Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

Fianna Fáil has an opportunity to show how much better it would be than any other party in government by producing a detailed and costed plan on bringing about universal health care in the first term of a Fianna Fáil government with Deputy Kelleher as Minister, presumably, and how he would achieve the transition. Perhaps I could learn from it. I look forward, therefore, to reading his manifesto and policy and hope it will be as good as he promises it will be.

Deputy Neville asked about mental health cover. Every health insurance policy must offer minimum benefits. After that, it depends on the particular policy. Any policy must offer at least 100 days inpatient care. Other policies offer more. I take his point that there should not be a distinction between a person availing of inpatient mental health care services and a person availing of any other inpatient service. It is a well made point but to address it, changes to the minimum benefits would be required and that is beyond the scope of this Bill.

Deputy O'Dowd made a number of comments which I also welcome. He mentioned prescription charges. They are set at a maximum of €25 per month for a medical cardholder. The sum of €25 is still the maximum for a person on a large number of medicines. I would like to reduce the figure in the term of the next Government, if I am part of it, but it would be expensive. Those prescription charges bring in more than €100 million in a year and the money does not go into the general Exchequer pot but directly to the health service. A reduction in half of the sum would require €60 million or so to be found either from another source or from cuts to services and we are not in a position to do so at the moment, for reasons the Deputy will understand.

Even in a utopia with the best public health service in the world, we would still probably have some form of supplementary health insurance. The NHS, or national health system, as Deputy Boyd Barrett referred to it, performs extremely well in terms of rapid and timely access to health care on an equal basis. It does not perform as well in terms of patient outcomes. We do better than that system in terms of many patient outcomes. A system might do well on access but it may not necessarily do as well on morbidity, mortality, outcomes, cure rates and survivor rates. However, even in a socialist national health system, no matter how one designs it, by definition, one will run into certain issues. There will have to be some degree of rationing. Even in the wealthiest, most socialist country in the world, the health budget is always finite.

A finite budget requires rationing and queues. People have to wait because someone else's case is more urgent. It requires the removal of choice. People may want to see a particular consultant and not another one but if one is going to have a socialist national health service, that choice has to be taken away. If everyone wants to see a particular guy, the waiting list will be very long. People will have to be split up and told where they have to go. Just as we do in a public education system at the moment, everyone cannot go to the school of his or her choice. It would not be possible for everyone to go to the hospital or doctor of his or her choice either.

There would have to be a degree of rationing when it comes to treatments, which is exactly what happens in the NHS. Certain treatments are not available because they are not considered to be cost effective on a population basis and that is increasingly the trend across the world in those public health systems. Unless we ban people from spending their own money on their health so that they can skip a queue, see a consultant or go to a hospital of their choice or get a treatment the Kremlin or whatever system is running the show does not consider to be cost effective, there will be some sort of private health insurance system.

Once there is a private health system, albeit perhaps a supplementary one, it needs to be regulated. We regulate health insurance in this country because we do not want to have a system like that in America. We want a system that says whether a person is old, young, sick or healthy, he or she pays the same amount for the same policy. That is what this legislation is about.

Even if he were elected with an overall majority tomorrow and he decided to raise taxes by €8 billion to introduce his socialist national health service system, it would still take Deputy Boyd Barrett time to do it. It would take him five or ten years, if not 15 years, to do it. In the meantime, he would need to have some sort of health insurance system in place. If we stopped health insurance tomorrow morning, our public hospitals would immediately lose €800 million. Those hospitals get €800 million in income from the health insurance system. Deputy Boyd Barrett would still need to have this Bill during the transition period. I, therefore, ask him to support it because so long as health insurance is not illegal, this Bill will ensure that in Ireland, the old pay the same as the young and the sick pay the same as the well for the same product. If Deputy Boyd Barrett votes against the Bill, he votes against that principle.

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