Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

Amendment No. 2 in my name reads:

To delete all words after "calls on the Government to" and substitute the following:"- in the interim, ensure the proper working of the system of risk equalisation to support the community rating principle, entailing the transfer of compensation from insurers who carry lighter risk burdens to those who carry heavier risk burdens, preventing unregulated market discrimination against the old and the sick or any other group or individual that insurance companies may decide are a greater risk;

- take measures to improve access to healthcare for all who need it;

- abandon its plan to base the health system on the discredited model of competing private health insurance companies;

- adopt a new approach based on universal access to equitable and efficient public health services based on medical need alone, funded from fair general taxation."

The focus of the Fianna Fáil motion is on health insurance. It should, in my view, be on health care and how we fund our health care system.

The first part of the motion describes the situation as it is and is not objectionable. The second part is not acceptable to me and my colleagues in Sinn Féin. It supports the maintenance of the current two-tier, public-private system that is at the root of the crisis in our health services. This is not surprising. More than any other party, Fianna Fáil is the architect of the grossly inequitable two-tier system that has afflicted the delivery of health care in this State for decades. A former Fianna Fáil health Minister said that the two-tier system had served us well. At least he acknowledged it was a two-tier system but his successors pretended that health care apartheid did not exist.

We saw the private health care system piggy-backing on the public system at huge cost to the State, the taxpayer and, above all, at the expense of the public health system. Citizens were paying for health through taxes, through charges and, in many cases, through health insurance premiums. That situation still maintains.

When in office, during the Celtic tiger period, Fianna Fáil, under health Ministers Deputy Micheál Martin, former Deputy Brian Cowen and former Deputy Mary Harney, boosted the private for-profit health sector as never before. Property-based tax breaks enriched the privateers. Private health insurance was encouraged. The failure to properly reform and resource front-line health care services - as distinct from the HSE bureaucracy - led many citizens to conclude that private health insurance was the only guarantee of decent health care. All of this has, of course, been followed by the inevitable collapse.

There has been a massive decline in the number of people with private health insurance. In 2008, there were 2.3 million people with private health insurance. In 2012, that has dropped to 2.1 million, while the cost of premiums is rising. People who have dispensed with insurance because they can no longer afford it are now totally dependent on the public health system which is under attack from this Government's failed austerity strategy.

The State continues to heavily subsidise the private for-profit health system with private beds in public hospitals, a fast-track to care for private patients while public waiting lists grow, and the dual working of hospital consultants in the public and private sectors continuing apace. As I said in the debate on the Health Insurance (Amendment) Bill 2012, that legislation is supposed to be a protection against the working out of the raw profit motive in the health insurance sector. It is supposed to be based on solidarity between generations and between the healthy and the sick. That is welcome, in so far as it goes but we in Sinn Féin would go much further, extending the principle of solidarity to the way we fund, organise, structure and manage our entire health care system.

The Health Insurance (Amendment) Bill 2012 is based on the recognition that there has to be social solidarity within the insurance sector, that the market has to be regulated to prevent price discrimination against the old and the sick. Given this, normal commercial competition cannot exist, otherwise we would have a US-style law of the jungle where the young and the fit would benefit from cut-price health insurance and the old and the ill would be fleeced or driven out altogether. Instead, the principle of social solidarity is recognised. That is a very welcome position from which to start. Why not then take the next step and extend social solidarity across the entire health care system? That is my appeal to the Minister.

If one takes that solidarity to its logical conclusion then one moves to a system of universal provision of health care based on need, and need alone, and not on ability to pay. The question then is how to pay for such a system. Contrary to the frequent assertions of the Minister and others, we in Sinn Féin recognise that health care is hugely expensive and has to be paid for. The question is how to pay for it in a way that ensures the best possible health care for all who need it, and which does so with the best achievable value for money.

The Government is proposing to bring in universal health insurance with the State subsidising those who cannot afford to pay insurance premiums. The State will still have a huge regulatory, managerial and funding role. Why then give private for-profit insurance companies such a central place in the system? What contribution will they make? They are funded by consumers who buy their products. The insurance companies, on behalf of policy-holders, will buy services from private or public hospitals, or other service providers. They will have to make a substantial profit in the process. Their shareholders will expect it and demand it. Why not cut out that profit for the privateers and keep the money in the health system and in the pockets of our citizens?

The only possible reason for not keeping out the profiteers is not a health care reason but a commercial reason. In going for the privatised insurance model, albeit including a slimmed-down VHI in the mix, the Government is putting business before health. For citizens the bottom line is that when they need health care, they need it promptly and need the best care possible. Everyone is exactly the same in that regard. This is the reason Sinn Féin advocates universal health care based on equal access for all. We want that to be State-provided, funded from fair general taxation and free at the point of delivery. This would involve a higher contribution in tax from the highest earners than they contribute at present. Sinn Féin does not favour the model of insurance-based funding for the reasons I have outlined. If health insurance is to be the basis for funding, then it should be a State insurance scheme. The Labour Party once claimed to be in favour of this but their former policy has been suppressed in favour of Fine Gael's stance on this matter. The least desirable model, as far as Sinn Féin is concerned, is an insurance system based on competing private health insurance companies. In that case, the profit motive and the interests of shareholders become paramount, rather than public health. This is the Fine Gael model and it won out clearly in the negotiations on the programme for Government.

I have referred this to the Minister previously but on 8 November 2012, the trade union IMPACT published an important paper entitled, The Future of Healthcare in Ireland. I make no apologies for again putting on the record its observations on the Government's plans:

The Government’s model of competing private sector insurers has not been properly tested. Delays in its implementation suggest that Government plans for UHI have been poorly thought out. If implemented, the model is unlikely to deliver equity, value for money, quality or universal access. Quite the opposite: lessons from the Netherlands show that a profit-driven commercial model led to an inequitable and inefficient system of funding, different tiers of entitlement, rising hospital deficits, and even bankrupt hospitals.

That is a very different view of the Dutch system to the glowing reviews of the Minister and Fine Gael. The IMPACT paper recommends examination of what it calls a single payer social insurance model along the lines of France, Germany and the Nordic countries.

See this speech in context