Alex White (Dublin South, Labour)

There are a lot of things which divide us in this House in terms of the policy and funding of social services. One of the things on which we all agree, which is reflected across the political divide, is that the market alone cannot deal with the distribution of health care. It simply cannot be done. The pure form market is good at some things but is peculiarly bad at the distribution of social services, including health services.

As far back as 1993 or 1994, all parties in this House recognised that because it was then that the evolving system of so-called risk equalisation was introduced. There was a recognition across the political spectrum and in the community that we could not have a situation where people who are a greater risk, because of age or inherent illness, would have to pay more. We should spread the risk across society, the community and generations. That is why we have the useful and laudable notion of intergenerational solidarity.

It is important to reflect on the view that the market is not the place where the problem can be solved but it has a role. Our discussion on universal health insurance is a recognition of that. Intergenerational mobility concerns people who suffer illness or are older and should not be penalised for that. I would add another category, namely the ability to pay. It is the great additional category which needs to be added to the equation and what brings us to universal health insurance.

President Obama had big battles in the US in the past two years. He was insistent that people who could not afford to pay for their health care should be brought into the system and that there should be a reliable and robust system of funding for health care which did not discriminate against people on the basis of ability to pay. The battle focused on the basic health services required. Luxury care can be paid for if people have money to do so.

People should not be discriminated against in terms of the basics in any civilised health service on the grounds of ability to pay, any more than they should be discriminated against because of age or an inherent illness. That is the one great additional step we need to take to get us to universal health insurance. I have huge confidence in the Minister of State, the Minister, Deputy Reilly and the Government, arising from the commitments in the programme for Government, that we will make the giant leap to reach the stage where we have a fundamentally fairer system of health care in Ireland. It will not be easy to achieve and will not happen quickly but a lot of the important work has already started.

As others have said, the Bill is an opportunity to have a wider debate. We are dealing with a relatively net issue. It is essentially a continuation of an interim measure which was introduced by the last Government when the Supreme Court shut down the system of risk equalisation which had been put in place. I remember having this debate with the former Minister for Health in the Seanad. I was surprised the then Government did not move more quickly to introduce a proper system. I understand tax relief is available but it is a sticking plaster approach. I mean no disrespect to the previous or current Government.

The Supreme Court did not completely shoot down the idea of community rating. Its judgment had narrow grounds for rejecting the idea. The Chief Justice said at the time and it was made clear in the judgment that it was possible to have a system of risk equalisation which did not offend the basic principles set out in the Act. I am surprised the problem was not addressed then.

A question has been troubling me. The Minister said this Bill will be passed this year and a more permanent system will be put in place next year. How does that fit in with our commitment to universal health insurance? Why would we go down the road of doing all the work on risk equalisation and tidying the system to make it more robust when we are, in any event, looking at the bigger picture of universal health insurance? I am not clear how the two things fit together.

Now we are heading toward universal health insurance could we not live with a sticking plaster, given that we have had it for two or three years? We could live with the sticking plaster for another couple of years in circumstances where we are introducing universal health insurance.

The are many reasons I am happy to see Fianna Fáil in opposition. For the first time people like Deputy Kelleher will become involved in this important debate, as he did this afternoon.

He pointed to the reality of our two-tier health system. I do not recall Fianna Fáil Members acknowledging that in the past. The party effectively abandoned all health policy issues to the former Minister for Health, Mary Harney, for six or seven years. It offered no initiative in terms of health provision in general, how resources should be distributed, the role of the market and the benefits of universal health insurance. I am not sure whether anything in this area was included in the party's election manifesto. The Fianna Fáil Party removed itself entirely from the pitch in regard to health.

As such, I welcome that party's return to the pitch. As Deputy Buttimer said, this issue is too important to be solely a prerogative of the Government in terms of its planning. Everybody should participate. I very much agree with previous speakers that the market will not provide the solution. The market is peculiarly unsuited to the issue of distribution of social services, particularly in regard to health. We look forward to the Minister's proposals for a universal system of health insurance. The Minister of State, Deputy Shortall, is working tirelessly in regard to the primary care element of it. I hope we can accelerate our move towards the new system rather than, as Deputy Ó Caoláin suspects may be the case, allowing any delay in doing so. It is a hugely important objective for this Government and I very much welcome the Minister's commitment to it.

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