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

I do not know about the Minister but I get a pain in my head when I begin to think about things such as risk equalisation, risk equalisation credits, lifetime community rating and all the other very technical and complex stuff contained in the Bill and which revolve around the private health insurance system. However, the pain I get in my head is minor compared to the pain and hardship felt by people who have to wait for hours, if not days, on trolleys. It is minor compared to that suffered by people who are waiting in chronic pain for more than two to two and a half years for operations.

I mentioned a lady in my constituency who is looking for a hip replacement to the Minister a while ago. This lady rings me regularly. She is in absolute dire and chronic pain. She cannot move. This woman worked very hard all her life. She is told there is an 18 month waiting list but, as she points out, it took her approximately six to eight months to get on the list. The 18 months clock only started ticking then. She asks me what she is supposed to do for the next 18 months given she cannot move. This is the suffering that is going on. We then have the shambles in child mental health services and the chronic under-resourcing of residential care for people with disabilities. The list of chronically under-resourced health services goes on and the people who the health service is supposed to serve continue to suffer terrible hardship.

Is there a connection between the pain I get in my head when I think about risk equalisation, risk equalisation credits and lifetime community rating systems and the labyrinthine systems surrounding the competitive private health insurance industry? I put it to the Minister that there is and it has now been exposed by what one might argue is an unlikely source. It is certainly not a radically left source. The source is the ESRI and its report on the universal health insurance model, a model the Government claimed it was going to deliver and claims it had been working on since it was elected.

The ESRI has blown out of the water all of the main contentions this Government put forward about the merits of universal health insurance. It has confirmed all the key criticisms of those of us who opposed that vision and model and said it would not work. By extension, it has confirmed the private health insurance industry is simply not the way to deliver the sort of health services people who are sick and in pain need.

Trying to trawl through the complexities of this stuff is a pointless and futile exercise. All of it is unnecessary; it is waste. We are developing a complicated system to guarantee the private profits of a parasitical, profit seeking, health insurance industry that does nothing to deliver the health services people need. It is purely parasitical. The ESRI confirms this when it indicates that the €300 million margin that is taken by the private health insurance companies is one of the major reasons, if not the major reason, that the universal health insurance model the Minister had championed is simply not workable, will be too expensive and will not deliver for the patients. That is due to their profit taking. This confirms what we have been saying to the Minister and his predecessor for four years. When the Minister's predecessor made grand announcements about how the universal health insurance model would begin to be rolled out from January this year and would be completed by 2019, that it would provide a better, more efficient and cheaper service, reduce the cost of health care and so forth, we said the opposite would be the case. All the international evidence, and this is confirmed by the ESRI, showed that it would be the opposite and that it would make health care more costly and would not deliver the goods in terms of services.

If we are honest and apply ideological commitments to competitive insurance markets and competition in the health area, is it not blindingly obvious that the private health insurance industry must take €300 million in profits, it must have a big administration for sending out bills, it must pay big executive salaries to the top people in the private health insurance companies and it must advertise? One cannot move without encountering private health insurance advertising. It is everywhere. It is on advertising hoardings, radio stations and television. That costs big money. The people who take out private health insurance are paying for it. Ordinary citizens are paying for these advertisements, the executive salaries, the profits and for the huge billing, none of which contributes anything to front-line services for the people who are waiting for two years for an operation or for days on a trolley. Is it not obvious that this is simply waste?

That is the reason we find it difficult to get our heads around a Bill such as this. The legislation is trying to manage an irrational and parasitical system. Risk equalisation is about keeping the private health insurers in business so they can make money. It is about luring them in. The Minister and I debated this issue on a television programme and I was one of the few people who were very critical of the Minister. I am not throwing language around loosely but I believed the measures introduced by the Minister meant the Minister was effectively acting as a tout for these private, for-profit health insurance companies. He was saying to people that if they were over a certain age they would be penalised unless they had already taken out private health insurance. That was scaring people into taking out private health insurance, a huge amount of which then goes into waste on advertising, billing and executive salaries. I forgot to mention the private consultants. A sum of €400 million per year goes from the private health insurance companies into the pockets of private consultants. That is waste. To top up their already substantial public salaries they receive an extra €400 million from the premiums paid by people for private health insurance.

What does one get for one's private health insurance? I have never taken out private health insurance, and I never will, because apart from not believing in a two-tier system in which one pays to jump queues, it is clear one does not get anything for it. The big news that must be conveyed to the people who are terrified into taking out private health insurance is that one gets nothing for it. If one has a heart attack one ends up on a trolley in the same way as everybody else. That is the truth. One might move a little faster in the queues for some operations, but not for others. I have much anecdotal evidence that people sometimes get things faster in the public system in some areas, even though they will still have to wait for months, than they would in the private system.

Has the Minister or the Government even quantified any of this? I have mentioned the amount of money that goes to private consultants from the private health insurance system. Do we know how much it spends on advertising? Would it not be useful to find out how much is wasted on advertising and billing administration? I asked about this with regard to the public health system last October. I tabled a parliamentary question seeking the annual cost of collecting fees in public hospitals for the last four years, including administration costs, the cost of debt collection agencies and legal costs. The Minister did not know the answer so he passed the question to the HSE. The HSE has passed it on to the hospital groups because it does not know either. How are we to have an efficient health system when the Minister does not know how much this stuff costs? How are we to accord him any credibility? Fine Gael is supposed to be the party of efficiency, yet the Minister does not even know how much this stuff is costing us. It is an absolute waste. Money is going on this stuff and even on the parliamentary questions that go back and forth in an effort to gather information about it. We would not have to ask them if the money was not going on this but into front-line health services.

International evidence shows that what I and other Members on this side of the House have been saying for the last four years is right. The cost of health insurance in Holland went through the roof under the model the Minister was pursuing. In the United States, billing costs account for over 30% of overall health expenditure. Please do not tell me that is efficient. That is the inevitable result of believing in competitive markets and competitive private health insurance being an integral part of a health system. It is simply parasitical. We can argue the toss on the efficacy of markets. There is not much strong evidence. The only evidence I am ever quoted about the efficacy of markets is Ryanair, God help us. Whatever about the airline industry, and it is debatable in that case to put it mildly, it just does not work in health care.

The other argument I hear, and I listened to a debate on the radio about this, is that if we had our way all the doctors would leave the country because we want to cut their wages to €100,000. There has already been emigration of some of our consultants, nurses and so forth. It was pointed out to me today that the consultants in the NHS are only paid €70,000. The Minister can shake his head, but that is what I was told. Perhaps he will give me the figures.

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