Thomas Pringle (Donegal South West, Independent) | Oireachtas source

Today we are witnessing yet another piece of legislation which seeks to further preserve the private health insurance industry. I am opposed to the Bill because I am opposed to the special protection afforded to private health insurance companies which profit off the backs of citizens in this country. The Government’s priority has never been to establish access to health care based on need as opposed to the ability to pay. Instead, it has gleefully pushed the two-tier model left behind by flawed governments of the past. Despite a nationwide call for a more compassionate health care system that does not abandon our elderly in the accident and emergency department corridors and that does not discriminate on the basis of ability to pay, we continue to bolster the health insurance industry. The Government’s inability to govern has meant a disintegrating health care system. Its failure to respond adequately to the health needs of the nation is shown by policy after policy that not only fail desperately but cause real damage to people's health in our country. While successive governments established the unfair two-tier system, this Government has pursued it, bringing inequality in access to health care to an unprecedented level. It was this Government which was responsible for implementing a permanent risk equalisation scheme in 2013 when the Health Insurance (Amendment) Act 2012 commenced and it has since failed time and again to govern on the health issue.

Despite an increase in health expenditure arising from this year's budget, health spending levels are still below pre-crisis levels by at least €1 billion. Free GP care for those over 70 is not sufficient to meet the health needs of elderly people. The correct Government policy would have been to assign free medical cards to those over 70 covering a range of community services, including hospital visits, dental services, prescription medicine costs, hospital care, optical and aural services, social work services and other community services. The Government also increased hospital charges, introduced new drug charges for medical card holders and increased charges for prescription items. These were all introduced in response to the so-called economic crisis. The Government's increase in drug charges was another step away from universal health care. The Mapping the Pathways to Universal Healthcare project in 2014 showed that Irish citizens paid €599 million more on prescription drugs and hospital charges than they did in 2007.

The Minister's imposition of a deadline last May for those under 34 years of age to acquire health insurance is another failed policy and another step away from universal health care. Anyone over the age of 35 who cannot afford private health insurance will be discriminated against on the basis of their age and inability to pay. In 2012, the former Minister, Deputy Reilly, introduced a target of nine months for hospital appointments. In 2014, the Minister doubled that target to 18 months and admitted even that it was unambitious. There are now more people waiting for outpatient, inpatient and day case hospital appointments than there were in 2012. This is a sad indictment. Furthermore, the Minister also failed in his suggestion that private companies could be allowed take over the management of under-performing public hospitals under future health service reforms. Is this the real model we are going to see in respect of the Minister's universal health insurance policy where hospitals will be handed over to private companies and a licence to print money is granted to them?

The Minister has also proposed that newly formed hospital groups should have the freedom to make collective agreements and negotiate independent contracts with staff "outside of the constraints of public sector rules in the way semi-State companies do now". Should they should also in his view be allowed to put the running of those hospitals out to tender because that seems to be way he will pursue the privatisation of health services?

At least one positive element emerged this week with the Government abandoning the plan to introduce universal health insurance with a multi-payer competing model. This model, which is based on the Dutch model, would have been disastrous for us. It would have seen the complete handover of control of the operation of our health service to the private sector. Perhaps that is something Fine Gael would like to see but it would have been a disaster and I welcome the fact that it has been abandoned. However, I am very worried that we will see an underhand development whereby the hospitals I mentioned earlier will be handed over individually on a piece-by-piece basis to private operators who can profit from them.

The introduction of this Bill which is another step away from universal health care by expanding on the lifetime community rating model which will only exacerbate the inequality of our two-tier health system. It privileges the access of private patients over public patients and is a step backwards on the road to universal health care, propping-up the profits of private health insurance companies and our two-tier system of health care.

What have all these disastrous policies done to people across Ireland? They have increased inequality in our health system through propping up the private health care system. What we need is a universal health care system. This can be brought about by establishing a fully functioning primary care model. People's health security is depleting and their health is in jeopardy. It was the Government's policies over the past four to five years that increased the costs of health care and reduced access for those who need it, which has left the prevalence of illness in this country still nowhere near under control.

The first Healthy Ireland survey provides up-to-date figures on the extent of illness in Ireland. Previous health research was cancelled due to austerity measures so this is the first data available since 2007. The nationally representative survey of 7,539 people found that 28% of the population has a health problem or long-standing illness, 19% are limited in their daily activities due to ill health and 43% had a health issue in the past year. The Irish Cancer Society published The Real Cost of Cancer Care, a survey of 409 people that shows the real costs of having a prevalent disease like cancer. A total of 35,000 people will be diagnosed with cancer this year. The survey found that the average additional cost of cancer was €862 per month and 40% of those surveyed did not have a medical card.

Regional health inequality has further marginalised people in rural constituencies. There is now a significant shortfall and geographical disparity in the supply of GPs and health inequality is becoming an increasing problem. We are witnessing a declining proportion of GPs working in rural areas, particularly in County Donegal. It has declined from 33% in the early 1990s to 22% in 2005. In County Donegal there are 48 to 57.7 GPs per 100,000 of population. The Government must recognise the peripheral nature of counties like Donegal in order to retain GPs in rural areas and restore the rural practice allowance to maintain GPs in our counties.

It is clear that we must move away from a privatisation model towards a universal one based on the need of services. The only way to achieve this is through the development of a primary care system with universal health care at its core. However, primary care has been talked about for over a decade now with very little results. Research has consistently proven that primary care is the best system, both in terms of equal access and cost effectiveness.

Strong primary care is associated with better population health, lower rates of unnecessary hospitalisations and relatively lower socio-economic inequality. Countries with strong primary care spend less on health care. However, Ireland's is the only EU health system that does not offer universal coverage for primary care.

Once again, the Minister is pushing further away the idea of a universal, single-tiered health service, which guarantees access based on need, not income. How can the promotion of greater uptake of private insurance and ensuring the structure of life-time community rating in our health system be seen as a step towards universal health care? Increasing the numbers of people with health insurance contradicts the notion of universal health care.

Today, there is still no right to health care in the Constitution or through any statutory provision even though Ireland is a signatory to Article 12 of the International Covenant on Economic, Social and Cultural Rights which recognises "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health". Unless we recognise and vindicate that right, we will never provide a universal health care system in this State.

See this speech in context