John Crown (Independent) | Oireachtas source

I have a brief question and another more provocative question. Is is considered to be in breach in the principle of community rating to charge a differential rate based on whether a person currently smokes? It strikes me that it should not be, in the sense that everyone has the right at every age to be a smoker or a non-smoker so there is no breach of community rating in doing that. It would be a very powerful incentive to people to stop smoking and in the interests of equity it would be a much fairer policy. It can be argued that people cannot instantly choose to be obese or not obese because it requires a bit of work; nor can one choose to be young or old, or to have the right or wrong gene pool. However, one can choose whether to smoke or to be a non-smoker. That should be admissible, in my view.

I sometimes pinch myself when I hear the conversations about moving to a money-follows-the-patient model and universal health insurance. I do not think people understand what is involved. This is a colossal and vast change. I suspect the smart people in the insurance companies, especially those with international affiliates, will be able to tap into expertise from other places where this kind of model works. In the view of the witnesses, do the skill sets exist on the other side of the table? Do the hospitals, the Department of Health and the HSE - if it continues to exist - actually have the skills to be able to deal with a very different funding environment? I do not think they do.