Caveat – What follows is all entirely my assessment, because nobody, even the Irish Government’s website, can give you a lucid, easy to digest description of what is and is not covered, when, by who, and for how much.
One of the first things you hear from just about everyone when you deicide to move to Ireland is, “Oh, they have free health care, right? And for a moment you allow yourself to fantasize about drifting lazily into the soft downy embrace of socialized medicine, where the care is good, access ubiquitous, and your out of pocket costs are next to nil.
What you learn when you get here is something slightly different. The care appears to be as good as any in the world (or so they say). And while you can gain access to it, it may take a bit of time for you to work your way through the waiting lists, or to build up enough credit (by paying money into the social welfare system) to be given access to certain parts of the system. Oh, wait, that’s for the free public system, which you are probably not going to be allowed to use anyways because you make too much money. So, you’ll have to pay for private insurance. So much for the soft downy embrace.
But you are entitled to some things for free.
Well, sort of
After you’ve been here a while and have torn your hair out trying to get a straight answer, you gradually piece together a few things. As a resident, you are entitled to a family prescription medicine card that caps your maximum out of pocket costs at €125/month. That’s not bad, particularly if you are on any hugely expensive drugs. But the drug coverage gets even better if you are being treated for a “long-term illness (such as diabetes, leukemia, hemophilia, Cerebral palsy, and some others). For these conditions, prescriptions are completely free (even if you are simply resident in Ireland and not a citizen). At this point I began to feel some soft downiness. Alas, my lifelong handicap is not considered “long-term”, so my lifts are not covered. Ahh, well. Some you win, and some you lose.
Nobody Really Knows
But all is not lost. Our Irish friends, and other long-term residents all suggest continuing to try and get things paid for. Because, this being Ireland, nobody is really sure what will or won’t be covered. Even if it’s not covered today, the policy could change tomorrow. And, if you hit the lottery (they’re big on luck in Ireland) and get the right person on the phone, you just might get something covered that is usually not covered.
Here in Ireland nobody really considers this to be dishonest, or illegal, so much as just looking out for yourself in a system that is, at best confusing, and, more than likely, deliberately opaque. And, in this place, where cynicism is practically a religion, and everyone just sort of goes along trusting that the government will look after them, most people tell you not to worry too much about it. You’ll be taken care of.
Yet again, I’m forced to hogtie my inner American to keep from screaming, “But where is this all written down? How do I know anything for sure, if it’s not written down?” Then, post Quaalude, I think to myself, how much can you really trust U.S. insurance companies and their glossy brochures where it is all “written down”? When you really need them, they’ll just change the coverage to suit their purposes and cite some arcane sub clause of the main sub clause of the addendum and deny your claim. So, perhaps a little uncertainty and faith aren’t so bad after all.
The System is Broke(n)
In Ireland, it’s sort of taken on faith that the health care system is skint. In America we know this for a fact about Social Security. Here, in Ireland, this is not so much a health care fact as this niggling itch in the back of everyone’s mind. Nobody will come out and say it, but, in a country with raging unemployment, an economy in recession (teetering on apocalypse), and no money for many basic governmental services, how could health care be anything but flat, busted, broke?
In the news lately we’ve learned that Irish nurses and other health care professionals apparently take more sick days than professionals in any other sector of the economy. Because the salaries of health professionals are effectively paid by taxpayers, Irish citizens are outraged by these revelations. But they’re not surprised. Graft, ineptitude, and fraud are all assumed. But nobody wants to face the shrieking horror of there being literally not one Euro left to spend on your child’s dialysis treatment, or plastic surgery for a child burnt in a fire. Sadly, that’s the fear lurking in the back of people’s minds.
It remains to be seen if the system is truly broke, or simply broken.
Because so much of the Irish health care system seems dark and confusing, a lot of people seem to put great stock in their GP (general practitioner). In this big social system, your personal physician is a face to put your trust in. She’s a person you can call for advice. They will actually sit in a room with you and give you advice. It’s assumed that you will have to pay for all (or most) of their fee in person on the day of service. But that cash and carry mentality is comforting in its lack of ambiguity. There’s no lingering obligation. It’s a very simple relationship.
MY first visit to my new GP was quite interesting. He gave me the usual spiel about exercise and weight loss. I was then told that my customary alcohol intake (1-2 drinks twice a week) equaled six units a week. I remarked that I hoped I was still below average in Ireland. He told me that if I consumed 20 units a week I’d still be well below the national average.
Later he too told me to plan on getting supplemental (private) insurance. He explained that, while I could get by without it, it will drastically shorten waiting periods when seeing consultants and specialists. It seems that without it, I’m still entitled to a certain level of health care, but, exactly what that is, he couldn’t say. He simply said, “Get the insurance.”
So, I’ve got my prescription card, my GP, and private insurance. I’m covered, but for what, and for how long? Who knows? For now I just go along and hope for the best. Perhaps I’m slowly learning to fit in here in Ireland.
Things to look forward to in upcoming posts:
The First Three Months