r e a l r e v i e w . i e

“Collateral” is one of the smartest words ever coined. Its use, like “friendly fire”, was designed to soften the impact of war reports, and it does that job well. You know about this, probably, so I’ll just sweep over all that, you know how it goes – blah blah Newspeak. Yeah, right.

The other thing about the world “collateral” is that it’s entirely accurate in terms of how it reflects the mindset of people who use it. Collateral doesn’t distinguish between people and things; but then, nor do people who run wars, in any real sense. If you work in an environment where you will habitually get people killed, be it deliberate or inadvertent, then you can’t start distinguishing between people and barrels of napalm – if you do, you lose the war. Collateral is a psychopathic word, designed for use in a psychopathic pursuit.

The best way to sum it up is as a Conflict Mentality, and it doesn’t just arise during actual conflict. Israel, as a state, is collectively gripped by it, which is why they can commit a humanitarian atrocity and seem completely unaware of the horror; as far as they’re concerned, any attempt to breach their blockade is de facto a terrorist act intended to aid their enemies, and it gets what it deserves. This isn’t to excuse their (unforgivable) actions, just to understand them. We have our own historical example; the execution of the 1916 rebels is often-cited as a horrific move by the British, but this ignores the fact that they were at war and routinely shooting young men for desertion. There wasn’t a doubt about appropriate action as far as Britain were concerned; Pearse and his crew had committed an act of treason, and they needed to be executed. End of. Any questioning of this wouldn’t just have been dismissed, it would have been met with blank incomprehension.

Adopt a conflict mentality, and any form of moral grotesquery becomes acceptable. “Collateral” is a perfect word, because it’s about people who don’t really count as people, just as a statistic. Now, you can’t use “collateral” when you’re talking about – say – economic policy, so we say “pain” instead. It’s not war, but it is a conflict mentality, in which considering the implications of losing your job or home is an impediment to doing What Must Be Done (assuming we don’t start going mad and trying to tax the wealthy, obviously).

We aren’t at war, though. Not like in 1916, not even like Israel. Let’s put it as baldly as possible; deaths matter. The government being responsible for deaths, be it directly or indirectly, is as close to completely fucking unforgivable as it gets. Officially, we now know that 37 children died in state care in the last ten years (19 of natural causes). But then, that figure was revised upwards from 23 over the space of a day. The HSE don’t seem too certain how many children they lost – yeah, say that again, they don’t seem to know how many children they lost – but there’s plenty of intelligent comment that suggests it’s staggeringly high.

It’s difficult to contextualise – these are children in state care after all, quite literally the most vulnerable strata of society – in terms of the actions of the higher-up, but it’s important to try. By its nature, malpractice in the HSE results in people dying. It’s an organisation where bureaucracy kills. We’re not talking “pain” here.

Mary Harney was appointed Minister for Health in 2004; she has been in the position nearly six years. Since then – if not immediately since she took over the post, then certainly soon afterwards – she has been engaged in a quiet battle with the HSE. Her actions suggest, almost uniformly, that she wants reduce it to irrelevance. When people talk about health care “reform”, they forget that the HSE is an organisation that Mary Harney has never shown any interest in reforming.

Government policy – and I make no apologies for singling this out as a Harney project, since there was a radical shift in emphasis as soon as she took over from Mícheál Martin – is to outflank the HSE by privatising the health system. Now, it would be easy to talk about why this is a terrible thing, but I’ve done that before, and it’s worth looking at the realpolitik for a minute. We might talk about two-tier health as a bad thing, but we’ve been living in a two-tier system for years; the moment that we offered VHI relief, two-tier became a reality. The VHI’s very existence is a tacit acknowledgement that those on a higher wage shouldn’t be expected to live with the service on offer to the clods; the government was prepared to help the middle-classes jump the queue, and that’s pretty much a textbook definition of two-tier. All Harney has tried to do is increase the reach of this two-tier system, by getting private patients out of the leaky buildings with all the inconvenient poor people and into privately-run hospitals. This isn’t creating a two-tier system, it’s just showing up the fact that we already had one.

When Harney (and Bertie Ahern) spoke about the private sector being able to deliver beds, and buildings, “more cheaply and efficiently than the public sector”, what they actually meant was “without involving the HSE”. This is the nub of what they were doing; the co-located hospitals project, and the treatment purchase scheme, were exercises in moving more and more patients to private hospitals. We might put this down to free-market fundamentalism, but in that case… why the hell would Harney introduce risk equalisation into the health insurance market, as anti-free market a move as you can get?

Because, surprising as it may be to anyone who’s heard the woman speak, she seems to have a vision for Irish healthcare; namely, the vast majority of facilities provided by private insurers, a widespread (and, quite probably, mandatory and part-subsidised) health insurance system, in which the state’s direct provision is limited to Accident and Emergency provision at most. A future with no HSE; in which the enormous, fiefdom-riddled, bureaucratic mess has quietly died.

So why reform a body you want to destroy? To Mary Harney, the HSE is the enemy. She’s damned if she’s going to take responsibility for them losing a few hundred kids, since that’s exactly the sort of thing that made her want to wipe the buggers out in the first place.

This isn’t all down to Harney, of course; a fair chunk predates her tenure. Nor is this really about the right or wrong of HSE reform, it’s about the moral horror of the decision to go to ‘war’ with them in the first place. By not even trying to reform the HSE, Harney accepted that there would be collateral. Both sides are aware of the terms, and have adopted the requisit conflict mentality. Because of their unchecked, unchallenged inefficiency, children – and (in other scandals) many more adults, who forgive me for saying so, are no less important – have died or suffered awfully.

The bureaucratic battle, though, has ended up with the grotesque sight of Ministers and leaders refusing to accept responsibility, and the HSE’s many-headed hydras trying to shovel the blame from one mouth to the other. This, more than anything else, is what’s sickening. Not the mistakes, or children going missing, or lives destroyed by foul-ups in the filing system; it’s the blank inability to do anything except mitigate the damage and avoid responsibility. At a time when you’d think anyone would show some semblance of humanity, some tiny hint of awareness of the misery inflicted on families and individuals.

There’s the big picture of the health service, and the ongoing conflict between the HSE and the government. Debating the models of public healthcare, or insurance-based healthcare, is a huge important question, and it shouldn’t be ignored; still this isn’t the sort of war that should ever have casualties or denials. This bespeaks how state and society failed the people who needed them most. It’s a black, rotten spectacle at the heart of our society, and it shames everyone involved.

This entry was posted on Wednesday, June 2nd, 2010 at 10:57 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.