Michael D Higgins (Galway West, Labour)

I wish to take this early opportunity of congratulating you, a Leas-Cheann Comhairle, and wishing you well in your new post.

Regarding this amendment, probably no other action of the Government reveals the appalling shift that has taken place in Government policy. There is no more glaring example of the price that will be paid for the infection of Fianna Fáil by a PD proposal to build private, for-profit hospitals on the grounds of public hospitals. The Taoiseach, who has now taken on this proposal as if it were his own, stands exposed in another respect. I have witnessed his so-called campaign for citizenship around the country, which in reality is an appeal for volunteering. There is nothing wrong with volunteering, which is a good thing, but it is not a campaign for citizenship. Missing from the Taoiseach's campaign is any hint of those egalitarian values that might be at the basis of genuine republicanism. This shows in a whole series of ways. It shows also how the public capital programme can be held back to make room for the most vicious kind of private accumulation. That is clear to anyone who has visited the University Hospital in Galway, known as the regional hospital, where there is an effective plan. If that plan was implemented, it would immediately yield up 150 beds. That plan relies on public capital investment, which will be withheld to facilitate the racket of private, for-profit hospital proposals.

Consultants are happy to work with their great professional gifts and training. The Minister for Health and Children's invitation for them to become involved in a new contract was minimally about their work and conditions. The majority of the contract's pages were about the opportunities in the new private racket to build on public hospital grounds. The Government is withholding public capital moneys from good projects in public hospitals to facilitate a private racket, in exactly the same way as with the 14.5 acre site in the centre of Galway city. Not one penny of public money will participate in a €1 billion development because it will sell off the greater proportion of the site for 800 apartments. The Government is withholding public investment to allow the private racket in.

All around the country, water systems require management and testing facilities. Instead of local authority projects being accepted, however, they are held back to facilitate build, design and operate projects from the private sector. It is profoundly ideological but deadly also. Those with whom the Taoiseach and the Minister for Health and Children have chosen to do business are people whose intellectual, corporate and moral history in the United States is something of which anybody would be ashamed. It is interesting that the HSE, in forcing itself to provide a half honest answer, said that those bidding for contracts are not currently involved in any investigation. It would have been interesting if they had looked at the intellectual, corporate and moral history of those with whom they are dealing. The evidence from such corporations includes having been sued by patients and insurers, investigated by the FBI, and having done incredible deals to literally stay out of jail as a result of their practices. In 2001 the health care corporation formerly known as Columbia HCA, the largest for-profit hospital chain in the United States, agreed to plead guilty to criminal conduct relating to five areas of medicare and medicaid fraud and paid over $840 million in criminal fines and civil penalties to the federal government and the affected states.

Can the Minister for Health and Children, Deputy Harney, and the Health Service Executive say that those with whom they are dealing have a clean history regarding fraud? I do not believe they can and this is why we are not receiving answers to fundamental questions.

Any definition of a caring health system in a republic would involve a unified hospital system providing universal access based on medical need, not income. This is the kind of system we can now afford to have, given Government revenues, but instead we are inviting the commodification of health. We are inviting an ethos and ideological drive that sees not a health care system but a sickness industry. Similar companies have attended bank-sponsored promotional meetings in Dublin and have suggested in Britain that, ideally, the state, in addition to providing incentives allowing them to exist, should guarantee a certain number of patients. As was said at the conference in Dublin, the great thing is that if the system does not ultimately make money the State can buy back the contract after a period of years. The companies may get paid whether or not patients turn up.

This is a disgraceful abuse of public space in Ireland that abandons public land owned by the Irish people and delays the public capital programme that could deliver a first-class health care system. This policy discards all values of citizenship and equality and splits the health service. One principled consultant, Dr. John Barton, has resigned because of his objection to this racket that compromises the professional integrity of consultants. Consultants are being invited to agree to the new contract and in return participate in the racket taking place on hospital grounds.

In the United States 16% of income is spent on health care, 43 million people are without health cover and, on average, insurance premiums cost three times more than in Ireland. A limited service is provided that is bloated by fraudulent and excessive costs that raise premiums and this is what is being created on Irish hospital grounds.

Studies have been done of private, for-profit hospitals and we should unemotionally examine what should be the test of a health system. Are these hospitals better for patients? Are they safer? Do they provide excellence? In every journal in the United States that has examined private, for-profit hospitals and public hospitals under these criteria, public hospitals have emerged as better.

How is this model of health care to be imposed? It is to be imposed through a refusal to spend money in the capital programme and in plans in the Department of Health. The greatest blackmail of all is to suggest no extra beds can be provided except through the co-location of hospitals. This pathetic blackmail has been forced on Tallaght Hospital but luckily there are other locations in the country where medicine means more than this, where professionals will choose to work in a way in which their vocation suggests is for the benefit of all citizens. Everyone who has examined the Irish health service, including Marie O'Connor, Risteard Mulcahy and Maeve Ann Wren, has suggested it needs reform but not a private, unaccountable racket on public hospital grounds. They object to the tap of badly needed capital funds being turned off, though those funds are available to give us the health service we need.

When all the Taoiseach's posturing and commemorations are over he should note that it is a shabby version of a state and certainly nothing that could be called a republic that decides to go down this road. In public transport, health and the maintenance of public water supplies it is always the same, the Taoiseach bends his knee to the ideological poison that is the influence of the Progressive Democrats in Cabinet and which was rejected comprehensively by the people. There is no public mandate for the Minister's policy, which is bad for medicine, the Republic and the State and will take generations to undo. For these reasons, it should be opposed by Fianna Fáil backbench Deputies who know very well that what I say is true.

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