Liz McManus (Wicklow, Labour)

I protest at the way this debate has been arranged. The Government did not intend to subject these changes to any debate whatsoever. The overweening arrogance of the members of the Government is such that they thought they could pass this measure without any debate. We have had a miserly concession of five minutes speaking time for each Deputy, which is not sufficient to deal with this very complex issue.

More than 52% of the population have health insurance, even though everyone has an entitlement to health care. The Minister for Health and Children continues to disregard this point when she talks about moving private patients out of public hospitals and into her super clinics. Everyone has an entitlement but because of the Government's failure to deliver the world-class health service it promised more and more people are turning to private health insurance to safeguard themselves and their families. That is the most damning indictment of the Government.

The principle of community rating and the balancing provision of risk equalisation have been a very important security within the health insurance area. I have great concerns about the shift being taken by the Government on community rating. This is all the more curious given that the Government fought for risk equalisation and won handsomely when it was challenged in court. The Government is now diluting the risk equalisation provisions in a way which is not necessary. This certainly relates to some kind of payback connected to BUPA's withdrawal from the Irish market.

This is a technical measure. Even the explanatory memorandum is opaque in certain parts. The formula devised to calculate risk equalisation is complex and may not be perfect. The Dáil cannot fulfil its responsibility to consider these changes if Members are allocated only five minutes to debate them. The removal of the exemption, which was forced through by the Minister and with which we agreed, was necessary to prevent the sharp practice of turnover of ownership in order to avail of the exemption.

Regarding risk equalisation at it stands, the case has been made by independent experts that the full burden of risk is not dealt with. It may even be as low as 50%, but we are now told that a further reduction is recommended, with a change to 80% and 20%. One thing about which we are sure in all this is that premia will rise. There is an almost fetishistic determination on the part of the Progressive Democrats to drive their agenda of "private good, public bad", "for-profit good, not-for-profit bad". That is the real agenda. The Progressive Democrats are driving the steamroller to ensure that they can push through their agenda in the dying days of this Government. They know that they will be kicked out of office very shortly.

We therefore have a further dilution in risk equalisation and a commitment to the removal of the derogation on solvency requirements for VHI. That points in only one direction, that of the privatisation of VHI. There is nothing in these changes to demand greater efficiency from insurers or better health care. It is not about those issues, even though that is what we must see. The idea is that competition in the market is somehow being jeopardised by risk equalisation. Hitherto VHI has set the fees and BUPA has followed. Although it is very difficult to get accurate figures, we all know that, as a result, BUPA made enormous profits in Ireland compared with what it was making in Britain. However, there was not and is not real competition, and there is no guarantee that this will bring it about. On the other hand, it will lead to increased premia.

We must talk about health insurance and examine it fundamentally, considering how we might use it to bring about a fair and efficient health service. There should be an opportunity when one establishes an expert group. Unfortunately, the Barrington group seems to have been set up to deal with competition and provide something for competitors entering the market, but there is a much broader agenda that should be addressed. We need a framework for the future whereby we consider the benefits of insurance and a universal system that integrates public and private. I hope that we will have that opportunity if and when we form the alternative Government that the people so desperately need. I very much regret the approach and the ideology behind these proposals.

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