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

As I noted yesterday, this legislation represents an updating of the regulatory regime for the health insurance sector in this State. Some of the Bill continues what I acknowledge, as the health delivery system currently is structured, is the necessary system of community rating, which helps to ensure that consumers are charged the same premium for a particular plan regardless of age, gender or health status, thus preventing price discrimination against those more likely to require medical treatment. Unfortunately, it is also but a way of propping up the ailing health system. Members still await details of the Government's long-promised universal health insurance proposals. In the interim, many people continue to take out private health insurance because they cannot rely on the health service when they or their loved ones are unwell and this, as I already have stated, in itself is a tragedy.

As long as the type of health insurance market and the type of health funding system that exist in this State are retained, the regulatory regime provided for in this Bill will be necessary. Accordingly, I record that Sinn Féin will not oppose the Bill's passage. It involves a complex system of risk equalisation to support the community rating principle. This entails the transfer of compensation from insurers who carry lighter risk burdens to those who carry heavier risk burdens. All this requires regulation, monitoring, enforcement and as provided for in this Bill.

In the absence of such legislation, the unregulated market would discriminate against the old, the sick or any other group or individual that insurance companies decides to be a greater risk. The legislation is, therefore, supposed to be a protection against the working out of the raw profit motive in the health insurance sector. It is supposed to be based on solidarity between generations and also between the healthy and the sick. That is welcome, in so far as it goes. However, as I have already stated on numerous occasions, Sinn Féin would go much further and would extend the principle of solidarity to the way we fund, organise, structure and manage our entire health care system. I will return to this point later.

Risk equalisation makes possible the scheme of community rating which ensures that all consumers are charged the same premium for a particular health insurance plan regardless, as I have already said, of age, gender or health status. The State continues to subsidise the private for-profit health system with private occupancy of public hospitals. Private health insurance still represents a fast track to care for private patients while public waiting lists grow and involves the dual working of hospital consultants in the public and private sectors. The background to private health insurance is laid out in the Health Insurance Acts 1994 to 2013. It includes such principles as intergenerational solidarity between all those covered by insurance.

The concept of risk equalisation is used in community-rated health to distribute the risk of insuring citizens with different risk profiles. A risk equalisation scheme has existed in the private health insurance market since 1 January 2013. Young, old, well and less well citizens are balanced to create premia that are more acceptable to all those choosing to take out private health insurance. In light of the system we currently have in place, this is a good thing. It is designed to stop market forces deciding to cherry-pick only healthy patients. Rampant capitalism does not have a place in health care in any circumstances. I am glad the Government recognises that. I am at a loss, however, to understand why it feels it appropriate to apply this rampant capitalism to their planned so-called universal health insurance plan.

The private health insurance model used by this and previous Governments allows for a hospital bed charge payable from the risk equalisation fund for each hospital visit involving an overnight stay. The main aim of this Bill is to outline the overall premium payable in respect of young adults and also to allow people to change insurers without being obliged to observe an initial waiting period. The Bill will also make changes to hospital bed credits and to the levels of stamp duty collected.

Section 2 makes provision for a sliding scale of health insurance premiums for young adults up to and including age 25 and will remove the requirement to be in full time education or to be dependent on the policyholder. The new subsection 5A to be inserted into the principal Act will mean that if offering young adult rates, health insurers shall offer the full range of rates within the specified bands. The regulations to provide for lifetime community rating will come into effect on 1 May 2015. After this date there will be late-entry loadings for those aged 35 and over who have not bought private health insurance up to this point. It will be a loading of 2% per year up to a maximum loading of 70% at age 69 and over. This is to encourage younger adults to take out insurance at a younger age than might otherwise have been considered.

Section 4 deals with those people who are to transfer from one policy to another and lays out that waiting periods need not apply in these cases. This is a common-sense approach. Section 6 and 7 revise credits payable from the risk equalisation fund and section 8 specifies the applicable stamp duty rates for the coming years.

Despite everything I have just stated, it seems that the Bill will not have the desired effect because most younger adults who do not have private health insurance are reported to have no intention of taking it out even if these measures are introduced. We have also seen that the HSE is directing hospitals to charge private health insurance patients as much as possible. We welcome the recouping of these costs but we also recognise that this will force more members of the public to turn to the public health system, which is currently ill-equipped to deal with any further increase in use of services.

This Bill arises out of a necessity to have social solidarity in the private health insurance sphere. Why not then extend social solidarity across the entire health care system? Unfortunately, it seems that Fine Gael and Labour are wedded to their flawed plan of providing universal health insurance at some unspecified point in the future. Theirs is a system that would see competing private insurance companies gobble up so much of the overall health spend and those moneys spent on administration and advertising, with the balance hived off to satisfy the insatiable appetite of investors for profits and dividends. In the case of an insurance system based on competing private health insurance companies, which, as we see it, is the least desirable model, the profit motive and the interests of shareholders - rather than public health - become paramount.

We still need to know much more about the funding of universal health insurance. What is compulsory health insurance going to cost people who have neither medical cards nor private health insurance at present? We still do not know the answer to that question. Sinn Féin wants to see the development of universal public health care based on medical need and funded from fair and reformed general taxation. We note that recently the Irish Medical Organisation has expressed concerns about universal health insurance as a method of funding universal health care. I welcome the IMO's intervention. We are again calling for an open debate on this matter by means of which we can examine all options for health care reform and funding, not just the flawed proposal of the Fine Gael and Labour Government.

The Government is proposing to bring in universal health insurance with the State subsidising those who cannot afford to pay insurance premiums. The State will still have a huge regulatory, managerial and funding role. Why then bestow on private for-profit insurance companies such a central place in the system? What contribution will they make? These companies are funded by the consumers who buy their products. The insurance companies, on behalf of policyholders, will buy services from private or public hospitals or other service providers. They will be obliged to make substantial profits in the process. The Minister has already recognised the failure of the insurance companies to reduce their outgoings and to address their cost base. Why not cut out that profit for the privateers and keep the money involved within the health system or in the pockets of citizens?

When Fine Gael and Labour should have been aiming for a system of universal health care that would allow timely access to suitable care - free at the point of delivery for all citizens - they looked instead to universal health insurance as a solution for everything. In reality, it is merely a funding model and a deeply flawed one at that.

It is a model that has been widely criticised, including by the medical profession, and many examples that have been held up are both flawed and very hard to compare to an Irish context.

Sinn Féin is strongly opposed to the pro-business and for-profit slant of Fine Gael on health care. Universal health insurance represents a fillip for private health insurance companies and the for-profit health care companies. Similar models in the Netherlands have seen the quality and range of care continually reduced, with premia rising by up to 40%. Further, the majority of the population purchases additional insurance cover to make up the shortfall in the universal health insurance basket of cover.

Another important fact is that the Dutch had made a large investment in primary care prior to the introduction of universal health insurance. We, on the other hand, have under-resourced primary care for many years now. In the United States, the system of privatisation simply diverts badly needed funds away from front-line services towards administration and introduces the forces of the market economy, with "consumers" buying "products". The multi-payer model also requires much regulation, again taking the focus away from treating patients.

Sinn Féin has long held that an equitable system of health care must be based on a progressive funding model to ensure that those in poverty, or those who are most in need of health care services, can access a service of an acceptable level without having to pay hand over fist at every turn. Again, we do not know what the cost of the Government system will be for an average family. Can we really trust the Government that gave us Uisce Éireann to overhaul the health service? I think not. We have no idea as to the quality and kind of care that will be provided, or even when we will see this system.

We in Sinn Féin want universal health care, based on equal access for all and on the basis of need, and need alone. We want that to be State provided, funded from fair general taxation and free at the point of delivery. This would involve a higher contribution in tax from the highest earners than they contribute at present. We do not favour the model of insurance-based funding. However, if health insurance is to be the basis for funding, it should involve a State insurance scheme.

We simply cannot continue to have a two-tier system in which people die simply because they do not have private health insurance. I do not exaggerate. I recall again in this House the tragic case of Susie Long who passed away in 2007. She had been referred for a colonoscopy in 2005. She waited seven months for this test. She found out in 2007 that another patient who had been lucky enough to have insurance had been referred and diagnosed within days. That she lacked insurance contributed to her delayed diagnosis. It is a great shame that we have not moved very far on from this system. While we hope this could not occur again, we know those who rely on the public health system rely on a system that is creaking and groaning under massive strains, dealing with a larger and sicker population, and doing less with less.

It is appropriate to pay tribute to front-line service providers, including consultants, doctors, nurses and the various other specialists and support staff, particularly across the network of hospital sites. They are doing heroic work at a very difficult time within the health service and personally considering all the strains that have visited all our lives, our families’ lives and our communities over the years.

The deeply flawed two-tier system is reeling from the health cuts of the Government and its predecessor, yet it is being asked to deal with ever-increasing demand. The promised market-based private health insurance system is not the route to real and necessary reform of our health services. We demand an open discussion on the most progressive and equitable ways to fund a single-tier system, free at the point of care, that provides for all on the basis of need, and need alone. We ask the Government to accept that it has chosen a bad model. We ask for a fair system. That surely is not too much to ask of those currently in government who claim the mantle of James Connolly.

I dtosach na haicíde is fusa í a leigheas. Ba chóir dúinn éirí as an bplean seo sula gcuirtear blianta eile amú air.

Like its predecessor, this Bill is a necessary measure for the insurance sector as it stands. Overall, however, the future of health insurance and the entire health system generally under this Government needs re-examination or we will risk wasting further years before we have a system that we can rely on and of which we can all be proud.

See this speech in context