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

In this system, the Minister is saying that hospital groups will compete with each other to provide health care, and they will then tender to work with the private health insurance companies. If I live in Moville, Carndonagh or in south-west Cork and the Minister has set up hospital groups from Tralee to Waterford and from Letterkenny to Galway, somehow there will be competition within that health grouping. Of course there will not be competition. This is only a pretence. We simply cannot have a system whereby there will be very competitive tendering processes and delivery of health care by different groups within those areas. That simply will not happen. Even the discussion document in the White Paper provides an indication that this will not happen. The Minister is trying to look at other countries with dense populations, such as Holland, which is not much bigger than Munster but has a population of about 16 million or 17 million. The Dutch had 18 insurance companies at one stage, but they are now down to three or four and none of the problems that emanated from the Dutch system and other universal health insurance multi-payer systems has been taken on board by the Minister. That is what I find incredible.

I would not be too worried if I was the only person saying that. However, the Minister's Cabinet colleagues are saying it as well. They say it to his face in the Cabinet and they certainly say it around here, because they simply do not believe that going down this particular route will deliver a fair, equitable, sustainable health system. In fact, some of his Cabinet colleagues have gone so far as to state that it will put the State finances at risk. That is something the Minister should seriously take into account.

Rather than highlighting the difficulties with the broader principle, let us go into the detail and assume that it is implemented. Every private health insurance company will be legally obliged to carry a certain amount of capital, as they will be regulated by the Central Bank. There has not been a mention of that in the Minister's discussion document in respect of how that will bear out in terms of costs. In order to have a very competitive insurance market, insurance companies will have to make a profit before they enter the market. They will have to be guaranteed that there is some form of return on their investment. When they make profit, they will be taking that amount of money out of the health system. That is what they will be doing. Assuming they work on a margin of 10%, or even 8% on a streamlined basis, with a €16 billion spend, that is a lot of money not going into the health system and going into insurance companies. All those issues have to be factored in, because they will only operate in a system whereby they make profit and they will also have to carry capital on top of that. All these things will take funding from the health system which will be transferred to private health insurance companies. Universal health insurance will add to greater sustainability problems and will not resolve the problems of equal access based on clinical need.

A press release was issued which stated "White hails Government decision on free GP for under sixes". I presume the Minister hails it as well. Nearly a quarter of a million will benefit from the decision. Unfortunately, there has been no extra allocation for medical cards.

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