John Crown (Independent) | Oireachtas source

I add my words of welcome. For the benefit of other members of the committee, the debate on the introduction of universal health insurance is frequently misunderstood. People keep referring to the Dutch model. What emerged from the synthesised programme for Government for the two coalition parties would more correctly be called the Deutsch model rather than the Dutch model. It involves a mixture of public, not-for-profit insurance entities - something like the VHI - in a market where there is competition with private insurance companies and various other types of insurance instrument. That is what exists in Germany, where the system is very successful. Of the large western countries, the Germans have by far the best health system, and it is far superior in all manner of outcomes to those working on the opposite principle of fixed general taxation and centralised command and control of administration.

The system, if introduced, would also involve the notion of a fixed percentage premium. The questions about cherry-picking would go.

Everyone would mandatorily have to pay a fixed percentage of income on health insurance. People with no income, and those with low incomes, would have it subsidised. That is how the general contribution should be made to the fund ultimately used for disbursement to hospitals.

On the question of incentives, the principle of community rating is incredibly important. People cannot help getting old and, in many cases, they cannot help getting sick. They should not be penalised and the concept of a no-claims bonus should not apply. However, people can help whether they smoke and it does make sense from the point of health insurance economics and, more importantly, as a public health measure, to give people as many incentives as we can to stop smoking. It is entirely reasonable for the insurance industry, in the new dispensation under universal health insurance, to have the fixed mandatory percentage adjusted downwards for people who do not smoke. Similarly, it is reasonable to do so for weight. People have some control over their weight and there is no doubt we need to enforce strict incentives in society to make people live a more healthy life.

I have a question on something that troubles me at the moment. In my day job, particularly in today's straitened circumstances, when I try to get new cancer drugs for patients, I am told by some of the smaller insurance companies that they will not approve drugs the VHI has not approved. Why is that not a cartel? I have used that word in discussing it with the smaller insurers and if they will only provide something if their alleged competitors-----