Sandra McLellan (Cork East, Sinn Fein) | Oireachtas source

Sinn Féin believes that health care is a right, not a privilege. It is an essential service that should be accessed on the basis of need, not income or private health insurance.

Consecutive Governments comprising Fianna Fáil, Fine Gael and the Labour Party have failed the Irish people in the delivery of health care. Our health services are in crisis and in need of serious, radical reform. The health service should be free at the point of delivery and funded by a progressive taxation policy. Simply put, that means people pay their taxes and those taxes are used to fund public services, including health care. Those who earn more pay more, but everyone has access to the same standard of health care service regardless of income, with nobody skipping queues with the wave of a cheque book or a private health care plan.

The Fine Gael-Labour Party coalition's concept of universal health insurance based on competing private health insurance companies is one that Sinn Féin has criticised as fundamentally flawed.

Even from the leaked extracts, the huge problems with such a system are apparent. Health care is too important to turn into an industry governed by profit margins and shares.

The Government's proposal amounts to the total privatisation of our health care system. This White Paper is the fundamentally flawed Fine Gael model based on competing private for-profit health insurance companies. The only people to benefit will be the private companies. The Minster has promised this White Paper for more than three years, and now we have a proposal that is not even costed. Clearly, this is a Minister who has been limping from crisis to crisis and has failed to live up even to his own standards.

The programme for Government reads: "This Government is the first in the history of the State that is committed to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income." There are no arguments with that, but then the Minister goes on to state that "Insurance with a public or private insurer will be compulsory with insurance payments related to ability to pay." That is where we part ways. Why would a Government that is committed to universal health care introduce - indeed, make it compulsory - to use health insurance to access health care? It makes no sense, unless of course the Government wants to bolster the profit margins of ailing private insurance companies. The Minister attempts to calm the public's fears by saying that "Under UHI public hospitals will no longer be managed by the HSE. They will be independent, not-for-profit trusts, with managers accountable to their boards." After the debacle of Rehab and its links with Fine Gael, his honeyed words will do little to calm people's fears.

Compulsory health insurance will mean hard-pressed families having to pay out more money for basic services that were once seen as an essential service funded by our taxes. Domestic waste charges, home tax, water charges and the fire service are all paid for out of our pockets, yet we still pay the same amount of income tax for a diminishing menu of public services. Now the Minister want to add health care to that list. Immediate concerns for many families will centre around the type of services provided for under this health insurance model, whether families with greater needs have to pay a greater premium, and whether certain conditions and syndromes be included and others not. Clearly, Fine Gael fingerprints are all over this proposal. They will privatise health care, remove universal health care and replace it with insurance.

The Labour Party manifesto for the 2011 general election also commits itself to universal health insurance by saying that the cost of insurance premiums under a universal hospital care insurance system should not change from what they are at present. It, too, is committed to maximising the profits of health insurance companies. Any charade of the Labour Party being committed to universal health care is gone.

The big difference between our proposal and the Government's proposal is that Sinn Féin's is based on meeting the needs of the public while the Government's proposal is about meeting the needs of insurance companies. Sinn Féin's vision is of a new Irish health system, with care for all based on need alone. The current health care system is a two-tier system, where wealth can buy better care in the private health sector. It is a private sector subsidised by the Government at the expense of the public system. Even at the height of the boom, the health care system never received adequate funding to overcome the vicious cuts in the 1980s imposed by governments involving Fianna Fáil, Fine Gael and the Labour Party. The health care system will only be transformed if we have a clear vision of the kind of health care citizens deserve. Of equal importance is the need to agree on how this system is to be funded.

Doctors, nurses and health care workers do a great job in circumstances that are increasingly difficult. We need a system that has primary and preventative health care at its core. We need to refocus on primary and preventative health care, together with complementary measures to address the social determinants of ill health. Over time, this will produce health care savings to the Exchequer by reducing the necessity for higher cost acute care in many cases.

Sinn Féin is committed to a new universal public health system that provides care to all free at the point of delivery, on the basis of need alone, and funded from general fair and progressive taxation. We want an end to the two-tier system. We are committed to introducing comprehensive community-based primary health and social care services for all, free at the point of delivery, including general practitioner and dental services, and abolishing all prescription charges. Accountability and transparency is vital to restoring the public's confidence in public services.

Sinn Féin proposes to restore direct ministerial and departmental responsibility for health services which are funded by public money. Sinn Féin in government would establish a health funding commission to plan the transition to a new single-tier health care system. We fully understand the economic challenges this State faces, but front-line staff and patients should not suffer for the sins of others. We need to streamline the health service. We need fewer bureaucrats and more front-line health workers. Sinn Féin will carry out a review of managerial and administrative posts within the health service and the Department of Health, with a view towards eliminating those positions that are surplus to requirements and using the money saved to hire more front-line health professionals.

Public money funding private profit represents a big drain on resources. We want to see an end to public subsidies for private health care, invest all health funding in the public system immediately, end tax breaks for private hospitals, phase out public subsidisation and ultimately replace the private system within an agreed timetable.

See this speech in context