Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

It is fair to say that the political differences between the Minister and me are most acute when it comes to health and, in particular, the issue of private versus public health care. We see legislation of this sort every year and with each year we are reminded of the body of work that progressive parties have ahead of them to address the imbalance in health care and remove private health care from our public hospitals.

The question of health insurance is a fraught one. On the one hand, it facilitates the skipping of queues and the bypassing of waiting lists. On the other, it represents a large number of people who go without other things in order to have health insurance because they are afraid that, without it, they will end up waiting 24 months for a colonoscopy or some other procedure. The health insurance market exists because the Government is a champion of it and because people are afraid of having to enter the public system and being left to wait for months or years for treatment. Nowhere would this be more starkly illustrated than if we took a trip to the print room.

It is not exactly a massive vote of confidence in the health policies being pursued by the Government, with the support of Fianna Fáil, when we see the Minister's own colleagues printing leaflets advertising to their constituents the facility to leave this jurisdiction and go abroad to get treatment. If that is not a vote of no confidence in the health policy of the Government, I really do not know what is.

We find ourselves where we are because successive Governments have driven as a matter of policy the privatisation and commodification of our health service. We have to ask whether this is the best way to run the health service. Is the manner of health insurance in this country fair given that a lot of cover is driven by fear and it constitutes an extra burden to be carried by citizens, and given how much is already contributed to the health budget by taxpayers? Is this a case of citizens carrying the can for the Government's failure to enforce and police the 12.5% corporation tax and other areas of non-income-based taxes?

The Oireachtas deals with a Bill such as this every year. It is about taking away the risk from insurance companies to equalise risk for certain policyholders - if only the Government was as quick to intervene in the market in other areas. While we will allow the passage of the Bill in order that older people and others are protected, we do so with serious reservations about a health service that buckles under the weight of demand, and we point out that fear drives people to take out private health insurance.

At present, the health care system is funded primarily through general taxation, accounting for 69%, with out of pocket payments making up 15.4%. Private health insurance only contributes 12.7% to the health care system, but almost 46% of the population has private health insurance. This is the case because successive Governments have failed to provide universal health care free at the point of delivery based on need and not ability to pay. Insurance companies trade fear for profit in the health market, and we have those in here who continue to cheerlead for them.

With regard to the Bill, it is important to see that lifetime community rating rules will exempt members of the Permanent Defence Force. Other new proposed changes with respect to no loading applying to people working abroad are also important, given that many people may be out of the country for a period and then return. This has particularly been the case of many young people who were forced to leave during the financial crash and subsequent austerity years.

Under close scrutiny, the Bill reveals the existing disparity between the health of men and women, and this cannot be ignored. If we look at the risk equalisation for men compared to women in the amendment to Schedule 4 of the principal Act contained in the Bill, we can see there is a higher risk rate for females, which is an indication that in older years there are greater health risks for me and all women. This is something which needs to be looked at from a health perspective and not from this insurance market risk equalisation perspective.

We have this debate yearly because of the necessity to intervene in the health insurance market, but we should be having a debate in here every week, if not every day, about the privatisation of health care by means such as this and others. The commodification of health care has been one of the most damning elements of the neoliberal privatisation agenda. The push to turn people's health and well-being into a revenue stream is morally repugnant. Where a public health system sees illness and patients in need, the private sector sees money and opportunity. Such a situation is how we end up with the unrealistic stretched income targets being set for hospital groups to generate private income, which then put hospitals under severe pressure, compromising patient care and creating myriad problems for the equitable delivery of health care based on need. The fall out is that private patients are treated ahead of public patients in our public hospitals. Deputies and Senators from the parties who push these policies then act surprised when they see the outworkings of their policies showcased on "Prime Time" again and again.

We will allow the Bill to pass, but it is high time we had a debate and addressed the issues of private health insurance and private health care in our public system. A total of 46% of people in the State have private health insurance. A total of 34% are covered by medical cards. I am very proud to say I am member of the 20%. This is because I do not believe in private health insurance. I do not believe that privatisation has any place in a public health care system. I look forward to the day when the 20% become the majority, by virtue of the fact that the public health system provides for people who now feel they have to go to private health insurance to get decent quality health services.

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