Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)

This Bill is inadequate to deal with the problem that it attempts to address. It is fundamentally dictated more by free market ideology, and the addiction of the troika to that free market ideology, than it is by any serious attempt to grapple with our real problems with health care provision in Ireland. This Bill is essentially trying to create a free market in GP services, with the implication that this will solve our problems with providing health care for people. I fundamentally disagree with that.

There is a manpower problem with the provision of GP services. The demand for GPs is expected to rise over the coming years, given a rising and ageing population. Compared with other OECD countries, we have a low proportion of GPs relative to the population. I think we have 0.6 GPs per thousand people in Ireland which, according to a recent study carried out by the Competition Authority, is low when compared with continental countries. We certainly need to expand the number of GPs. It might appear a benign and uncontroversial intention to expand the number, access and choice of GPs by removing restrictions on which GPs are allowed to see medical card holders, but the Bill suggests that this must be done by creating a free market. I have a fundamental problem with free markets, especially in health services. I do not see the provision of health care to human beings in those terms. It is not about creating markets. I do not think there is any strong evidence to suggest that by creating a free market in GP services, the number of GPs will be increased or access to them will improve.

What is necessary is what the Government promised in its programme for Government, namely, free GP care provided by a system other than one where people have to pay. In so far as there may be disincentives for GPs, the problem for ordinary people in going to GPs these days is that they have to pay at all. Many people who do not have access to medical cards just do not go to the doctor. It is a budgetary decision. With the worsening economic conditions, with higher levels of unemployment and with the pressure on people's wages as a result of the austerity programmes being implemented by this Government and the previous Government at the behest of the troika, more people just do not go to the doctor or have to think twice about doing so. For those who are just over the threshold for medical cards, going to the doctor is a serious budgetary decision. That is the problem that must be tackled, but creating a free market in GP services is not the answer. It just reflects the false ideological belief that if competition is created in GP services or in the provision of any service, this will lower prices. I would like to see some hard evidence of that, because I do not think there is any.

When is the free GP care plan going to be introduced? That is what we need, so that everybody has access to GP services and it will not be a budgetary consideration. They will go to a doctor because they need to see one, and will not have to question whether they can afford it. I suspect that the focus of this legislation on creating a market, moving away from a planned approach to the provision of health services, reflects the longer term plan of the Government to deliver universal health provision and cover. The Government sees this provision as being carried out by private health insurance companies. Again, it is the obsession with the private sector as the means to deliver health services, which to my mind are just too important to be left to for-profit companies. A sector in which competition for profit is the main dynamic is not designed to deliver a service that people should get as a matter of right and not because somebody can make a profit from it. It is linked to that thinking, which is mistaken. There should be a national health service, with GPs employed directly by this service on public general practice contracts. A planned approach is required; we should sit down and work out how many GPs we need and where we need them, then employ those GPs. That would also deal with another problem people are facing, which is overcharging by GPs. We have a scandalous situation in which people are in some cases being charged €70 to see a GP. There may be arguments about rents in particular areas or the staff they must employ, but when there is such a wide variation, with some GPs charging €35 and others charging €70, it seems that someone is profiteering on the back of this situation. The Minister thinks competition will be the way to deal with it - that is what is implied in the legislation - but I do not agree. The way to deal with it is through a single public-service GP contract under which the Department of Health decides how many GPs we need based on population trends and current service shortfalls and then employs the GPs we need, funded through progressive central taxation. That means we must bite the bullet that this Government, and the authorities in Europe who are obsessed with neo-liberal market ideology, do not want to bite. There must be an option of increasing taxes on wealth and having a genuinely progressive tax system in which a wealthy minority, who have essentially escaped making a contribution to our society and to the provision of services, are forced to pay their fair share through higher rates of income tax. That is what we need if we are to fund a proper health service and ensure that everybody gets health care as a right. If we did that, we might also make some contribution towards dealing with the crisis in our hospitals and accident and emergency departments. The disincentive for people to see their GPs due to the punitive cost of doing so means their conditions worsen unnecessarily because they do not receive early intervention. They wait until they are really sick and then present at accident and emergency units, which cannot cope with them.

We need to break with the fixation with market solutions, particularly in an area as vital as health care, which should be a right for all our citizens. This is even more of an urgent priority now, given that financial and economic constraints resulting from the recession and austerity measures mean it is even more difficult for people to access the health care they need. We need a different approach which involves the establishment of a national health service funded through progressive taxation and a planned system under which the State employs doctors to provide GP services. That is how we will keep our doctors. If they do not have to depend on the ups and downs of markets to sustain a practice, they are more likely to stay here. They will be employed by the State because it has an obligation to provide health care to its citizens.

See this speech in context