A lot has really changed, or has it since those days when medical students padlocked themselves to the railings at Castille.

Some of them went abroad, never to return. Some of them are now very successful private practitioners. A minority only dedicate themselves enough to the State sector, and who can blame them considering the rubbish rewards given in that sector? We live in a country, which, thanks to much stronger militancy from certain unions, has produced wages where baggage handlers at the airport can earn as much as doctors in our hospitals. I have nothing against baggage handlers, or their being paid decently. But doctors deserve a decent wage too.

However, not a lot has changed since then in many ways. The problems in other words concerns doctors’ pay, and who controls the charge and the income of doctors who have been educated for free with taxpayers’ money at our very good medical school, have not gone away. Mintoff confronted the doctors and sort of won in the short term anyway because many left, the hospital service went on running though not as well as before. The Nationalists got elected, many doctors came back and they won. They are now very successful both financially and otherwise, but nobody has had the guts and the honesty to tackle the problems Mintoff tried to tackle and failed miserably when he did. The public in other words has not been well served by the confrontation, weaknesses and, sometimes, self-interest on both sides.

The result, a two-tier health service in all but name. And if you dispute this go to a polyclinic in the south of the island and compare the experience to waiting at St James. Money talks and never more than in our health service. My question. Is this inevitable? And more importantly, is it desirable?

There are plus points. We do have excellent consultants. You can easily consult them, if you can afford to. Some overcharge but many are reasonable too. However, not everyone can access them. Consultants, the best ones are not giving, and financially cannot always afford to give enough hours to the state sector. The result – a country where Doris from Bormla may be treated very differently to Sam from Sliema. Perhaps we don’t care but I think all three political parties do agree that we are all entitled to the same level of high quality care, irrespective of our earnings. Is this happening? And do we really believe this? I mean that while it is acceptable that I can choose to buy a T-shirt from the Monti if I live off relief, or a T-shirt from Armani if I can afford it, is it acceptable that we apply these principles to our health service, as incidentally is also happening in education?

I suppose it is a sign that we are not that well off enough yet, as are say the Scandinavians, that we have such a two-tier country, two Maltas in all but name. What applies to education applies to health too. The issues of health and education are not burning political issues in this country, at least not yet, simply because the growing middle class has simply opted out of the State system and is buying into the private sector.

So a group of people who would otherwise be some of our strongest voices and lobbyists complaining about many lousy State schools, and weaknesses at St Luke’s or in the polyclinics, are not doing so because their middle class needs and gripes are being settled with cash, with no real receipts to speak of (why?) to our doctors, often via our insurance companies too. And it is a shame that more of our middle class do not use the State service more. I for one am so impressed by the patience and resilience of the staff at the Mosta polyclinic, which is open day and night, working like slaves to deliver a good service. They look over exhausted; at least many of the doctors and nurses do, perhaps because they also do a private shift to cope, or often because they have been there for an ungodly number of hours.

Now with the new hospital all can have access to a nice environment, something that was lacking at St Luke’s, that was only found in the private sector before. But are there enough doctors able and willing to give the hours needed to staff this hospital as it should be staffed? I am sure the government is trying but can anyone really touch the doctors’ livelihood, now that so many of them have become some of the more wealthy in our society. And again this is not a gripe or a criticism, just a reflection on the change that those padlocks brought to our system of healthcare. Mintoff, in other words, by confronting the medics may have, unwittingly of course, contributed in no small measure to today’s burgeoning private practice and two-tier health service.

After all, those students were saying they wanted to study in Malta, not they wanted to be very well off. But now they are, at least the medics of that generation are. Many of the new ones are having their studies funded for free by the State and then leaving. Again who can blame them? But can the country afford this brain drain? And who has lost out in the process? Well I think we can all agree that the one-tier health system has lost out. At least it was much less two-tier than it is today. Sure there are great private hospitals and great doctors in the private sector. But today the treatment and prognosis of the two main classes of Maltese is perhaps not measurably, but appreciably more different than it was in the 1970s and 1980s. We have in many ways gone forward, but we have gone backwards too.

And it seems we have given up, although there is this amazing new hospital, on trying to make the State sector the sector of choice and are trying to attract the private sector to have an even bigger role. The news that government is planning incentives for those who take out private insurance is proof of this deepening trend. Is it the only way to go though? This is all good for the achievers and high earners in this country, but it means many will be left behind too. A Ms Borg recently, and very interestingly, tried to analyse the charges in the State and in the private sector. Of course in a way you cannot compare because in St Luke’s consultants are paid a wage and presumably in the private sector they can charge what they like. It is not, as far as I know, regulated.

We use market forces to decide the cost of operations. Is this totally acceptable? And I already said there are huge differences in the charging policies of various consultants and many are very, very reasonable. But some are giving the others a bad name and it may be a good idea for tariffs to be agreed by the government, the private insurers and doctors themselves to ensure a bit more sanity and a bit less might is right. After all, when you are sick or dying you are in the most vulnerable of positions and wouldn’t dream of quibbling with a doctor you so desperately need. So we cannot let the market decide in healthcare any longer.

We are lucky we have very good doctors in this country. But this does not mean that only market forces should prevail. The padlocks of yesteryear have brought a two-tier health service to this country. It’s about time the insanity starts to be slowly reversed so Doris from Bormla and Sam from Sliema get a similar service, health wise at least.

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