Mattie McGrath (Tipperary South, Independent) | Oireachtas source

I welcome the opportunity to speak to the Health Insurance (Amendment) Bill 2012. The programme for Government commits to providing a system of universal health insurance. I recognise that the Government has to get through a full list of legislation, but I am concerned that we are down to the wire on health insurance, given that the current interim scheme expires on 31 December. Rushed legislation is often bad legislation. Clearly, there is a huge crisis for the private health insurance market and it is deepening by the day, if not the hour. I first started thinking about health insurance when I got married in 1984 and then started my family and established a business. When the health insurance products first came on the market, I welcomed them with open arms. I do not dismiss those who cannot afford private health insurance, but there is some comfort to be gained from having it. However, the issue has been abused and hijacked during the years.

A situation existed across the insurance industry where spurious claims were made. I remember RTE had very good advertisements on this describing how when John had an accident and decided to claim he was putting his hand in our pockets. Many people have their hands in pockets with regard to costs, not in a sly way but in an up-front way. I remember being in Shanakiel hospital about 15 years ago for a number of days. I was quite sick, but believed I was covered by VHI. However, on the morning I was leaving, having recovered and lived to tell the tale, the sister came in and slipped a white envelope under my plate. I thank all the medics who were involved in my care, who were tremendous people. I am aware medical professionals are bound by the Hippocratic oath and I sympathise with the medical staff in the hospital in Galway involved in the recent very sad case, but I obviously await the outcome of the independent investigation that will take place. In the main, 99.999% of people in the medical area, doctors, nurses and so on, are in health care because it is their vocation and passion and they want to do good. However, mistakes will happen.

When I opened the envelope, I was quite taken aback to find a bill for £600. The reason I got the bill was that I had to go to Cork University Hospital for a special test. I could have walked over, because the distance was only from here to Grafton Street. The walk would have been good for me and would have helped reduce my blood pressure before going for the test. However, a private ambulance was hired to take me over. I could not have walked back because I was comatose, after an anaesthetic. However, the bill for that came to £600, absolute daylight robbery. Some £100 would have been a big sum at that time.

The problem is we use and abuse the scheme and there are no checks on it. I do not blame the current Minister for this or the Minister of State present. When the scheme was set up first we were all delighted with it. It seemed like progress and many good causes were championed. However, people get used to a scheme and it gets hijacked. Far too many people get on its back and start pulling and drawing off it, but nobody watches what is happening or sets up checks on it. There is a chronology to this, since the establishment of health insurance and the VHI in 1957. A liberalised market was promised in 1992 when the third life directive, thankfully, forced competition in the area of private health insurance. We blame Europe for many things, but some of its directives have been good. However, things can go wrong depending on how we implement them, fail to implement them or use them to suit ourselves and different vested interests.

The Health Insurance Act 1994 made provision for the establishment of the Health Insurance Authority, HIA, but the body was not brought into existence until 1 February 2001, a long time later. Why did it take this long? The 1994 Act was amended by the Health Insurance (Amendment) Act 2001, providing for, among other things, an enhanced role for the HIA, with more responsibility than envisaged under the 1994 Act. I welcomed that. The HIA is funded by a levy imposed on private medical insurers, but obviously this, like everything, is passed down to the punters. Premiums were to be independent of the State. The role of the HIA includes acting as a registrar of medical insurers and undertakings and vetting new market entrants. It is also involved in consumer protection and provision of information and also provides advice on matters of medical insurance to the Minister for Health. The HIA receives returns from medical insurers every six months and on that basis makes recommendations to the Minister regarding risk equalisation.

One would wonder, considering the massive increases that have applied over the past 18 to 20 months, whether the HIA has been disbanded. Does it still exist or is it one of these quangos that is just there to rubber stamp things? What has gone wrong? Where is it and why is it not acting on behalf of the hard pressed people of Ireland, ordinary people who got mortgages and jobs and started families and decided to pay for health insurance? Now these people find themselves without jobs, unable to pay their mortgages and unable to pay ever higher premiums. In some cases premiums have increased by 100%. It is daylight robbery.

I do not understand why insurers cannot see that these increases are creating an even bigger mess. The drop-out rate from health insurance is enormous. I do not have the figures to hand, but I know the drop-out rate is significant. I know what is happening from seeing what is happening with my own health insurance. I am a parent of eight children and naturally I expect my insurance to be expensive. I moved from VHI to Aviva, but have found that the goalposts keep changing. Now, we find if we go for a procedure we are covered for very little. We are covered to get in the door. The health insurance industry could be compared to the people on Grafton Street with billboards, coaxing customers into their premises. However, once customers go in, they are fleeced.

We do not have the health care we should have. I will not use the words I would like to use to describe the situation, but it is disgraceful. It is not fair, equitable or sustainable. What is happening is that pressure is being piled on our already overcrowded public hospitals because people cannot afford health insurance they could afford previously. They get a huge shock then when they have to wait on the public system where there is huge pressure and the Minister is fighting a battle to ensure services are maintained. When in opposition, he promised that if Minister he would eliminate the need for people to wait on trolleys, but that cannot be done. Situations occur every day in hospitals which give rise to the need for the use of trolleys. However, the Minister claimed he would be the messiah in this regard and would rid all hospitals of the need for trolleys. However, while wards are being closed in hospitals because of the financial situation and the cutbacks, we are bound to have trolleys. A trolley free hospital is not achievable.

When Barry Desmond was a Minister 25 or 30 years ago, before I was ever in politics, he was fighting this battle. I look at the situation this way. If a farmer wants a vet at 2 a.m., 3 a.m. or 5 a.m, he can get a vet within half an hour. However, despite the CareDoc system and everything else, it is very hard to get access to a medical practitioner at those times. One could get three vets if one wanted in the middle of the night. They are there. They work hard and provide their own laboratories and everything else. Any child over four or five can tell a doctor what is wrong or where he or she has a pain, but an animal cannot speak. Therefore, vets must be better at making a diagnosis. They have no help.

The point I am making here concerns consultants. I met some consultants here last week when they were fighting the cause of the south-east regional hospital and I support the work they do. However, I believe they should have their own facilities to treat private patients. It is a no-brainer. They are able to charge enormous fees. They do great work, but why should the public be disenfranchised and have to wait. If consultants want to carry out private work, let them go to the Beacon or other clinics. That is the choice they should have to make. That is business and the way things are done. Why should the State carry them? Why should the State provide those services? Why should the State provide for them to have a public clinic for just a few hours and then allow them use the facilities for a private clinic? That is not right. I recognised what Barry Desmond was trying to do and supported him. He is a long time gone from this House, but his party should continue in that vein. The party to which I belonged did not and the Minister with whom I had to deal in the previous Government, Mary Harney, did not. She was all for privatisation, the more the better. He who pays the piper calls the tune. However, let them do it in private hospitals.

I am very concerned by this Bill. The deadline is too short and we seem to be rushing into this. Why are those drafting the legislation and advisers not dealing with this situation? We can blame the Minister, but he can only do so much. However, there are layers of bureaucrats involved. Why are they not dealing with this? Why does all legislation have to go on and on? The previous Government failed to grapple with and deal with these issues on several occasions. I admit this happened when I was a member of the Government party. However, I argued constantly with the Minister at the time, Mary Harney, about her ideals with regard to private health care. I wrote to the then Taoiseach when the Progressive Democrats disbanded, asking him to remove Mary Harney from the Department of Health, because of the lack of accountability. She had no party to answer to. She came to our party rooms to answer questions a few times, but we got no answers.

I am not saying I have all the right on my side. However, the situation must be dealt with. We can discuss risk equalisation and age etc., but Deputy Durkan was right.

I know other Deputies who spoke after him said he was wrong. They did not agree that one should be able to build up and use a no claims bonus. That is fine, but I think people should get some recognition for paying their premiums regardless of what they are charged. When these companies increase their prices, their customers have no say in the matter. They have to pay when they receive their bills. Some people have to take out loans to do so. It is gone over the top. Many people cannot pay. If the economy had stayed going the way it was - we all knew it could not - people would find it hard to pay these increased charges. Do the insurance companies and the people who are billing the insurance companies think that people will keep paying as they continue to increase these immoral charges, percentage point by percentage point?

It is not rocket science to suggest that this approach, like the austerity approach, is not working. We saw all the trouble all over Europe yesterday. I do not advocate any kind of activity like that. Thankfully, we did not have any in this country. This is austerity in the other way. There is another word for it, but it is not coming to me at the moment. As far as I am concerned, it is a question of milking the system. We cannot continue to pay it. As I have said, the pressure is going back on the public hospital system.

I spoke about the need for fairness in the system when Deputy Ó Caoláin and I raised a matter on Topical Issues in the House last week. I understand that Deputies from the Waterford area raised a similar matter this week. The Minister of State, Deputy Kathleen Lynch, who had many backers when she came into office, has been trying to regionalise services and put services out into the community. I was opposed to it, but I have to say it seems to be working fairly well so far. I will never say that I have all the answers, or that I am not open to change. I am open to change.

The people of my local area, led by consultants at South Tipperary General Hospital including Dr. Peter Murchan, Dr. Paud O'Regan and my late brother, Dr. Eddie McGrath, bought into the mantra that was being trotted out, which was that cancer services should be provided at eight regional centres of excellence throughout the country. Even though it is not possible to get to Waterford from many parts of my constituency within the golden hour, we accepted the new approach and put our shoulders to the wheel. As politicians, my colleagues on all sides and I had to sell this change to the people. As Deputy Coffey said, everything was working well and certain services were being returned to the smaller hospitals, for some reason. I compliment the Deputy, who mentioned the hospitals in the south east - Waterford Regional Hospital, which we knew as Ardkeen; South Tipperary General Hospital, which we knew at St. Joseph's; Wexford General Hospital; St. Luke’s Hospital in Kilkenny and Kilcreene Hospital.

Everyone in the region has been working together on this package. We have the magical figure that is required for a centre of excellence. We have the population of 500,000 that is needed to ensure there is enough throughput to make such a centre viable. When HIQA was created - it is a bit of a monster as far as I am concerned - it watched us to make sure we had what was needed. Something funny is going on now. I do not like it. I suspect it was going on during the term in office of the last Government. Certain authorities in Kilkenny, who have the ear of the Minister and of certain consultants, have decided they want to go to Dublin. One can travel between the two cities in an hour on the new motorway because it is a good road. The approach that is being taken is depleting the cohesion that existed in the south east when all medics and consultants were buying into it. We need to maintain that cohesion.

We do not know what will happen next. We might be told we will have to go to Cork. We are waiting to see the report of Professor Higgins. There is nothing worse than a report that is being leaked when we do not have it in front of us. I have no axe to grind with Professor Higgins. I do not know the man at all. I am just saying that we are undermining ourselves. Certain people in Kilkenny have gone off and done a solo run. I suspect that my friend, big Phil - the Minister, Deputy Hogan - is not far away from the shenanigans that are going on. Those involved are undermining the credibility and sustainability of the ideology we bought into and on the basis of which substantial investment was made. While I suspect that the Minister is involved, he can answer for himself. I heard that his answers were not too helpful when he was interviewed on local radio yesterday. I am concerned that certain interests are diminishing the cohesion that has existed before now.

When I spoke on Topical Issues last week, I mentioned that there is a population of 1.2 million in Dublin. I do not know exactly how many major hospitals there are in Dublin - I have not gone around to count them - but I have been told there are nine or ten. There is a population of 500,000 in the south-east region, which covers counties Carlow, Kilkenny, Waterford, south Tipperary and Wexford. We have found out that loads of patients from the Thurles area, who used to be catered for in Limerick, have been moved into the south-east region because the Mid-Western Regional Hospital cannot cope. The leak is coming in. People from parts of east Cork who are just 20 minutes from Cork University Hospital are also going to Waterford Regional Hospital to be treated and looked after. Something is very wrong if that is happening. Something is rotten in the state of Denmark.

I have observed what has been done with the system in various parts of the country, including the Monaghan-Cavan area - my wife is from County Monaghan - and Sligo. There were some terribly heated debates and protests etc. We cannot buy into the system if the goalposts keep moving. As I said, the Bill before the House is moving them further. I accept that it is an attempt to straighten the goalposts and keep them visible. However, it will not affect the mighty fat cats who took a Supreme Court challenge when the then Government acted in a similar manner in 2004. These people have the power, money and resources and the little people of Ireland do not matter anymore.

It is time we started to listen to ordinary people again. We heard what they told us last Saturday. Every other Deputy in the House and most of the people in the system were saying "Yes", but the people sent a message telling them they did not trust them. I did not go out canvassing or knocking on doors. I did not intend to do any public engagements on the matter. I took a family decision. The people out there are watching us. They are not happy with us. Governance seems to have become the preserve of the elite. The ordinary people who want these services are as entitled as anyone else under the Constitution to receive them. If we cannot ensure every citizen enjoys a meaningful modicum of respect, what did Connolly and Pearse - I do not need to mention the rest of them - die for? We need to deal with everyone equally and fairly.

We have to listen to what the Royal College of Surgeons, which is an eminent body, has to say in this present case. Who else would we listen to? Those involved in the college are the experts in the field. They have expressed their support for the situation in Ardkeen and throughout the south-east region. We must be left alone. We cannot have Ministers or anybody else doing solo runs and undermining the credibility, sustainability and good work of these consultants. Some of them will throw away the tools of the trade and retire because they will not be willing to put up with what is being done. They have families and lives of their own. They have to know what the future holds for them. Above all, they have to serve a population of 500,000 so they have the proper throughput that is demanded by HIQA and every other body.

Ministers can make statements and take actions, but the mighty HIQA often follows them like a hoover. Everybody shivers when this powerful body gets involved. When it decides to visit a small community hospital that is trying to keep going, it sends out a bill of €3,500 for its services. I am all for the standards that are needed in health care, but it is not all about badges, tags, folders, proper entrances and exits and everything else. Health care must be the most important thing. Where are the representatives of HIQA between 2 a.m. and 4 a.m., when 20 or 30 patients are to be found on trolleys? They are not resting because one could not rest on narrow and small trolleys. It is indecent, immoral and wrong. We have to go back to the drawing board. We have to be cognisant of the people we are supposed to serve in here. We should not be serving ourselves. We have to be honest with ourselves.

I conclude by wishing the Minister and the Minister of State well with this legislation. We have to examine the dots and commas. We will need to be strong and careful. We should make haste slowly. We should not allow ourselves to be boxed into a corner just because this is expiring in 2012. There is a limited number of days left in 2012. When one is pushed into a corner and forced to make rushed decisions, it is a bad business.

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