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

I have no difficulty with the Bill before us and the annual requirement that we pass this legislation. As an insurance system, community-rated voluntary private insurance is fine and it is essential there is a risk equalisation scheme as part of that. We cannot really argue about that if we are talking about a health insurance system. However, the difficulty arises with the health system we have, which is a two-tier, dysfunctional, mix-and-match one. It really does not serve people terribly well. Many people wish they had the money to afford private health insurance and many others struggle to meet the cost of that. In the main it is higher-paid categories of people who tend to be in very senior jobs and decision-makers at administrative and political level who have private health insurance. There is very much an attitude of “I’m all right” and that it is too bad if others cannot afford private health insurance.

The dysfunction within our health service was the motivating force behind the Committee on the Future of Healthcare being set up and it developing the Sláintecare reform programme. The programme was agreed by all parties in the House and is official Government policy, though sometimes one wonders whether that is really just a matter of lip service being paid. While nothing happened for the first few years and there was the pandemic and all of that, in the last couple of years there was progress on that reform programme and I have no hesitation in acknowledging that.

We were starting to see real change in the health service, a commitment and a belief among many healthcare workers that we were serious this time, in spite of all the false dawns in the past. Over the past two budgets, we saw reductions in the cost of accessing care. Cost is a significant barrier to accessing care and feeds people's belief that they have to have private health insurance. There were important initiatives. The removal of the €80 a night charge, the reduction in the drugs payment scheme threshold and the expansion of access to free GP care were all very important initiatives and they gave the impression that we were on the road to serious reform.

That is why the Government's decision in last month's budget was so disappointing and surprising. As some commentators have said, it was an own goal by the Government. When we were reaching a stage at which people were seeing these improvements in respect of access, the new consultants' contract and the expansion of GP care, all of which seemed to indicate that we were going in a certain direction and were experiencing much-needed reform, the door suddenly came down and no additional money was provided for healthcare. The programme that was under way has now come to a shuddering standstill and people are asking what that is about. They are asking why, after having made a certain amount of progress and with the Taoiseach, the Tánaiste and others claiming credit for the past couple of years, which is fine because we did make progress, we are now stopping. We were going in the right direction but have now suddenly come to a standstill. It just makes no sense at all and it results in health becoming a political football once more.

The Minister of State has asked for that. Health is going to become a political football and there are going to be rows about it because Government has smashed the consensus there had been about the need to move forward on a cross-party basis and to get Ireland to the point practically every other European country is at, a point where there is a single-tier universal healthcare system. A major mistake has been made. I do not know if Fine Gael was pushing for this but there was always doubt about its commitment to universal healthcare that is free at the point of use.

I will also raise a few other issues. One relates to one of the most surprising facts about the dysfunction within the healthcare system. More than 47% of people in this country now have private health insurance. Looking at the global figures for the funding of our health service, it would be expected that if nearly 50% of people pay very expensive premiums for private health insurance, it would make a major contribution to the cost of healthcare but it does not. Private health insurance contributes 14% or 15% of the cost of running the health service. That is extraordinary. I do not know if the Minister of State is aware of that figure but it is extraordinary that it is so low. It can, therefore, be seen that the public system and the public purse provide a major subsidy to private healthcare. It is a bit like private schools. Those who can afford to get in then get all the benefits from the State, which is not a very fair way of funding the health service.

The value that people get for private health insurance is very poor. Most people buy private health insurance to skip the queue. It enables people to do so and that is, in itself, wrong. It should not happen like that. However, most people accessing the healthcare system do not need to go to hospital. They need care at community level. In the main, private health insurance does not pay for GP care or to see a consultant. We are talking about fees in excess of €200 to see a consultant. It can be as much as €300 or €350. People are paying for private health insurance and forking out something in the region of €300 to see a consultant. That is an indication of the shockingly dysfunctional nature of our health service. People are paying for healthcare through the taxation system but they are paying on the double because they are also paying what amounts to a health tax through their expensive private health insurance. That should not be the case.

In the vast majority of cases where people really need hospital care, when they are in an emergency situation and have to attend an emergency department, they do not go to a private hospital because, if it provides any emergency department service, it only does so between 9 a.m. and 5 p.m. The rest of the time, people have to use the public service. In many ways, that service is very good, especially in the case of a serious emergency or something like a heart attack, but it is a public service and private health insurance does not cover it. In most cases, people also have to fork out to avail of diagnostic services, which can cost a few hundred euro. They are again paying on the double. It is entirely dysfunctional.

We need to move away from that. The stronger the public health service is, the weaker the case for people to buy private health insurance. We should not force people into a situation where they feel they have no choice but to pay for such insurance. There are many people who are on very low incomes but who, through fear, feel they absolutely have to scrimp and save to buy private health insurance, which is a terrible reflection on the health service.

The last point I will make relates to the Minister of State's own remit. Of course, there should not be this great emphasis on hospital care, waiting lists and so on. There should be much greater emphasis on prevention and health promotion, which is the subject of one of the five chapters in the Sláintecare report. I do not know if she has read that report. We have not heard anything of any great substance from her with regard to health promotion and prevention since she took up her current role. That is really where she should put her energies to raise people's general standard of health through improving lifestyles. There is an awful lot of work that can be done in that area.

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