Séamus Healy (Tipperary South, Workers and Unemployed Action Group) | Oireachtas source

I welcome the opportunity to speak on the Health Insurance (Amendment) Bill. The Bill raises fundamental, serious and significant issues for the health services of this country. What type of health service do we want? What type of health service have we got? Do we want to follow the private health care model? Do we want to privatise facilities? Do we want to have the health care system driven by health insurers? How do we fund the health care system? How do we pay for the system? Are the budgets provided for the system adequate? Should we continue to maintain the two-tier system we have currently?

In my view, the provision of health services here should be on the basis of equal and timely access, based on medical need. Services should be free at the point of use and should be funded through general taxation. One of the fundamental problems with the health service here is the model we use and the manner in which the system is funded. This has resulted in a system in crisis. It is worth examining the current situation and what the austerity measures and cutbacks in health services have meant for the service and for those who require it, such as patients requiring hospital services and patients requiring community based services.

What is the vision for the future of health services here?

As the Minister and a Fianna Fáil speaker said earlier, a person with private insurance who is in a private hospital or a private bed in a public hospital receives what is known as the Rolls-Royce treatment. Such a person gets every examination, regardless of whether it is necessary or appropriate, so that the health insurers can make a commercial benefit - a profit, in other words - from his or her hospital stay or health care service. However, it is evident in places like the United States that when the system is dominated by health insurance companies, they will do the exact opposite and start to tell medical people, consultants and hospitals what services to provide. At that stage, it will be a question of reducing the various services and examinations that might be needed. We will go from one extreme to the other.

Our current two-tier system, which has not worked, can be described only as a system in crisis. It is important to paint a brief picture of a system that is simply not working by referring to the number of people on trolleys in hospital corridors throughout the country. According to today's figures, a total of 287 people are on trolleys, including 25 at Beaumont Hospital; 14 at Connolly Hospital; 28 at St. Vincent's University Hospital; 12 at Cavan General Hospital; 28 at Mid-Western Regional Hospital in Limerick; 30 at Our Lady of Lourdes Hospital, Drogheda; ten at South Tipperary General Hospital; seven at Waterford Regional Hospital; 11 at Mercy University Hospital, Cork; and 13 at Cork University Hospital. Similarly, figures that were issued yesterday indicate the budgetary difficulties that are being experienced in our hospitals. The extent of the trolley problem is a feature of hospitals throughout the country. It is not something that can be attributed to particular difficulties in one or two hospitals. It is a systems problem throughout the country.

The budgetary problem in hospitals throughout the country is also a systems problem. It is not a question of rogue management or inexperienced management in one or two hospitals. Every hospital in the country has a significant over-run. I will give some of the figures. Budgets have been exceeded by more than €2 million at Waterford Regional Hospital; €2.5 million at St. Luke's Hospital, Kilkenny; €3.1 million at Wexford General Hospital; €3.2 million at South Tipperary General Hospital; €12.3 million at Cork University Hospital; €790,000 at Mallow General Hospital; €2.5 million at Kerry General Hospital; €2.4 million at Mercy University Hospital, Cork; €7.4 million at Sligo General Hospital; €8.05 million at Letterkenny General Hospital; €6.4 million at Mayo General Hospital; €1.3 million at St. John's Hospital, Limerick; €19.1 million at Mid-Western Regional Hospital in Limerick; €6.7 million at Portiuncula Hospital; and €23 million at the Galway hospital group. On and on it goes throughout the country. As I have said, these difficulties indicate that there is a systems-based crisis. It is not something that can be solved by dealing with one, two or three hospitals. It is clear that this country's health services are significantly under-funded. These chronic difficulties need to be addressed urgently and immediately on the basis of the public funding of a public health system.

The question of waiting lists is another issue that indicates this is a systems problem. The difficulty relates to how we provide the system. There is no vision of how the system should be provided. It is clear that outpatient waiting lists are absolutely huge at present. Approximately 385,000 people are on outpatient waiting lists. That represents an increase of 20,000 on last month. More than 115,000 people have been waiting for more than 12 months for appointments. Some 185,000 people have been waiting for longer than six months. Approximately 11,000 patients have been on waiting lists for more than four years. This crisis has been driven by a lack of vision. The State has failed to deal with this difficulty by providing a public system that is free at the point of use and based on medical need. The problem is that our two-tier system does not provide for access to services on the basis of medical need. Under the system that is in place, medical services can be bought, in effect, and private medicine takes precedence over medical need in many cases.

The funding of the system is a core issue. I believe we should have a public system that is funded by the State. I know it will be said that it is not possible to provide for such a system in the current circumstances. As I have said previously, where there is a will there is a way. A small but significant number of people in this country - approximately 5% of the population - are very wealthy and have significant assets and income. They have increased their assets and their income over the course of this recession. It is clear from CSO figures - they are not my figures - that the assets of the 5% of people who are very wealthy increased by €46 billion in the 2009-10 period. That pattern has continued since then. The same CSO figures have also shown that the people in question have increased their incomes by 4% or 5% at a time when the rest of the population has experienced an average income reduction of approximately 18%. I believe these people have significant leeway to pay a wealth tax. The figures show that the total assets of the 5% of people in question are worth approximately €239 billion.

A modest wealth tax would bring in significant income that could be used to ensure our health services are properly funded. I know it will be said that this cannot be done without driving the people in question out of the country. The fact of the matter is that wealth taxes are accepted as a form of taxation in many European countries and many states of the United States. Such a system was introduced in this country by a previous Fine Gael-Labour Party Government. If the system introduced by the former Minister for Finance, Richie Ryan, was in place today at a modest rate, significant moneys would be available to fund a public health system in this country.

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