John Halligan (Waterford, Independent) | Oireachtas source

The Government will get no argument from me that the existing health service is undoubtedly unfair and penalises those on low incomes. However, jumping into a new system of short waiting lists where everyone is treated the same at no extra cost is a utopian proposal at a time of cruel blanket cuts. I have a feeling that there are huge doubts on both sides of the House about whether this plan will ever become a reality. We are discussing a system of health care which will not come into existence, if at all, until about 2019 and probably under a different Administration. More incredibly, the Government insists that it can construct this world class system on the foundation of our current health system, which is a completely unstable shambles. In the region of 54,000 adults and children are on public waiting lists for surgery while another 300,000 are in the queue to see a specialist. Thousands more are being added every week. Unacceptable standards of hygiene are consistently putting people's lives at risk. Our public system is under intolerable pressure as increasing numbers of people find private health insurance beyond their means. The proposal cannot succeed without a functioning health service to work with.

I have no doubt that people who are struggling to keep up their private health insurance payments will mutiny at the details of this White Paper, which will force on them additional costs for such supplementary benefits as a private hospital room. These are extras that are already included in their existing private health insurance package. A recent Red C opinion poll suggested that nine out of ten people who currently pay for cover do not want to queue for treatment. There is no mention in the White Paper of dealing with waiting lists and delays.

The issue of cost remains foremost in everyone's minds. The Government's proposed vision has been compared to the Dutch model. It must be acknowledged that this system increased overall per capitaratio costs by approximately 46% since it was introduced in 2005. A central element of the Dutch model was significant investment in general practice before they even put the model in place. This created a high-functioning primary care sector. We cannot even get agreement with GPs on care for children under six.

If we cannot get our primary care system functioning adequately, what is the point in putting forward all of the these proposals which are unrealistic? We are unable to deal with the consultants at present and I gave an example in the House some time ago in that regard. A woman went to a consultant to get a letter for an insurance company. The insurance company then asked for a second letter so that as well as paying €180 to see the consultant in the first place, she had to pay €300 for the letters. We cannot deal with the consultants or the general practitioners so how we are going to deal with a health system that is free for all at the point of entry?

Figures from the Health Insurance Authority show that the average premium paid per person in 2012 was €1,048, which has decreased since. Even if payment is subsidised to a certain extent, paying for universal health insurance will surely be beyond the capacity of many people. We cannot get the current health system right in terms of the basics of dealing with general practitioners, emergency departments, beds and the consultants who rule the roost and tell the Department what they will accept as pay and what they will do. At present we have consultants who are still insisting on working in public hospitals only when they see fit to do so, while also working in private hospitals. This would not be tolerated in other countries - doctors are either working in public hospitals or in private hospitals. Until we deal with such simple issues, which are simple in the sense that the Department of Health has power over consultants and doctors and their working conditions, then this proposal will fall and will not succeed.

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