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

He certainly did, unless the record is mistaken, but I doubt that. In 2006, the Fine Gael leader, Deputy Kenny, said he was opposed to the introduction of risk equalisation, the Government scheme that would see BUPA hand over €160 million over the following three years to its competitor, the State-owned health insurance company VHI. The leader of Fine Gael who said that is now the Taoiseach. In 2009, Deputy Reilly expressed fears that the premium levy of €160 would make private health insurance unaffordable and would result in a contraction of the market by at least 10%, or 200,000 subscribers. He said the €160 levy would also significantly increase the cost of employee benefits for companies. Deputy Reilly, now Minister for Health, said at the time: "The levy is anti-competitive and it is a means to prop up the State dominant player. VHI remains super dominant in the health insurance market." He concluded his speech in 2009 as follows.

I would not commend this Bill to the House. I oppose it vehemently and believe it is ill advised. It is anti-competitive and is driving families out of the insurance market. It will put more pressure on our already pressurised health service. On all counts it is destined to be a disaster. We will regret the measure and, in fact, many people who have had to give up their private health insurance are already regretting it.

He made this speech in 2009 when a Bill was introduced to bring in a levy of €160. The Bill today is authorising a €399 levy.

The concept of risk equalisation, community rating and intergenerational solidarity is very important. We have supported it at all times. The difficulty I have is that I am being asked to support a Bill that will further undermine the very concept of intergenerational solidarity - that is, support from younger, healthier people who are coming into the insurance market for those who are older, sicker and needing medical care. This is the dilemma and it is being exacerbated by the Minister's continuing policy of undermining the private health insurance market. We had the bizarre situation a few weeks ago during the budget where the Minister for Finance drove a coach and four through the Minister for Health's stated policy on health insurance. The Minister for Health said he had not been consulted about this, so he should ask why not. However, we might at least think that the Minister for Finance would be consistent in trying to underpin what is a central tenet of the programme for Government, which is the need for a vibrant private health insurance market to underpin universal health insurance when it is introduced in 2016 or thereafter. Instead he put a cap on tax relief of €1,000 for an adult and €500 for a child, and he described this as only affecting gold-plated health insurance policies. We all know this is simply not the case. That particular policy announcement alone will increase the cost of VHI's Family Plan Plus Level 2 and other plans that are not gold-plated but are basic private health insurance policies. It will affect hundreds of thousands of people who have private health insurance. It will force people out of the private health insurance market. Not only is the Minister for Health undermining his own policy, but the Minister for Finance is doing the same thing. We are now engaged in a farcical debate in which the Minister says one thing and then does the exact opposite. Nothing in this Bill shows me that he is committed to encouraging people to retain private health insurance, nor to attracting younger people into the private health insurance market to sustain community rating and risk equalisation.

I am not the only person out there who is saying this. Several reports have stated the same thing. The Minister referred to the death spiral. The death spiral is happening continuously, but the Minister is in the vortex of that death spiral, forcing families to give up private health insurance. Every day we hear about cases in which people must make decisions about whether to renew their health insurance or use that money to fill the tank with oil or purchase basic items for their families. That is where we are at. I will get the usual lecture from the Minister about why we are where we are and all the rest of it, but the Minister is where he is now, and his policies are forcing hundreds of thousands of people to give up private health insurance. The figures are there to underline that statement. It is not alarmist; it is a fact. Behind those statistics are families who just cannot take any more. This not a positive step when all the other policies being pursued by the Government and the Minister for Finance are shattering the very principle of risk equalisation.

Let us look at the number of people dropping out of private health insurance. In 2011 and 2012, the fall-off among those aged under 60 was 133,735. We now have a situation where the risk equalisation and community rating requirement is falling on fewer shoulders. Therefore, premiums will go up, and we will then have a further drop-off in the number of people taking out private health insurance. The Minister is making no effort to introduce proposals on lifetime rating to encourage young people into the marketplace. He has made no advances in that area, so the idea that we are going to have a utopian universal health insurance system is further from reality every day, due to the Minister's policies.

At the beginning of this debate, I asked if it would be possible to delay the introduction of the Bill in order that we could discuss the report of the Health Insurance Authority, which will be published in the middle of December. The Minister said we could not do so because the health insurance companies would have to trade in the pricing of this levy. Trading in just means trading up. Their costs are going to go up. The people who have to carry those costs will be people all over the country who are trying to forage around to keep their direct debits going or find the money to front-load one payment for the year. The Minister should know this better than anybody, because he was one of the most vociferous opponents of increases in private health insurance during his time on this side of the House. He used to be apoplectic with rage, claiming that inflationary increases in private health insurance of 3%, 6% and 7% were the straw that would break the camel's back.

The camel is in quicksand and there is much more than straw on its back. It is unsustainable and the Minister knows that as well as anybody, but the pretence continues.

The Minister has decided to charge private patients in public beds the full cost. I do not expect the public health system to cross-subsidise private health insurance companies but there must be equity. People who take out private health insurance do so for a number of reasons but they are also ensuring the State does not have to treat them. They take out health insurance to lighten the State's health care provision burden. The Minister has stated that. He has said that people who fall out of the private health insurance market end up being treated in the public health system, which is under-resourced in its ability to meet its commitments to the people who do not have private health insurance. Now the Minister is lumping more people into the public hospital system day in day out.

The Minister talks about the roll-out of primary care, treating people in the community at the point of lowest cost, outside the acute hospital setting. We all support primary care. The primary care strategy was published in 2001. The Minister said it went at snail's pace for a number of years and that there was no commitment to it. I could argue very differently. I could certainly debate the point that it is in reverse. GP services throughout the country are under great pressure and stress. In the next few months we will see surgeries amalgamating and closing and GPs having to go to other jurisdictions because they cannot sustain the level of primary care cuts. The Minister expects them to take on further demands regarding chronic illness and other diseases such as diabetes and chronic obstructive pulmonary disease, COPD, to be managed in the community setting, but he is giving them no supports. There is a pretence that the Minister is fully committed to primary care but nothing could be further from the truth. He is committed to a few primary care centres around the country.

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