Mary Harney (Dublin Mid West, Progressive Democrats)

We are about to have a philosophical debate. When the Progressive Democrats Party was formed many years ago, we advocated universal health insurance. However, we changed our minds after being presented with the prospective consequences by a group established to examine the issue. What Deputy O'Sullivan is proposing is compulsory universal insurance whereby some would pay the full commercial cost of health services while others would be entirely subsidised and still more would be somewhere in the middle.

I read an article in The Economist today which set out various models of health provision, including the Dutch model under which there have been rising prices and consolidation of insurers. The reality is that there is no perfect model. I do not mean to be critical of the Opposition proposals, although I would like to see them costed. When Professor Charles Normand, who is a member of the expert group we have established, put forward the universal proposal for the Adelaide Society, he estimated it would cost a minimum of €300 million per year for hospital cover alone. There will always be better-off people in society who will be willing to purchase more. There is no doubt about that. Even under a universal model such as that proposed by the Deputy, there will be people who wish to avail of extras in addition to the basic cover.

The State health insurer was established by the then Minister, Mr. Tom O'Higgins, because the better-off did not have universal access to hospitals. It was envisaged that 10% to 20% of the population would take out insurance and thus cover their own costs for hospital care. When universal cover was introduced in the early 1990s, we began to see the consequences of having this mishmash in hospitals where doctors receive a public salary as well as a top-up for insured patients. In any normal situation, economics play a part in all our lives. Those types of incentives inevitably cause unnecessary problems such as the case of the late Susie Long who was told in a hospital funded by the State, in which all the staff and services are paid for by taxpayers, that she could have a colonoscopy the following week if she had health insurance, otherwise she must wait. In her case, unfortunately, the consequences were fatal.

Under the new consultant contract, some 25% of consultants now work full-time in the public system. While I wish the figure was 100% and everyone would be seen on the basis of medical need, at least we have made a start. As I indicated, someone from a different party was critical that one cannot secure preferential access to a named consultant in County Louth because he no longer does private work. The consultant is obliged to see everybody because everyone has cover.

Deputy Reilly is trying to fillet the Bill. The purpose of the legislation is to make sure health insurance continues to be affordable. Regardless of what arguments one makes, companies have a way of defining products to attract members of a particular age group. For example, sports injury and maternity benefits are only attractive to younger people. Even active 80 year olds do not generally suffer from sports injuries and will certainly not find themselves in maternity hospitals. In the autumn, after the Bill has been passed, I hope to address the issue of minimum benefits. I am concerned that services such as rehabilitation, stroke care and so forth are being limited by the insurance companies. I do not want such circumstances to prevail.

Other people introduced risk equalisation, which is a principle I support. I tried to implement such a system but the legislation was struck down by the Supreme Court. The Bill marks a time-limited effort, over three years, to transfer from the young to the old and from the healthier to the sick by way of a tax credit skewed in favour of older people so as to make insurance more affordable for them and make older people more attractive to insurance companies.

A great deal of ingenuity and effort has been invested in this legislation by public servants, actuarial advisers and many others. Having discussed at length and with numerous people means of achieving our objective in the short term following the Supreme Court decision, I have concluded that this legislation is the only way to do so.

The purpose of Deputy Reilly's amendments is to fillet the Bill. If they were accepted, we would never be in a position to secure authorisation. We must implement our objective in this calendar year. This can only be done through the tax credit model and stamp duty on insurance companies. For this reason, I cannot accept the amendments.

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