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

I welcome the opportunity to speak on this issue. Obviously, our party will set out its views on this and on how we fund our health service in the years ahead. I listened to the Minister's remarks regarding universal health insurance and read The Path to Universal Healthcare, which is called a White Paper. We are a long way from seeing a White Paper on universal health insurance as this is simply a discussion document which will facilitate consultation with the public, Members of the Oireachtas, the health committee and other stakeholders. That it would be called a White Paper simply indicates that people in the Department of Health do not know the parliamentary process. A White Paper is supposed to be a body of detail that will generate legislation, and this document is a long way from that. It is, in effect, a discussion document. Nevertheless, it is available and is in the public domain, so we can now discuss it.

The Minister said that he is a republican and that every member of society should be cherished equally. We all subscribe to that. In fact, in our election literature Fianna Fáil calls itself the republican party. The word "republican" has been much maligned in Ireland over the years, but I claim to be a republican too and a member of a republic. That is a sweeping statement, but the broader issue is how we fund our health service over the next number of years to make it equitable, fair and sustainable. One can have an equitable and fair system, but it will not be sustainable, or one can have a sustainable system that might be unfair. The issue is to put a funding system in place whereby people can access health care based on their clinical need as opposed to their ability to pay.

The implication by some commentators in discussions on this issue is that private health insurance is almost parasitical and that these people are living off something else. The bottom line is that private health insurance has for many years lightened the burden on the State in its obligation to provide health care for its citizens. That is a fact. For a long time up to now, perhaps half of our population has taken out private health insurance. While the number has dropped dramatically in recent times, the general principle of having private health insurance has been well established. When people take out private health insurance, they lighten the obligation on the State to provide health cover for them. While that is subsidised through tax reliefs, when a person uses the public hospital system, they subsidise that system through payments from insurers.

There is a very complex system for funding the health service in this country. The public hospital system is funded by taxation and subvention directly from the taxpayer. There is a certain percentage of funding from private health insurers and there are out-of-pocket payments. That combination is how we fund our health service at present. Is it inequitable and unfair? Yes. There are huge elements where some people cannot access health care when they need it. The key question is why that is the case. Is it that the public health system is inefficient and is not run in a way that makes it efficient, lean and, more important, responsive to individuals when they present to it?

What the Minister calls a White Paper and what I call a discussion document is very light on detail. We still must be convinced that by 2019 we will have a system in place whereby a bunch of health insurers will line up in Dún Laoghaire or Dublin Airport to come to this country, claiming to be delighted to get into the Irish health market and anxious to become part of this system. I am dubious as to whether many health insurers will come into the Irish health sector to provide private health insurance. I do not believe that will be the case.

We currently have four insurers. There is the big player, VHI, and the three private health insurance companies. The four of them insure just under half of the population, and that number is dropping. There are many reasons for that. There has been a downturn in the economy and people's ability to pay for health insurance has been damaged. Equally, on the Minister's side, there has been a series of policies which have made private health insurance unaffordable for many families. Last year, the Minister for Finance came to the House and, with a single swoop of his pen, increased the burden on families. I am quite sure the Minister was not happy with that proposal, because it increases the cost of health insurance for families who are already hard pressed. Equally, there is the full cost recoup of private patients in public beds, which will have another impact on the cost to families for the provision of health cover.

In the meantime, the Minister, in his stated policy, wishes to encourage people to take out private health insurance so that when we move to compulsory universality, as many people as possible will be insured. Those on medical cards who cannot afford it will have it purchased for them, and for the cohort in between, who have neither medical cards nor private health insurance, there will be some form of subvention from the State. That means people will be fully assessed. Key questions must be asked in that regard. What will be considered discretionary income? Will it be based on the medical card assessment or on what will it be based? What types of expenditure will people be permitted in terms of mortgage repayments, maintenance of cars and investment in education? All of these questions will have to be answered.

We are a long way, on the Minister's path to universal health insurance, from knowing how much this will cost an average family. We are an equally long way from knowing what type of cover they will have. The Minister says there will be a basic basket of services and that the acute hospital setting, inpatient and outpatient services and mental health services should be included in it. However, if they are to be included, it should be stated in the White Paper, if it were a White Paper, and we could discuss the issues relating to it. Nothing is said in the White Paper about what should be in the suite of services or basket of health care to which people will be entitled under universal health insurance. That is a big void in this document.

Turning to the mechanics of this and the funding model proposed by the Minister, there are many assumptions in it. The Minister said that no one will pay more than they are paying already. That is simply inaccurate. Of course they will pay more than they are paying now. Private health insurance premia are increasing by the hour. Three years ago the Minister said that no one would pay more than they were already paying, but premia have increased by 20% to 30% under the Minister's watch. Even if it was introduced today, many people would be paying a great deal more than they were paying three years ago. Are we to assume there will be no inflation in private health insurance premia between now and 2019? That is the only way it will not cost more, and I do not believe we can make that assumption.

Are we to assume that the tax reliefs in place for private health insurance premia will continue, or will they be removed? If they are removed, it will be another inflationary impact on the cost to families. How will the 20% cohort in between be able to afford to pay for private health insurance? Bear in mind that this is the compulsory purchase of private health insurance. The days of the two certainties of death and taxes are gone. It is now death, taxes and compulsory private health insurance.

There is a great deal to discuss. This is not simply about deciding the suite of services that will be included in the basket.

There is an awful lot more to this than the Minister is outlining, along with the complexity of it. However, the key issue is whether or not it will be sustainable. Will it be sustainable for the State? Will it be sustainable for many families who are making a contribution to the health services through their taxation, but who are unable to afford private health insurance? What happens that cohort?

We endlessly talk about the Minister's endless utopian ideas, but when we look at the discussion document, we cannot find any credible substance to what he is proposing and how he intends getting there, other than this meandering consultation that we are to have tonight, over the next month at the health committee and at the commission that is to be established to look at all these issues. The fundamental principles in this are slim enough, but the most important issue had to be in respect of the suite of services, the basket of goods, the cover that will be provided by health insurance companies. None of that is in the Minister's discussion document.

The Minister looked at the German model, the Dutch model and around the world to find the best model, or an amalgam of models that would suit the Irish situation. That is fine. Of course he should send people out to look at the various models to ascertain which one is most suited to this country. However, when we talk about the cost of health care, there seems to be a perception in Ireland that we are spending huge amounts per capitaon health, but when we look at the figures, we are still a long way behind some countries that the Minister claims will provide a more efficient health system than our own. The OECD statistics on the per capitaexpenditure expressed as purchasing power parity is on page 57 of Health in Ireland: Key Trends 2012, which was published by the Minster's Department. According to the statistics, the Netherlands spent $5,000 per capitain 2010. Germany spent $4,338, France spent $3,974 and Ireland spent $3,718 per capita. That includes public and private providers. The Minister is coming in here and telling the House that he is going to create a fairer, equitable, more sustainable model, and he is following countries that are spending far more per capita-----

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