Alex White (Dublin South, Labour) | Oireachtas source

I do not propose to continue the battles of the past in the House tonight. I am not interested in doing so. While many Members say in their contributions that they want only to speak about the future and that Members on the opposite side want only to speak about the past, one finds that five minutes into their speeches they are speaking about the past, which is ludicrous. We cannot make any progress if that continues. However, I can banter another day about that. This is far too important an issue to do so now.

I thank Deputy Kelleher and his colleagues for raising this important matter and giving the Government the opportunity to restate its commitment - which has not been abandoned, far from it - to the introduction of a system of universal health insurance which will bring an end to the current two-tier health system which for so many years, it cannot be denied, has discriminated against patients on the grounds of income.

As stated last night by the Minister, Deputy Reilly, this Government is the first in the history of the State committed to developing a universal single tier health service which guarantees access to medical care based on need and not income. We will leave the failed policies of the past behind and introduce UHI with equal access to care for all. This has been a useful debate. I welcome some of the contributions made on all sides of the House. I do not underestimate the size of the task ahead. I have previously made clear that it would take two terms in government to achieve our aims in relation to the introduction of universal health insurance. Much has been achieved already. It is only fair that Deputies opposite would acknowledge this. For example, through the efforts of the Special Delivery Unit, SDU in my Department, working with hospitals and clinicians, we are successfully tackling problems associated with delays in accessing care. These are real achievements and substantial improvements that should be acknowledged.

As Minister of State with responsibility for primary care, I want to see progress continue to be made in building capacity in primary care and in chronic disease management, particularly for the management of diabetes. Only today the Health Service Executive announced the appointment of 17 clinical nurse specialists who, as part of their role, will support health care professionals providing care for diabetes patients in primary and secondary care settings. Currently 1.8 million individuals in the State hold medical cards, the highest number in our history. The Bill to allow for the extension of free GP care to persons with prescribed illness will be published this year. It is not unreasonable for Deputy Kelleher to raise the issue of the pace of change. We all want to see change happen quickly. I have been Minister of State for almost six months now. I too am often frustrated at how long it takes for particular changes to imbed in the system. However, change is occurring. As acknowledged last night by Deputy McConalogue change takes time, particularly change in the health services.

I would like to address the issue of risk equalisation, which is the meat of this debate. As Deputies will be aware the Health Insurance (Amendment) Act 2012 has provided for the introduction, for the first time in this country, of a permanent risk equalisation scheme, RES, with effect from 1 January 2013. I recall that legislation was strongly supported on all sides of this House, although some Members opposite appear now to be criticising it. The new scheme will play an essential role in maintaining stability in the private health insurance market. As outlined last night by the Minister, with effect from end March 2013, support levels under risk equalisation will increase substantially over 2012 levels for higher risk groups, particularly men aged 70 and above. This will further reduce the incentives which insurers have to select younger and healthier customers at the expense of older and less healthy customers. It will help to ensure to a significant extent that private health insurance remains affordable for older and less healthy people. I regard risk equalisation as an indispensable element of the necessary reforms of our system.

Deputy Kelleher raised the issue of the pace of change. The recurring theme of the speeches made by Members opposite has been the number of young policy holders leaving the system. I acknowledge this is a problem. I do not seek to suggest that is not an issue. Members opposite have described the problem. The challenge is to come up with solutions. Seeking to undermine the risk equalisation scheme will not form part of any realistic solution. For example, a deferral, as advocated for in the Fianna Fáil motion, of the increase in the health levy, which is scheduled for end March 2013, would manifestly undermine the risk equalisation scheme and would take from it. It would add to the problems rather than reduce them. It may be attractive on the face of it to suggest children should be removed from liability to the levy. Three to five of the proposals in Fianna Fáil's motion would, I respectively suggest, rather than help the situation undermine the risk equalisation scheme and levy system crucial to it. I can do just as well as Deputy Kelleher in describing the problem. There can be no doubt in anybody's mind - Deputy Dooley will have to acknowledge this - that the reduction in the number of people who hold or have reduced their insurance cover is manifestly linked to the reduction in people's living standards owing to the economic and financial collapse here and the increase in the number of people unemployed and the affect this has had on families. In terms of everybody being honest with each other, it appears strange to me that the Opposition would not acknowledge this is a factor.

Deputies opposite say we need a solution and to look to the future and address this issue in the long term. I agree with them. I call on everybody in this House, particularly those who have taken an interest in this issue, to contribute to the debate on what universal health insurance should look like. I do not regard as a settled issue precisely how it will manifest itself or be implemented. I ask Members opposite to contribute to the debate on the way forward. Wisdom does not reside on one particular side of the House or with Government alone. I would welcome a good, strong and healthy debate on these issues.

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