Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The purpose of this Bill, which is essentially technical, is to oblige the board of the VHI to attain the level of reserves needed to achieve authorisation as an insurer. According to the explanatory memorandum, this legislation will give the VHI a structure that, among other things, will give it commercial freedom on products and pricing. The board members of this statutory corporation are appointed by the Minister for Health and Children. The VHI, which is regulated by the Health Insurance Authority, is the main provider of personal health insurance in Ireland, although a number of competitors have entered the health insurance market in recent years.

The VHI plays a key part in health funding in the State. The content of this Bill will not change these essential features of the VHI. As risk equalisation is essential, it has received cross-party support in the Oireachtas. We have been told that the changes being made in this Bill are necessary to ensure the continuation of risk equalisation. Regardless of the detail or contents of the Bill, what it is leading us towards is another matter entirely. It does nothing to remove the doubts about the future of VHI as a statutory corporation for which the Government has a clear and special responsibility. The Government has not made its position clear. Everyone in this House is aware of the penchant of this Government, especially the Minister for Health and Children, for the privatisation agenda, which may well give us reasons to be concerned.

The Irish Congress of Trade Unions' landmark study of our health care system, How Ireland Cares, states:

There is no necessary logical reason to link the risk equalisation decision with the ownership status of VHI. The authors advocate that VHI continue to be a state company so that it can continue to serve national rather than private or parochial interests. Whatever the future of VHI, it should not become a for-profit company

I note that a member of one of the Government parties, Senator Deirdre de Búrca of the Green Party, made a significant contribution to the debate on this Bill in the Seanad. She stated:

The Green Party broadly supports its thrust but we see the Bill as significant in that it may be the necessary precursor for the privatisation of the VHI. While the intentions of previous Governments in regard to the privatisation of the VHI have not been clear, we are aware the VHI board has indicated its preference for the privatisation of the company.

She went on to say the Bill could tilt the balance towards private medicine as opposed to the public system. She might have added that the intentions of the Government, of which her party is a member, are not clear either and this must be repeated today. However, she admitted that no reference is made to the future ownership of VHI in the current programme for Government. It seems from her contribution that the Green Party is against privatisation, at least in this specific instance.

It is interesting to read the response of the Minister for Health and Children when concerns were raised in the Seanad about the prospect of VHI privatisation. She made the following statement:

If one has private health insurance, one has preferential access to diagnostics and facilities paid for by the taxpayer and for which a group of employees in this State gets a fee.

This surely is an interesting contribution from the Minister for Health and Children. The Minister appeared to speak disapprovingly of this preferential access, yet she has done everything over a series of years to maintain the system that sustains that preferential access which is the two-tier system of which I and many Deputies have spoken about in this House on many occasions.

In 2005 the Minister said the fact that, "more and more people are getting private health care is a good thing. It's a sign of increasing disposable income." What the Minister did not say was that the increasing number of people taking out private health insurance is also a sign that people are moving away from the public health system because of long waiting lists and a steady deterioration in confidence in that system as operated by the HSE, the Department of Health and Children and with the accountable responsibility of this Government now in office in excess of a decade.

A vicious circle has been created. The public health system has been allowed to deteriorate and this prompts more people to go private. The for-profit health sector grows richer and this is indisputable. This Government is fattening this for-profit health care business as never before, most notably with the Minister, Deputy Harney's flagship project of private hospital co-location on public hospital sites.

Many uninsured people are also abandoning the public system and going into debt to pay for private care in order to avoid long waiting lists and to have their procedure performed at the earliest possible time to address their agony, their pain and their suffering or that of a loved one within their family.

In recent years, credit unions have reported growing numbers of people taking out loans to fund health care. Given the understanding of the market that credit unions primarily seek to serve, this is a sure indication of real failure in terms of the provision of a quality health care system available to every citizen on the basis of need. If credit unions have indicated that they loaned in excess of €30 million in 2004 to fund health care access, then this Government has truly failed the average citizen in this State. If that is the figure for 2004, I wonder what is the figure for 2005, 2006 and the current year. I warrant the figure has increased steadily in each of those years and it is imperative that the statistics be published and made publicly available.

We do not know the total amount of money expended on health services. We know the Government's commitment to health care delivery as part of the overall Exchequer spending but that is not the whole picture; far from it. We know that the best use is not being made of the public moneys because it is being applied inequitably and inefficiently in a two-tier system. Approximately 70% of the population pays for their health care twice, once through taxes and again through personal health insurance or direct-user fees for GP services, medicines and hospital care. People are paying twice and meanwhile the proportion of the population with medical cards is declining. This complex and inefficient funding system has been used by successive Governments to underpin the grossly inequitable two-tier public-private system.

The Government's fundamentally flawed policies and gross mismanagement of the health services has meant that increasing numbers of people have had to take out personal health insurance for themselves and their families. Many of these people are on relatively low or moderate incomes, do not qualify for the medical card and are concerned that if they rely totally on the public system they will face long waiting lists and poorer health care outcomes. They are paying on the double for health through tax and PRSI and through private health insurance. Many people fall between two stools and do not qualify for the medical card nor can they afford private health insurance.

Many of these people are getting into serious debt to pay for health care. I have stated before in the House that I have seen the anguish of young parents on low incomes with young children having to make the choice between some essential and the worry of bringing their child to the doctor. They do not have a medical card nor can they afford access to health care. They are in that limbo bracket in the centre, viewed by the continued annual review of the threshold for qualification for the medical card to be able to provide for their own health care needs from their own resources, but this is far from the truth. These people are suffering and they are forced to go without in order that their children have access to a local GP or whatever other referral is necessary. This is a disgraceful situation. I know of such cases and I have had to help in any way I can.

Sinn Féin has called for the establishment of a health funding commission. This is necessary for a proper assessment of all the money currently being spent on health services both by Government and by citizens directly in the form of health insurance premiums and user fees. Such a commission would not be engaged in a statistical exercise but rather its purpose would be to plan the transition to a truly fair and efficient system of health care funding, leading to the delivery of a quality public health care system.

It should be accessible to every man, woman and child on the basis of need alone and should not discriminate on the basis of the money in one's pocket or bank account or where one lives on this island. All citizens have that right. They are born equal and should be treated equally throughout their lifetime. This is the single fundamental common fact that all Members must face.

In Sinn Féin's strong view, the way forward is a universal, single-tier system of health care accessible to all based on need alone and regardless of income. Such a system would be funded from general taxation based on the principle of ability to pay. It would protect the most vulnerable and ensure there was no fast track to better care for some, while others languished on waiting lists. The best care should be available to all. There are very few winners in our current inequitable health care system. The exceptions are those who profit from the increasingly lucrative private health business. Overall, our population suffers an inequitable and inefficient system. This has been proven both repeatedly and in recent weeks and not only in the midlands. Its fundamental structure is flawed and it is plagued with bad political and bureaucratic management.

A new beginning is needed and health funding is central in this regard. No one accepts the proposition that because the Government is spending more than at any previous time, its commitment to quality health care delivery is clear and obvious. Nothing could be further from the truth. While more money is being pumped into the health system at present, the population dependent on it has also increased. Moreover, both the awareness of, and incidence of, need among our citizens are growing. A much wider debate on these issues is required than can be facilitated by the debate on this Bill regarding voluntary health insurance or by the Private Members' time accorded to the debate on the Labour Party motion of no confidence in the Minister for Health and Children, Deputy Mary Harney. Members require a substantive period to be allocated by the Government to address the realities of health care delivery in this State. The Government fears such a debate most and is not likely to accommodate it. However, I urge it to so do to address such matters in the round and holistically and to ensure the full facts are properly aired and exposed in this Chamber, as is appropriate.

I note the content of this Bill and await the Minister of State's response. I hope that were this Bill to proceed from Second Stage to further Stages, Members would have the opportunity to address some of the real concerns I have articulated. I refer in particular to the Government's intent and its absolute weddedness to a privatisation agenda in health care delivery. Shame on it for this and shame on those who voted last night to continue the writ of Deputy Mary Harney in health care in this State.

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