Some might wonder how people like me, who to a reasonable extent have been blessed with an ability to live their own independent life, keep persisting in writing about values, principles and innovation while simultaneously drawing anger and resentment from the political environments that so sharply divide the nation.

I am repeatedly asked this question by close friends who wish me well and who insist that banging one’s head against the wall only tends to hurt the head and not the other way round.

When I stop to ponder I realise that even though I managed to build my profession and my business, I have always tried to help those in distress and never to my knowledge rode on the backs of those who were in need. It might be that those seriously in need never come to me knowing that I am part of the private and not the public health system.

In the context of today’s materialistic world, it may sound strange for a man who has achieved most of what he wanted to state that I have always had an empathy with the small citizen and felt obliged to seek out and draw public attention to cases of injustice and inequality. Injustice demands redress. To achieve this we have to keep up the pressure on the powerful on behalf of the powerless.

As I touch with my own hands the miseries of this life, the more I am inclined to reflect, and write, on the different circumstances that mould our life. The life of every person on this island is very much tied to the present and future financial wellbeing of our country. But when that wellbeing is used to create inequalities, the harder life is for those at the bottom.

For several decades people have argued for piecemeal improvements in different areas of life, campaigned against new environmental threats and have demonstrated against policies which make the people pay for managerial inefficiencies. But nowhere is there a popular movement capable of inspiring people with a vision of how to make society a substantially better place to live for the vast majority. Without that vision politics will rarely provoke more than a yawn. And although politicians recognise a deep-seated malaise and, in campaigning for votes, say that they stand for change, they sometimes seem to have few ideas for change which go deeper than differences in the personal images they project. There is no suggestion that they have any view of how to begin changing daily life into something more joyful and fulfilling.

We have lately been discussing health reform. We have a minister who admits that change is necessary and that this has to start from the very foundations on which our heath service is premised. Those who have come to regard the family doctor as a poor specimen of their profession will not relish the minister’s statement that patients have to be referred. The minister, being a medical professional and a consultant himself, has time and again witnessed the pain that people go through when they seek expensive expert advice when all that is required is the simplest of advice, investigation or treatment. He must have witnessed patients going to the wrong professional and forking money they could ill-afford, when all they needed was to be directed to the appropriate channels.

If this ingrained mentality is to change, it will need long term health education and it will require time – unless change is forced on one and all by legal diktat.

We have two systems: A national, so-called free, health system for which we actually all pay even when we are not using it, and a pay-as-you-go private system. The situation is similar to that in education where we have free state schools and church schools subsidised by us all, and independent private schools where parents have to pay. Many parents found this very unjust for those who opted for independent schooling for their children were in effect paying twice, both for the service they used as well as the public service they chose not to use. The government has acknowledged the justice of the parents’ contention and has moved to alleviate the situation by partially reimbursing the parents who use the independent schools. It has recently been announced that the taxpayer will subsidise the extension and buildings of church secondary schools. Why cannot the same redress be afforded to those opting for private health care? Why should people pay double for health when in the education sector this situation has been acknowledged to be unjust?

The question therefore has to be asked: Does Malta want a private health sector, one that can earn big money for the island through medical tourism? In a democratic country, should the State award itself a monopoly of health treatment (and one that is proving so costly to deliver to an acceptable standard) or should its role be to ensure that nobody falls outside the net and that in actual fact each and every person has access to treatment? If the citizens of Malta want private medical treatment, then it’s about time for the two systems to work in symbiosis and not in competition. As things stand at the moment both systems are being abused by the very people who should make it work. And governments seem to be happy financing abuse while at the same time eroding its own ability to cope with the ever increasing problems.

We think that because we pay for our health and therefore we expect it and all that goes with it for free. But what do people actually pay for? We pay social security for work-related benefits such as pensions. For the rest we pay out of our taxes and the more we get for free the more taxes we pay whether we make use of the public health system or not, whether it is well and efficiently run or not. We find private medical care expensive and believe we are ‘screwed’. But what we pay for is not the health itself but the system to run it, efficiently, safely and in accordance with the ever mounting regulations and laws and set standards. People pay for the maintenance of the buildings, cleanliness and environment, receptionists, security, clerks, accountants, engineers, labourers, machines exorbitantly expensive, ever increasing electricity and water rates, wages and bonuses and so many other items that together make up the service.

The truth of the matter is that any society is composed of differing layers of ability and circumstance and as long as inequalities exist, the need for a health service which is not directly paid for will remain. But should this apply across the board? If we assume relatively honest income declarations, then level one (the really needy) should enjoy free care. People with a level two income should be charged at, say, 20%. Level three people should be charged 50% and those above that should enjoy no benefits. These percentages are merely indicative but this is what social benefits should be about. The mentality that benefits are rights to be enjoyed by all has to be changed.

Otherwise we shall continue with a system that provides socialism for the rich!