Opposition to Barack Obama's healthcare plan has become so aggressive that last week former president Jimmy Carter intervened, musing that he thought the animosity was inspired by racism. Perhaps Carter simply cannot understand all the fuss: it has to be about race, surely, as there can be nothing seditious in Obama's intention to make healthcare available to all Americans. After all, the United States is the only first-world nation that doesn't have universal healthcare, despite spending more per capita on healthcare than any other country (and twice as much as Ireland), according to the WHO.

Here in Europe the controversy has been even more mystifying, as we Europeans regard universal healthcare as a right, and Obama isn't even going that far. That includes Ireland, though people will swear till they're blue in the face that you're wrong when you tell them that. If I had a euro for every person I've met who thinks free hospital treatment in Ireland is available only to medical card-holders, I'd have enough for a downpayment on some whimsical non-essential surgery. Better yet, I could buy a giant sandwich board, obviating the need for surgery and saving a packet. On the front I'd print 'Ireland has a universal healthcare system'; on the back I'd write, 'But not for much longer'. Mind you, there's free and there's freeish. If you don't have a medical card, you are liable to hospital charges of €75 a night, but you won't have to pay more than €750 in any one year, a sum that wouldn't keep your hospital consultant in fine dinners for a week. Let's be fair: our health service is really not bad, at least on paper. The theory is sound, even if the practice is dogged by waiting lists and the inequities of privatisation. Despite this, most people who don't qualify for medical cards have private health insurance. This must be for one of two reasons. One is that they believe they will get better care (not true), and sooner (true), if they go private.

The other, supported by the anecdotal evidence, is that they don't realise they are entitled to hospital care without it. This widespread ignorance of the universal entitlement is to the government's advantage. The cost falls to insurers instead of the state – or it would if private health insurers actually paid the government what they owe, and as we found out from the Comptroller & Auditor General last week, they don't. However, if – or rather when – Fine Gael and the Labour Party coalesce to form the next government, they propose to make health insurance mandatory for all citizens, dismantling the very principle of universal free healthcare, and not even having the guts to call it that. The policy has been weirdly uncontroversial. Worse, newspapers have repeatedly billed it, in slavish deference to Fine Gael spin, as the introduction of universal healthcare.

After the next election, if you have neither a medical card nor health insurance, you can forget about being inclined to take your chances under the public health system – which is your statutory right. You will be forced to pay a private corporation for the service, while continuing to pay the same taxes to a government that used to provide that service for free. Of course, there are some people who believe the principle of universality is outmoded, and that those who can afford to pay should pay. Funnily enough, they're often the same people who see nothing wrong in saving up their universal child-benefit payments for a private school for little Sophie.

"Our health reform programme represents the most revolutionary change in the Irish health system since its establishment," said Enda Kenny. I'll say. Fine Gael will be to private health insurers what Fianna Fáil is to property developers. Labour backs the proposal, and the Greens, having no doubt noticed that it caused no trouble for the bigger boys in the playground, have also weighed in. Patients will no longer be seen as "costs" to the health service, said James Reilly, Fine Gael's health spokesman, but as "sources of income". Lovely. What a lovely sentiment. People will also be able to "top up" their insurance to get other or better services. In other words, it's the perfect prescription for a system that is just as inequitable as the one we have now, except that more people will be paying more money for it – and to the private sector at that.

Come back the PDs, all is forgiven.

Nightmare on Kildare street II: Ganley returns

CURSES. Declan Ganley has covered himself in woad again and re-entered the Lisbon affray. However, this fight is not so much Braveheart, to which Ganley compared it last week, as a horror sequel in which it turns out the monster wasn't really dead at the end of the first film (or in Ganley's case, at the end of the Euro election count in Castlebar). The 'Yes' side clearly regards the electorate as the hapless blonde who doesn't know the Creature is in the house and doesn't think to pick up a poker. Anyone would think Ganley didn't have the right to spend as much money as the government or Ryanair or Intel or any other vested interest to promote the result he wants. It's probably unrealistic to expect another rejection of Lisbon, but is it reasonable to hope that the 'No' vote, such as it is, is not attributed to Declan Ganley this time? Please?

etynan@tribune.ie

Diarmuid Doyle is on holidays