Patricia Ryan (Kildare South, Sinn Fein) | Oireachtas source

The Bill concerns an issue dealt with every year in similar Bills to provide risk equalisation. Risk equalisation is a mechanism designed to support the objective of a community-rated health insurance market whereby customers pay the same net premium for the same health insurance product irrespective of age, gender or health status. The Health Insurance Acts have provided for a risk equalisation scheme for the health insurance market since 1 January 2013. Under the scheme, insurers receive risk equalisation credits to compensate for the additional cost of insuring older and less healthy people.

The differences across the political spectrum are most obvious in terms of the health service. We need to address the imbalance in healthcare to remove private healthcare from our public hospitals and our public healthcare system. It is high time we moved from away from a two-tier health system. I could not afford health insurance as a private citizen and I know many people who make sacrifices to keep their health insurance because they are afraid that without it, they will end up waiting 24 months for a colonoscopy or some other procedure, and this is wrong.

There are many people stuck in the middle of earning too much to qualify for a medical card and too little to be able to afford health insurance. This is also wrong. Ability to pay should not have any bearing on how one is treated in the healthcare system. The American healthcare system is the extreme side of a private healthcare system but we are not far behind. I spoke to a lady this week who is scrimping on Christmas this year so that she can pay €250 to a private consultant for an ear, nose and throat, ENT, assessment. She is in her third year on a waiting list in Tullamore hospital. A year ago, she received a letter from the hospital asking if she still needed to be on that list and she has had no communication since. She is one of the lucky ones in that she has health insurance which she hopes to use to have that procedure in a private hospital. People are languishing on waiting lists getting sicker while those with health insurance are fast-tracked to the front of the queue. In some cases, they are treated by the same doctors and even in the same hospitals. As a "Prime Time Investigates" programme in 2017 showed, consultants sometimes treat private patients on public time. A question by my colleague, the former Sinn Féin councillor, Mr. Thomas Redmond, to the midlands health forum in 2017 showed that this happens in rent-free rooms in our public hospitals.

Health insurance exploits a failed public health system that is being killed off by successive Governments that favour a private health system. As with the commodification of housing, the commodification of our health service is hurting those who need it most, such as our elderly and those who are on low incomes - in other words, the working poor. In an ideal world, we would have no need for the private health insurance market. The industry exists to paper over the cracks of our broken public health system. Our waiting lists in most areas are out of control. Vulnerable people are being exploited. I recently asked a parliamentary question in relation to the pain clinic in Tallaght hospital. There are over 1,100 people waiting for up to four years on an appointment there. These people are living with chronic pain and this is having a profound effect on their lives. Their mental health is suffering. In some cases, their life expectancy will be lowered. Sinn Féin in government will deliver an all-island health system that is free at the point of delivery and is based on need rather than income. People deserve nothing less.

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