Michael Conaghan (Dublin South Central, Labour) | Oireachtas source

Our system of health care is frequently described as a two-tier system in which ability to pay, rather than medical need, is a deciding factor. Such arrangements do not reflect our better side as Irish people and as human beings. We are instinctively caring and compassionate. Our institutions should reflect these instincts and values, and that should particularly be the case where vital matters such as illness and health care are concerned. It is imperative, therefore, that the existing arrangements be changed fundamentally. We need to introduce a new structure that expresses our better side, instincts as a people and sense of caring and a system that prioritises medical need and well-being, not the ability to pay. The latter should be the decisive variable.

What would or should such a new system look like? On what considerations should it be built? What values should it incorporate and what priorities should guide it? Deep down, we all believe its driving force should be the care of people and not the financial clout or considerations of consultants and doctors.

Were we to articulate a vision for a new system, one that we know deep down expresses our values and best instincts, I believe the following statement would do us justice and would articulate, reflect and capture the deeply held convictions and feelings of Irish people about health care structures. I will read a brief quotation about the National Health Service in Britain:

Since its launch in 1948, the NHS has grown to become the world’s largest publicly funded health service. It is also one of the most efficient, most egalitarian and most comprehensive.

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth, a principle that remains at its core [to this day]. With the exception of some charges, such as prescriptions ... the NHS remains free at the point of use for anyone who is resident in the UK. That is currently more than 63.2m people. It covers everything from antenatal screening and routine treatments for long-term conditions [right across the spectrum] to transplants, emergency treatment, and end-of-life care.

The fundamental changes that our Ministers wish to bring about in our system would, I believe, rest on a similar set of values and objectives to those that underpin the NHS. Take, for example, the first proposed phase, that is, free health care for all children up to six years of age. This measure, which the Minister, Deputy Reilly, and Minister of State, Deputy White, wish to bring in, will come very close to mirroring the values and practices of the NHS. That is why it is such an exciting prospect, but it is only the start of the mission to transform utterly the way we experience health care in Ireland, that is, by a process centred on people's needs, not on their wallets.

I believe the vast majority of Irish people support this ambition of Government. I believe they yearn for fundamental change of the sort planned by this Government, not least because it reflects the deeply held instincts, views and values of the Irish people. However, there is opposition to the Ministers' noble ambitions. A tiny minority of Irish men and women have set their face against this scheme and have set out to resist it. They have set out to stop the Ministers doing their job and doing what they were elected to do by the people. The opposition of doctors and consultants is already in full flow. They are opposed to the kind of delivery of medical care to children under six, as proposed by the Minister of State, Deputy White.

We remember the noble plan of the mother and child scheme in the 1950s and the opposition of church and some political forces and doctors in order to scupper it. This is the mother and child scheme Mark II. This time, however, it is the democratic will of the Irish people that will triumph, not the prejudices and interests of a tiny minority. Doctors and consultants should not cloak their opposition in any veneer to hide the main driving force of their opposition, which is money and their wallets. They should be ashamed of themselves, ganging up on the children of Ireland. Where is their Hippocratic oath now?

I want to finish with a quotation from an Irish journalist, Jerome Reilly, who recently wrote a good assessment of the system that is being proposed in an article headlined "Disgraceful 'two-nations' system must be dismantled". The article states:

A single-tier system will deliver proactive, integrated care at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. And it will provide equal access to healthcare based on need rather than the ability to pay.

How can this be achieved?

The basic principles underlying UHI is a multi-payer system where all citizens can buy insurance from competing insurance companies.

All those on a medical card will have their insurance paid. Those on low and middle incomes will be subsidised by the State. Most of the money will come from general taxation. Public hospitals will remain in State ownership.

Yes it is aspirational, yes it is loftily ambitious. It took the Dutch some 19 years to bring in fully their version of universal healthcare.

Dr Reilly, despite facing intolerable opposition ... has given himself a tight deadline with the full introduction planned for 2019.

But it is worth aiming high. Universal Health Insurance is about fairness, equality and justice. It is astonishing that critics of the system can't grasp that essential truth.

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