Jan O'Sullivan (Limerick East, Labour)

I am not necessarily talking about the Dutch model because there are elements of what Labour and Fine Gael are proposing which are not necessarily exactly in line with that. However, we both subscribe to the core universal, single-tier model based on all the population being insured, with the State subsidising those who cannot afford to pay, and those who can afford to pay paying most of their costs.

I wish to go back to the cost issue, which was being debated a second ago. When Labour published its policy document in 2002, we estimated that a fair and equitable one-tier system based on universal health insurance could be implemented by raising spending on health from €5 billion to €7 billion. Even allowing for inflation, the current bill of approximately €16 billion in public money and €4 billion in private money is way ahead of what we proposed at that time. We did cost it and got some experts to examine the figures. The Adelaide Society has costed what it calls a Rolls Royce model at not a hugely significant extra cost to what is being spent at the moment. It can be done, so one must question what we have been doing for the past ten or 12 years and particularly since 2002 when our scheme was costed. We are now up to €16 billion in health spending, yet there is very little improvement to show for it. In fact, there is widespread public dissatisfaction with the health service. Despite the Minister declaring that accident and emergency was a national crisis a couple of years ago, accident and emergency departments are as packed as ever. The Minister has an aspiration to transfer more activity to primary care but it is just an aspiration and has not happened. Yesterday, members of the Joint Committee on Health and Children went to see a lovely model in Mitchelstown, but there are very few of those up and running around the country. In fact, the transfer to primary care has not happened to any great extent. Unfortunately, the Minister's own privatisation agenda has made the two-tier system even more unbalanced than it was when the Labour Party published its proposals back in 2002. It is imperative that reform comes as soon as possible because it is clear that spending more money in a bad system cannot be allowed to continue, especially in the current economic climate where we have swingeing cuts throughout the health services. For that reason the legislation we are discussing today and the legislation the Minister plans to introduce subsequently to reform the original scheme are very important; we must ensure that we properly regulate the private health insurance market in the context of what I believe will be changes for the better in the health service in the very near future.

One of the ways that needs to be done is to ensure that the Health Insurance Authority does its job well, that we have proper regulation of the market and that we get this right. With regard to the Bill, the Supreme Court judgment stated that the Minister had misinterpreted the Act when designing the scheme and that was why it was ultra vires and void. Rather than introducing this very cumbersome mechanism with a levy and so on it would have been better to simply change the original Act to accommodate a scheme that by and large people were happy with prior to the judgment of the Supreme Court.

I know that this was meant to be temporary and that it was meant to be introduced a couple of months ago because we expected the EU Commission to make a decision in mid-February, which it still has not done. Was it not possible to introduce what would be the eventual scheme rather than having this very cumbersome interim scheme? People have many doubts about it. To quote from the Bills digest document that we received from the Library:

Although the Supreme Court struck down the Risk Equalisation Scheme of 2003, the Chief Justice stated in subsequent proceedings related to the judgment that this would not prohibit the Minister proceeding with risk equalisation in any statutory form she wished.

It was not necessary to introduce the type of scheme we have before us today.

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