This article by John Molloy first appeared in the 17 May 2025 issue of Unity, the weekly all-Ireland publication of the Irish Communist Party.
The Stormont Health Minister Mike Nesbitt, within part of a stated £215 million plan to tackle waiting lists, has stated that patients who have waited more than two years for surgery will “be able” to pay for it within the (private) Republic’s health system and then claim reimbursement within their own, home, health provider, the NHS. As usual, due to the scale of the crisis within health and social care and the wider problems generated by the removal of welfare safety nets, such attempted firefighting is irrelevant in comparison to the base and extra amounts of money needed in relation to health spending. In this way, these figures represent no attempt to restore the funding needed to catch up with more than a decade of “real terms” austerity cuts in health spending/staffing or the scale of investment that is required for wider society’s post Covid recovery.
More dangerously, although the initial cost signalled for this “pay first/claim back” initiative is relatively small (£10 million) it makes even more overt and solidifies the policy precedent of a “two-tier” health system – even within a hollowed out NHS. Politically, waving a white flag to market intrusion may have been an increasing fact of life – that those in pain, needing interventionist diagnosis etc. and able to find the money/insurance to access a consultant’s appointment/timely medical intervention would not have to queue – but this initiative runs the risk of setting up a financially discriminatory pilot as the only means of not risking further health deterioration that could then be expanded via greater means testing within the NHS. How far we have come from Nye Bevan’s declared ambition at the creation of the NHS in 1948 that “the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.”
Of course – the long struggle for such provision was not an isolated struggle but a mass assertion of the necessity of rebuilding post Second World War society. In the same year as the NHS’s creation we also saw the Universal Declaration of Human Rights and, thirty years later, the Alma-Ata declaration from the World Health Organisation (WHO) “that primary healthcare should be freely available to everyone in the world by the year 2000”. As the journalist Afua Hirsh described it Alma Ata aimed to offer “a shift from militarism to peace, a redistribution of power from the global north to the global south and a New International Economic Order…nothing less than a total re-imagining of global financial systems, resource distribution and power.”
The projection of this vision came within three years of the formal, electoral dominance of neo-liberalism represented by Thatcher and Reagan’s first electoral wins and a decade of “Chicago Boy” economics being deployed via US directed military dictatorships. Little wonder that people’s resistance in that hemisphere also exposed the theological tensions within pro-Establishment hierarchical religion – the virulent anti-communism of Pope John Paull II on the one hand and, on the other, the clergy who preached a “liberation theology”. One of its advocates, Brazilian Archbishop Camara summed up this contradiction – “when I give food to the poor, they call me a saint. When I ask why they are poor, they call me a communist”.
On this island we know very well, as Marx did, the contradictions of religion’s place in society but it is ironic that in a week when we see the British Labour Party latest rightward move on migration, that there is now more chance of hearing capitalism being challenged by the community activities within organised religions than the leadership of Western social democracy. The late Pope Francis’s last Easter message emphasised where their surrender to sociopathic markets have led the world – “today’s builders of Babel tell us that there is no room for losers, and that those who fall along the way are losers…theirs is the construction site of Hell”. This is the terrain on which social movements will organise to resist a privatised future.