Jan O'Sullivan (Limerick East, Labour)

There has been a development since our debate on this matter commenced last night in that the VHI has issued a statement in respect of the comments made by the Minister in the House. The Minister took the opportunity to reveal some of the contents of the Milliman report, which has been available to her and the VHI but to which Members are not privy because it has not been published. The Minister indicated that she would publish the report in redacted form, leaving out market-sensitive information.

The statement issued by the VHI earlier today suggests that the Minister was disingenuous, to say the least, in the context of what she said about the company. She indicated that it should be able to make significant savings if it changes its system. In response, the VHI has stated that, in effective, it is being asked to become a US-style health utilisation company and that this would require it to invest in and establish significant pre-authorisation processes, concurrent review processes, post-care processes, etc. I do not know what is the truth of the matter because I have not seen the report. If we are going to engage in a debate on this matter, it should be an honest debate. In that context, we should all be given the information that is available to the Minister.

It was not fair to the VHI for the Minister to disclose some of the information she placed on the record last evening without making the full report available in order that commentators and public representatives might provide an honest appraisal of its contents. However, there are areas in respect of which the VHI must provide answers. One of these - the Minister must also provide an answer in respect of this matter - is whether the company acted legally when it increased the costs relating to the plans preferred by elderly customers by more than those which obtain in respect of the other plans it offers. That would appear to be in contravention of the spirit behind, if not the law on, community rating. When the Minister of State, Deputy Moloney, makes his contribution, I would like him to indicate the legal advice, if any, the Government has obtained in respect of this issue.

Plan B and Plan B Excess are used more by elderly people, who have suffered greatly as a result of the recently announced increases. Many elderly individuals have informed me of their concerns to the effect that they will be obliged to discontinue paying their health insurance. They are very scared about doing so because they have reached a point in their lives when they will need health care to a greater extent than would have been the case when they were younger. Most of those to whom I refer have been paying health insurance for most of their adult lives and have not been obliged to claim before now. It is important that we should discover whether a legal issue arises in respect of this matter.

A number of people have indicated that the VHI has paid out on their behalf in circumstances where it should not have done so. I refer, for example, to individuals with haemochromatosis who have stated that the VHI was charged in respect of situations where they did not receive consultant care. I understand that it is frequently the case that people with private health insurance who are treated in hospital settings never see a consultant. However, in addition to a hospital bill these individuals also receive a consultant's bill in circumstances where they were actually treated by a non-consultant hospital doctor who is paid a salary out of the public purse. I am of the view that questions must be asked with regard to what is happening in this area.

I would certainly not state that the VHI is without fault in all of this. As already stated, however, the Minister's comments were not fair because she made claims regarding what the VHI could do on the basis of a report which Members have not seen and the contents of which we are consequently unable to challenge.

The Minister also stated that because she is preparing the VHI for privatisation, she has basically surrendered the power which used to be at her disposal in the context of telling it not to raise its prices. I would be interested in hearing the Minister of State's comments on the first part of Fine Gael's amendment, which calls on the Government to "instruct the VHI to postpone premium increases until the Milliman Report is published and debated". I would question whether the Minister is in a position to do this now. She would certainly have been able to do it before she surrendered the power to which I refer. In effect, the Minister has left subscribers exposed to the vagaries of the market because she has not retained the power to protect them.

Is it really intended, in current circumstances, to privatise the VHI? Significant public money would have to be invested in the company to fatten it up for privatisation. There are many better uses to which such money could be put in the health service at present. Honesty is required from the Government in this regard. Is it intended to proceed with privatisation and, if so, from where will the money come? The VHI is currently not in a position to be privatised.

The Labour Party has a completely fair approach to this matter. We want to ensure that all patients will have access to services on an equal basis. The basis of our universal health policy is that, in effect, all patients will be insured. This would ensure that when people find themselves in a difficult position as a result, for example, of losing their jobs or whatever, they will not lose their health cover. Part of the major concern for people at present is that if they lose their jobs and cannot afford to pay their cover, they must give it up. That is unfair. It is also unfair that people who have health insurance can, in a sense, buy their care quicker than someone who does not possess such insurance. That is the ultimate injustice and the Labour Party is of the view that it should have no place in any health service. That is why we intend to introduce the change to which I refer.

Until such time as that change is implemented, there is a need for a fair system for those with private health insurance. The only way to establish such a system is by legislating in respect of risk equalisation and replacing the current interim solution. The latter has been in place since the court decision of July 2008. Despite what the Minister stated in respect of the complications involved, I cannot understand why it is taking so long to introduce the necessary legislation. I accept it may be complicated but it must be remembered that risk equalisation was previously in place. In addition, there are risk equalisation models in use in other jurisdictions so it is not as if we are seeking to invent the wheel. While the legislation is awaited, it is obvious that there will be unfair systems in place in the area of health insurance provision. Those who bear the brunt of the inequality created by such systems are the elderly, the sick and people who cannot compete. The costs relating to these individuals' plans are being increased by 40% or 45%, which is unfair. I am of the view that the market cannot be left to operate in this way for the period envisaged by the Minister.

I again welcome the opportunity to discuss these complex issues. Ultimately, we must move to a new and fair system which will use the public and private money spent on health in an efficient and effective way that will be to the benefit of patients.

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