Gino Kenny (Dublin Mid West, People Before Profit Alliance) | Oireachtas source

Yes. Private health insurance is part of Ireland's two-tier health system.

Health insurance is a way for people to jump the public queue for health care, particularly elective surgery and investigations like scopes and scans. This distorts our health service by prioritising health care on the basis of wealth and not medical need. As this means the most needy get more sick as they wait, it causes unnecessary suffering. Those who jump the queue onto consultants' private waiting lists are seen more quickly by those consultants because decisions on who sees consultants are not made on the basis of need.

In 2011, the Fine Gael-Labour Party Government that was in office at the time promised to bring an end to the two-tier system by putting everyone on private health insurance. The proposed system of universal private health insurance, or UHI, was not costed by Fine Gael until very late in the day. By 2013, it was a flop. It was prohibitively expensive at approximately €3,000 per person. A system of private health insurance distorts the way patients are seen. It sucks out money in profits, advertising, corporate salaries, bonuses and transaction costs. The billing, accountancy and legal costs associated with private health insurance are above and beyond those encountered in the public system, where the bill is one's tax bill. UHI collapsed, not surprisingly, and Fine Gael still has nothing to put in its place. Instead, we have the ongoing sticking plaster of a wasteful and inefficient supplementary private health insurance system that is propped up by tax breaks. The National Treatment Purchase Fund is continuing to sell patients on public waiting lists to private hospitals, often to be seen by consultants who have their own public waiting lists.

Private health insurance should be replaced by a system of universal health care as advocated by the Anti-Austerity Alliance-People Before Profit. If this does not happen, the current wasteful and unwieldy market system will continue to need constant attention and intervention by the State to prevent the overcharging of sicker and more elderly patients as part of the system of risk equalisation, which involves redistributing payments between different private health insurers. This system of health insurance, tax rebates, stamp duty and credits unnecessarily complicates the health service. It also duplicates the functions of the taxation and funding systems of the Departments of Finance and Health. In 2016, private health insurance covers 46% of the population. This represents a reduction from 51% in 2008. Many of these policies offer very limited cover, usually for hospital overnight stays and accident and emergency charges. The decrease in the number of people paying for health insurance is largely due to reduced incomes as a result of austerity and the mass emigration of our youth. It is estimated that the large private bureaucracies of the private health insurance companies and the Health Insurance Authority handle €2.45 billion a year. That money would be better and more efficiently spent as part of the public health system.

The community rating system that this Bill is designed to regulate through risk equalisation payments has been described as being designed to promote "intergenerational solidarity" regardless of "age, gender or health status". Anti-Austerity Alliance-People Before Profit strongly recommends this social solidarity, but equally strongly it points to the waste associated with private health insurance and the distorting effects it has on our health system. The use of progressive taxation to increase the tax rates paid by the richest individuals and corporations would fund equal access and improve health by reducing inequality. The sooner private health insurance is replaced by a national health service, the sooner all of this wasteful, complex, time-consuming and ultimately unnecessary regulation will come to an end. The two-tier health system is bad for everybody's health.

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