Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The Fianna Fáil Party opposes this Bill for a number of reasons. It is clear from a cursory perusal of the programme for Government that it makes no reference to the measures being taken in the legislation. The proposals before run contrary to many of the claims and policies outlined in the programme for Government. While the Minister frequently states he has received a mandate to implement his policies, none of the policies proposed in the Bill was ever presented to the electorate. The Minister does not have a mandate to increase charges to fund the health services.

When one drills down into the proposals, they will clearly have serious knock-on effects for the insurance industry. Deputies deal daily with families in crisis who must decide whether to keep their health insurance policy or downgrade their cover. This legislation will drive even greater numbers of people out of the private health insurance system. This runs contrary to the Minister's policy of trying to introduce universal health insurance. He wants to introduce a single tier of health care in which access is based on need rather than ability to pay. The problem is that the number of people who will be unable to meet the costs of their private health cover is set to increase, with the result that more people will move into the public hospital system. The Minister's proposal is effectively another tax on hard-pressed families. He may wish to dress it up as something else but he cannot camouflage it.

The number of people who have dropped out of private health insurance demonstrates that the industry is in crisis. The Minister spoke of having a dynamic health insurance market to underpin his proposed system of universal health insurance. The opposite is the case and the market continues to contract. We have debated previously the reasons it is shrinking. What is certain is that if Government policies exacerbate the difficulties being experienced by families through increases in premiums, the corollary will be increasing numbers of people presenting at public hospitals. All the provisions in the Bill contradict statements the Minister made prior to 2011 and commitments the Government gave in the programme for Government.

On the increase in asset limits under the fair deal scheme, my party understands the pressure on the State as it seeks to provide services for older people. The changing demographic profile and the fact that people are living longer and healthier lives are placing a strain on services, including the provision of long-stay places. The Government has reduced home help hours and home care packages, failed to increase the number of public health nurses working in communities and is rolling out primary care services at a slow pace. This contradicts everything the Minister says.

Approximately 22,000 places are being funded under the fair deal scheme, which makes long-term residential support affordable to families. Given the need to fund the scheme, one can argue about the need to increase the asset contribution from 5% to 7.5%. However, when a measure is taken for the right reason and will have an appropriate outcome, my party will not oppose it for the sake of opposition. On the broader issue of how we fund services for older people and do everything possible to provides services and supports to help them maintain their independence, the Minister is stripping away home help services, home care packages, public health nurses and primary care and community services. At the same time, he speaks of pursuing a policy of trying to keep as many people as possible living at home independently and with dignity for as long as possible. This policy has been articulated in the fair deal review and everything that flows from it. The policies set out in the legislation contradict the objectives the Minister has set out in his broader policy statements. This is a cause of serious concern.

To return to the charge that will be levied on private patients in public hospital beds, the proportion of private beds in public hospitals was limited to 20% in an agreement thrashed out many years ago because the State was unable to make direct payments to consultants. Citizens fund the health service through general taxation but Government policy is inflating the cost of private health cover. The Government is telling those who hold private health insurance that they will be charged a second time if they go to hospital. This policy is anything but equitable.

The Minister's stated objective is to encourage as many people as possible to take out private health insurance in order that we have a vibrant health insurance market and an economic model to underpin universal health insurance. He should discourage shrinkage of the private health insurance market. Last September, when introducing other legislation, the Minister made a commitment to exempt lower levels of insurance cover from the higher health insurance levy. This has not been done. The measures being introduced incrementally feed into a price spiral. The figures are stark and show a shrinking market in which insurers are imposing the additional costs on customers, many of whom are deciding to abandon or reduce their cover and enter the public health system. This is not sustainable in the short or medium term because if, as the Minister wishes, we adopt the universal health insurance model, more people must take out health insurance cover.

It is clear from the demographic profile of those who hold private health insurance that younger people are not joining the system and are not being encouraged or incentivised to do so. The policies being implemented by the Minister undermine the basic principle of intergenerational solidarity and the need to create a sustainable health insurance market which will fund services and alleviate the burden on public hospitals.

The Minister said that public hospitals provide a direct subsidy of €200 million to the private health insurance market. The Minister argued that is a subsidy to private health insurance companies.

The difficulty is that it is not. It is and will be a charge on citizens with private health insurance who are doing their best to try to reduce the burden on the State in providing health cover for themselves and their families. In his press release after this was announced in the budget, the Minister outlined his reasons for it. That press release in December acknowledged that it would lead to an increase in premiums. Throughout this year he has said it would not have a major impact on premiums. Of course it will have a major impact. Every independent assessment of the health insurance market shows it will have a major impact on families. It will also have a major impact on the private health care providers.

The Minister has spoken about establishing hospital trusts and hospital groups which will tender against each other for work from the private health insurance companies in the provision of care. Equally, private hospitals have a capacity that is very beneficial to the broader health system. With this legislation the Minister will undermine their ability to continue to function thereby shrinking the capacity of the provision of health care. There is no point in camouflaging it in any other way. This is simply about taking money from people who have already paid private health insurance to fund the public health system and is effectively a double taxation on people. To state that the private health insurers are being subsidised is deeply disingenuous. The premium holders will end up paying more. Mr. Colm McCarthy, Dr. Brian Turner and many other independent experts who have analysed the insurance market have major concerns about this issue.

The fundamental problem we have is that the Minister has in his mind a universal health insurance model. He has spoken with passion about the Dutch model, but that seems to have faded to a certain extent. We are still awaiting the White Paper on universal health insurance. We are now in the third year of this Government. If we are to go down the route of changing fundamentally how we fund our health system one would have expected that two and a half years into Government the Minister would have at least the principle and some detail as to how it is intended to fund the health system. I have asked the Minister this on numerous occasions and he claims it is very simple and that we will have private health insurance companies, people will take out private health care if they can afford it and the State will take it out on behalf of those who cannot afford it.

If it is that simple why has the country been waiting for two and a half years for the White Paper, especially given that the detail of the policy was in the Fine Gael's general election manifesto - the Dutch model, which was supposed to resolve many of our difficulties? The people gave the parties in Government a mandate and one would think they would have acted on it and that a White Paper on universal health insurance would have been published to allow us to give an input in scrutinising it and proposing ideas. However, we continue to wait. In the meantime the Minister is proceeding with hospital groupings, hospital trusts and all that is to flow from the universal health insurance model without us having any detail of how we will fund a sustainable health care system here.

Fundamentally this comes back to how the State will fund health care that is fair, equitable and accessible to all. I do not believe the Minister's proposals on universal health insurance will do that and the steps he has taken to date have done anything but that. They have driven more people out of private health insurance into public hospitals that are already under huge pressure given the numbers for which they must cater and the resources available to them. In one fell swoop the Minister has done the exact opposite of what is needed to sustain his model of health insurance.

At no point in the programme for Government does it state that the Government would publish a health amendment Bill that would require the full cost of private patients in public beds to be recouped, nor did it state that there would be increases in the various charges. Any rational person would accept that there is huge pressure on the State finances and that the health system needs to be funded in some way. However, the Minister's approach is further undermining the very principle he is trying to establish and I cannot understand why he is going headlong into it.

Even more amazingly the Minister has ignored the advice the HIA has offered to him on a continual basis. It claimed there was a need to ensure that those with lower health insurance cover would be exempt from the higher levy, but that never happened. When we discussed that legislation in the Dáil last year the Minister gave us categorical assurances that this would be the case. In February we discovered that it would not happen. That has now forced health insurance companies to downgrade the cover to get into the lower levy. Older people now find they cannot afford the health cover they had previously and are being offered packages with less cover which removes the very areas of health care they most need at that stage in their lives. That again runs contrary to everything the Minister has said about universal health care being equitable and available to everybody based on need. I cannot understand how the Minister can claim this Bill is part of Government policy based on the programme for Government. It undermines every health care provision in that programme which promised fairness and equity. That is why we will oppose the Bill.

The Minister is now pursuing a policy that will probably close some of the private health care providers. One would have assumed if the Minister's universal health insurance plan comes to fruition that they would offer competition and capacity. The Independent Hospitals Association of Ireland has stated this policy will probably result in some of these institutions going out of business thereby diminishing the capacity of overall health care provision.

We can debate the successes or otherwise of people waiting for appointments to see a consultant on an outpatient basis. The Minister claims that 330,000 is not a large number of people because more than 200,000 are seen every month. However, the Minister said that to me six months ago and we still have the same problem. It is not as if it is getting any better for many citizens. If it is not a major problem, one would have expected a reduction in the number of people waiting to see a consultant on an outpatient basis.

The Minister has claimed he is making inroads into the numbers of people awaiting procedures on an inpatient basis. The problem is that any cursory investigation shows people cannot get on the inpatient list because they cannot even see a consultant on an outpatient basis. By stealth the Minister is not allowing people to be assessed, processed and deemed to need a procedure and placed on an inpatient basis. Last year and again earlier this year the Minister told me in replies to parliamentary questions that 200,000 a month are seen by consultants and therefore that we would get on top of the issue but it has not happened as we stand here early in July 2013.

That is an area where the Minister promised a good deal but it is certainly not being delivered in accordance with his commitments.

We will consider the Bill and what the Minister is proposing on a forensic basis and we can do more of that on Committee and Report Stages. I find it remarkable that the Minister can say that he may not outsource the running of the fair deal scheme but it is a provision in the Bill. That is fine and it is something the Minister has said may or may not occur, but he is making provision for it. He has also said that he may not implement all of this if the insurers play ball, if they can find further savings within their administration and if they can negotiate prices downwards. However, the problem is that they cannot negotiate prices downwards in the public hospitals because the Department of Health and the Minister have set them in stone. We are asking the private health insurers to negotiate on a per procedure basis, to strike deals with the private health care providers and to seek deals with consultants for the provision of care. However, by the same token they are not allowed to enter into negotiations with the public hospital system. Insurers are having difficulty with this and have to operate with one hand tied behind their backs in terms of negotiating. At the same time, the Minister will charge every private patient who digs deep into his pocket to pay for private health insurance. The Minister will burden them with further costs to retain health cover. I cannot believe that the Minister is contemplating that, never mind bringing it to the floor of the Dáil and asking us to support it.

There is an increase in the daily charge for public inpatient services in acute hospitals from €75 to €80. I realise the Minister can put a cap on it from between seven and 15 days and that the maximum that can be charged in one year is €1,200. However, all these costs add up. At one time the now Minister was apoplectic with rage because there was a 50 cent charge placed on prescriptions. The Minister used to fall over himself arguing about 50 cent. He continually highlighted that this was something that would diminish people's ability to access basic medicines. However, he increased the charge. Here the Minister is increasing charges again not by 50 cent but by €5 and up to a maximum of €1,200 in a full year. All these things impact on people's ability to access health care.

The Minister has referred to health care based on need, not ability to pay. Certainly, in this legislation there is a requirement to have additional funds to afford health care in this country, even in the context of the public hospital system. The Minister is increasing the charges and there is no two ways around it. The principle the Minister is trying to enshrine is being undermined by these charges. At one time 50 cent to the Minister was an amount of money that could put people's lives at risk. That is what the Minister said. He said it would diminish their ability to access health care, but it was only 50 cent. The Minister has increased that up to a maximum of €20 per month although it was something he had proposed to abolish.

I find it difficult to accept because what the Minister says and what he does can be at complete variance. This is the case in the context of what is outlined in the programme for Government, the universal health insurance model, the White Paper to be published, the establishment of hospital trusts and hospital groups, the competition that would be created as a result and the dynamic health insurance market to underpin everything. However, now we are back having to deal with figures of people who are simply unable to sustain it.

I know the Minister's stock-in-trade answer. He will stand up and say that it is hard to take lectures from me, across the floor, because the reason people cannot afford private health insurance is because of the policies we pursued for 14 years, and I will listen to that.

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