Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

That is regrettable. We will have a two-tier contribution.

In the introduction to the document we are addressing, entitled, The Path to Universal Healthcare: White Paper on Universal Health Insurance, the Minister for Health, Deputy James Reilly, on behalf of the Government, says it aspires to "a universal single-tier health service with access based on need, not income". I want to say that I personally, and we in Sinn Féin, share that aim, and that it has been the very basis of the health policy I have presented here over many years. However, we believe the model the Government has adopted is fundamentally flawed. It is a so-called free market model based on competing private, for-profit health insurance companies, and that is where we clearly part. This is the Fine Gael model which, in my view, won out in the programme for Government. This is a purely market approach, treating health care as a commodity and believing that consumers will benefit from competition, but the real beneficiaries will be the private health insurers, and they will benefit doubly. First, they will have a mass of new customers forced by Government legislation to take out policies and, second, they will benefit directly from Government payments to them on behalf of people who cannot pay private health insurance themselves.

I have said it here before and I make no apology for repeating it. We often hear the phrase: "Cut out the middleman". The Minister's, Deputy Reilly's, model of universal health insurance is cutting in the middleman. It is adding to the cost of health care because the profit margin of the private health insurance companies will inevitably push up the cost of health care. We in Sinn Féin say to cut out the middleman. This can be done by funding public health services from fair and reformed general taxation.

The Minister's plan is based ostensibly on the Dutch model, which is not working as is claimed and has actually led to the rationing of health care and to much greater medical inflation. We believe this plan will cost both the State and the citizens more than a State-provided taxation funded system. We believe it will lead to a system where private health insurance companies will ultimately determine what level of health services people receive. The private health insurance companies will become gatekeepers if this system is adopted and future Governments will be constantly trying to play catch-up with legislation and regulations.

We need a real debate and real progress on health reform. The consultation process and public debate on the best model insurance, whether State-provided or a mix, should have begun when the Government came into office three years ago. Instead, we have had a predetermined outcome as presented by this so-called White Paper. A "White Paper on financing universal health insurance" was promised early in the term of the Government and it is interesting that, at some stage, the word "financing" was dropped from the title. That was the title and it is no longer there.

Sure enough, there is precious little in this White Paper about the financing of universal health insurance and, in particular, what it will cost individuals and families. It has taken over three years to produce a White Paper with a truncated and narrow consultation process with, again, a predetermined outcome. It is both very late and, as I have already said, half-baked. What is compulsory health insurance going to cost people who have neither a medical card nor private health insurance at present? That key question is not answered in this document. Crucially, the document does not describe the basket of care that will be provided under universal health insurance, which a consultation process is supposedly going to help determine. This immediately raises the question of what conditions, syndromes and needs will not be covered, as will be the case. We are being presented with a consultation process with a predetermined outcome and a deadline of 28 May, clashing directly with the local and European elections now swirling about us.

Sinn Féin wants to see universal public health care based on medical need and funded from fair and reformed general taxation. On this basis, we will be participating in the consultation and the debate, and we will make our own party submission. I urge others listening to and watching this debate today also to participate as I believe that is critically important. We are calling for an open debate that will examine all options for health care reform and funding, not just the option presented by this White Paper.

Even in the very unlikely event that this plan is delivered on schedule, we will not see it implemented until 2019. What happens in the meantime? Let us for a moment look at what is happening now. We have ongoing cuts year on year which have caused huge damage in our health services. To give just one example, with a growing and aging population, we cannot possibly sustain safe hospital services when over 5,200 nursing posts, or 13.5% of the total, have been cut since 2010. As has been highlighted in the Private Member's motion this week, only one in every three people with life-threatening conditions were responded to by an ambulance service within the target time last year.

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