Newton Emerson wrote:

“If there is one thing that unites unionists and nationalists it is horror at the Republic’s healthcare system.

This fear is based on ignorance - almost nobody in the north seems to know how the southern system works. It is enough to be dimly aware that not everyone can access free treatment at the point of delivery to have the whole arrangement damned as a third-world aberration.

In reality, the Republic has a similar healthcare model to most of Europe. It has its origins in nationalising and regulating medical insurance, unlike the first-world aberration of the NHS, which nationalised doctors and hospitals.

There is a lot of variety in how European countries mix public and private healthcare and the Republic has its own unique and admittedly bewildering approach. At any given time between 30 and 40 per cent of residents hold a means-tested medical card, entitling them and their dependents to free care at the point of delivery. So in effect the Republic has an NHS for the most needy third of its population, efficiently adjusted through boom and recession.

At the other end of the income scale, the Republic has a high proportion of residents with purely private health insurance. Of the roughly 40 per cent of people who buy cover, only half choose the part-nationalised VHI. This indicates that regulation of the market is successful. Under the so-called community rating principle, each provider must offer everyone the same premium and compensate firms with an older customer base. This principle is strongly enforced. In 2006, Bupa Ireland - then the state’s largest private health insurer - threatened to leave if community rating was not watered down. The government refused and Bupa closed its Irish operation.

For patients who fall between the insurance and medical card requirements, further help is available via contributory benefits.

In a final complication, the public part of the mix of public and private hospitals is run by a government agency, the Health Service Executive, that to northern eyes looks simply like an NHS with an inadequate budget.

All of this is so alien to UK experience that it can distract from what really matters - health outcomes. Ireland has the same life expectancy as the UK, which is above the EU average. It also has above-average healthy life expectancy. Cancer survival rates are below the norm for northern Europe but are higher than in any part of the UK. The percentage of the Irish population who report feeling healthy is the highest in the EU.

For a developed country, the UK spends relatively little on health as a share of GDP. The Republic spends slightly less, counting both public and private, yet seems to get better results. It also has a better record than the UK in controlling the growth of spending. This is doubly impressive for a small country, given the importance to modern medicine of scale and specialisation.

So while the southern system is far from perfect, it is nothing to be afraid of. As only unionism can benefit from such fears, why do nationalists not do more to debunk them?

Of course, it is toxic for any party in Northern Ireland - let alone left-leaning nationalist parties - to hint at remodelling the NHS.

Sinn Féin has taken the opposite all-Ireland tack, supporting an extension of the medical card entitlement until it is universal.

However, only the far left finds that plausible, so there is a large political space for more realistic long-term thinking. If the NHS is in as much trouble as widely suspected, that space can only grow. At some point in the next 10 to 20 years, an all-Ireland plan B for health might even seem attractive to unionists.

In the meantime, we have only what unionist grandee John Taylor used to call ‘northsouthery’. Nationalist sniping about the need for better cross-border cooperation seems oblivious to how well it is already developed. British and Irish citizens can already access each other’s healthcare systems free at the point of delivery, without even needing a European medical card. Facilities are already shared along the border and specialisations are already delivered on an all-Ireland basis, with DUP health ministers signing off groundbreaking initiatives on both. This is about as far as cooperation can go while it is a case of two systems cooperating.

To go further, you need to consider a whole new system - and that means somebody in nationalist Ireland talking about health insurance and private hospitals in the north.”

See here:

http://www.irishnews.com/opinion/columnists/2016/04/21/news/unionists-should-start-thinking-about-an-all-ireland-health-plan-491732/