Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance) | Oireachtas source

On the face of it, this Bill is not one that one would oppose, and it seems like a reasonable attempt to deal with a problem. The problem, as the Minister knows, is that there is a crisis in the health insurance sector — I hate to use the word "market". I will state later why I hate to see the words "market" and "health" together in the one sentence. However, given that health insurance exists and that many people feel obliged to take it out, this legislation, on the face of it, is a reasonable attempt to deal with the fact that rising insurance premiums, combined with the impact of the recession, income cuts and the consequences of unemployment, have meant the number of people in a position to retain their health insurance has dropped pretty catastrophically over recent years. The percentage has dropped from over 50% to 44%, a big drop. Anecdotally, we know people must question all the time whether they can maintain their health insurance or, as somebody told me yesterday, avail of it for six months, then drop it and take it out again when he can afford it. I refer to obtaining cover intermittently. There is a real problem in this regard. In so far as these measures are going some way towards making health insurance a little more affordable, obviously against a background of premiums rising very significantly, by an average of €100 per year over the past couple of years, the Bill seems to be an attempt to contain the dramatic increases in the cost of health insurance and the falling off in the take-up of health insurance cover. However, it is worth saying that the Minister has said publicly he can give no guarantee these measures will actually contain the prices. He is quoted as having said the Bill will create an environment in which the health insurance industry can contain the increase in fees.

Ultimately, however, that decision will be taken by the private health insurance companies which is a matter of significant concern because those companies are out to make money. The private health insurers' primary interest is not to maintain affordability or, for that matter, to ensure that subscribers are covered, but to make money by whatever means is best. The Minister might say it is in their interest that greater numbers take out health insurance and therefore the insurers will want, where possible, to make premiums affordable, but the two do not necessarily go together. That is a matter of concern. The bottom line is it is left in the insurers' hands to determine whether insurance premiums are affordable.

On the face of it the Bill is a reasonable attempt to deal with a problem that we all are aware of, but to my mind this is like a sticking plaster on a gaping wound. It fits in with an approach to providing health care for the population that, ultimately, will not work and can result only in a two-tier health system which also is not particularly good value for money in terms of health expenditure generally, that is, the model of a health insurance market and of generally making a market of the delivery of health services. It just does not work. The problems we are seeing on a range of levels are merely the symptoms of a fundamentally flawed approach to health. The fundamental flaw is the idea that the private market is the appropriate vehicle to deliver universal health care for ordinary citizens and the crisis, in terms of the affordability of private health insurance, is one significant indicator of the unsustainable nature of that approach to health care.

The other side of this coin is the crisis in the public health service which is reaching dramatic proportions. For a number of years there has been a very severe crisis which has been dramatically worsened by the €3 billion of cuts in the public health service since the crash of 2008 and which has resulted in an incredible 10,000 staff being taken out of the health service, not to mention the closure of 2,000 beds across the country in the past couple of years and thousands more that have been taken out over the previous number of years.

Where all of this really stares us in the face is when we hear now on the radio as we drive home the proliferation of advertisements for the Mater Private, the Beacon clinic and the Blackrock Clinic. It is blasted at us, day in, day out, that for a price, if we have the money to take out the particular private health insurance package that is required to get into the Mater Private or wherever, we can deal with a crisis heart situation. If we have an accident and emergency matter, if we have the money, we will get it seen to in these places. With a dire situation in the public health service resulting from cuts, the pressure is on to do precisely that. Otherwise a person will wait a year, as 40,000 people do, for procedures or the person may die, as one young man did recently in Limerick. As was discussed earlier, a patient may die on a trolley waiting for care in the public health service. Certainly, a person could sit on a trolley waiting in the most unacceptable circumstances, as so many people do.

Some 6,977 patients waited on trolleys in October 2014, an increase of 63% on the number on trolleys in 2007. Those statistics indicate the disastrous situation we face. For those who might be tempted by the advertisements which imply they will not have to go into that nightmare which is the public health system if they can afford the premium packages of private health care, increasingly, for ordinary low and middle-income families, these are completely unaffordable and they are screwed if they do not have a lot of money. That is not an acceptable way to deliver health services which should be a basic human right in a civilised society.

Neither is it good value for money. Fine Gael often would pride itself on being the party that cares about the efficient use of resources. I point out to the Minister that in the United States, where there is one of the most privatised models of health care in the world, approximately 40% of all health spending is on administration, such as billing and all that is associated with a privatised model. It is spent not on the delivery of front-line health care, but on the making of profits for the private health sector. Is it not obvious that private companies will take a slice of the funding that should go into health services? That is what they are about. Inevitably, where there are private providers, in insurance or in services themselves, they will take a big slice for themselves and that is funding that should go into the health services. The alternative, as the Minister will be aware, is the National Health Service model, funded through progressive and fair taxation and delivering, not universal health insurance but universal health care, to all citizens at the point of need, and without which the Minister will be faced inevitably with the contradictions, crises and anomalies that he is trying to deal with in this Bill.

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