Mick Wallace (Wexford, Independent) | Oireachtas source

I accept that Fine Gael has more of an appetite for the private sector than for the public sector. I am not completely anti-private sector myself. I have done plenty of business in the private sector. However, the State sector does not have to be inefficient. In the area in which I worked, I saw many problems with what was being done in areas of the State sector but the problems were fixable. Similarly, it is possible to have a positive health system that is completely controlled by the State. Perhaps the Minister thinks that is impossible but I do not. If we leave matters in the hands of private companies, as is the case in Holland, we will be at their mercy. Private companies have a legal obligation to maximise profits for their shareholders. I do not think it is the perfect model or the one for which we should aim.

The Government knows that its current strategy for achieving its policy goals is failing. This is why we still have not been given a clear statement of how universal health insurance will be financed and why we continue to await the mythical White Paper on universal health care announced two years ago. Deputy Ó Caoláin claimed that the first page of the White Paper has not yet been written. I hope that is not the case because I am looking forward to reading it. I have no doubt it is a challenging policy area but I will welcome the policy if it comes to fruition.

Slashing the health budget on the one hand and introducing a universal health care system on the other will be difficult to reconcile. With the number of advisors the Government has on hand, surely one of them could have told the Minister what is obvious to a six year old child. It is bordering on fanciful for the Government to continue to pretend to the Irish electorate that it will introduce universal health care when its actions are actually working against such a system. If the recent report in the Sunday Business Post on the Government's spin on the budget is to be believed, such delusion and deception are hardly surprising. Why has the HSE stated that the cut to the health budget is €1 billion when the Government is claiming it is €666 million? Was this part of a general public relations strategy, whereby people in Ireland were told one thing about budget adjustments and people outside of Ireland another? God knows, people outside of Ireland have a considerable interest in our budgets nowadays. Whatever the answer, the cuts to spending on public health have serious immediate and long-term consequences. The aforementioned report notes that Ireland has low numbers of doctors when compared to other OECD countries and, along with four other countries, has the lowest number of obstetricians and gynaecologists per 100,000 women in the OECD. In the wake of the Savita Halappanavar tragedy and the several reports that were prepared on her death, we now know that Ireland's low numbers of maternity staff are a significant factor in the risks to women's lives and well-being. Ireland has 30% fewer maternity staff than internationally recommended. The director of the National Maternity Hospital, Dr. Peter Boylan, has stated that his requests for more consultants have repeatedly been turned down. Have we learnt nothing in recent months? How many more lives are this Government willing to risk in the name of fiscal adjustments and austerity, which are bringing an already stretched system to the brink?

Major issues arise with the Government's professed policy goals. Even if it could live up to its wonderful pronouncements on universal health care, there are serious questions about whether the model being pursued is the best or most suitable for Ireland. Several commentators have noted that Ireland is simply too small for a competitive health insurance market, and have pointed to the flaws in the Dutch system. The Netherlands introduced a universal health insurance system in 2006, the rationale being that competition among insurance companies would drive down spending, provide choice for consumers and improve quality of health care. It is not hard to see why these basic assumptions of a regulated but essentially market driven system should appeal to the current Government. However, the universal health insurance system introduced in the Netherlands has not to delivered any of the predicted benefits. Four insurance conglomerates control 90% of the Dutch health insurance market and costs have inflated massively, with Dutch families experiencing cost increases of 41% within four years of the system's introduction and government spending on health increasing by 5% annually. Given health insurers' drive for profitability, there have also been significant increases in spending associated with regulation. The tax office alone has had to hire 600 new staff to administer just one aspect of the new insurance system. So much for choice and efficiency.

In general, the health market is not like any other market, such as the hotel or retail market. Market based health care systems are not efficient because private health insurers are in the business of making money. In the US, the country with the highest levels on spending on health care even though large swathes of the population are excluded from health insurance coverage, unnecessary costs are integral to the system because they make profits for private health providers. Unnecessary treatments and tests are prescribed and medically unnecessary procedures are recommended to increase profitability rather than the well being of patients. The inefficiency of market based systems is borne out by the World Health Organisation's assessment of the US as among the worst health care systems in developed countries in terms of death rates and reductions in suffering.

Fine Gael's free market ideology is dominating the future of the Irish health system. Ironically, this means that its own policy goal of introducing a system of universal health insurance is being undermined by its adherence to neoliberal principles. Market based, universal health insurance has been discredited in the Netherlands and it is time we woke up to the need for a single not-for-profit health provider that will allow people to avail of a system that is patient centred, accessible and equitable.

I have a friend, Molly Waters, who cared for my children when they were small and is a year younger than my mother. She needs a hip operation but she will have to wait a year before she can get one. She is in a wheelchair and her children want to expedite the operation because a year is a long time for a woman of her age to wait. God knows how long she might have left to live. The operation would cost €12,000 through the private sector but she will have to wait a year for public treatment. I do not know how the system works in other countries but I am sure the Minister will agree it should not be this way. It is unfair on this woman.

See this speech in context