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

We are here again for what is effectively an annual debate. It is a reminder of one of this that is wrong with our health system.

The political differences across the House are most acute when we are debating issues such as private healthcare and private health insurance. The political differences between this Government and me are most visible when it comes to healthcare provision, particularly in the context of the issue of private versus public healthcare. When this Bill came across my desk, I was reminded of the body of work progressive politicians have ahead of them to address the imbalance in healthcare and the importance of removing private healthcare from our public hospitals and our public healthcare system. As stated last year, the question of health insurance is very fraught. On the one hand, it facilitates the skipping of queues and the bypassing of waiting lists created by this Government and, 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.

I fundamentally oppose the need for a private health insurance market. We should be addressing that issue today. Why is there a need for a private health insurance market? The industry exists within the crevices and the cracks of our broken public health system. I do not blame the health insurance industry for how it operates. As is the case in other countries, it is exploiting a failed system. If health insurance companies want to provide access to private care in private hospitals, I wish them well. That is their prerogative.

My anger is reserved for those who have broken our health system and who have allowed private medicine to exist within it. It is clear that the system did not break because of those working within it. The system was deliberately broken. The process in that regard began with the Fianna Fáil-Progressive Democrats Government. Why did this happen? The system was broken to allow private medicine to make a profit from people's ills while convincing them that this was actually a good thing, and possibly even good for their health. The health insurance market exists because the Government champions it and because people are afraid of having to enter the public system, where they will have to wait for months or years for treatment. We are where we are because successive Governments have driven, as a matter of policy, the privatisation of aspects of the health service and the commodification of health itself. We have to ask whether this is the best way to run a health service. Is the manner of health insurance in this country fair, particularly in view of the fact that much of cover on offer is driven by fear? It constitutes an extra burden to be carried by taxpayers who already contribute a large amount to the health budget. Is this a case of citizens carrying the can for the failure of the Government to enforce and police the 12.5% corporation tax rate and other non-income based taxes?

The Oireachtas deals with a Bill such as this every year. It seeks to take the risk away from insurance companies and equalise the risk for certain policyholders. It would be great if the Government was as quick to intervene in the market in other areas. While we will allow the passage of the Bill to ensure that older persons and others are protected, we do so with serious reservations about a health service that is buckling under the weight of demand. In addition, we must point out that fear and a health service crippled by mismanagement and ineptitude are driving people to take out private health insurance. The CSO data on health spending for last year shows that the healthcare system is funded primarily through general taxation, which accounts for 69%, with out-of-pocket payments making up 15.4%. Private health insurance only contributes 12.7% to the healthcare system, but over 40% of the population has private health insurance. This is the case because successive Governments have failed to provide universal healthcare which is free at the point of delivery and which is based on need and not on ability to pay. Insurance companies trade fear for profit in the health market. There are those in this House who continue to act as their cheerleaders.

While there are a number of technical amendments to this year's Bill, there are also a number of amendments to the existing Acts which underpin and govern the Health Insurance Authority and the VHI. I would like the Minister of State to expand further on the expansion of the membership of the board. I understand provision will be made to broaden the composition of the board of the VHI and also to enable the company to sell international healthcare plans directly. I would appreciate it if the Minister of State could respond orally or in writing. I understand that the role private health insurance plays in our health system could change significantly into the future. The regulator must be able to react to its changing role and advise the Minister for Health if there is an increase in risk or other related matters. Is this the core reason for the change or are there broader reasons? There is a target of having a broad mix of skill and experience within the expanded membership in line with public sector governance obligations. How will this be achieved? One of the amendments seeks to remove the restriction whereby the number of board members representing health service providers is limited to two and to allow for a broader composition. This would give the Minister oversight to assess the skills mix when making appointments. While that seems fine in theory, will there be oversight for the Oireachtas in terms of these appointments, perhaps via committees, in light of the increased powers this move will give the Government?

Some amendments allow the VHI to sell international healthcare plans directly rather than via an agent. Such amendments will remove the need to seek ministerial approval before selling these plans. Insurance plans are regulated by the Central Bank. I am not insinuating that there is anything untoward here. However, is ministerial approval really that much of a burden? Does it really have to be removed? Can we get some further details on this matter?

Looking at the categories and grades of risk equalisation in the Bill, it is clear that a disparity exists between the health of men and women. This should not be ignored. The risk equalisation for men compared with women shows that there is a higher risk rate for females. This must be considered from a health perspective, not from the point of view of risk equalisation in the insurance market.

The commodification of healthcare 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 wrong. I repeat what I stated last year - where a public system sees illness and patients in need, the private sector sees money and opportunity.

Sinn Féin will allow the Bill to pass, but we must have a more robust debate around the issue of private health insurance and private healthcare in our public system. I look forward to the day when we can provide a health service which delivers for the people based on need rather than ability to pay, and where private health insurance is no longer needed because of the quality of such a universal health service.

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