The Goose and the Golden Eggs.

"I want a goose that lays golden eggs!"

So said Veruca Sulk before she went the way of a bad egg at Willie Wonka’s chocolate factory.

Without wishing to sound facile. Irish medicine is a bad egg, and it stinks! Most commentators begin by saying as much, in perhaps more erudite terms. Usually analysis of our broken system begins with a litany of ongoing horrors with which we are all familiar; the inhuman conditions in A&E the length of time granny is waiting for her hip, the absence of a functional psychological service, for a nation that is recovering from the mental illness that was the Celtic Tiger, and so on.

Consultants and GP’s love to join in the fray and each medical discipline passionately points to the ‘reality’ that the cardinal problem with health care in Ireland is that we don’t have enough money or enough manpower to deliver services. And there you have it! Turn the pages of most contemporary medical analysis and that’s the nuts and shells of it!

As Joyce’s brutally practical medical student Buck Mulligan often shouts; ‘Scutter!’ We have heard it all before, and will hear of it for another millennium, at least until we evolve the capacity to look a little deeper at our problems and accept that we doctors are as much a part of the problem, as we are the purveyors of the usual solutions.

Apparently this same lack of money and manpower have been the nuts and balls of it for many decades. Yet strangely, after decades of ‘more money’ and ‘more manpower’, the problems have not gone away; the waiting lists are as long, and A&E remains largely unchanged. Paddy still devotes almost half his PAYE to health-care; plus an additional €50-60 to see the GP and €150-200 to see the consultant,- despite his overpriced insurance premium.

What if we were to do something really bold and suggest (you might want to sit down and have a gulp of espresso) that the problem is not ‘a lack of money’ but too much money, and not a lack of manpower but too much manpower; much of which is quite possibly paralysed by having its finger stuck in the wrong place for most of the day?

What makes a molesting clergyman most repulsive is the fact that the most immoral act is perpetrated by a moralist. What makes our health service so abhorrent is the fact that it is defined by a particular stupidity, one that is perpetrated by those of us who are considered by many to be amongst the least stupid in society.

In the privacy of our silent read, and without choking on ones croissant, lets be honest for a nanosecond. Where does most of the existing budget for health go? That’s right wages! Staff wages, our wages! The truth is not pleasant when we see it in black and white, but there it is. If we took less there would be much more to go around. This is not leftist dogma, or profound philosophy, but the arithmetic of a school child.

Here is the elephant in the bedroom. It is as much an intrusion upon the intercourse of medicine as it would be if it were sitting at the edge of ones bed and observing the intercourse of intimacy.

Money! We don’t like to admit it but we are all addicted to, or at least largely dependent upon it as a primary source of happiness. It is part of the reason we get out of bed, it has purchased the bed, and it might even be the sole reason that we have someone to share the bed with?

The health system is interesting in that it is a microcosm of the state. From the top down our dysfunctional health-system is perfectly reflected in our dysfunctional politics. Just as we pronounce that there is not enough money being spent on health, our government tells us that if we don’t vote yes at the end of next the month, we may be deprived of the pleasure of borrowing additional billions to continue running the country.

When will the addiction and the madness end? Perhaps only when we answer the question that Tolstoy poses in his timeless short story How much land does a man need?

If we were to lead by example and show that the wealth-game has reached its sell by date, there would be far less pathology in the land, and far less strain on the mental health of the state, and even the self.

If we were to prove by algebra that happiness arises not out of wealth, but out of a ‘philosophy of living’, …what then? Not only would there be more money for health, but there would be less ill-health, public and private. The question for the nation is in reality a question for the self. How do we know when we have enough?

Unfortunately we are wealthy relative to the wealth of others; our car becomes old when our neighbour drives a new one, and our clothes become old when they are no longer fashionable. Our children’s needs are not being met when they don’t have what ‘all the other kids have’. This madness of modernity, was recently described in a BBC documentary Status Anxiety, presented by Alain de Botton.

Our present recession is Granny’s time! For she will gladly remind us that a car is for getting from A to B, our clothes are to keep us warm, and that a child will benefit more from a library book than an I-pad. She might also remind us grown-ups that putting more on our plate than we need is called greed, and she might inform the health service that a bowl of chicken soup will treat a cold better than any antibiotic. Oh Granny, why did we ever send you to the nursing home and sell your fine house in the suburbs?

If we could wave a magic wand and take relativity out of the picture we would all be millionaires! Emperors who are ferried about in mechanical chariots, and have our clothes washed by fantastic machines. But relativity is here to stay and we are as rich or as poor as our peers and our 'betters' might directly or indirectly tell us.

Next month for nine weeks Minister Reilly will open his home and castle to the public. The 15 bedroomed, three storied ‘Laughton House’ situated on it's 150 acre 'garden' in Co Offaly, will be open to public visitors at €5 a head, (€3 for Granny). The Minister’s residence is listed as a ‘heritage house’ and as such he avails of an €80k per annum ‘tax-break’ if he opens some rooms to the viewing public during the tourist season. A nice addendum to a GMS and a Ministerial pension to boot.

It is hard to imagine how austerity can be preached from such a vantage point? Yet therein lies the irony of both Irish medicine and Irish politics. If there is anything to this relativity lark Laughton House leaves my humble abode in the hay-penny place.

Yet I am sure my auld Gran would approve of my doubtful penury and definite happiness.

“Umpa lumpa dupety da

If you’re not greedy you will go far

You will live in happiness too

Like the umpa lumpas dupety do!”Roald Dahl