Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

As others have said, this is the annual event at which we look at the 2013 permanent risk equalisation scheme and make the normal annual adjustments to elements of that original legislation. The legislation is introduced at the end of each year to make adjustments to the risk equalisation scheme in respect of the stamp duty levies, risk equalisation credits and hospital utilisation credit rates. Private health insurance is regulated by the Health Insurance Authority and it is on its recommendation that these annual proposals are made. They are generally nodded through on the basis that there is general support for the principle of risk equalisation.

If one is going to have a system of private health insurance, risk equalisation is an important element of that insurance system because it prevents cherry-picking in the health insurance system. This is especially the case given the history of health insurance in this country where the VHI had the field to itself for many years. It is really only in the last decade that we have seen any competition within the market. As a result of the VHI having the market to itself for many decades, the company has a disproportionate number of older members and it would be unfair to allow new entrants into the market which could cherry-pick younger and healthier clients or customers. That is the purpose of risk equalisation and it is very difficult to argue against that scheme. Most of the new arrangements and rates will apply from 1 April 2021.

The Minister is proposing to tweak what can only be described as a dysfunctional private insurance system relating to what is a dysfunctional health system. In many ways, we are having the wrong debate tonight. We are talking about a situation in which nearly half the population feel they have no choice but to take out expensive private health insurance. That kind of two-tier system does not happen anywhere else in Europe. Many people who cannot afford private health insurance feel that they have no choice but to pay for it because of our public health system being so weak.

The standard plan B cover that many people take out costs in the region of €1,200 per person when taking all premiums into account. As we know, that figure can often be a great deal higher, especially for older people. The average figure for over-50s is more like €1,500 per person. That is way beyond the reach of many people, especially older people and people who are on pensions, but many of those people make sacrifices in many other aspects of their lives in order to maintain private health insurance. They do so out of fear that if they are faced with a serious medical condition, they cannot depend on the public health system to be available to them when they need it. That view of the public health system is a shocking indictment of our public health service. We are alone in Europe in this regard. Every other European country has a reliable, dependable public health system whereby people feel that when they need care they will be able to access it in a timely manner.

In Ireland, 46% of people feel mainly out of fear that they have to fork out for high premiums. In return for those expensive premiums, they do not get a terribly good deal. Obviously, over recent years many people have had to give up private health insurance. During the last austerity period, the level of cover went down to its lowest level with the percentage covered in the low 40s.

It has been gradually creeping up and last year it got to approximately 46%. The figure has remained at that level. Some surveys were done in the middle of this year showing it is still in or around 46%. It certainly did not go up. The idea that so many people would fork out for private health insurance is unheard of in all other European countries. Generally, people in other countries in Europe have access to an affordable public health system that is free, or almost free, at the point of use. That is the kind of system we should have in this country. It is the kind of system to which Irish people should be entitled.

Unfortunately, we are in a situation where a large number of people in this country feel they have no choice but to take out health insurance. That must be seen for what it is. In effect, it is an extra tax on people. On the basis of a premium of €1,500 per year, it amounts to an additional tax of €38 per week, or some €167 per month, in order to buy private health insurance. If it had been announced in the recent budget, or any budget, that new taxes of €167 a month were to be introduced, the Government would have been laughed out of it. Somehow, people seem to think it is all right to put this kind of charge or tax on people just to access health cover. This goes on year after year. On the one hand, there are Government representatives talking about cutting taxes and, at the same time, people are paying out for a very basic service. There is nothing more basic in terms of meeting people's needs than having access to a public health service. We cannot even provide that for people in this country and we tax them to the level of €167 a month in order to be able to access timely healthcare.

The basic plan B health insurance provides people with basic health cover. It really only enables people to skip the queue and jump ahead of others who do not have private health insurance. There is cover for elective surgery but there are a lot of other things the premium does not cover. By and large, the health insurance policies that are available in this country give very poor value for money. Even where a person has plan B, they will still, in the main, have to fork out to see a GP. Again, this is unheard of in other European countries. I do not know whether the Government appreciates that we are the only European country where people have to pay the full amount to see a GP. It just would not be tolerated anywhere else. A charge of €50 or €60 is a real disincentive to accessing care when we should be encouraging people to access that care at an early stage. Even if people have private health insurance, they still have to fork out €200 or €220 to see a consultant. There are very few policies that give any relief in regard to those charges. What about accessing medicines? Again, the standard policy does not provide any relief in that regard. In all other European countries, medicines are available free of charge or for a nominal charge. We are completely out of line with what is standard for all our neighbours in Europe.

The other element of the private health insurance issue is that tax relief is provided to those who access it. It is a reducing tax relief, which used to be at the higher rate but is now at the standard rate. The cost of providing tax relief for health insurance is estimated at €355 million. That is a direct transfer of public money from the weakest to the more affluent. Everybody contributes to the tax relief but only 46% of people, who make up the most affluent part of society, benefit from it. There are huge issues of equity there.

In conclusion, we are having the wrong debate tonight. The debate that should be happening is about implementing Sláintecare and accelerating its implementation. Everybody is signed up to that but the Government needs to account for its tardiness in this regard.

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