Public funding – rebelbreeze

Diarmuid Breatnach

(Reading time main text: 2 mins.)

Politicians were last week briefed by the Irish Department of Health to the effect that the construction costs of the projected National Maternity Hospital are expected to reach €800 million — and it appears that neither the land nor the management of the hospital will be under the control of the State. The project has been controversial from the outset, with issues of its location, cost and religious institutional management and now conflicting narratives on discussions of ownership of the land have appeared between the Government and the religious bodies involved.

It is precisely concerns over governance arrangements at the hospital, linked to ownership of the site, which have stalled progress on construction over the years, while projections of costs have grown from the original €150 million. The most recent estimate was around €350 million but on Friday, a spokesperson for Minister of Health Stephen Donnely said: “The building infrastructure cost has been priced at €500 million. Further commissioning costs, including fit-out and transferring an entire hospital to a new site, will be a further €300 million.”

The Religious Sisters of Charity, which order owns the land, is transferring it to the newly-created private charity St Vincent’s Holding CLG, which will then lease it to the State for 99 years. The directors and members of this new private charity are the shareholders of St Vincent’s Healthcare Group, of which in turn the Sisters of Charity are the sole shareholders.

According to a report in the Irish Times, politicians were told on Thursday that several attempts had been made to purchase the site but this was contradicted by the religious institutions.

The Religious Sisters of Charity said it had “never at any point been contacted by Government or the State to discuss purchasing the site”, while SVHG – on whose campus the new hospital is to be located – said in a statement: “At no stage was any proposal or approach to sell the land, meaningful or otherwise, received or considered by the board of SVHG.”

While the text of a letter in 2017 from the St. Vincent’s Group may appear at one reading to contradict their later statement, another reading may see it as purely forestalling any attempt to purchase the site from them. The text, shown to the Irish Times presumably by Government sources reads: “This is why SVHG cannot countenance any sale or lease of part of the land on site, or any separate ownership of a hospital on site”.

The versions of the Government and of the religious institutions contradict one another and which is correct remains to be ascertained. What is certain however is that the religious institutions wish to control the site and at least influence governance, while at the same time it is the taxpayer who will fund the construction and the running costs of the hospital.

Asked on Saturday if the site might have to be abandoned for the hospital, the Tánaiste Leo Varadkar said: “Of course there is that risk, that’s the reality of the situation.” He added: “This hospital has to be publicly owned and it has to be the case that any obstetric or gynaecological service that’s legal in the State has to be available in that hospital.”

Earlier, the Taoiseach (Prime Minister of Irish government) Mícheál Martin told RTÉ, the national TV network: “But there’s a very basic point in terms of the taxpayer, and I think into the future we’re in a new era, when the State is building new hospitals and paying the full total of the costs, the State should own the facility.”

UNHEALTHY SERVICE IN THE IRISH STATE

The Irish State has never had a comprehensive public health service, unlike the rest of Europe. When the State was created in 1921, there were a number of health care institutions run by the Catholic Church and the State integrated them into the state-funded service, leaving them under religious institutional management but providing them funding through the state’s health care budget. And so it continued to this day.

This means not only that the public taxes of residents of the Irish state are funding private health care but that those institutions are not answerable to the public in terms of policy on what they consider moral issues – in other words Catholic Church ideology. Hence it is not known at the moment whether the new proposed National Maternity Hospital will provide a service within the terms of what is legally permitted in the Irish state such as voluntary sterilisation, gender adjustment or IV fertilisation. Or pregnancy termination along the lines of what is agreed and desired by the majority of the citizens in the State, as shown in public opinion polls and the 2018 Referendum on Abortion.

In addition, private health centres compete with public services for funding and for staff.

The controversy around the governance and construction costs of the National Maternity Hospital is not alone since there is also another with regard to the projected National Children’s Hospital siting and construction costs, with BAM company claims against the National Paediatric Hospital Development Board (NPHDB) totalling €300 million. The original construction cost estimate was €1.74 but some projections now are estimating an excess of €2 billion — and completion not until 2024.

Since construction companies in the Irish state are all private capitalist companies, these problems of course end up in the profits of the companies and a loss to the common taxpayers.

INCREASED HEALTH FUNDING – FOR WHOM?

Leo Varadkar, Tánaiste (*Photo credit: Eamonn Farrell/ Rolling New*s)

The Tánaiste (Ireland’s Deputy Prime Minister) Leo Varadkar has stated that the funding of the State for the Health Service which was increased to deal with the Covid19 pandemic is not to be cut when the pandemic is over but will be kept at €22 billion. If the projected costs of the maternity hospital construction works of €800 million are going to come out of that (without any estimate on site purchase cost), it would leave only €21.2 billion to run the whole health service which is actually less than the 2018 budget of €22.5 billion. And if the €300 million of BAM’s claims were granted, this to be deducted from the budget, only €20.9 billion would remain.

If we assume that the projected construction costs of the National Maternity Hospital are to come from a different budget then it still leaves us the question of who is to benefit from the health budget, the public health service or the private services (Church and other).

In 2019, €1.311 Billion of public funding went to just five private health services¹

Sisters of Mercy (including Mater Hospital, Mercy University Hospital — €432 million
Sisters of Charity (including St. Vincent’s University Hospital — €373 million
Brothers of Charity — €218 million
St. John of Gods – 166 million
Daughters of Charity €122 million

A TWO-TIER HEALTH SERVICE

The existence of private alongside public health care facilities creates a two-tier system, one with fast access to treatment alongside another with long, sometimes fatal delays (especially in the case of cancer diagnosis and treatment). Yet both are funded, as we have seen above, by the taxpayer.

With the disparity in waiting time and, to some extent quality of treatment, people who can do so of course tend to opt for the private service. And in order to afford that access, they take out private health insurance.

“According to the Health Insurance Authority, the average health insurance premium has increased from €423 per person in 2002 to €1,200 today”, “which has led to tripling of premium income for the insurance industry, from €822 million in 2002 to €2.5 Billion in 2016, as the numbers taking out insurance have also increased substantially.”²

IN CONCLUSION

It is not tolerable that our taxes are going to fund health care facilities that may not, because of religious ideology, provide a full service within what is legally permitted. Nor is it tolerable that our taxes are funding private healthcare facilities at all, never mind funding them to compete with public ones.It is not acceptable that our two-tier system discriminates against the less wealthy and promotes the huge growth in the private health insurance sector. Nor that people are being driven to take out private health insurance which has that sector’s companies raking in profits.

People resident in Ireland need and are entitled to a public health service that is well-funded and staffed to undertake timely illness prevention and health care at all levels in all areas of medicine. And a service that has the spare capacity to deal with emergencies without straining its facilities and harming its staff.

That is what we need and the vast majority of the population would support that, in this state and even in a united Ireland³. But which political party would give us that in government? Not FG, FF, Lab, Greens or SF, on any rational prediction. Although it would be just a reform, will it take a revolution to achieve it?

Let the religious fund their religious-ethos health services and let the rich fund their own private services but ALL PUBLIC FUNDING FOR ALL-PUBLIC SERVICES ONLY.

End.

FOOTNOTES

1From “A brief history of Ireland’s two-tier system”, (Rupture Issue 2, p.22).

2Ibid, p.23, quoting the HIA 2004 / 2005 report and Irish Times article.

3People in the Six Counties have a part of the UK’s NHS there and use and by all indications approve of a public health service.

SOURCES

Maternity Hospital news report: https://www.breakingnews.ie/ireland/fresh-controversy-emerges-over-maternity-hospital-as-state-offered-to-buy-land-1144144.html

https://www.irishtimes.com/news/politics/projected-cost-of-national-maternity-hospital-now-800m-1.4597579

https://www.breakingnews.ie/ireland/government-outlines-concern-over-relocation-of-national-maternity-hospital-1143266.html

https://www.breakingnews.ie/ireland/new-location-may-be-needed-for-national-maternity-hospital-tanaiste-1144316.html

https://www.thejournal.ie/national-maternity-hospital-cpo-5472271-Jun2021/

Background to decision to build new hospital: https://www.irishtimes.com/news/politics/q-a-why-is-the-national-maternity-hospital-moving-and-why-are-people-concerned-1.4579356

Government plan to expand Irish health service: https://www.breakingnews.ie/ireland/tanaiste-calls-for-e22-billion-health-budget-to-be-retained-permanently-1144208.html

Construction company suing over Children’s Hospital: https://www.irishtimes.com/news/ireland/irish-news/contractor-bam-suing-national-children-s-hospital-board-in-20m-costs-dispute-1.4532352

Moratorium on BAM’s litigation: https://www.irishexaminer.com/news/arid-40297367.html

National Children’s Hospital costs overrun: https://www.rte.ie/news/2021/0209/1196082-childrens-hospital-pac/

Diarmuid Breatnach

(Total reading time: 5 mins.)

It is reported in the news today that Trump has ordered the deregistration on the Stock Exchange of three China companies in the belief that they are basically fronts for the Chinese military. It is reported also that the incumbent, Joe Biden, is unlikely to take a different line and that “US officials have complained that China’s ruling Communist Party takes advantage of access to American technology and investment to expand its military, already one of the world’s biggest and most heavily armed.”

China’s military may indeed be one of the world’s biggest and most heavily armed but there is no question of which power is the most heavily-armed, far above all others: the USA. According to statistics supplied by an EU armed forces comparison site (see SOURCES below), China spends $288 billion on its military, which is much more than doubled by the USA’s $610 billions. And the USA’s military share of its GDP (Gross Domestic Production), at %3.1 is way ahead that of China’s 1.9%.

One of the few areas in which China’s military outstrips the USA’s is in active personnel, at 2,300,000 against 1,281,900. Which is hardly surprising, as China’s population is more than four times that of the USA’s (1.43 billion, compared with 329 million). And that too would account for its reservist imbalance, 8,000,000 versus the USA’s 811,000.

China Type99 Tank. Armoured vehicles and numbers of personnel are the few areas in which China outstrips the USA. (Photo source: Internet)

Another area in which the Chinese military outstrips the USA’s is in tanks, armoured vehicles, artillery, self-propelled artillery and rocket artillery (that last by not so large a margin). But the USA has three times the total military aircraft of China, twice the number of attack aircraft, nearly four times the number of multirole aircraft and over four times the number of helicopters. Only in fighter aircraft does China outnumber the US’s and that by a significant amount: 1,150 against 587 – but multirole aircraft, of which the USA has 2,192, are designed for air-to-air combat as well as missile launching against ground targets.

In naval power, although China’s total of 780 looks impressive next to the USA’s 437, the USA has 20 aircraft carriers while China has …. two. The USA is not bothered with frigates or corvettes, of which China has respectively 54 and 42 but the USA’s 85 destroyers are more than double China’s 36. In submarines they are not far off level pegging, with China’s 76 against the USA’s 71.

The USA has 20 aircraft carriers while China has just two. This hi-tech US carrier cost $13 Billion. (Photo source: Internet)

These figures tell us that the USA far outranks China in military hardware and also that its military production per head of population is vastly greater than China’s. But when we look at the type of weapons in which one predominates over another (without regard to quality or modernity), it tells us something else: the USA is far better fitted for long-range warfare than is China. No state is safe from long-range attack by the USA military but many parts of the world are relatively secure from such an attack by China’s current military capability.

Furthermore, in a war between both powers, the USA would rely on hitting China from afar with bombing raids from air bases in countries with US-friendly regimes (e.g Pakistan, Indonesia, Australia, Thailand, Philippines, South Korea, Japan) and from its fleet of aircraft carriers.

China could perhaps overrun the USA’s defences on the ground but how could their troops and vehicles reach America?

Of course, the USA vastly outnumbers China in nuclear warheads too: 6,500 against 280.

MILITARISATION OF THE ECONOMY

Lenin and others wrote that increasingly in the capitalist countries, finance capital had become merged with industrial and whereas finance had earlier fed industrial development, it was towards the end of the 19^th Century deserting industry at home to invest in super-profits available through exploitation of natural resources and labour power in the developing world. Countries that had large colonial territories and foreign investment preferments or monopolies were neglecting their industries in the time of imperialism while capitalist countries without the same outlets were concentrating their capital on modernising their production models and methods.

In the USA, finance capital merged long ago with industrial but, since WW2, with military expenditure also. But not only merged — the military side has come to dominate. Not necessarily in actual production statistics, though these are pretty high – according to industrial analyst Louise Echitelle writing in 2017, Roughly 10% of the $2.2 trillion in factory output in the United States goes into the production of weapons sold mainly to the Defense Department for use by the armed forces. But in addition, over half the World’s arms sales in 2013, according to a SIPRI (Stockholm International Peace Research Institute) pie chart quoted by Wikipedia, were by the USA and this share is likely to have increased since.

USA’s multirole fighters far outnumber China’s. This is the F-15E Strike Eagle. (Photo source: Internet)

Military production is publicly funded in Government purchasing and also in allocation of production sites – Echitelle wrote three years ago that the bidding to get a major company to locate in a municipality

“can sometimes top $100 million per factory location. A manufacturer who finally accepts a municipality’s bid collects tax breaks, a gift of land on which to put a factory and sometimes the cost of building and equipping the factory itself at taxpayers’ expense.”

Share of arms sales by state in 2013: chart by the Stockholm International Peace Research Institute (Photo source: Wikipedia)

Incidentally, that level of reliance on military production also makes for a militarisation of the labour force, a binding of workers and trade unions to military production. This will be reflected also in cultural products such as war films (documentaries of US Wars, fictional or semi-fictional war films, Sci-Fi with US military in the future), war games and novels, USA Armed Forces Day barbecues and street parties on the third Saturday of each May, all together resulting in social support for war, invasion of other countries and …. further military expenditure.

Although the figures here have concentrated on military production and its public funding in the USA, one has to take into account many other aspects, such as that expended on raising and educating a child to military age and all that is involved in that huge investment over a period of 18 years or so.

Another factor in the calculation is what is not being produced because of the concentration on military production and its secure source of public funding. Or no longer being produced. Echitelle points out that at the end of WW2, US industry produced cars and appliances, clothing, shoes, houses and furnishings for the home market and exported many of them too. The reliance on military spending in production facility and its public funding has seen the US give way to foreign competitors in those consumer goods not only abroad but in its domestic economy too. On the other hand, China is increasingly producing such goods for its huge home market and even exporting some, for example in communication technology products.

One does not need to be a supporter of the Chinese regime to burst out laughing at the irony when a US President or US officials accuse the Chinese of militarising their economy.

End.

SOURCES

https://www.breakingnews.ie/world/new-york-stock-exchange-to-delist-three-chinese-companies-under-trump-order-1058223.html

https://armedforces.eu/compare/country_China_vs_USA

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