Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I support the general points made by Deputy Naughten. We have been debating this issue both in this House on Committee Stage and in general health debates for some time. The bottom line is that while the Department of Health puts its head in the sand, thinking the health insurance market will improve, the opposite is the case. We have had more alarming figures today with regard to the number of people falling out of health insurance. The most surprised man in this House during the budget was the Minister for Health himself when the Minister for Finance announced a cap on tax relief for private health insurance.

I was accused of being alarmist when I said this drives a coach and four through the Government's policy on universal health insurance, but it certainly does. The theory and principle behind universal health insurance is that there would be a vibrant, sustainable health insurance market that could underpin the funding of health services. It is not a complex system in terms of the principle but the Government is making it exceptionally difficult. Deputy Naughten is right that if the Government continues to not incentivise young people to take out private health insurance, the burden will fall on fewer shoulders over a period of time and, as we said, the death spiral will take rapid effect and dismantle private health insurance in this country.

While we talk about profit and loss, and private health insurance companies making all of this money, the fact is they do not make a lot of money. Private health providers have been laying off staff in recent days and hospitals will be on the verge of closing in the coming months. The private health insurance market is under stress and the private health providers are under stress and duress. At the same time, the Department of Health seems to be in a state of denial, along with the Minister himself, with regard to the crisis.

I take the historical lecture week in, week out from the Minister, Deputy Reilly, with regard to the downturn in the economy, and we take that as a given. However, the Government has compounded this by having the Minister for Finance limit the tax relief on what are not gold-plated policies. There is now an acceptance that these involve ordinary families whereas we were initially told it was only for gold-plated private health insurance policies. There is no such thing as gold-plated private health insurance when a family is put to the pin of its collar trying to retain private health insurance.

Private health insurance lightens the burden on the State in terms of providing care for those who take it out, and they are already entitled to care by the very fact they are citizens and taxpayers of this country. What are we doing, however? We are deciding to destroy and dismantle any chance of there being a vibrant private health insurance market. Competition is being downgraded and we now see health insurers coming forward with downgraded policies. For example, elderly people must have ophthalmology, orthopaedics, oncology and cardiology in their cover and they must also have inpatient cover. However, because of the bungling of health policy, there is now an issue with regard to advanced and non-advanced policies. Clearly, therefore, while the Government looks at universal health insurance as the model, it is putting obstacles in the way of getting to the nirvana of universal health insurance as outlined in the programme for Government.

Community rating is an integral part of this. My belief is that the Government will not introduce this because it would be admitting failure in terms of the rollout of universal health insurance. The Minister of State will tell us that universal health insurance will be in place in a matter of years. However, I doubt very much that we will have a sustainable health insurance market that will be able to underpin universal health insurance. We talk of young healthy people in the context of "cross-subsidisation", "community rating" and "intergenerational solidarity". These are meaningful words; they are not just policy written on a piece of paper. They actually mean something and they underpin a very important principle in this society, namely, that young healthy people will cross-subsidise those who need it most, which is the principle behind intergenerational solidarity and community rating. While we talk about this a lot, the policies are the exact opposite.

I urge the Minister of State, as a rational person, to talk to the senior Minister and try to get him to understand that private health insurance is in crisis, and to get the senior officials and the HIA to sit down and acknowledge they can no longer continue in this vein of absolute denial. If universal health insurance is to come in at some stage in the future, the Government should in the meantime incentivise lifetime community rating and incentivise young people. What is happening is that young people are not taking up health insurance. They are deciding that as there will be universal health insurance down the road, the State will either provide for them or they will be compelled to take out insurance, depending on their means and income. However, we will still have the difficulty that if universal health insurance struggles to be introduced in the coming years, people aged 60 to 65 will then take out health insurance without having made any contribution during their earlier life, and further draw on the system. That is the problem. While we talk about universal health insurance, in the meantime, young people are dropping out because they can see that, at some stage, they will be provided for or they will have to provide for themselves under legislation on universal health insurance. However, if it never happens, they can always rejoin without any penalty.

There is already a model in Australia, which should be looked at. I believe most people dealing with the private health insurance market do not understand it, and I am no expert in the area. However, we have had bungling in the answers from the Minister and people appearing at committees who seem to pretend that everything is fine.

The daily statistics show that we are haemorrhaging the very people we want in private health insurance to underpin a principle dear to everybody, that of intergenerational solidarity where those who are young and healthy subsidise who need health services more. For all those reasons, we must look at that principle and try to embrace it in the legislation. Otherwise, if universal health insurance drifts, it will continue to drift and, in the mean time, another cohort of young people who should be cross-subsidising and supporting older people will be making no contribution. We will then be asking older people to fund themselves and the spiral will continue.

An elderly couple over 70 can be paying up to €4,000 next March for their private health insurance. This is not gold plated. It does not involve a person going up to the Shelbourne Hotel and having somebody look after them for three or four days in a nice room. This is very basic health insurance. This does not involve going into exclusive private areas of clinics. It is about basic private health insurance and people who have made the sacrifice and contribution and who at the very least deserve to be supported when it is their turn to draw from the system when they need it most. We are saying we will not, which is quite shameful.

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