Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the debate on this legislation, which affords us an opportunity to discuss the health insurance sector and the broader issue of health care provision. Without wishing to imply any reflection on the Minister of State, Deputy Kathleen Lynch, who I know personally as a constituency colleague and a committed public representative, I am exceptionally disappointed that the Minister, Deputy James Reilly, is not in the Chamber for this debate. I admire the work the Minister of State is doing and her commitment to her brief.

This legislation encompasses a fundamental principle in terms of the future operation of the private health insurance sector in this State, in the context of the comments made by the Minister, Deputy Reilly, outside the House in regard to the implementation of universal health insurance. I had expected the Minister to outline to Members the progress he has made to date in terms of setting up the implementation body, the criteria to be laid down for its operation, its riding instructions, the guidelines under which it will work and the reporting mechanism to apply. I had also expected him to outline how he envisages the future of health insurance funding and the broader provision of health care in the coming years.

In regard to community rating and the need for inter-generational solidarity and all that goes with that, this legislation is critical in ensuring there is a continuity of that policy. However, we must be brave in acknowledging that the current system of private health insurance is simply not working as we envisaged. It has not worked since competition was introduced into the marketplace. All that has happened is that we have Peter being robbed by Paul. So long as private health insurers are allowed to enter the market and cherry-pick the younger, healthier customers who carry fewer cost implications in the short term, VHI will always be under pressure. It is clear from the company's accounts and the profiling and spread of its customers that as time goes on, VHI will become less profitable, less solvent and a greater burden on the State in terms of ensuring its compliance with the regulations of the Central Bank and all that goes with that.

We have a major problem in the private health insurance market, which is made worse by the great uncertainty arising from the Minister's announcements when in opposition. A speech of his on Tuesday, 10 March 2009, for example, makes for exceptionally comical reading when one considers what has happened since early March 2011. We were told for a long time that the Minister had a vision and a plan and that all he needed was the mandate to implement them. Ten months into the lifetime of this Government, we are still awaiting the establishment of an implementation body to bring forward proposals for the introduction of universal health insurance.

I am concerned that we are moving backwards. We now have a situation where VHI is continually undermined. The Minister spoke some months ago about breaking up and selling the company. Today, we had a leak to the newspapers indicating that not only is there no plan to sell VHI but that the State also plans to purchase Quinn Healthcare. What is the policy of the Government and of the Department of Health with regard to private health insurance? We all acknowledge that we have a dual system in this country of private health insurance alongside the public hospital system. There is a fundamental flaw in that, based as it is on the principle of inequality. We cannot allow a situation to continue where people with private health insurance or the ability to pay will receive treatment quicker than public patients or those who cannot afford to pay for private treatment. That is unacceptable and must be addressed.

Nobody has come up with a magic solution to the fundamental issue of who should pay and how the health service should be funded in general. There is a large body of people who wish to retain their private health insurance and are not willing to stump up any more in terms of taxation to the central Exchequer for public health care funding. As political parties, as a Parliament and as a society, it is time to decide once and for all how health services should be funded. We are being told one week that we will have universal health insurance and that a myriad of private health insurers will be coming into the Irish market and providing wonderful competition. Only a few weeks later the Minister is announcing that, instead, the State will purchase another health insurance company. The Government's policy is in disarray.

We must at least be informed as to the implementation body's riding instructions. Surely, after ten months, the Minister can come to some arrangement with regard to publishing the criteria and riding instructions of the body, naming the board members, getting it up and running and indicating when it will report on an interim basis to the House. We cannot be waiting two or three years for this body to decide how we will fund one of the most critical public services any state must provide, that is, medical care to its people.

This legislation offers merely a short-term solution in terms of community rating and ensuring there is inter-generational solidarity and some equality in terms of those who can afford to pay subsidising those who cannot and the healthy supporting those with illness and disability. That is a noble concept and one we all support. However, it does not go far enough in the current climate. VHI is haemorrhaging young, low-risk customers to its cherry-picking competitors on a daily basis. As sure as night follows day, if we do not do something about this, Quinn Healthcare or Aviva will, in turn, have an older age profile in years to come and new cherry-picking providers will follow them into the market. There must be a mechanism in place which will ensure that any entrants into the market in the short to medium term are not allowed to cherry-pick customers, extract huge profits from the State and then move elsewhere. That is what is currently happening.

This Bill is welcome in so far as it seeks to protect community rating. However, we cannot wait years for the implementation body to report. The Minister has said we will not have universal health insurance for between six and ten years. We cannot wait that long for his noble ideas to be implemented. His record to date has been anything but noble in terms of fulfilling commitments he has made. He walked into Hawkins House and I assume he was welcomed by the Secretary General and his officials. One of his first actions was to sack the board of the HSE. We found out in recent days that he is now attacking the HSE, the organisation of which he has taken control, because it is not paying out travel and subsistence allowances and expenses to its employees. Who is in charge? Is it the Minister, the Secretary General, the HSE board or some combination of all of these?

We were given a commitment that the Minister would be ultimately responsible in this House, yet he will not even come to the Chamber to deal with the issue of health insurance. I do not like being critical of individuals, but when one considers what was said and what has happened since, it is clear that we are going backwards. I fully appreciate the pressures on our public finances and the challenging times we are living in. However, that does not prevent the Minister from setting up the implementation body, publishing the guidelines and his objectives in terms of outcomes, and letting that body carry out the due diligence and come back with a report in the short term. How long must we wait for this to happen? We will not accept being sold a pig in a poke forever. Will we have another Bill such as this in 2012, 2013 and 2014 while we wait for progress?

In the meantime, the health insurance sector is running into a cul-de-sac in terms of its funding in the short to medium term. The mythical idea that there is an array of private health insurance providers queuing up to enter the Irish insurance market is a nonsense. We will be fortunate to hold onto what we have. If the HSE or VHI is to be mandated by somebody - I assume the Minister - to purchase Quinn Healthcare, we will have even fewer providers. We must have a debate in the short term because we cannot allow this to drift for much longer. Otherwise, we will end up with a situation where VHI's solvency and reserves are in question. Quinn Healthcare is also in difficulty and we might well end up with another huge liability being imposed on taxpayers.

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