John Lahart (Dublin South West, Fianna Fail) | Oireachtas source

I enjoyed the research on this Bill, mainly because a constituent came to my clinic last night who raised the issue and brought along his and his wife's private health insurance policy. He had noted that the premium for 2022 compared with the premium for 2021 had reduced but the credit for the risk equalisation had also reduced, resulting in little change in the overall cost of his premium. He was wondering about the risk equalisation piece. I am in a much better position today to tell him, having read through the research, briefing notes and some other bits and pieces. Notwithstanding everything that has been said because this is, to use a term that has been used this week, part of the peculiarity of the Irish health system, I was amazed that this couple in their 70s were paying almost €3,000 between them for their health insurance for the year. That is unacceptable in this day and age.

Like every other Deputy present, I strongly support Sláintecare and yearn for the day when there is universal free healthcare, universal access to healthcare on an equal basis and good and decent healthcare. I do not just mean universal access, but universally timely access to every sort of procedure, every sort of consultant and every sort of care that is necessary for individuals.

I am also mindful, though, of the great Republican Party slogan during an election a number of years ago when the Democrats were putting forward the virtues of Medicare and Medicaid, an issue that arises consistently in the USA. The Republicans had a scary slogan: "If you think health care is expensive now, just wait until you see what it costs when it's free". Something that strikes me, and that was mentioned by another Deputy, is that we will always have people who can access private healthcare. Even if we had the resources in the morning to produce a universal healthcare system, there would probably be a splurge in the development of even more private hospitals, including private specialist hospitals. There would then be an even more striking elite with access to that kind of healthcare. However, there is no aspect of Sláintecare that is not virtuous.

I was lucky enough to go to and graduate from college. When I got my first job, my parents' advice was to take out a pension and private health insurance. It was part of the DNA. I never thought I was gaining superiority over anyone else. I just assumed it was something that everyone did and to which everyone had access. It was a seamless decision in a world that probably was not characterised by as many inequalities and inequities in terms of accessing the health system.

The purpose of the legislation and the reason for the risk equalisation fund being revisited every year have been well rehearsed by other Deputies. It is a good. Whatever about having private healthcare, imagine if we had a system of private healthcare like the system in the US, which is unbridled and unfettered and where no account is taken of someone's age. In fact, the older one gets and the more likely one is to get sick, the larger the payments one must make and health insurance moves out of ordinary people's reach. I am not giving bouquets to our system. Far from it. I believe in an equal system and it is what we all strive for. I certainly strive for it. For example, and to go slightly off topic briefly, the National Treatment Purchase Fund could be used to provide access to psychological services that are otherwise not available. As a society, we could examine this matter. I recently had a case of a child who waited four years for an assessment and, after getting that assessment, must now wait another four years for treatment. The child will have gone through every developmental phase by then. It will be over developmentally for that child.

We understand that the reason for the risk equalisation fund is to ensure that people who are in their advancing years and who are more likely, although not always, to become more ill, develop ailments or require hospital admission or specialist care do not pay any more than younger cohorts who are regarded as being stereotypically fit and health. I wish to make two points on this. I enjoyed reading the Health Insurance Authority's paper on this matter. It was well explained, provided good background information and was detailed, but the authority only had 20 respondents to its public consultation. That is risible. The Health Insurance Authority ought to be more robust in its public consultation. It could request that all private health insurance providers include a consultation piece in correspondence to all their members, including a feedback form and the authority's questions. The questions that the authority asked were legitimate and explained to many people the need for risk equalisation, but when one thinks of the millions of people in Ireland who have their health insured privately, that there were only 20 responses to the consultation indicates there was something lacking. We need to do something about it.

The Minister of State will be aghast to know that there are more than 380 different health plans. The bulk of them are held by Irish Life. Next is Laya, with VHI holding the fewest plans. Regularly, Claire Byrne and Pat Kenny do the State some service when they have a specialist on who tries to navigate the public's way through the myriad of plans. How can anyone reasonably hope to get value for money in a health insurance plan? I am confident that there are thousands of people who, if they had a helping hand in buying their private health insurance, would save a great deal of money. We could do the State some service, to use that phrase a second time, if we asked the health insurance companies whether they really needed so many plans. I believe Irish Life has 180. Why does a health insurance company need 180 different plans?

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