Dáil debates

Thursday, 16 April 2015

Health (General Practitioner Service) Bill 2015: Second Stage (Resumed)

 

11:10 am

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

One would not oppose this Bill in so far as it proposes to extend free GP care to those over 70, as this is something that will benefit that age cohort. The Bill is welcome in that regard. However, this small step serves to highlight the spectacular failure of the Government to honour the promises and commitments it gave to the people in the run-in to the last general election. The Bill fails also to honour the rhetoric that was screamed from podiums at the demonstrations that took place against the moves by the last Fianna Fáil-led Government to remove medical cards from the elderly. Fine Gael and the Labour Party joined in the chorus of opposition denouncing those moves by Fianna Fáil, who it seems has now suffered a conversion on the road to Damascus. I have heard its spokesmen here espousing universal health care and complaining the Government has not gone far enough. That is a bit rich coming from Fianna Fáil since it was the party that started the attack on universal provision for one cohort, the elderly, during its last reign in government. Its hypocrisy is apparent.

Given that the Labour Party and Fine Gael joined in the justified chorus of indignation when Fianna Fáil launched that attack, this Bill falls far short of restoring the situation in terms of health cover for the elderly and far short of the trumpeting of universality it promised in terms of a universal health insurance system and free GP care for everybody. The programme for Government suggested that free GP care would have to be phased in, but this Bill also runs counter to the priorities the Government set to provide free GP care first of all to those with the greatest medical need, particularly to those with chronic or long-term illness.

The provision seems fairly arbitrary and random and does not make much sense, notwithstanding that it is a good provision for those who will benefit from it. The problem with isolating particular groups or cohorts and ensuring a free GP care service for them is that this results in injustices, unfairness and anomalies around the edges of the groups. For example, what has the Government got against those aged from 65 to 69 years? They have retired, their income has fallen, but they do not get free GP care. This is a cohort which quite often has greater medical needs, but has been hit by other cuts inflicted by the Government, including to an income that will fall on retirement. They also have lost out on household benefit packages and telephone allowances. Many of these people are also living in areas where property prices are high and will be victims of the property tax. Often, people on very low incomes must fork out huge amounts in property tax. This tax bears no relation to their income or ability to pay. Arguably, this cohort needs free GP care just as much as others, but do not get it. This is the type of injustice that can arise. Similarly, a child of six or seven may have a particular need for free GP care, but does not get it.

This debate offers the opportunity to highlight this failure to deliver on the great rhetoric the Government trumpeted pre the election regarding how it would introduce universality in terms of GP care and health care generally. Instead, we are getting piecemeal, random, small incremental changes, some of which do not make sense in terms of priorities. Added to this is the whole debacle regarding discretionary medical cards that the Government rowed back on and the change in income limits for medical cards, which have removed medical cards from many of the elderly.

It is something and it is better than nothing but it is far short of what was promised nor does it not make a whole lot of sense in terms of priorities. Even where those who benefit from getting the free GP care that will result from this legislation - they will then be referred to surgery or to hospital - do not have a full medical card they will still face the problem of the costs they may have to bear such as hospital charges and consultant fees. Very likely they will also face very long waiting list times because of the assault - not just under this Government and the previous Government - of cuts to the health budget, the significant number of beds that have been closed, the chronic under-staffing and under-resourcing of the health service generally. Even where such persons get free GP care and are then referred, they still face all the problems in the rest of the health service. What this highlights is really the failure of the Government to deliver on the vision of universality and the failure to sort out the mess that is our health service which the Government promised four years ago. That failure to deliver on the promises and aspirations flows fundamentally from the fact that the Government does not have a plan. In so far as it has tried to deliver on those promises, its whole vision is based on a flawed model of a mixture of a public and private system. It has not recognised that the only way to sort our health service is to move away from this mixture of public and private which does not work, is dysfunctional, unfair, inherently about a two-tier system that creates injustices and anomalies, and to grasp the nettle of the need for a national health service. That is the only way we will resolve this system. However, the Minister's determination, which one can only describe as an ideological determination, is based on his belief that private health insurance companies or the private sector has some useful role to play in health, when it does not have such a role. There is no evidence anywhere in the world that relying on the private sector is helpful in terms of delivering a universal health service in a cost-efficient way. In fact, all the evidence points in the opposite direction. The most notable example of course, being the United States which spends more per capitathan any other country in the world on health but about 40% of that expenditure goes into the pockets and the profits of the private health insurance industry, the private sector generally, into unnecessary costs and administration, billing, advertising, all the waste that goes along with a system where the private for-profit sector is involved in trying to deliver something that should be a universal right for all citizens, namely, health care. It is that failure, that ideological blindness and blinkered attitude of this Government, that is at the back of its failure to deliver on all the promises.

For many people, when they heard the rhetoric of universality prior to the election, what they imagined was precisely a sort of national health service model but they did not really hear the word "insurance". The two things directly contradict each other because the universality and a single-tier system go out the window once private for-profit insurance interests or private for-profit health companies or hospitals or whatever it is, are in the mix, because they are in it for the money and not to provide a service to people.

I will not oppose this Bill but it is a very pale shadow of what the Government promised. It raises as many questions as it answers in terms of the prioritising of health care services to those who need it but the biggest question it raises is whether this Government really has a plan to sort out the mess that is the health service, in order to deliver the universal system, the health care to which every citizen is entitled on the basis of need. Has the Government a vision and a plan? More than four years into this Government's term, it is absolutely clear that it does not. The Minister has more or less admitted this, with universal health insurance being put on hold. All the talk of the Dutch model has disappeared now because any serious examination of the Dutch model shows very serious problems associated with the cost of health care. This has all gone out the window and we are left not knowing where we are going but we are left with very serious problems in our health service that this Bill will not address in any serious way, notwithstanding the fact that some people may gain some benefit from it.

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