliver the services.


I did say "whether the service is delivered or not"


Purple said:


> People are people, most of them want to do a good job. That applied in the State sector and in the private sector. The issue in both is getting the culture and structure right. That's harder in the State sector because there is no sanction on an organisation for being structurally incompetent. In the Private sector they go bust, in the State sector they close Wards. It's really hard in both to sack anyone for being bad at their job.


I agree


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## RetirementPlan (18 Jan 2022)

Carnmore said:


> In Ireland unless one is benefitting from it and in denial.
> 
> In the latter case, then it's all the governments'/senior management/too many administrators fault


Strange how when you ask people who use those services, the vast majority are happy with the quality of service recieved;






						Minister Donohoe publishes results of the 2019 Survey of Civil Service Customer Satisfaction Survey
					

This is the eighth survey since 1997 that has been carried out among the Irish public to determine satisfaction levels with services received from civil service departments and major offices.




					www.gov.ie
				




Or when you look at international benchmarking by OECD or Cap Gemini or many others over the years, Ireland generally stands up well, and has been towards the top of the tables for eGovernment for many years.

Are you relying purely on anecdote for your own conclusions on the matter?


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## Purple (18 Jan 2022)

RetirementPlan said:


> Strange how when you ask people who use those services, the vast majority are happy with the quality of service recieved;
> 
> 
> 
> ...


The biggest spend by the State is on healthcare. I don't think too many people are happy with the quality of the service there. Taking our waiting lists and waiting times in A&E into account and seeing them in the context of a health system that has been one of the best funded in the world for last three decades if people are happy with it then they have very low expectations.

Getting back on topic; I think people would be happier with the rates of income tax they pay if they thought they were getting good value for their 'spend'.


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## roker (18 Jan 2022)

ClubMan said:


> I see several posters here and in other threads claiming "income tax is too high in Ireland". Is that really the case? This research seems to suggest that this may not be the case.
> 
> 
> 
> ...


Do we consider PRSI and USC as a tax


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## RetirementPlan (18 Jan 2022)

Purple said:


> The biggest spend by the State is on healthcare. I don't think too many people are happy with the quality of the service there. Taking our waiting lists and waiting times in A&E into account and seeing them in the context of a health system that has been one of the best funded in the world for last three decades if people are happy with it then they have very low expectations.
> 
> Getting back on topic; I think people would be happier with the rates of income tax they pay if they thought they were getting good value for their 'spend'.


Funnily enough, when you ask people who've been through the healthcare system as inpatients, five out of six of them tell you they had a good or very good experience, which is pretty good.
https://yourexperience.ie/inpatient/national-results/ 

And yes, of course there are huge issues with waiting lists in some areas, but there is only so much you can do with finite resources.


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## Purple (18 Jan 2022)

RetirementPlan said:


> And yes, of course there are huge issues with waiting lists in some areas, but there is only so much you can do with finite resources.


Yes, but we can do far more with the vast resources we have. That's the issue.


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## Carnmore (18 Jan 2022)

RetirementPlan said:


> Strange how when you ask people who use those services, the vast majority are happy with the quality of service recieved;
> Are you relying purely on anecdote for your own conclusions on the matter?


I am too but take exception to being charged on the double to see a GP and hospital charges in addition to funding them through taxation.
Also only having services available when they suit the staff rather than when they're needed is obviously not acceptable.


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## Carnmore (18 Jan 2022)

RetirementPlan said:


> And yes, of course there are huge issues with waiting lists in some areas, but there is only so much you can do with finite resources.


The waiting lists and finite resources are a unionised staff creation-inflexible work practices, not working when and where they're needed, demands for "upskilling" payments, the list is endless. 
In summary, these issues are due to staff intransigence.


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## RetirementPlan (19 Jan 2022)

Carnmore said:


> I am too but take exception to being charged on the double to see a GP and hospital charges in addition to funding them through taxation.
> Also only having services available when they suit the staff rather than when they're needed is obviously not acceptable.





Carnmore said:


> The waiting lists and finite resources are a unionised staff creation-inflexible work practices, not working when and where they're needed, demands for "upskilling" payments, the list is endless.
> In summary, these issues are due to staff intransigence.



Yes, damn those junior doctors, only working up 90 or 100 hours per week including >24 hour shifts. If only they'd work a bit harder, we could clear all those waiting lists so easily.








						Urgent action needed to stop bullying and exploitation of doctors, some of whom work 90-hour weeks – report
					

URGENT action is need to end bullying and excessive working hours suffered by Irish doctors while hundreds of consultant posts are unfilled, a new report warned today.




					www.independent.ie


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## Purple (19 Jan 2022)

RetirementPlan said:


> Yes, damn those junior doctors, only working up 90 or 100 hours per week including >24 hour shifts. If only they'd work a bit harder, we could clear all those waiting lists so easily.


Who is suggesting that people should be working harder?
There are structural issues within the health service which causes massive duplication of process which results in massive waste. Lack of labour flexibility means that people can't be moved to different tasks so one area can be under staffed while another is over staffed. This also causes massive waste. That doesn't mean people are slackers.


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## Carnmore (19 Jan 2022)

RetirementPlan said:


> Yes, damn those junior doctors, only working up 90 or 100 hours per week including >24 hour shifts. If only they'd work a bit harder, we could clear all those waiting lists so easily.


Irrelevant as well as facetious. If the unionised staff stopped inhibiting service delivery we'd have a much better functioning services


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## RetirementPlan (19 Jan 2022)

Carnmore said:


> Irrelevant as well as facetious. If the unionised staff stopped inhibiting service delivery we'd have a much better functioning services


Facetious? Moi?

I don't suppose you've come up with any examples of how unionised staff are inhibiting service delivery since the last time I asked you?


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## Carnmore (19 Jan 2022)

RetirementPlan said:


> I don't suppose you've come up with any examples of how unionised staff are inhibiting service delivery since the last time I asked you?


Do you like repeating the same question despite it being answered numerous times?


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## RetirementPlan (19 Jan 2022)

Carnmore said:


> Do you like repeating the same question despite it being answered numerous times?


Was just hoping that maybe you had some examples by now, but apparently not


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## Purple (19 Jan 2022)

RetirementPlan said:


> Was just hoping that maybe you had some examples by now, but apparently not


Do you expect other posters to conduct research in order to support their posts on what is a discussion forum?
What posters see is one of the best funded health services in the world with some of the longest waiting list in the developed world.  

This is a good overview of the Irish Healthcare system, though it ignored our very young population as a control factor for spending and outcomes and it should be noted that the main sources of information are from within  the Irish Healthcare system and State sector.
Overall we are not doing to badly but averages are not such a good indicator as our private system makes them look better than they would if we just measured the public system. It's also worth noting that we are spending over 11% of our GNI on health, way above the EU average.

It is fair to say that our Civil Service is too small. It's about the same size as it was 10 years ago and our population and economy are considerably bigger now than they were then.


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## RetirementPlan (19 Jan 2022)

Purple said:


> Do you expect other posters to conduct research in order to support their posts on what is a discussion forum?
> What posters see is one of the best funded health services in the world with some of the longest waiting list in the developed world.
> 
> This is a good overview of the Irish Healthcare system, though it ignored our very young population as a control factor for spending and outcomes and it should be noted that the main sources of information are from within  the Irish Healthcare system and State sector.
> ...


The specific claim here is about "unionised staff are inhibiting service delivery". I don't expect anyone to do research. I'd expect that before anyone would make a claim like this, they would have information or knowledge on which to base the claim. If this is some kind of gut feeling or act of faith, it really doesn't add much to policy discussions like this.

If union intransigence had one-tenth of the impact that some posters here would suggest, we'd be tripping over ourselves with press reports and PQs and government statements in relation to such issues. I've seen no actual evidence to suggest that this is the case. To me, it seems to be posters relying on 1980s tired old tropes.

If this stuff is happening, let's get the evidence out on the table. If there's no evidence, it's not happening.


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## Bluefin (19 Jan 2022)

As someone who worked in both union and non union companies my experience has been that change was always very difficult in union companies where non union employees had very little choice (apart from moving to a new employer) but to go along with change.. 

Members of unions had to be paid off in order to implement change


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## Purple (19 Jan 2022)

RetirementPlan said:


> The specific claim here is about "unionised staff are inhibiting service delivery". I don't expect anyone to do research. I'd expect that before anyone would make a claim like this, they would have information or knowledge on which to base the claim. If this is some kind of gut feeling or act of faith, it really doesn't add much to policy discussions like this.
> 
> If union intransigence had one-tenth of the impact that some posters here would suggest, we'd be tripping over ourselves with press reports and PQs and government statements in relation to such issues. I've seen no actual evidence to suggest that this is the case. To me, it seems to be posters relying on 1980s tired old tropes.
> 
> If this stuff is happening, let's get the evidence out on the table. If there's no evidence, it's not happening.


There is certainly an overhang from the 80's in the perception of Unions but at the same time it's very hard to prove a negative and the people who would be doing the examinations would be either in the Unions or gathering data from people who are in the unions.
It hardly needs to be states that there is less labour flexibility in unionised workplaces and that lack of flexibility has a significant impact on productivity.
Here's an example, and I appreciate it's only one example.
When my eldest son was two and a half he was very sick in Tallaght hospital for a few weeks. I stayed there every night, going directly to and from work each day. One evening he spilled a drink on the floor and when I went to wipe it up a nurse said "You can't do that". I went to hand her the blue paper so she could do it and she recoiled (no exaggeration), saying that wasn't her job. She went to the Nurses Station and called a cleaner, staying there for about 10-15 minutes until the cleaner arrived. When she got back to the room with the cleaner I'd already cleaned it up. She gave out to me. So, something that should have taken 20 seconds took up 15 minutes of her time and 15 minutes of the cleaners time. Does anyone seriously think that would happen in a non-unionised environment?
As an aside, a few nights later I heard, from my sons room 20 feet away, a Nurse recalling in graphic detail the oral sex she's given to someone outside a pub/nightclub the previous weekend.


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## ClubMan (19 Jan 2022)

To be fair that incident could be explained by paranoia on account of people suing them because the spillage wasn't dealt with "professionally".

P.S. you didn't get that nurse's number by any chance?


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## Sophrosyne (19 Jan 2022)

Poor experiences that have been _repeatedly_ related to me were mainly:

Information not passed on
Lack of vigilance
Lack of supervision
For instance:

A heart patient who could not have aspirin. Information given to A & E clinicians. Not passed on to various ward clinicians. Relatives, frustrated at having to constantly repeat the same information and afraid of what might happen in their absence had to put a sign over the patient’s bed themselves.
Patient in her 70s with osteo and rheumatoid arthritis and a leg ulcer, ambulanced to hospital after a fall. Placed in a geriatric ward with minimal medical treatment and no subsequent x-rays after the 1st in A & E. The relatives witnessed a carer drop a sterile dressing on the floor and was about to apply it to the patient’s ulcerated leg. She later contracted MRSA and was moved to an isolation room. The room had a musty smell and was never cleaned. She died shortly afterwards.
Relatives visited their father in the evening. There for circa an hour and half. Before leaving one relative went to straighten the bedclothes and discovered a urine bottle. The father was embarrassed to mentioned it. It had been there for an hour before they arrived. He had pressed the bell over his bed several times but said it was very seldom answered. Relatives went to the nursing station to discover the staff nurse and 5 or six other nurses. When they asked why they were in the nurse’s station and not on the wards, they were told they were studying for exams.
Son received a telephone from the hospital to inform him that unless he took time off work to feed his mother, who suffered from dementia, during every mealtime, it could not guarantee that she would be fed.
I have usually had good experiences, and I hope these events are not typical, though I have had similar recounted to me often enough.

I’m not sure that these failures have to do with union membership but rather with a combination of inadequate resourcing and poor individual management.


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## Protocol (19 Jan 2022)

roker said:


> Do we consider PRSI and USC as a tax




USC is an income tax.

PRSI is debateable, it has aspects of an insurance premium, but many consider it an income tax.


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## Protocol (19 Jan 2022)

RetirementPlan said:


> Facetious? Moi?
> 
> I don't suppose you've come up with any examples of how unionised staff are inhibiting service delivery since the last time I asked you?



Some quick examples from the west of Ireland.

Doctor followed by RTE (Primetime?) doing very little public work.

Doctor in hospital "screaming" at the bed manager/waiting list official, that they won't take any more patients.

Two porters watching Steptoe and Son videos after their boss leaves.


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## Purple (20 Jan 2022)

ClubMan said:


> To be fair that incident could be explained by paranoia on account of people suing them because the spillage wasn't dealt with "professionally".


That's a bit tenuous though, isn't it?


ClubMan said:


> P.S. you didn't get that nurse's number by any chance?


No, she was studying for exams.


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## RetirementPlan (20 Jan 2022)

Purple said:


> There is certainly an overhang from the 80's in the perception of Unions but at the same time it's very hard to prove a negative and the people who would be doing the examinations would be either in the Unions or gathering data from people who are in the unions.
> It hardly needs to be states that there is less labour flexibility in unionised workplaces and that lack of flexibility has a significant impact on productivity.
> Here's an example, and I appreciate it's only one example.
> When my eldest son was two and a half he was very sick in Tallaght hospital for a few weeks. I stayed there every night, going directly to and from work each day. One evening he spilled a drink on the floor and when I went to wipe it up a nurse said "You can't do that". I went to hand her the blue paper so she could do it and she recoiled (no exaggeration), saying that wasn't her job. She went to the Nurses Station and called a cleaner, staying there for about 10-15 minutes until the cleaner arrived. When she got back to the room with the cleaner I'd already cleaned it up. She gave out to me. So, something that should have taken 20 seconds took up 15 minutes of her time and 15 minutes of the cleaners time. Does anyone seriously think that would happen in a non-unionised environment?
> As an aside, a few nights later I heard, from my sons room 20 feet away, a Nurse recalling in graphic detail the oral sex she's given to someone outside a pub/nightclub the previous weekend.





Protocol said:


> Some quick examples from the west of Ireland.
> 
> Doctor followed by RTE (Primetime?) doing very little public work.
> 
> ...



Maybe it's just me, but anecdotes about poor treatment or strange policies aren't evidence of the health service being strangulated by union intransigence. For a start, anecdotes are anecdotes, and don't give us any kind of reasonable picture of over what is happening with 100,000 staff across the health service. Evidence of poor responses by staff tell us nothing about how the unions work, or don't work. If you want to show that the health service is strangled by union intransigence, you'd need to be showing that management are working to fix or improve these issues and are being actively prevented from implementing sensible fixes by trade unions. This would be coming out of WRC cases or Labour Court discussions, and the press would be only too delighted to amplify such instances. But I haven't seen such cases coming through or being reporting recently. There was one case about 15 years ago around changing of light bulbs, which on the face of it, seemed to indicate a degree of union intransigence. Is there any evidence that kind of thing is happening on an ongoing basis?


Sophrosyne said:


> Poor experiences that have been _repeatedly_ related to me were mainly:
> 
> Information not passed on
> Lack of vigilance
> ...


That's really my point - what's all this got to do with union intransigence?


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## Protocol (20 Jan 2022)

More examples:

(1) A consultant stated that he gets four times as many procedures done in the private hosp compared to a public hosp. This quote was in the public domain.

Now, I suspect a certain amount of hyberbole, but I'm sure there is some truth to that.

Output per day is bound to be higher.

(2) I spoke to a HR manager in a large private hosp, tells me scans/MRI/imaging continues until 2am. I asked are there really patients going in after midnight for scans? Yes.

But not in the HSE hosp.


(3) Staff in Sligo endoscopy unit confirmed to me that they often have excess staff, as the number of staff isn't matched to the volume of patients on the list.


I accept that unions may not be involved in all these issues.

However, I contend that is all hosps were run on the basis of "money follows the patient" / UHI, I feel output would be higher.


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## Sophrosyne (20 Jan 2022)

RetirementPlan said:


> That's really my point - what's all this got to do with union intransigence?


Yes, I agree that these are individual failures caused by managerial shortcomings and/or a lack of adequate or appropriate resources and personnel.

Blaming unions is often a bum steer to mask a multitude of sins, such as the hospital plan from hell.

I don’t think that comparing public and private hospitals is particularly relevant as they don’t act in the same framework.

The fact that Ireland is a high-cost economy probably has the greatest material bearing on healthcare costs.


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## odyssey06 (20 Jan 2022)

Sophrosyne said:


> Yes, I agree that these are individual failures caused by managerial shortcomings and/or a lack of adequate or appropriate resources and personnel.
> 
> Blaming unions is often a bum steer to mask a multitude of sins, such as the hospital plan from hell.
> 
> ...


It's not just individual failures, it's a pattern and why do they occur more often there. It's because of a lack of accountability. 
What do you think would happen to the manager who tried to make those individuals accountable and tried to drive efficiency and flexibility over rigid separation of duties?


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## Purple (20 Jan 2022)

Sophrosyne said:


> The fact that Ireland is a high-cost economy probably has the greatest material bearing on healthcare costs.


Figures on spending are adjusted for purchasing power parity. What people get paid isn't the issue. We should be asking the question "In a optimally structured healthcare system would the task the individual is doing be necessary?".


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## Carnmore (20 Jan 2022)

Protocol said:


> Doctor followed by RTE (Primetime?) doing very little public work.


Yes, an ophthalmologist averaging of 13 out of 39 contracted HSE hours per week over a three month period.

Straightforward theft of public money and dereliction of duty- they should have been criminally charged, prosecuted and struck off the medical register but it doesn't work like that in Ireland. 

Liveline was inundated with calls the day after the programme was broadcast but a positively muted response from the presenter - none of the usual hyperbole "gurrier" type guff.


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## Carnmore (20 Jan 2022)

Protocol said:


> More examples:
> 
> (1) A consultant stated that he gets four times as many procedures done in the private hosp compared to a public hosp. This quote was in the public domain.
> 
> ...



Providing actual examples is preposterous and does not fit the public servant union-apologist narrative!

This inanely perpetual discussion might have nowhere else to go now.


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## RetirementPlan (20 Jan 2022)

odyssey06 said:


> It's not just individual failures, it's a pattern and why do they occur more often there. It's because of a lack of accountability.
> What do you think would happen to the manager who tried to make those individuals accountable and tried to drive efficiency and flexibility over rigid separation of duties?


Maybe instead of speculating as to what might happen to the manager, we could look at actual facts, actual evidence - WRC cases, Labour Court cases, press reports of union negotiation, any other credible sources, instead of just making guesses?


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## RetirementPlan (20 Jan 2022)

Protocol said:


> However, I contend that is all hosps were run on the basis of "money follows the patient" / UHI, I feel output would be higher.


FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.

Higher output isn't the only criteria, or even the main one. Quality of output is more important than speed of output. It's easy for private hospitals to cherrypick the simpler procedures and simpler cases, and they won't hesitate to fall back on the public system, handing the more complex cases back to the public service when they can't squeeze any more insurance payments out of them.


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## odyssey06 (20 Jan 2022)

RetirementPlan said:


> Maybe instead of speculating as to what might happen to the manager, we could look at actual facts, actual evidence - WRC cases, Labour Court cases, press reports of union negotiation, any other credible sources, instead of just making guesses?


You don't bring a case you know you will lose. You don't even try.


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## Purple (20 Jan 2022)

RetirementPlan said:


> FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.


I don't think that was the only reason. Resistance from players at all levels who have an interest in maintaining the current system was strident. 


RetirementPlan said:


> Higher output isn't the only criteria, or even the main one. Quality of output is more important than speed of output. It's easy for private hospitals to cherrypick the simpler procedures and simpler cases, and they won't hesitate to fall back on the public system, handing the more complex cases back to the public service


That's a valid point.


RetirementPlan said:


> when they can't squeeze any more insurance payments out of them.


Can you provide evidence that this happens?


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## RetirementPlan (20 Jan 2022)

odyssey06 said:


> You don't bring a case you know you will lose. You don't even try.


I'm not 100% sure on your implication here.

One implication is that unions aren't really all that intransigent, so they don't challenge cases where they would be seen to be intransigent, so they effectively 'give in' to management on such cases.

Is that what you mean?


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## Purple (20 Jan 2022)

RetirementPlan said:


> I'm not 100% sure on your implication here.
> 
> One implication is that unions aren't really all that intransigent, so they don't challenge cases where they would be seen to be intransigent, so they effectively 'give in' to management on such cases.
> 
> Is that what you mean?


Now you are being obtuse. Funny, but obtuse.


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## RetirementPlan (20 Jan 2022)

Purple said:


> I don't think that was the only reason. Resistance from players at all levels who have an interest in maintaining the current system was strident.
> 
> That's a valid point.
> 
> Can you provide evidence that this happens?


Cherrypicking has been fairly widely reported over the years, at home and abroad;









						Cherrypicking off the public sector
					

YES says Gerard Bury. Private medicine can not be compared withpublic healthcare




					www.irishtimes.com
				












						When Private Hospitals Cherry-Pick, Teaching Hospitals Pay the Price
					

By Joanne Conroy, MD I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their...



					thehealthcareblog.com
				






			https://www.imo.ie/policy-international-affair/documents/imo-submissions-archive/IMO-Sub-on-Risk-Equalisation-2010-Final.PDF
		






__





						Subscribe to read | Financial Times
					

News, analysis and comment from the Financial Times, the worldʼs leading global business publication




					www.ft.com
				




I remember when herself was in Holles St, she met a bunch of mums of twins who had planned to deliver in Mt Carmel, but had been dumped back into the public system when their cases looked a bit risky.


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## nest egg (20 Jan 2022)

RetirementPlan said:


> FG came into power in 2011 with UHI as their stated policy. When they went to actually implement it, they found that Ireland was too small a market for UHI to work, which is why we ended up with Slaintecare.


Do you have any sources for that? I'm genuinely curious. There's no perfect solution but UHI always struck me as the most pragmatic way to solve the two tier health system.


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## Protocol (20 Jan 2022)

I will try to post some data on healthcare costs.


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## Purple (21 Jan 2022)

Protocol said:


> I will try to post some data on healthcare costs.


It's worth noting that our GDP is grossly inflated. That's why the CSO came up with GNI* or Modified Gross national Income. For most countries *GNI and GDP will be the same or very close so it's good to use it instead of GDP for these comparisons. Our spending as a percentage of GNI is just over 11% of *GNI which would put us in the top 3 on your first chart.


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## odyssey06 (21 Jan 2022)

I would also be curious to see the definition of health expenditure. Does it include private expenditure on health such as payments for GPs, physiotherapy, private health insurance, prescriptions, co-payments etc as this varies from country to country also.


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## Purple (21 Jan 2022)

odyssey06 said:


> I would also be curious to see the definition of health expenditure. Does it include private expenditure on health such as payments for GPs, physiotherapy, private health insurance, prescriptions, co-payments etc as this varies from country to country also.


Yes. It's all expenditure on health, both public and private.


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## RetirementPlan (21 Jan 2022)

mojoask said:


> Do you have any sources for that? I'm genuinely curious. There's no perfect solution but UHI always struck me as the most pragmatic way to solve the two tier health system.


From 



> 2011 was the first year the Irish government made a commitment to universal single tier health system which was to be delivered through compulsory universal health insurance and universal primary care [13]. This commitment to universalism was restated in a 2014 White Paper on Universal Healthcare [14], however analysis of this period shows that despite the policy intent, there was less universalism in the health system in 2015 than there was in 2011 [5].
> 
> An independent assessment of the 2011 universal health insurance (UHI) proposals which planned to provide coverage through competing private insurers found that the model would be too costly, that the vast majority of care would remain tax funded and many charges would remain [15]. By 2016, no party was advocating reform through an insurance model [16].


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## nest egg (21 Jan 2022)

RetirementPlan said:


> From


Therefore they believed it would be too expensive, based on certain assumptions taken, rather than Ireland's market size, if I've followed correctly. I had a quick look at the referenced report and the first thing which jumped out was _"The authors are also grateful to the many officials of the Department of Health and HSE, who have assisted this research, including the staff of the newly established Healthcare Pricing Office". _

Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay. Cost control is obviously an important factor, but surely eliminating the two-tier model is the most humane reason to reform our healthcare system? UHI would solve that in one fell swoop, everyone on a level playing field.


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## RetirementPlan (21 Jan 2022)

mojoask said:


> Therefore they believed it would be too expensive, based on certain assumptions taken, rather than Ireland's market size, if I've followed correctly. I had a quick look at the referenced report and the first thing which jumped out was _"The authors are also grateful to the many officials of the Department of Health and HSE, who have assisted this research, including the staff of the newly established Healthcare Pricing Office". _
> 
> Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay. Cost control is obviously an important factor, but surely eliminating the two-tier model is the most humane reason to reform our healthcare system? UHI would solve that in one fell swoop, everyone on a level playing field.


I have some previous experience on one aspect of UHI, and it is very, very complex. Things might look sensible in principle, but putting them into practice is another matter entirely. My understanding, as set out in that paper by a very respected academic in the area, is that all parties involved found that UHI was unworkable in the Irish market. 

I'm not an expert, so I can't tell you anymore, but I'd be wary about broad assumptions from afar.


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## ryaner (21 Jan 2022)

mojoask said:


> Coming back to two-tier system, I honestly can't understand why it's tolerated, it's horrific that rich people, like me, can queue jump those less fortunate, based on an ability to pay.


It is even worst than a two-tier system. What really annoys me is the pricing differences. If you need some and decide to pay for it privately, you will pay double (or more) than what the private hospital would have charged the insurance company should you have been covered.

Sadly even if UHI just came in indirectly tomorrow, with say the gov just buying everyone the top tier of health insurance, you'd still get an uneven playing field with people who can just paying to get ahead of the new queues.


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## Baby boomer (22 Jan 2022)

ryaner said:


> It is even worst than a two-tier system. What really annoys me is the pricing differences. If you need some and decide to pay for it privately, you will pay double (or more) than what the private hospital would have charged the insurance company should you have been covered.


That actually shows the benefit to the consumer generated by the bulk purchasing power of the insurance company.



ryaner said:


> Sadly even if UHI just came in indirectly tomorrow, with say the gov just buying everyone the top tier of health insurance, you'd still get an uneven playing field with people who can just paying to get ahead of the new queues.


No.  Initially, there would be queues.  They would soon evaporate as the private system expanded it's capacity to cope.  That's the way private business works.  Just do it.  No reports, commissions, study groups, or endless negotiation.  We don't have waiting lists for food, clothing, holidays, furniture and the myriad other consumer products and services supplied by the private sector.  Markets work.  Output rises to meet demand.


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## Purple (22 Jan 2022)

RetirementPlan said:


> I have some previous experience on one aspect of UHI, and it is very, very complex. Things might look sensible in principle, but putting them into practice is another matter entirely. My understanding, as set out in that paper by a very respected academic in the area, is that all parties involved found that UHI was unworkable in the Irish market.
> 
> I'm not an expert, so I can't tell you anymore, but I'd be wary about broad assumptions from afar.


The problem isn’t the funding structure, it’s the delivery structure. There’s no way UHI will work with our current structure and there’s too many interest groups that would lose our if it was fixed so it won’t be fixed. I do agree that it’s very complex and, to be fair, for the first time in my lifetime there’s a cross party plan to improve things. They just have to have the strength and fortitude to keep pushing against the monoliths.


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## Sophrosyne (22 Jan 2022)

There was an extensive thread circa 2012 about UHI on AAM, but it seems to be gone.

Then as now, there were considerable unfulfilled healthcare needs.

UHI involved a basket of healthcare products to be purchased from competing medical insurance providers. See this

Those who could not afford healthcare premiums would be subsidised.

Because of the high-cost, low-waged economy, almost 2m people - medical and GP visit card holders - would have required subsidization to the basic healthcare basket.

But there was a dearth of information on the products in the health basket and also on the private sector profit margins & costings.

A report published circa 2012/2013 which examined potential costs per capita, I just can’t find it, but from memory it did mention lack of data to facilitate proper analysis.

Sláintecare seems to be exhibiting the same lack of cost transparency.

According to the Fiscal Assessment Report, December 2021, under the heading Fiscal Stance, paragraph 4;

“On health commitments, there is currently no clearly identified budget to continue implementing Sláintecare reforms in health beyond next year and there are no up-to-date estimates of the costs of implementing remaining reforms”.


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## nest egg (23 Jan 2022)

Purple said:


> ...there’s too many interest groups that would lose our if it was fixed so it won’t be fixed...


If that's the case Slaintecare faces the same fate as UHI.


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## NoRegretsCoyote (23 Jan 2022)

mojoask said:


> Therefore they believed it would be too expensive, based on certain assumptions taken, rather than Ireland's market size, if I've followed correctly. I


UHI can work in a small market.

The 2015 decision to shelve UHI (Varadkar's doing, which no one remembers) was mainly on the grounds that it would be expensive and involve changes to pretty much all delivery of healthcare at all levels.

But this was just another policy choice, not some kind of insurmountable obstacle.


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## Purple (24 Jan 2022)

mojoask said:


> If that's the case Slaintecare faces the same fate as UHI.


It's already heading that way.


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## RetirementPlan (24 Jan 2022)

NoRegretsCoyote said:


> UHI can work in a small market.
> 
> The 2015 decision to shelve UHI (Varadkar's doing, which no one remembers) was mainly on the grounds that it would be expensive and involve changes to pretty much all delivery of healthcare at all levels.
> 
> But this was just another policy choice, not some kind of insurmountable obstacle.


You think Slaintecare won't be expensive and wont involve changes to pretty much all delivery of healthcare at all levels?


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## NoRegretsCoyote (24 Jan 2022)

RetirementPlan said:


> You think Slaintecare won't be expensive and wont involve changes to pretty much all delivery of healthcare at all levels?


No, and I never suggested as much!

I'm agnostic about healthcare delivery models and I don't have an expertise. There are lots of options from UHI, to something like the NHS, to the US system. 

None of these are impossible in the Irish context. Large-scale structural reform requires near-infinite political will, and I won't see much of that around.


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## RetirementPlan (24 Jan 2022)

NoRegretsCoyote said:


> No, and I never suggested as much!
> 
> I'm agnostic about healthcare delivery models and I don't have an expertise. There are lots of options from UHI, to something like the NHS, to the US system.
> 
> None of these are impossible in the Irish context. Large-scale structural reform requires near-infinite political will, and I won't see much of that around.


I'm not an expert either, but I know that the NHS isn't an insurance model at all, unless I'm badly mistaken. There is a fair degree of political will and near all-party support for Slaintecare. Why would UHI have been canned when Slaintecare has similar demands for reform?


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## NoRegretsCoyote (24 Jan 2022)

RetirementPlan said:


> Why would UHI have been canned when Slaintecare has similar demands for reform?


I guess different constituencies are catered to or discommoded.

AFAIK Sláintecare is not going anywhere either.


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## nest egg (25 Jan 2022)

Back on topic, the Irish Times had an article today on income tax rates. Nothing revelationary. 

https://www.irishtimes.com/business...land-a-high-tax-country-for-workers-1.4782265


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