Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank the witnesses for their presentations. I may have to leave at some stage before the witnesses might get to my questions but I will be observing their responses from my office. The Minister outlined his pathway to universal health insurance yesterday. We welcome the publication of the White Paper which will hopefully stimulate some form of discourse and broader debate about how we fund our health services. The Minister has decided to go down the route of universal health insurance. This will not necessarily meet with universal support. However, it will stimulate some form of debate.
We are all prone to platitudes and self-appreciation from time to time but I do not believe that what was announced yesterday was earth-shattering. There is nothing very new in it. It was a case of defining what the Minister already said on previous occasions. That is not a criticism, rather it is an observation. The work that must be done on universal health insurance relates to the basket of services and types of cover. The more cover is included, the more expensive universal health insurance will be. It should cost the same to the State but cost to individuals is an issue that will be discussed. The more we include in that basket of services, the more expensive it is going to be for some individuals. That is a key issue that must be discussed.
The Minister said that he is putting building blocks in place. When putting building blocks in place, any handy builder or project engineer would also have a rough idea as to the actual cost of the various materials going into that project. Assessing how much a project will cost is basic due diligence. The difficulty we have is that there seems to be no view as to what it will cost. It depends on many assumptions. If we want to have a proper debate, we need to get down to some harsh realities with regard to how much this will cost and we cannot make assumptions about what will happen in 2019. We must assess what it will cost based on what we have now as opposed to hoping that down the road, taxation-based policy will be friendlier to universal health insurance or that certain events will address it. If we want to have a genuine up-front debate for everybody, not just politicians in this room, but the public, the least we should do is decide a basic suite of services and what that would cost, which could be done quite quickly. This does not necessarily mean that this will be the actual suite of services that we decide on but there is a matrix there and the Government can work it out. The problem is that if it works it out, it will find that it will be a bit more expensive than it thought it would be. We could try to look at that but it is probably for another day.
For fear the Minister would take us up wrong - I am not saying he did so intentionally - the committee will play its part. The fact that members are from different political parties who may have differing views on universal health insurance does not mean we will obstruct the passage of it. We fundamentally do not agree with the policy. If legislation flows from that policy we will co-operate as legislators like everybody else. We are not going to be outside the door with placards opposing it but we will use whatever means we have to explore other avenues regarding how we fund health services in the years ahead.
In respect of broader issues surrounding medical cards and primary care mention has been made of primary care and free GP care for the those under the age of six and moving to universality over the next number of years. There is a major problem which I said I would bring to the Minister's attention because he does not seem to accept that there is a problem. A number of meetings are ongoing around the country. GPs are attending in large gatherings and highlighting the huge concerns they have. It is not just in the context of the under-sixes contract, although there is no doubt that this was the catalyst in terms of bringing them together. Even prior to the publication of the contract for free GP caver for those under six years of age, many people were saying that there is a major crisis with GP services in this country. There have been recent cases where GPs have passed away, the HSE has advertised and nobody took up that GMS practice. If this is happening, the Government has a problem. We are now having difficulties in maintaining GPs in the country, which is a key issue.
When the Minister refers to the roll-out of primary care as a critical plank in reducing admittance to acute hospital sections, at the very least, there should be some quid pro quoincrease in budget over the next number of years. There seems to be no concept of how the Government is going to fund primary care other than it being lauded every day and the strategy since 2001 being rolled out on a continual basis as being a central plank in the delivery of health care in the least complex and least expensive setting. We all agree on that but there is no commitment to making sure that it is working in a way that is sustainable not only for the individuals providing the service but collectively for customers, patients, clients, GPs and other allied professionals.
How much time do I have left?