Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance) | Oireachtas source

I will probably only take ten minutes but you never know. I will try to keep to ten. This legislation comes before us every year. While we continue to operate a two-tier system of healthcare in this country, which we believe is fundamentally wrong, this legislation goes towards trying to keep premiums down for health insurers that cover a larger cohort of older people, particularly the VHI, to prevent them putting up premiums for older people. Within the parameters of a fundamentally unfair system in which great numbers of people are forced to take out private health insurance, we support this minimal measure to equalise premiums. Much of the debate I have heard rightly reflects what we say every year, which is that this measure highlights the need to get away from the two-tier system, which people are, by and large, forced into. A very high level, just under 50%, of people feel the need to take out private health insurance and to pay very hefty monthly insurance premiums, which are a significant burden on them.

In one recent case I was involved in an elderly family was being made homeless. They were in their late fifties and early sixties, which is not really elderly these days. They had health issues in the family and they were being evicted, through no fault of their own, from their family home. A significant part of their outgoings was private health insurance. They were terrified about the prospect of not paying their health insurance because the husband had a serious heart condition and his partner also had health issues. For them that is money they have to pay because they are terrified of having to rely on the public health system, given it is such a mess. That was money they desperately needed to try to find alternative accommodation to avoid being homeless. They had been living under the terror of being homeless when they were seriously unwell but they felt obliged to pay private health insurance because of the terrifying prospect of them needing the health system to deal with their illnesses. That eviction went ahead; they were evicted from their family home where they had lived for all their lives with their two children. Much of the conversation I had with them during the eviction was about their fear that they would die because of the stress of it. These were working people. The following is something the Minister of State might look at: in assessing their income they found they could not get on the social housing list. They had no options because their income was over the threshold. A significant portion of their outgoings was money for private health insurance against the possibility of being ill. It was not money they had in their pockets but it was money that was counted by the local authority to say they were not entitled to social housing. As a consequence they were entitled to nothing.

A lot of working people are caught in that bind, paying large amounts for something they should not have to pay for and for which they are paying twice. That is the reality of private health insurance; people are paying twice. What are they paying it for? Critically, they are paying it to make an awful lot of profits for private health insurance companies that want to exploit people's fear of having to be put on a waiting list where they could wait months or years for treatment. It is worth noting, if we take Laya Healthcare as an example, that its pre-tax profits for this year are up from €28.85 million to €36.55 million. Private healthcare is making lots of profits, essentially out of the fear and terror that working people have of having to rely on a public health system that is in very significant trouble. That private system is pulling public resources and money in order to make money. As well as taking huge amounts from working people to pay the premiums, it is also pulling resources and money from the public system.

Let us take the national children's hospital as an example of that. It is expected to cost more than €2 billion and included in that are consulting rooms for private healthcare. The public are paying €2 billion for this state-of-the-art hospital and public money is being used to subsidise two-tier private healthcare to make money for the private consultants and health insurance companies. It is also being used to force working people, who feel compelled to take out private health insurance, to pay twice. They pay with their taxes already and then they must pay again with hefty private health insurance premiums.

The worse the crisis gets in the public system, the more people feel the pressure to go into the private system. It is understandable why people feel compelled to do so. As a matter of principle I do not take out, never have taken out and never will take out private health insurance because it is fundamentally wrong to do so. It is particularly wrong for public representatives who are charged with maintaining the public health system to in any way benefit from a two-tier system. If we are going to represent the majority of people in this country, we should be the ones who have a personal incentive to ensure the public health system functions for everybody.

I will make a few comments on how bad things are in that regard and provide evidence on why people might be pushed towards the private healthcare system. The INMO is feeling compelled, because it is not something it wants to do, to consider industrial action because of the recruitment freeze the Government has imposed. That is against a background where the INMO reckons that we are 2,800 jobs short of having the nurses and midwives needed to make the health system function. The Irish Hospitals Consultants Association, IHCA, is saying that the Government is significantly behind in achieving the 10% reduction in waiting lists that it promised by the end of 2023. We are already facing a 65,000 shortfall by the end of September. There are 893,000 people on some form of National Treatment Purchase Fund waiting list, which is up almost 23,000 or 3% this year alone, and by an additional 309,000 plus 53% of people since Sláintecare. The IHCA president, Robert Landers, said:

The 2023 Waiting List Action Plan is now unlikely to achieve the reduction targets set for the end of the year. The Government needs to urgently increase public hospital capacity to address the increasing number of patients on waiting lists.

That leads to all of the fear and things that would lead people to think they have no choice but to take out private health insurance. Then, as I have mentioned previously, there are advertisements week in week out for the Beacon Hospital and the Blackrock Clinic. The subtext of those advertisements if that if people go there, they do not have to queue but if they go to the public hospital, God help them because they will be sitting on a trolley or be put on a waiting list for weeks and months.

A lot of people need occupational therapists. For example, if they need to get housing with certain types of adaptations, they need occupational therapist reports. Even to get their wheelchair fixed if they are disabled, as someone informed me recently, they need an occupational therapist but there are hardly any available in the public service. In Dún Laoghaire, the service was recently cut to two days per week. It used to be that there was an occupational therapist available every day for an hour. People could ring somebody in the local health centre to say they needed to service their wheelchair or that they needed a new wheelchair, for example. Now that has been reduced to only two days per week because of a lack of occupational therapists. These are the basic things that result from the lack of staffing and the failure of the Government to address the staffing crisis in our health service. This is terrifying people and they end up, in one shape or form or another, having to go private, which is not acceptable. Healthcare should be for everybody.

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