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

We have a two-tier system. It is an obscenity that access to decent health care is dependent on how much money a person has. We are in a situation where, as a result of the EU-IMF arrangement, albeit under the cover of health and safety considerations, health services are being slashed across the country. Local hospitals and accident and emergency units are being downgraded and there is a trolley catastrophe daily in many of our hospitals. Those are the problems we have to resolve if we are to have a health system of which we will be proud, which is fair and where there is equal opportunity for access to decent health care, which is one of the most important priorities for anybody and for any decent society.

This legislation proposes to extend the risk equalisation scheme. We have a two-tier, privatised health system that many people, because of the chronic underfunding and the crisis that exists in our public system, are forced, because they do not have a choice, into taking out private health insurance. Given this and in so far as this is a measure to try, at some level, to regulate the private health insurance system and create some sort of level playing field, we have no choice but to go along with it. However, the problem is that it still follows the failed strategy of having competing private health insurers as the way in which to deliver health services. In other words, it accepts and is underpinned by the notion of a two-tier system where affordability will dictate the quality of a person's health care.

Those who advocate this kind of approach to delivering health care would say that its principle objective is to improve access to health services. In that regard, it is failing completely. Competition has not led to lower premiums and Irish health insurance companies are raising their premiums, most recently with Quinn Insurance hiking up its premiums by 12%. Health policy expert Professor Charles Normand of Trinity College, Dublin warned in the aftermath of this hike that those plans that have competing private insurers may not be a very good mechanism for keeping prices down. If we look at the case of the United States, we find dramatic evidence of how correct that is.

The health system in the United States is based on competing private insurers, and it is the most bureaucratic and the most expensive health system in the world, with US costs twice those of comparable countries. Some 31% of health spending goes on bureaucracy, executive salaries and massive profits. Over $600 million of the $2 trillion spent on health in the United States, which is 15% of GDP, goes on these salaries, bureaucracy and profits. In the Irish case, the Government is proposing to continue down this road of competing private health insurers, although it is costly and does not deliver access to the health service. The Government must abandon the universal health insurance model, which is only about profit in private health insurance companies, and instead provide a national health service that is accessible to all and is based on progressive taxation.

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