Dáil debates

Tuesday, 7 December 2021

Health Insurance (Amendment) Bill 2021: Second Stage

 

6:00 pm

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour) | Oireachtas source

I thank the Leas-Cheann Comhairle for the opportunity to speak. Annually, we have a debate about the health insurance Bill wherein we establish the regulations and legislation around the private health insurance sector. It is a difficult thing for those of us who have fundamental issues with how the Irish health sector is set up at the moment, and how it has been set up for many years. In the past two years the deep problems of our healthcare system have been clearly exposed for all to see. As a State, we operate a two-tier health service and we attempt to operate these systems in tandem while not having enough capacity within our service to meet the basic public need. That is underlined by massive issues in recruitment and retention. Essentially, our health system is failing to cope with the basic needs of the State and has been for many years. This has led 2.2 million Irish residents to have private health insurance. That is 45% of the population. In the UK, the figure is 13%. While the NHS is not perfect - far from it - it is one of the great achievements of public health in Britain that the vast majority of its population do not pay for for-profit health insurance, because they believe in their health service. They strive for their health service to be better and they are invested in it.

It is not just about comparisons with the UK. According to the WHO, Ireland is "unique among EU countries in not providing universal coverage of primary care." It states:

Its system of entitlement to publicly financed health care is also complex ... gaps in coverage in Ireland already create significant financial barriers to access, particularly for people who do not have medical cards or [private health insurance], resulting not only in unmet need but also in inequitable and inefficient patterns of use ... these barriers are often substantial relative to most other EU countries, especially for primary care.

That is absolutely damning of our health system and we know it. We see the outworkings of it every day in our advice clinics, in our communities and in our families and we discuss the outcomes in various debates in this Chamber. Much of it boils down to the complexities of the two-tier system and trying to unravel that. Believing that Sláintecare is the answer to that is slightly misleading.

Sláintecare, if delivered in its entirety or nearly in its entirety, would not replace private health insurance. It would create what will hopefully be an attractive alternative to private health insurance, namely, a public health system in which people have so much confidence and that has such ease of access in terms of cost across many different aspects of healthcare that we feel we do not need private health insurance. That is a huge offer of faith in terms of a health policy. Most people are behind Sláintecare, or say they are, but even if it is delivered we will still have a private health insurance market in this country. It will still be actively touting for business from Irish residents and will be coming from a position of huge advantage because of where it is at the moment, the facilities and resources it has and because it is unconstrained by having to provide pure holistic public health policy. It is a huge ask just for Sláintecare to be delivered and then we have this offer of faith that if it is delivered it will be so attractive and function so well that the private health insurance market will be diminished to an extent similar to the UK, where it only covers 13% of the population. That feels light years away in the Irish context.

We need to have some hard conversations about what Sláintecare can and cannot achieve. I do not have faith that Sláintecare will achieve what we need it to when it comes to our reliance on private health insurance. A reliance on private health insurance is what the State has at the moment. That is something we need to move away from. Looking at news articles on private health insurance, two consistent trends are clear. You will see the price of health insurance going up and the profits of health insurance companies going up. What you will not see is waiting lists in the public health system coming down or costs for health insurance coming down. Inequality is widening. Due to the way we have it currently set up this House is hamstrung. No matter what your ideological bent, because of where we are right now this Bill will have to pass. However, we will back here again next year having a very similar debate. Even if great strides are made and we catch up on the delays and make strides where we need to, Sláintecare is not going to fundamentally solve the problem of our two-tier health system and the hold private health insurance companies and private health providers have. We need to get real in that debate. We are where we are with it now.

It is another example of a deeply flawed structure within our health system. As I said, we see its outworkings across many areas. We have a huge recruitment and retention problem. Part of that is due to the fact that private healthcare providers can provide better pay and conditions for staff who are then taken from the public health system. Consultants are working in both private and public healthcare and so the same person on the same list could be offered the same consultation 18 months or two years down the line or they could have it in a week or two with the same person, sometimes in the same room. That is just immoral and that has to change.

Turning to our GPs and the pressure they are under, our primary care sector has performed Herculean tasks over the past 20 months, but Covid has laid bare just how stretched the sector is. Real investment in public and primary care will have to come hand in hand with an approach to private health insurance that removes the guilt factor for people who feel that they need to have insurance. It is fantastic if people who are on their own do not want to get private health insurance and decide to take their chances, but if their circumstances change - they get married and have families or other dependants - the pressure on many to stretch their household budgets to include private health insurance tips hard-working people who are just trying to get by onto the edge of the poverty line. This is because they do not have the primary care access that they need and the certainty such access brings. Every Deputy knows and understands that but not everyone is providing the solutions to change it.

Comments

No comments

Log in or join to post a public comment.