The Hand of A Free Market Christ in the Glove of the State


‘What you have isn’t covered by the policy, but we can treat you for something more economical.’

Here’s a variant of an old joke.  Two nuns are in deep discussion of a spiritual question when suddenly a hideous vampire-like creature with the pallour of death and bloodcurdling moans starts banging on the window.

“Quick!”, says one to the other, “Show him your cross!”

And the other says “Get the fuck out of here you bloodsucking filth! This is a private hospital!”

A report in yesterday’s Sunday Independent detailed how the St. Vincent’s Hospital group, owned by the Sisters of Charity, had mortgaged its publicly-funded hospital so as to expand its private hospital enterprise.

Let me quote myself from an earlier post:

“The Sisters of Charity refused to contribute to a compensation fund for the victims of the Magdalene Laundries, two of which it ran. It operated various industrial schools. The Commission to Inquire into Child Abuse report concluded that there was a ‘high level of severe corporal punishment’ in Goldenbridge, an institution run by the Sisters of Mercy. There was a ‘pervasive climate of fear’ in the Institution as a result.

  • ‘Children were beaten and humiliated for bed-wetting by both nuns and lay staff’.
  • ‘Bead making became an industrial activity that was pursued obsessively; the work was difficult and uncomfortable and it was painful for children’.
  • ‘Scraps were thrown out of a receptacle into the yard, and children scrambled for them.’
  • ‘Children drank out of the toilet… some children were deprived of water in an effort to cure bed-wetting, and they found water where they could.

The idea that religious orders should own hospitals paid for by the public, but with an important private and exclusive component, is treated as something normal in Ireland.

The Sunday Independent report on the Public Accounts Committee also details how the Health Services Executive had committed to paying full market value to the St. Vincent’s Hospital Group in the event it should ever be required to buy the site.

Conventional economics has it that market value is established through the interaction of supply and demand toward an equilibrium. The point at which the buyer’s willingness to purchase, on the one hand, and the seller’s willingess to sell, on the other converge. This is the ‘natural’ course of things. Conventional wisdom has it that this ‘natural’ course of things in market economies redounds to the benefit of society as a whole.

  • This is what Adam Smith was talking about with his famed image of the ‘Invisible Hand’. The invisible hand of the market leads the rich to distribute resources equally, without their intention and without their knowing. Smith tells us that it is not from the benevolence of the butcher or the baker that we get fed, but from their pursuit of self-interest.

    In Ireland’s health system the benevolence of the doctor is as irrelevant as the benevolence of the butcher or the baker. The organising principle has it that it is through the pursuit of self-interest that the best medical treatment can be obtained for society as a whole (which is not to say that the average doctor is pursuing mere self-interest).

    Hence the Irish State splits health care into public and private components. Private firms and organisations are contracted to provide health services to the public. General practitioners run their surgeries as private businesses. Looking out for number one is conducive to the health of the nation. Hence so-called ‘top ups’ for administrators: why shouldn’t they pursue the highest possible salary? Isn’t that how society moves forward?

    Although St. Vincent’s Hospital Group is owned by the Sisters of Charity, charity doesn’t really come into it, except as an ideological gloss to pacify those uncomfortable with the idea you should make money out of the suffering of others.

    When St. Vincent’s Hospital Group mortgaged its public-funded hospital to set up a private operation, it was simply operating in keeping with the Irish State’s dominant conception of what health is: a commodity, one which, it is fervently believed, will be more equitably distributed through the guidance of the Invisible Hand.


    Jimmy Sheehan is ‘founder of the Blackrock, Galway Clinics and Hermitage Clinics, private medical facilities which operate according to a Catholic ethos’, according to the Iona Institute, the right-wing Catholic organisation of which Sheehan is also a patron. Shareholders in the Blackrock Clinic include beef baron Larry Goodman. Back in July, Health Minister James Reilly attended the launch of Sheehan’s book,  ‘Life Close to the Bone:  Musings of an Orthopaedic Surgeon’. Sheehan spoke about the ‘synergies between public and independent hospitals’ (for ‘independent’, read ‘private’). For his part, according to the Blackrock Clinic, James Reilly called ‘the contribution’ of private hospitals ‘tremendous’ and ‘stated his intention to keep the valuable Independent sector integral to Irish Healthcare.’

    Notably, the founder of the Blackrock Clinic claimed ‘the division of services into public and private was an illusion created by the media and politicians’. Unfortunately the report of the book launch does not elaborate on the nature of this illusion. But you could forgive a member of the public for believing that public and private health services are -or ought to be- two different things.

    For instance, last week, according to the Irish Times, the National Maternity Hospital met with the HSE to explain that the unauthorised €45,000 in private allowances paid to the hospital Master Rhona O’Mahony on top of her publicly funded salary came out of ‘a group practice at the hospital for semi-private patients’.

    What does ‘semi-private’ mean, exactly? Is it not like being half-pregnant? Doesn’t private mean -like the sign says: keep out? Doesn’t it mean there are some people who will be unable to access the service because they haven’t got the economic resources? Health rationed on the basis of wealth? Where did they get the semi- from?

    Well, in the particular case of Holles Street, it means -or at least it meant from what I could see- a portakabin in the midst of the hospital complex, where a queue of women get weighed, give a urine sample taken, and then four or five minutes with a consultant, who tells you with a benevolent smile to buy a copy of his book if you have any further questions.

    There is, of course, another meaning of ‘private’ that might have particular appeal in the case of maternity services. ‘Private’ as in ‘respecting one’s personal intimacy’. When gynaecologist Michael Neary -another committed Catholic- was on the wards of Our Lady of Lourdes Hospital in Drogheda, he would make women stand to attention in front of their beds and in full view of everyone as he made his rounds. So there is a way in which the distinction between what is public and what is private is the distinction between what is undignified and what is not. ‘Public’ thus is rendered equivalent to ‘state property’ and ‘inferior’ and ‘humiliating’; ‘private’ is rendered equivalent to ‘dignified’ and ‘respectful of personal intimacy’.

    What is public, in the context of the Irish health system, isn’t a matter of common dignity and respect for all in a site that belongs to all, but a matter of what is inferior and deprived in a site owned by people who have the know-how and money to administer. And it has been the special role of religious orders and the Catholic Church more generally to guarantee this distinction -and the rule of the Invisible Hand- in the health system. Or, to paraphrase Joyce, the hand of a Free Market Christ in the Glove of the State.

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