Mr. Jim Dowdall:

There are consistent answers to the questions from the insurers. I will just pick up on a couple of specific ones. Mr. Dónal Clancy referred to an additional levy if someone downgrades. Deputy Naughten's point in this regard is correct.

Let me pick up on a couple of Senator Crown's questions. I totally agree with all the insurers that there should be an opportunity for us to encourage people to adopt healthy lifestyles. That is not facilitated at present. It would be in breach of regulation if we in any way tried to do so. Again, that is an example. There are opportunities to do what is proposed. With the Department of Health, we should be tasked to produce implementation programmes in this area.

Senator Crown asked about money following the patient and the significant challenge this presents. I completely agree with him in this regard. Our experience of implementing considerable reform in the Department is not one from which we can take great comfort. This will be a very significant challenge.

Universal health insurance has been targeted for 2016. The scale of the challenge is quite significant. If we examine the recent levy scheme that was amended, we will note it failed and was a mistake. What was committed to in November and what transpired in December and January was wrong. If we get the first step wrong, we must question our confidence in getting it right as we move forward.

Let me address a couple of points made by Deputy Kelleher. If I understood him correctly, he referred to the Rolls-Royce subsidy in respect of the move from non-advanced to advanced plans. He is absolutely correct. There is a significant subsidy going from those people who can least afford health insurance to those people who can afford it. That is an error; it is not what was intended.

The Department of Health or Health Insurance Authority will tell one that insurers can just introduce more plans that can be non-advanced. What they may not state is the fact that one must strip benefits from the new plans being implemented. It is a question of stripping benefits from plans that people can least afford, which is absolutely wrong. Insurers may tell one it is difficult, as with lifetime community rating or measures on some sorts of smoking activities. Everything is difficult; we just need to be determined to make what we desire happen. We can do that.

Let me pick up on what our colleague from the VHI, Mr. John O'Dwyer, said. I understand from his presentation that the VHI would prefer not to have two tiers of levy. That is understandable because the VHI benefits from having everybody on a higher levy as it results in very significant increases in the associated age-related tax credit. This has to be about more than the VHI. That may be the reason the Department of Health has implemented the change in question and why the legislation is not as originally intended. We need to call that because hundreds of thousands of health insurance customers will suffer at the end of next March because we have implemented a measure that was not intended, the beneficiary of which will be the VHI.