Thomas Pringle (Donegal South West, Independent) | Oireachtas source

I welcome the opportunity to contribute to the statements today on universal health insurance which have come about from the publication of the White Paper by the Department of Health in the past week or so and the discussion on universal health insurance. The one thing about the White Paper is that there is very little information that allows ordinary people across the country to figure out what universal health insurance will mean for them. There is very little information about what it will cost to allow the citizen to see how they can budget for it. There is very little information about what will be included in and excluded from the so-called basket of care. This is one of the key points that will be very significant in respect of universal health insurance coming into effect in the first place.

The Minister has made much of how universal health insurance will be the panacea for our health services. The first worrying thing in the White Paper is the fact that the Government has stated that it will be achieved without increasing expenditure on health. That is not possible. There is no doubt that the health services are in crisis and we need to find a way to fund them and provide equal and fair access for all our citizens. However, we cannot do that without providing extra funding for the health service. Even if the health service became more efficient and dealt with waiting lists and the treatments that are required for patients who need them, it would cost more money. If we ended waiting lists, it would cost. We would get better outcomes and it might work out cheaper for the State in ten or 15 years' time when less serious illness has accumulated because of the lack of waiting time to get treatment, but there is no doubt that it will cost more money. The contention that it can be done more cheaply is the biggest falsehood in respect of universal health insurance because it cannot be done. What will happen under universal health insurance is that the money will be directed away from the health service and towards the profits of private companies and people who want to make money on the back of citizens who require health care.

The Minister intends to establish hospital trusts across the country who will be paid for services by the health insurers. Effectively, we are going to hand over control to the health insurers so we will have the VHI and if we are lucky, we might have two other providers who will dominate the market and control what they pay for the services to the hospital trusts who will try to deal with the patients on their books through the funding they get from private health insurance companies. The State will even take a back seat and be dictated to in terms of what it must contribute. We are handing over total control of our health services and this is seen as being a progressive step and something that will be good for our citizens. I think it is an absolute disaster, it should be scrapped and it should never have got to the stage of being the subject of a White Paper because it will not deal with any of the issues. I would like to think that the Minister believes that it will resolve the issues and difficulties within the health service but there is no way this will happen. If the Government gets back into office and is able to roll out this service, we will be sorry five or ten years down line that we ever did it and will try to roll back from it again.

The Minister talks about how the provision of universal health insurance will not cost the Exchequer any money. Let us look at the case of Letterkenny General Hospital, which is probably one of the most efficient hospitals in the country. Something like 93% of patients dealt with at the hospital are non-elective so it is run very efficiently and effectively, yet the hospital began the year with a deficit of €6.5 million. If universal health insurance comes into effect and there is no extra Exchequer funding and no extra cost to the citizens of the State, how will Letterkenny General Hospital be able to survive and provide the treatment it currently provides with a deficit?

The only way that can be done is by restricting access for people who require health care and treatment.

Then we come to the basket of services that will supposedly be available under the standard insurance package. We simply do not know what is going to be in that basket. Another worrying aspect of universal health insurance is that the Minister has already provided for a basket of top-ups. What we will quickly see is movement from the standard basket into the basket of top-ups because this has happened elsewhere. It has happened in the Dutch model of health insurance where services such as physiotherapy have been moved to a top-up payment. Is that what we are going to see here? I would like to hear from the Minister whether MRI scans and such like will be in the standard basket or the top-up basket. Those are the kinds of things that will move very quickly once universal health insurance is implemented. That is the real risk with this system.

The Government has said that universal health insurance will be gradually rolled out, with full implementation by 2019 at the latest, which is four and a half years from now. That sounds good, but the Dutch model, which no one except the Minister is holding up as a model to aim for, took 20 years to implement. The Dutch worked at it for decades but the Minister has said he will do it in four and a half years. When the Dutch model was introduced first in 2006, there were 18 insurance providers for a market of 20 million people, but today there are only five.

See this speech in context