How to be a good milking cow!

The truth behind Universal Health Insurance.

One of the strangest ironies of Irish society is our near national inability to read between the lines, when across the gamut of western literature, Irish writers are the time honoured  authors of many of those same lines.

Personally I suspect that something is happening to the intellect of western man, I firmly believe that it is undergoing a contraction of sorts, one that is equally driven by an increased dependence upon the sugar high of modern technology and the materialist ideology that lies at the heart of globalisation. Collectively our attention spans are becoming shorter, the amount of cerebral activity we are willing to devote to a particular piece of writing (like this one for example) is almost certainly decreasing. The chances of you making it to the end of this paragraph a re much lower than they would have been 20 years ago, when there was not the option of 57 channels and the incoming buzz from an i-phone.  Unless there are a few sugar stimulants  mid paragraph, like 'sex' or 'cudos';  readers are likely to become bored or distracted by one of the weight loss advertisements at the side of the page.  It might be that the rapidity at which information is now disseminated has meant that the western intellect now expects the mental equivalent of  junk food, intellectual 'happy meals', 'one for everyone in the audience', and has become entirely averse to that which must be ruminated upon, that does not give up the sugar easily.

This putative contraction in national intelligence has meant that any mode of journalism that attempts at the more demanding task of analysis, beyond the superficial or sugar coat of 'good guys and bad guys'  or the good old  'blame game';  places itself at an immediate disadvantage and is unlikely to generate the revenues that validate all forms of contemporary printed discourse.

Recently the flavour of the week for Irish media was the media generated controversy surrounding  Minister Alan Shatter and the Garda whistle blowers bla bla.  The Minister's incompetent handling of his ministerial brief, prompting opposition politicians to sniff blood and launch an assault upon the Minister in the hope of securing his resignation and destabilising the government for their own obvious ends. This is an old media game that is played out time and time again, it is cheap news that entertains the plebs and allows the state media to continue to dissipate it's massive state funding  upon the salaries of presenters and executives, rather than real news or true analysis, the former would cost and the latter offend the hand that feeds them.  The vulgarity concealed behind this current bottle of smoke is the obvious reality that politicians behave like children with the usual infantile 'tit for tat' carry on that one encounters (albeit in a less sophisticated form) on any playground throughout the country.

Meanwhile, in the real world, rivers burst their banks as a consequence of global warming, nations brace for internal and external wars, heroin addicts drop dead on Dublin street corners, and rape victims wait for justice outside the gates of a judicial system that is as morally bankrupt as our banking and medical establishments.  The real problems in Irish society the real suffering, must take a back seat to the petty politics of 'tit for tat', and what is most amazing is that most Irish people are happy to consume their staple from their national media and accept it as "the news".. that it is as far as the story goes.

This week's flavour of the week pertains to the "news" that the director of one of Ireland's biggest charities Rehab, (Angela something or other) is in receipt of a pre-bonus salary of some 250k per annum.  The news here, is the obvious irony that  a charity worker should be in receipt of a salary that is higher than that of the president of the United States, or the Taoiseach of Ireland.  In Ireland charities are amongst the most corrupt of our institutions (even more than Medicine Law and Banking, these institutions at least pay some taxes), they can afford to pay the highest salaries, and have the deepest expense accounts simply because they are tax immune (no DIRT no Corporate tax, zippo!) and instead of profits being dispensed as 'shares', the dividends are carved in the form of salaries, bonuses and expenses.  Being registered as a Charity in Ireland is the holy grail of enterprise, the only thing that comes close, is the favoured status of Multinationals who pay almost nothing in tax.


We Irish are not yet stupid enough to have Apple, Diagio, or Google, register as charities... but if the contraction continues perhaps it wont be long?


And what of the Charities that are also Multinationals?



The RCSI in Dublin is an exemplary example of a multi-billion euro charity with a multi-million euro wages bill.  The RCSI has business interests in; Dubai, Malaysia, a Medical School in Bahrain, Private Nurshing homes and hospitals, not because these places are filled with the distended bellies of  Somallian famine victims, but rather because that's where the money is.  In Dublin the RCSI charges medical students 50k per annum in fees, whilst the state through Beaumont hospital pays the wages of the doctors who teach those students, pays the canteen bills and picks up the tab for the toilet paper etcetera. It even provides the guinea pigs in the form of plebs: living cadavers, for a population of medical students most of whom will leave Ireland once finished their training. Charity begins at home, and in the case of an Irish charity it begins with the charity itself. RCSI must wait its turn in for the inevitable spot light,presently  however it is perhaps too powerful an institution to experience the glare of a truly independent media.

We consume our distracting  'muck-news' and actively believe it to be news for precisely the same reasons that consumers return to Mcdonalds to purchase  nutrition, time and time again, despite the fact that they are eating little more than sugar, fat and a ball of carcinogens.  It tastes good, it makes a turd,  one need not suppress ones taste buds as much as ones brain cells.

This particular story of the executive making hundreds of thousands, whilst grandma waits for her new hip or little Johnny waits on his wheelchair and so on, has become the burger and dries of Irish media. The same story is staple of RTE , cheap news in abundance. What is more amazing than the repetition,  is the fact that the plebs continue to consume it with relish, on a regular basis, as though it were the cake that Marie Antoinette is supposed to have prescribed for a bread-less proletariat.

The simply reality that there is hardly a man or woman in the state who would have turned down the Charity Directors pre-bonus salary, on the basis that it is too high,  confirms that this ludicrous "story" is more about jealously and sour-grapes, than about any notions of governance, social justice or basic morality.  That is the sickly sweet irony of contemporary Irish society, the 'shite in the tulips';  that it attempts to be sanctimoniously socialist and brutally capitalist, at the same time! The universal disgust at the salary of the Chief Charity worker is easily reconciled with a universal lust for the same kind of salary; this is the idiocy of modern Ireland. A total lack of honesty that reinforces the complete impossibility of either a clear political vision or real change, beyond the poster variety.

The Charity workers salary of 250k per annum is  subject to tax at the rate of 50-60% meaning that she is likely to take home somewhere in the region of 100-120k . If  our angelical Angela has a Celtic tiger mortgage, a couple of kids in private school, and a few health insurance premiums to pay, she is not going to be that well off after all.  Amongst her pals in Business, Banking, Law or Medicine, she is probably on the relative breadline.  In truth, her taxes (like the taxes of the one  in four Irish people who actually work), must fund the unemployment benefit  for 12% of the population,  Medical cards for 40% of the population, the social clean up costs for our national love of the alcohol industry and all the other freebies that socialism dispenses to the needy and the crafty alike.  For herself and her family angelical-Angela must pay privately for almost every medical and educational interface with the state thereafter, she will soon pay for her waters and will pay mandatory health insurance.  It might pay for one of Angela's begrudger's to investigate what a medical card holder in Ireland is actually "entitled" to  before they cast the stone at the charity worker. Perhaps Angela has one hand in the pocket of the poor whom she ostensibly manages, but there are bigger  more hungry hands in her pockets.

Undoubtedly a significant portion of medical card holders are no more in need of medical cards than the man in the moon. I encounter the abuse on a weekly basis when I am asked by patients whether they should use their medical card, or their private health insurance  for referrals to hospitals and specialists.  In Ireland everyone is screwing everyone else. You must either screw or be screwed it's survival of the shrewdest. The system and all of its vast complexities, it's bureaucracies of broken venal institutions, quangos and colleges are constructed upon this brute reality and the media is simply a diversion fro this cold unsavoury truth.

We don't mind paying for the corrupt dealings of bankers and developers, as long as the payment is called something different; like a water charge, or property tax. The proletariat don't mind paying for the screwer's as long as we can do a little screwing of our own.

When the British left Ireland they left behind a broken, malleable, and subject  people, who will swallow any auld muck, once it has a bit of sugar on it.  After three hundred years of domination it takes no effort what so ever to politically piss upon the backs of the Irsih PAYE worker and simply inform that its raining honey from heaven.  It was only inevitable that the English should be replaced by a lordly class of our own making.  We Irish have yet to live up to an independence that was so painfully purchased.  For as long as we continue to swallow myth and delusion we will never be free, and would be better under the open and honest oppression of our former masters. It is the essential and going mission of state institutions like RTE to keep us stupid, to keep us from asking the right questions.

Contemporary national scams such as "free health care", in the guise of a mandatory health-tax upon workers and employers,  the transfer of private fees from GP's to Insurance companies, of water charges and property taxes to bail out bankers, are clear examples of our predilection for delusion; of a national spirit that was broken long ago, or has left on the emigration boat.

The recent diet of muck that is presently being sprinkled with spin and icing sugar, is the notion of free health care.  Only in Ireland would you find a media that is willing to continuously describe the coming implementation of "free universal health care", within the same sentence that announces it in the form of  a mandatory insurance policy that everyone will have to purchase. Which basically means that the product is free only after it is purchased. How Irish is that?

Current estimates put the figure of this new tax (or insurance policy as it is being called) in the region of 1600 euro per person per year  (See Irish Medical Times 28/2/2013). Never mind the fact that the non-free VHI plan B can be purchased for 1700 Euro per annum.

Of course the reality that once everyone has purchased mandatory health insurance, nobody will have health insurance, has been entirely missed by most commentators.  Currently the possession of health insurance allows us to be treated at private hospitals and to unethically skip the queues at public hospitals (we the skippers of the queues have no problem with this).  However once everyone has the same insurance policy, there will be only one queue, and no opportunity for skipping (at least not for the plebs). Universal health insurance is simply the end of affordable health insurance, and the birth of another new tax, upon a nation that will apparently swallow anything at all,  once it is promised by somebody in a suit.

One of the most entertaining aspects of this current  charade is the fact that GP care is to become 'free' this is the carrot that most of  the public are holding their breath for.  All the plebs have to do is simply  elect Fine Gael/Labour into office for a second term (the freebies  can't or wont be delivered in full, until after the next election). Vote for me and I'll buy you a pint! Asinine as it sounds, it goes down like tea and hot cakes. The mandatory insurance policy will cost us in the region of 1600 per annum.  Meanwhile, an entirely private GP franchise (GP NOW) operating with branches in Dublin and Cork and Galway, are offering unlimited GP care for 2 adults and 3 children, including nurse visits vaccinations and blood tests etc  for 999 Euro for TEN YEARS. One might save billions if this  GP NOW were to take over primary care in its entirety.   They are offering  private medical care for 5 people for 10 years,  for less than one person's, yearly  subscription to the government's mandatory insurance plan.  

Whilst we the plebs consume the sweets of Alan Shatter and Rehab Charity Workers etcetera, and patiently await the golden shower of 'free healthcare';  Big business and government can get on with the business of running the country, carving the real cake, and stealing money out of peoples pockets under the guise of ever more elaborate hoaxes such as; water taxes, house hold taxes, and mandatory health insurance.  Angela pays 60% tax and Apple pays 2% tax, it is as fine as it is Irish.

Once the ongoing enquiry into the recent  greed induced collapse of the banking system, reaches the inevitable conclusion that Sean Quinn and the Anglo golden circle, were in fact duped into loosing billions, by the State, via  the then Financial Regulator.  And the predictable trip to the European court finds the Irish State to liable for Quinn and his Pals  (Regulator approved) investments into Anglo; the plebs will have some more bankers bills to pay, and will need to be taxed and milked  a bit harder. Of course this will take time but there is no harm extending the milking parlour and preparing for the future. At present there is a lot of money changing hands at the reception desk in General Practice and this is soon to be channelled into the coffers of Insurance companies and the State.

The problem facing the government at present is that one of the more powerful lobbies in the country the Health Insurance Lobby is experiencing difficulties as people are not renewing health insurance policies and revenues are falling.  The health insurance companies and their man Minister Reilly  have come up with a plan that has been sanctioned by the government.  The plan is simple and it involves the transfer of liquid health asset in the form of the cash that is paid to GP's in private fees to the Insurance companies. GP's will then be advertised as being "free" of charge, when in reality Paddy will have to pay a mandatory health insurance.

One year ago the fire brigade came to my house to put out a fire in our Chimney , they left behind a bit of a mess and a bill for 500 euro. Given that in addition to the tax on our wages we plebs pay: television tax, road tax, water tax, property tax, county council rates, GP visits,  registration fees at Universities and schools (which amount to the same fees that private Universities in America charge),  legal fees to access the justice system, and at last, a health tax through mandatory health insurance.. perhaps now we might ask what (other than the salaries of those who tax us) we are paying taxes for at all?  Angelical Angela was a fool to forgo her bonus!

This in essence means that private fees and some more, will now go to state favoured  insurance companies who will deduct their own costs fees and profits and then compensate the GPs for the subvention of their private incomes. The state will be selling Health Insurance contracts like mobile phone contracts, and the gravy train will keep running. Only thing is, this is no gravy train, it is more like the train that used to travel beneath the sign that read: Arbeit  Macht Frie.  

The system is an elaborate hoax that involves the simple transfer of private fees from the GP to private Insurance companies, who will take a share for themselves and pass the remainder onto the medical profession. On the surface the scheme appears "free" but  even the most superficial analysis reveals that the additional layer of bureaucracy vis the intermediary of profit driven  insurance companies, means that the consumer is going to have his pockets picked whilst he is availing of the ostensibly 'free' services. His Boss will have to contribute to the scheme, so he can forget about looking for a pay increase.

In an Irish context this type of national delusion works perfectly well . Essentially the insurance companies commandeer the private incomes of General Practices, and these monies will be supplemented by a new tax that will be called mandatory health insurance.  The incomes of GP's will be eroded to a small degree; to that which the profession will tolerate. Ultimately the insurance companies will be in a position to pay the GP's reasonably well, given that their coffers will be swelled with the revenues from this new tax. The financial burden will be shouldered by the least powerful group in Irish society, the working plebs who pay for all things taxable. They will shoulder this additional burden obediently,  as long as the appropriate spin is applied, if like the animals on animal farm they are encouraged  to believe that all animals are equal, but some are inherently more equal than others.

Christ have mercy.

Garth has friends in low places!

The Slovenian philosopher Zizek describes with his usual candour, the diligence that Norman Bates brings to the task of mopping up the blood after he has committed his murder, the perfection and finality that he brings to his work is symbolised through the conscientiousness of his hand washing. There is indeed a certain beauty to be found in the grotesque, the beauty for example of the 'perfect crime', where everything is returned to a state of order and completion that is a perfect reflection or even an improvement upon the previous state of affairs.

When one considers corruption, political, social and institutional in an Irish context it can be considered upon the level of a perfection, a completeness and thoroughness that at times might even (from a certain perspective) be considered as beautiful. A recent example of this perfection is to be found in the thousand words that are spoken by the picture of the leader of the Irish People and the Head of the Apple Corporation exchanging a hand shake.  Beneath the beaming dignitaries the caption proudly declares:

 31 JANUARY 2014. 

"We'll shake on that then Tim.  2% Tax for Apple and 50% tax for the plebs, 
its a deal! Will you throw in an ipod for meself, like a good man?"



"APPLE chief executive, Tim Cook, staged a private meeting with Taoiseach

Enda Kenny in Cork as the Irish city celebrated 1,000 new jobs in just seven days." (Irish Independent 31/1/2014)

Like many corporations Apple has it's European headquarters located in Dublin because Ireland maintains the lowest corporate tax rate in the EU. It is for the same reason that Yahoo recently announced (much to the annoyance of the French) that it too would be moving its headquarters from Paris to Dublin. Latvia has a corporate tax rate of 19% Romania has a rate of 16%. These relatively poorer European nations must compete with Ireland's rate of 10%, and Ireland's relatively advanced and almost entirely EU funded infrastructure.

In Ireland we pride ourselves upon our special relationship with America, inwardly we imagine ourselves to be the Quiet People, the fifty-first state of the Union. We remind ourselves of the real or imagined ancestry of a majority of US presidents, of the special interest America has always taken in the Northern Ireland peace process. Any dislike we might feel towards America or Americans is merely the manifest form of the transient jealousy a schoolboy might feel towards his best friend, towards his idol, the boy who has everything. In reality we love America we dream of America, and in terms of our national identity we wish to become all that we romantically perceive America to be.

Click here for a recent example of Ireland's inferiority complex, expressed with the usual bombast of the insecure.

When I was a child, my grandmother's council flat in Fairview, in her hallway next to the Pope was a picture of JFK. Today not far from her flat Crowe Park stadium (rebuilt in the height of the boom), has a capacity for 80,000 people. Garth Brooks, tired, overweight and artistically well passed his sell by date, has sold out five consecutive concerts at Ireland's biggest stadium. 400,000 thousand people, 10% of the entire population will come to pay money and homage to a piece of the American Dream of twenty years ago (that dream has evolved a little Since Brooks was in the ascendancy). Christ would be lucky to draw as big a crowd as a pot bellied Garth, singing to his friends in low places that he has 'friends in low places.

It is an interesting irony that the United Nations Earth Summit in Rio in 2012 was an international event devoted to Sustainable Development, and ending world hunger, and so on and so forth; it drew an estimated crowd of 40,000 people. perhaps one should not be surprised at Brooks popularity, we live after all in a world that still brings its Children to the Zoo and Sea World to watch abused and demoralised animals jump through hoops and pace about in concrete pens.

It is only very rarely that we might be encouraged to think,  to look beneath our 'special' relationship with America and see that it is our corporate tax rate, or  the reality that CEO's are granted private audience and influence with the Taoiseach, that attracts American firms. My sisters live in San Francisco and they describe their frustration at the soaring house prices in silicon valley, a soar that is driven by the growth and incomes of Tech firms such as Apple, whose profits are greatly influenced by their tax arrangements with the Irish government. A recent study by Professor of Finance at Trinity College in Dublin revealed that whilst Ireland might publish a corporate tax rate of 10%, its effective rate for US multinationals such as Apple is no more than 2.2%. (irishtimes.com) Ironic that we in Ireland bemoan the bubble that has recently burst in our own housing market whilst at the same time we actively inflate the bubble in Silicon Valley.

The Irish vote in US elections is almost as important as the Jewish vote. It is this fact and the reality that American Bombers may use Shannon as an unofficial military base in the North Atlantic, that so endears us so to our American heroes. A hearty helping of sugar coated doggy biscuits: of John Wayne, Rambo, Clint Eastwood Elvis and Garth; Miley and Carley for the teens, Disney for the kids and NASA for the rationalists, have all effectively sealed the deal and won the hearts and what remains of the minds of the plebs.

It is interesting to consider what Chruchill might have made of Irish Neutrality had German planes been granted the same use of Shannon Airport that American bombers and personnel carries were granted during the Gulf war. We might have no need of a Georgian preservation society, had the same rules applied there would be little to preserve. This is the perfect nature of corruption in Ireland, that it can run so deep that so many people and politicians can convince themselves of a superficial neutrality in the face of such a blatant contradiction.

We continue to shudder at the repugnant thought of Priests or figures of authority interfering with children.  Yet our inability or unwillingness to see the reality of what is occurring, in preference to the reality that we would rather believe is as as pathological as the abuse, perhaps more so. It is pure folly to assert that of the many past and present victims of child abuse, there were no cries for help, no pleas for recognition of what was occurring, of the horror that children were compelled to endure.

The unspoken and unexamined truth of abuse is that many if not most in Irish Society chose not to see it, in the same way that the majority choose not to see the reality of Shannon Airport, or that of Apple or the truth of the Zoo. Or the relation between consumption and the sand bags that county councils are distributing to families and local shop owners, so that the reality of global warming might not come rushing into their homes and businesses. There is perhaps no society, no culture on earth that is more adept at protecting itself from the truth of the real, of the moment. Joyce referred to this innate ability as our collective 'paralysis'.

"I call the series Dubliners to betray the soul of that . . . paralysis which many consider a city." Joyce believed passionately that Irish society and culture had been frozen in place for centuries by two forces: the Roman Catholic Church and England. The result, at the turn of the twentieth century, was one of the poorest, least-developed countries in all of Western Europe. Cliff Notes (Online 2014): Dubliners.

The poverty of Ireland today is one of intellect, of literature, culture and philosophy.  Our paralysis our inability to actualise an identity, a culture of the modern, creates a vacuum, a space that is partly filled by Garth Brooks and Miley Cirus.

If Joyce could have lived and encountered the blooming of that paralysis into Ireland's national broadcasting agency, he would undoubtedly concur that thinking in Ireland is as paralysed today as it was one hundred years ago. However one need not refer to Dubliners for a treatise on the psychological paralysis of the Irish people, one need only listen to Ireland's most popular broadcasters, to Gay Byrne, Marion Finucane, Tubridy or Pat Kenny, to encounter the living form of that pathology the refusal, the innate inability to look beneath the surface of things, to see new aspects of reality, that in truth are not new at all and in fact have been lost to us through our embrace of paralysis.

Irelands' rebound love affair with her new colonial master, prevents her from seeing the wood from the trees, from looking behind the mask of her saviours, the house-wifes choice. To recognise capitalism or the market, as the motive behind the rising waters, behind the unhappiness of relative wealth, the filling of prisons, the illiteracy and ennui of youth; would be to handle the bite that feeds us.

The straight jacket that we are compelled to wear is typified by the empty irony that Sin Fein have evolved into. In the past Ireland's enemy was the English. The destruction of the language, culture, the economy, our national identity etc, were all the fault of our oppressive colonial masters. Out of this 'truth' Sin Fein, 'we ourselves' were born. Out of this 'truth' revolution and civil war were born. Sin Fein are the bearers of our historical chalice of woes; of the famine, Travelian's corn, the six counties, Hill Sixteen and so on. The Citizen in Joyce's Ulysses, gives a near perfect rendition of the familiar tale of Ireland as the passive victim of her colonial master.  Sin fein are compelled to remain frozen within this historical paradigm, whist the new master; the markets, capitalism and materialism are eating the very heart of the Irish nation.

Sin Fein remain cast in this traditional mould of England as the enemy, for several reasons all of which border upon a tragedy of Shakespearean proportion. It was to America that De Valera appealed for money for the cause of hackneyed liberty, it has been America that has filled the coffers of Sin Fein since the party's inception, It was American dollars that financed the war of independence, and the IRA.  Garth Brooks' musical career might have peaked in the US and be approaching its nadir, whilst in Ireland he approaches his zenith; so too are the anti-British ideals of Sin Fein almost spent in Ireland,  yet they are alive and well in America, from where the party continues to derive a substantial amount of its revenues.

The modern Irish tragedy  is that, Sin Fein, (the keepers of Ireland's tradition of Independence), have become the lap-dog of the most significant ongoing threat to that independence.  They are in effect, entirely wedded to Ireland's new colonial master, and hence to the ideals that have usurped what remains of an Irish cultural identity, at the very least inhibiting its growth in a new and evolved form.  Today it is not the Church and the English that paralyse Ireland's intellectual development it is our collective inability and unwillingness to see beyond current redundant paradigms.

The process of globalisation might simply be described as the global aspiration and application of the American Dream, of capitalism and the markets and those ideals that are the bedrock of the American definition of freedom, or democratic capitalism. Whilst Sin Fein was once a party that was devoted to the cultivation and preservation of Irish independence, it has somewhat inevitably evolved into a paralysed and toothless guard-dog one who barks at everyone except the thief that is his master.

In a letter to History Ireland Desmond Fennell posed the following question:

Sir,—It is normal for national historians, in the narration of the history of their nation, to mention or recount, in due place, the intrusion, progress and influence of a foreign ideology or world-view. Irish national historians have done this, successively, in the cases of the arrival and impact of Christianity, the Anglo-Norman invasion, Continental Catholicism, Protestantism, the English legal system, French republicanism, British classical liberalism, Victorianism, Catholic Ultramontanism and socialism. Hence my puzzlement at the absence of any treatment, in the Irish historians’ accounts I have seen, of the principal foreign ideological penetration of Ireland in the past half-century. I mean that of American left liberalism, which, with its new set of dos, don’ts and do-as-you-likes for behaviour, thought and language, has become—with the support of Irish legislation—the Republic’s reigning ideology. The fact that since the 1960s/70s this American ideological colonisation has produced the reigning ideology of western Europe generally takes nothing from the fact that its arrival via London, and takeover in Ireland, have been a substantial part of our recent national history. Omitting an account of this from our historical narrative has been equivalent to Romanian or Hungarian historians failing (unimaginably) to recount the arrival and implementation of Russian Communist ideology in those countries from the 1940s to the late 1980s. Can anyone, beginning with our historians, explain this remarkable omission from the Irish historical narrative?—Yours etc.,

Desmond Fennell

History Ireland April 2013

The answer to Fennell's astute observation is that Ireland cannot afford to recognise its most recent invader. It cannot afford to recognise it's invader, for the same reason that families could not or would not see the powerful abuser in their midst. Indeed today there is no desire to recognise the current transformation of Irish culture as invasion as it is an almost entirely willing transformation.

Ireland's  historic relationship with England might brutally be described as a rape, with all of the attendant feelings of injustice; of wrong and abuse translating ultimately into an  indignation and a support from her sons and daughters in America. However in this present cultural invasion or usurpation, that is this process of globalisation, Ireland is a willing and compliant bed fellow. We do not wish to consummate the union by an open declaration of marriage, and therefore the transformation is not to be openly advertised in the media or History Ireland. Part of Ireland's confused modern identity is a vigorous assertion of that new identity in the context of the Union,(we are proudly European) of Europe, of the other who is bigger than us or our former colonial master.  In asserting we are European we preserve the we ourselves, the anti-english element of our historic identity  Of course we still wear the green jersey, and sing the fields of Athenry, yet in reality we move further away from a national identity, towards the homogeneous conglomeration that is an American or European Union. This union brings with it, the social and humanitarian consequence of the 'free' market, it brings with it the ennui of 50 channels, the consequence of readily available pornography, the diseases of sugar, fat, speed, and excess, and the diminution of philosophy and literature in place of shopping catalogues and shopping malls. Generations have come and gone since the Gaelic League, since the Cummans, the White Boys.  The winning of independence was the greatest blow to Irish independence, it came a century too soon, for Ireland had not yet created an identity into which that independence might have grown.  Had the English remained in authority in Ireland for a further hundred years, the language movement, the development of a viable cultural identity would have been more complete and vital enough to have grown into something substantial.  As the Basques struggle for independence and preserve and promote their language as a crucial feature of their cultural identity, so too will they experience the decline and demise of that language should its preservation and promotion be not firmly established prior to the arrival of their independence.

Recently I attended a talk by the Joyce Scholar Declan Keiberd in the Abbey Theatre in Dublin. Kieberd began with a crowd pleasing reference to the hardships 'we' are enduring as a consequence of the recession and the tragedy of unemployment. At the end of the presentation I asked Professor Kieberd whether the real tragedy in Ireland is not one of unemployment but rather one of mis-employment. I suggested that upon most coffee tables throughout Dublin one would be far more likely to find a dog-eared copy of the Argos Catalogue, than a copy of Joyce's Ulysses. That the real poverty we face in post industrial revolution Western society is not of wealth  but one of intellect and culture.

Kieberd perhaps did not have time to consider my question, for he replied that he had an Argos catalogue himself and he was sure that Joyce would have one were he here today. I suspect that Kieberd was (to quote from the American Historian Will Durant) as 'wrong s someone can be within the limits of a single sentence'.

Joyce was indeed a materialist, however I suspect that his  dream, (if he had a dream at all), was of a Dublin removed from the squalor and poverty that is inflicted by the self and the state. The state through an inequity that is symbolised by the pomp and circumstance of trhe Viceroys regal cavalcade, and the self through alcohol dependence through the self pity and an intellectual or moral paralysis that are typified by the Citizen, and by the 'overarsing leafage and silver effulgence' of Dan Dawson's speech.

"---Sinn Fein! says the citizen. Sinn fein amhain! The friends we love are by our side and the foes we hate before us." Ulysses: Cyclops

The brute poverty of Joyce's Dublin has been effectively remedied, if it exists at all it is of an entirely different form to the barefoot poverty of a century ago.  I have often witnessed a beggar on the streets of Dublin, texting on his mobile phone whilst begging, an expensive and wasteful cigarette hanging from his lips. Poverty, when it does come alive, is a consequence of addiction and abuse rather than deprivation. If it is ever experienced by Kieberd's audience, it is almost entirely of the relative kind. There are no barefoot children on Moore street, and the squalor of the tenements has disappeared, leaving behind an occasional wreck of filth that is the consequence of an absentee landlord, of addiction, abuse, or mental illness.

Social welfare payment for one, amounts to 180 Euro per week; a full chicken and a ten kilo bag of potatoes can be purchased from a Dublin supermarket for less than 10 euros.  Admission to a public library is as free as the sea air, or a walk upon the strand. These are not crowd pleasing truths but they are truths nonetheless. The industrial revolution has brought us a freedom from actual poverty, yet it has plunged us into the unhappiness and despair of a relative poverty who's consequences are as severe upon the mind as those of real deprivation are upon the swollen and distended bellies of malnutrition.

The screams of women in childbirth with nothing more than prayers as analgesia, have changed too. Today it is not poverty that creates deprivation but rather wealth itself, for many women it is not the lack of analgesia available in childbirth, but rather the choice and empty promises of that analgesia that exacerbates their pain. It is not poverty that creates pathology but excess; fat, sugar, legal and illegal dependence, unhappiness, speed, and the relative nature of wealth, these are the diseases of modernity.

As a consequence of the intellectual paralysis of Irish society, the absence of a forum of ideas, of an oasis (physical or ethereal), where thinkers might come together and exchange ideas, might drink from the real and unfettered thoughts of others, where intelligence and deeper thought might be celebrated rather than vilified;  there is little choice but to flee. Ironically it is to America that Irish intellectuals like Kieberd have chosen to escape the global consequence of the American Dream.

Sin Fein are perhaps representative of the biggest tragedy upon the Irish cultural landscape. And yet Sin Fein are reflective of their popular base, of those who vote for them and sip from the elixir that is Banba's cup of woes. The paralysis of Sin Fein within its anti-english paradigm, the absence of a political alternative to Globalisation or the American dream, means that what remains of actual political independence is to be observed in the persona of politicians like Ming, Mick Wallace, the United Left or Senator Ross.  However even these weak and ineffectual 'alternatives' must struggle with the reality that cut off from language, culture and philosophy, they too have no alternative. That in an Irish context, alternative visions outside of the market, and the universal plea for more money for this or that section of the populace; outside of the pointing to the failures of capitalism and the infinite examples of institutional and individual corruption,--- there is no alternative.  Irish society is wedded to the markets, and entirely enamoured by its new colonial master. We remain therefore, compelled to see and bemoan the consequence of the American 'dream' yet we are incapable of formulating a new dream or vision for the future. We remain incapable of imagining a future not because we have an insufficient reverence for the past, but rather because we are frozen within or past and have an insufficient reverence for the present, for the here and now.

Every year, every day in Ireland the difficulty in reconciling the truth of social reality with the pretence of old ideals and old morality becomes increasingly difficult. When truth and fiction can no longer be reconciled, insanity or flight become the inevitable choices. In Catch 22 Joseph Heller refers to this process of reconciliation as 'protective rationalisation'. One can either be too stupid or too smart to find oneself incapable of the process, to listen with complacency to the narrow world according to RTE.   I am not sure to which school I belong, however to continue with the farce has become too much to ask of a soul on life support.

One can either be a capitalist or one can be a socialist, one either believes or one does not, one is either pregnant or one is not, there are absolutes, there is a point where compromise is impossible. We have as a nation passed the point of compromise with the past, we must move into a new and rational future, Joyce recognised that we had passed that same point one hundred years ago.

To practice medicine successfully in Ireland, one must be either shrewd or stupid. One must cherish conscious or subconscious beliefs in respect of ones entitlement, ones superiority; or one must recognise that morality within the system is to be got around and overcome, much like ones tax obligations. Ours is a system that is not for the benefit of  public and private alike, it preserves its colonial ideals, tipping the cap to the moral authority whilst inwardly dreaming ways to out smart it. Only thing is that, without England we are  reduced to cheating and out smarting ourselves alone.  In Ireland the biggest crimes occur within institutions, by their own members and not from without. Today Ireland needs to be protected from none other than itself. Personal gain or private benefit is the ultimate truth the guides one between the obstacles the moral turpitudes the shady areas between black and white. Ones morals need only be in keeping with those of a Joe Duffy or a Pat Kenny, Ireland’s contemporary  Archbishops of the mind, her abiters elegantarium. The prerogative of the individual is 'more more more', that of the state is economic growth, (the same more more more); the hymn sheet has become universal and one must merely pay homage to our quasi neo-liberal moral code and its big mouthed purveyors.

Nowhere are the contradictions more blatant and the distance between right and wrong more pronounced than in the Irish  institutions of Medicine and Law.  The majority of participants in these modern tragic comedies appear secure in the belief that they are decent moral people, living in abeyance to the quasi moral code; good citizens, good employees, good physicians, good leaders.  And yet nowhere is the truth of an inverse so blatant, nowhere are corruption, nepotism, thievery and venality so rank.

Self preservation is dependent upon shrewdness or delusion, there is no middle ground. It begins at the beginning, at the place where 17yr old boys and girls begin to learn to be doctors or lawyers. How can a mere child make such a decision?  How can a virgin to the sufferings of man, to man’s inhumanity to man, sit at the bedside and listen to talk of abortions, of abuse, of hurt, of neglect, of self destruction in its myriad of contemporary forms? It begins with 50 thousand Euros in fees for the pleasure of attending medical school at the Royal College of  Surgeons, and with that institution's perverse relations with the nations busiest and biggest public hospital. A thousand medical students most paying fifty thousand Euro per annum for three years of training at a public hospital, where the tea the coffee the teaching and the toilet paper are paid for by the same tax payers who are guinea pigs, the practice and the cadavers. The corruption  transcends the state subsidised private tuition fees, and the registered charity status of the nations wealthiest private college, and mingles with the blood that is taken from public patients at public hospitals and passed on to private biotech firms to engage in research to isolate the genes for new patented treatments for cardiovascular disease.

From medical school to the colleges, to the schools of post graduate training, the institutions regulatory bodies and doctors unions. The the chief of the Irish Medical Organisation recently retiring on a pension package of 20 million Euro, to the role of the sitting Minister, former head of the same union, in the approval of that package. A union with no more than four thousand members and a retirement package 20 million, forgotten almost as quickly as the story broke.

And what of the sale of medical card patients (herds of milking cows) by the Irish College of General Practice? Not a peep. The safest form of corruption in Ireland is institutional corruption. A GP on the Nedical Council's 'Specialist Register' can obtain a GMS or medical card contract from the Health Service Executive.  A contract that allows the Doctor to be paid to treat medical card patients. Applications for inclusion on this specialist register are all referred by the Medical Council to the Irish College of General Practioners in Dublin; membership of that college is the easiest and most common way for a Doctor to obtain the approval of the ICGP, access the specialist register and 'ownership' of a list of medical card patients.

Emergency emergency! Universal GP care is upon the horizon, free GP care to under 6's is on the way, and only those doctors on the Specialist Register can avail of contracts new and old! But what of the several hundred doctors who are not on the specialist register, but are on the older General Register. Doctors such as myself who can see and treat medical card patients as locums or in the out of hours, but cannot avail of a list or a GMS contract?

Don't panic, don’t be afraid, Irish Capitalism ICGP has come up with a plan that will calm your fears of exclusion. They (The College and the Council) call it the alternative route, a mechanism whereby doctors can become members of the Irish College of General Practice, and thereby obtain the all essential GMS contract and list. The process is in three steps, an interview, submission of a portfolio and a multiple choice test submitted upon a piece of paper that is corrected by an automated machine. The price tag? A mere 7100.00 Euro. (no extra zeros). The usual delusion of everybody being a winner invariably applies to institutional corruption of the Irish variety. Locums and single handed practices usually declare their own taxes, and the college fee is entirely tax deductible.  Therefore one can pass the immediate pain onto ones patients in the form of excess consultation fees, and ultimately to the taxman by deducting it from ones taxes. As usual everybody wins! Or at least thats what is believed. 

On to the practice of the noble profession. So the tax take for the government is in the region of 30 billion, the budget for the department of health 2013 is in the region of 13 billion. As such nearly half of ones taxes are devoted to health, and yet what does on receive in return? With the exception of maternity care and childhood immunisations the PAYE worker must pay one of the highest fees in the OECD to see a doctor. Almost 40% of the taxes stolen from his pocket by an inept and corrupt government are devoted to Health and yet the PAYE worker must pay for every interface with the Health service. 50-60 Euro for a consultation with the family doctor, if there is a referral to ancillary services such as; counselling, physiotherapy or dietician, these too must be paid for privately. If a prescription is given it is charged at one of the highest prescription charges in the OECD. On top of the 30-40% of his or her wages that is devoted to health, 40% of the population choose to pay for private health insurance. A practice and a payment that is clearly indicative of the reality that the Irish population are indeed a broken people, a subject population that will in essence not merely tolerate many forms of political abuse, but actively and enthusiastically embrace that abuse.

On top of their health Insurance premiums, most of the willing 40%  will also pay 150-200 Euro for a consultation with a consultant physician or surgeon.  This private fee is of course not refundable for most policy holders and after this the insured might then be permitted to skip the queue for treatment at public hospitals, that are built and funded by the tax payer and equally by the sixty percent of the population without medical insurance.

That the Irish people can be relied upon not only to tolerate but actively embrace this kind of state sanctioned abuse, is testimony  not only the intellectual paralysis of the populace, but the extent to which the Irish people have been quietly oppressed by a political leadership that is more venal and more corrupt than the colonial authority it rebelled against almost a century ago.

From the outer margins of the system in its entirety to the isolated practice of medicine within the consulting rooms of the typical Irish physician the system of health delivery and function is entirely corrupt and morally bankrupt. No where is this more obvious than in the relations between General Practitioners and the other most corrupt institution within the state, that of the legal profession.

For example almost every car accident in Ireland is followed by a back pain or a neck pain that travels to the courts and extracts many many thousands from insurance companies who simply pass the expense on, in the form of one of the highest insurance premiums in the OECD. The medical profession is entirely complicit in the routine practice of fabrication, where once again 'everyone is a winner'.

How the system works is rather simple. Minor road traffic accident, following day those who were not at fault in the collision, present to the General Practitioner with the usual back and neck pain. The GP makes note of the “symptoms” and awaits the inevitable letter from the solicitor..., along the lines of.. “we look forward to receiving your report and undertake to discharge your fee upon receipt of same.

The fee for said report is in the region of 200-300 Euro  plus the initial consultation and a few more consultations as the claimants are generally advised by their counsels to attend the GP for regular follow-ups, prescriptions for pain killers and if possible a referral for physiotherapy and a few x-rays and scans for good measure. The role of the GP is simply to document the subjective symptoms of the claimant, and as long as he or she is willing to attend and pay a consultation fee these subjective symptoms are recorded under the auspice of a medical consultation. It is not the job of the GP to determine the validity of symptoms, a relatively impossible task at any rate and especially difficult for a General Practitioner, who is hardly going to argue with his fee paying patient, whom he or she might have known for many years.

On more than one occasion I have had patients return for follow-up consultations where their solicitor has insisted that they be sent for x-rays or physiotherapy.  I have had one solicitor pay for a patient's physiotherapy out of the ostensible  'kindness' of his own pocket. I have had another solicitor write to me and ask me to amend my report so as to "improve the value of the claim for the sake of the patient". The corruption is patent and blatant and unites what are perhaps the two most corrupted establishments within the state, that of medicine and that of Law.

Yet the vast majority find these practices acceptable, and in fairness to the claimants, (legitimate and illegitimate alike), there is no other mechanism to have ones expenses or ones pain addressed other than a visit to the solicitor and his or her referral to the doctor and thence to the waiting lists of  the courts. Much as the regular payment by the state for ones herd of medical milking cows often encourages a disinterested referral to the waiting lists of public hospitals.  In Ireland we  bemoan the length of the waiting lists of either establishments, yet we lack the intellectual capacity to look deeper into the reality of how they are formed and continue to grow.

One could write a book on the corruption that defines medicine and Law in Ireland however the truth is not as palatable as the daily news that is freshly baked in the ovens of RTE.

When my family and I lived in New Zealand we moved hose 3 times, each time we sold our home and purchased a different one. The process of property conveyancing (buying or selling through a solicitor) is refreshingly different in another country.  The process is essentially the same, with the same necessary dependence upon the legal profession, however in New Zealand the legal profession (in addition to the medical  profession ) are appropriately regulated. About on or two weeks after each move in new Zealand we would receive a cheque from the solicitor in question for the interest that is accrued upon the mortgage monies that are transferred by bank or individual into the solicitors client account.  When we bought our home and our practice  in Ireland, I asked the bank, 'to whom does the interest accrue on funds that sit in the solicitors account for as long as the attendant complications with a house sale remain in place..., I was told that the bank did not know, and probably the money sits in a non interest bearing account.   If I were an astute solicitor and I am sure there are many throughout the state I would be sure to let one out only when another comes in.. or to keep a healthy amount in my Client account, a mere million at one percent would return 10,00 euro per annum.  One wonders at the amount of Client account interest that accrued to the profession during the boom years.

Another refreshing aspect to a regulated legal profession was the fact that the solicitor would tender his or her fee bill before or after the transaction, and was not entitled as they are here in Ireland  to simply subtract their fees from their client account, and send the perfunctory and irrefutable 'bill' on whenever it suits.

In many respects one might fairly ask of the legal system, how it can pretend to justice or the addressing of legal grievance when outside of the criminal system the first question that is asked of a victim or someone in need of  arbitration by the court..., what is the content and the depth of your pockets?   The same may be said of medicine.

These points are merely for illumination of the underlying pathology, the examples of venality, abuse and corruption are rife through medicine, justice, banking and education, the pathology runs deeper than the roots of contemporary media are willing to go.  The pathology of brute capitalism does not paralyse other societies in the same way that it paralyses the moral, intellectual and social development of Irish society, because other societies are not burdened with a self imposed duality; a cultural schizophrenia. Instead  they embrace their capitalism and regulate it accordingly. In Ireland we have a capitalism that is strictly regulated by an entirely absent but universally professed 'Christian' morality. 

The very practice of medicine itself is compromised by having to practice it in an Irish context. Of course antibiotics don't treat he flu, yet how can a GP insist upon this basic reality to a patient who is expected to shell out some 50-60 Euros at the reception desk following this consultation?  In the same respect if the paying patient wishes to be referred for testing or scanning on the basis of a particular anxiety, how can the Doctor refuse his insured and fee paying patient?  Anxiety in a medical context is the most common pathology encountered in General Practice. Ironically it is the most costly diagnosis to make as it can only be entertained once a myriad of expensive scans, blood tests and specialist opinions have been exhausted.

The yearly  rates bill for my single handed practice on the main street of Rush is some 3500 Euro, on top of this I must pay separately for utilities, waste and water. Each morning I must sweep the rubbish outside my surgery door where the public refuse bins are perpetually overflowing.

The corruption in Irish medicine runs from the top to the very bottom. From a Minister who opens his castle (Laughton House) to the public each year for a few weeks in order to avail of an 80k tax break. Himself no longer on the medical register, and yet his GMS contract is maintained for him by the HSE, who continue to pay mortgages upon his extensive medical premises in North Dublin, GMS pension contributions, in addition to a Ministerial salary and ministerial pension. All of which is entirely above board in an Irish context.

The extent of the gullibility of the Irish people, of the paralysis that moved Joyce to write some of the finest works in literature, is confirmed by the stark reality that 200 years ago Ireland was governed by Lords who dwelt in castles, were bankrupt and insisted that we the people must live within our means and tighten their belts.

For my own part I have chosen to flee this soulless land, lest I too become a zombie.. I can no longer live or work in a system and a state that is so fundamentally corrupt, one where the people themselves are either complicit or oblivious to a corruption that ultimately undermines the ideals of almost every public and private institution in the state, from profit driven banks to registered charities.

I recall pictures of old mills in operation, mediaeval contraptions where oxen or horses are bound to a turnstile and walk in circles all day long turning the grinding  mill wheel without pause or question. I recall looking at these images thinking how terrible it would be for a human being to be confined to such a fate. Cursed like Sisyphus pushing his bolder to the top of the hill each day and having it roll to the bottom just when he nears the summit.   I had consoled myself in thinking that whilst animals might tolerate this interminable repetition  as a consequence of their ignorance; humans would rebel as a consequence of their soul and the indomitable spirit of the race. I have reached the sad conclusion that my country has lost its soul, its spirit and its vision and I am finding it ever hard to catch my breath in my own back garden..