I'm watching the #CancelTheContract discussion with some bemusement. (Of course there is nothing funny about people being deprived healthcare treatment). What seems evident is that this discussion has been framed private consultants v nasty HSE.

The pantomime between these parties has been going on so long, it seems difficult for either side to break out of the default position.
There is a lot of heat and precious little light.

I presume faced with the prospect of an overwhelmed public health service, the decision to commandeer private hospitals was done in good faith. Indeed that there was no other option having run down the public system over years.

I presume faced with the collapse of their elective customer base, the owners of private hospitals faced the real prospect of bankruptcy and so were only too delighted to have the state buy up their spare capacity.

I don't subscribe to the "Private = Bad ; Public = Good" thinking. I am sure that the consultants working in private hospitals are as caring and as patient centred as those in public hospitals. I imagine that they chose to work in a functioning health system.

It prob doesn't come as any surprise to them that the private hospital owners don't really care about patients in pretty much the same way that those in charge of the public system generally dont either.

For the owners of the private hospitals, the key priority is financial return on their investment. For those who run the public health system, it is about control. Notwithstanding their glossy brochures or values statements, it isn't about patient care for either.

So that leaves doctors and their patients in something of a dilemma. How do you advocate for clinical activity when both paymasters are quite happy with the status quom

Where he to hand back the private hospitals, Paul Reid would be scarified when the 2nd wave of Covid-19 appears. All the excellent work done to prevent an overwhelming of the public system would have been for nothing.

But handing back the private hospitals would also likely hasten their financial demise. So it seems likely that they will need to titrate activity levels back to something like normal in a controlled manner.

Just as well one party prioritises financial return and the other prizes control.

Of course this leaves the patients and vocationally-driven doctors in something of a bind. It is ultimately these who pay the price through delayed healthcare and loss of autonomy.

Of course, instead of cancelling the contract, maybe the doctors could take a leaf out of the HSE book and just renege on it.

If the powers-that-be were using a good crisis to advance a bright new vision - Sláintecare 2.0, they have most probably made a mess of that too. Or maybe this is all about collapsing the private system so that you have a single tier health nirvana.

What is for sure is that this area deserves more scrutiny than our politicians gave it in Leinster House this week. They were too busy trying to blame our Public Health experts for the pandemic to pay any attention to Public (or Private) Health Policy.