John Crown (Independent) | Oireachtas source

Go raibh maith agat. I am speaking slightly out of turn because I misunderstood the procedure for dealing with the questions this morning. However, I shall make a few very general points.

I welcome the Minister's unveiling of the White Paper on universal health insurance. I look forward to studying it, collaborating with him and working on it in the years to come. It is something that I have advocated for 20-odd years. I have spoken about health insurance over the years and I have always editorialised about the three problems with the health service in Ireland and that is being unequal, inefficient and of poor quality. I have heard a great deal of stress being put on addressing the equality issue which is correct. However, it is the quality issue, in particular the poor and mediocre quality of the service delivered to public patients over the years, which is the key pathology that must be addressed. That must be the first priority.

In addressing this, and perhaps pre-empting some of the criticisms the Minister will encounter, I think it is fair to state that built into this kind of plan, where at present a big chunk of tax money goes into paying for a health system which will now be paid for in a different way, is that the tax take goes down by exactly that amount. It also means that those within the public service who are making their living out of that part of the tax will seek alternative employment, in many cases, in the new health system or in some other service entirely. This is because it is in the logic of an insurance-based system, even the kind of social democracy-based insurance system I would espouse, based on a principle of social solidarity.

As a little throw-away remark about the high qualify of our medical graduates internationally, I would say, with great respect to the Minister because this is not his fault, we have high quality medical graduates despite, and not because of, our medical schools where one has six medical schools for 4.5 million people, which is twice the European average, and where one has a total - an aggregate - of I believe 60 consultant level people employed by those medical schools, or ten per school, in contrast to Harvard Medical School which has 1,500. One has to ask how the schools regularly get recognised by the international authorities with such dismally poor levels of clinical staffing.

I am going to say something, which I am sure will be the provocative thing to state today. One of the reasons we have such high quality is unfortunately that the shortage of consultant staff means that our junior doctors get to practice on patients.