Duncan Smith (Dublin Fingal East, Labour)

We will support the Bill, as we do with related legislation every year, but that endorsement is not an endorsement of the two-tier system that exists in our health service. Why do 46% of the population, or 2.5 million people, feel they must have private health insurance? It is because our public health system is buckling at the seams. As of 31 October 2025, there were 626,000 people on outpatient waiting lists. So far this year, 103,545 people spent time on trolleys awaiting beds. Many of us in this House have had family members waiting on trolleys this year. There are 6,858 vacant posts in the public health service at this time. A total of 400,000 people entitled to medical cards and GP visit cards are not availing of them.

The public system is struggling in many respects. Health insurance providers step into that breach, with health insurance being a tax on people's fear that if they get sick, they will not get the help they deserve and that should be their right through the public system. Sláintecare is moving at a glacial pace, with a reduction in funding for its implementation from last year to this year. The question is whether the Government is as committed to Sláintecare as was the whole Oireachtas two Dáil terms ago when the cross-party group on the future of healthcare made its recommendations.

We also need to discuss health insurance in the context of the cost-of-living crisis. We talked in this Chamber today about the big energy providers in regard to profit making and price gouging. The same arguments can be made about health insurance providers. Irish Life Health recorded post-tax profits of €24.1 million in 2023, with dividends of €11 million paid last year. VHI reported a net surplus of €36 million for 2024. Laya recorded pre-tax profits of €19.02 million in 2024, which was a doubling of its profits from 2023. People are struggling with mortgages and rent, high energy costs and food prices. They have little left of their wages. With 46% of people availing of private health insurance, the average policy increased from €1,683 in July of last year to €1,839 in July this year. The average price rise between 2023 and 2024 was more than 12%, which is a lot higher than the rate of inflation. Health insurance is not a luxury item or elective product; it is for basic healthcare. This is the Ireland of today and the health system that currently exists.

We need to see a real drive towards the implementation of Sláintecare. It must happen not only in our acute hospital settings but also, as Deputy Cullinane outlined, in the delivery of elective hospitals, the pace of which has been glacial. We also need to look at the community level. Mental healthcare in the community is underresourced and does not have enough staff. People are falling through the gaps. I have huge concerns about the number of people with acute mental health illnesses, unquantified to this point, who are not in receipt of a service at the moment because they have been discharged for missing appointments. That is a huge concern and one the HSE must take seriously. Children are timing out awaiting assessments of need in the public waiting system, which dictate what services, if any, they will get and assist with securing an adequate school placement. Those families are having to resort to claiming from their private insurance to access private assessments or, if the insurer does not cover that, paying out of pocket on top of their insurance. Even then, there are waiting lists in the private system. That is how broken the system is in terms of assessments of need for neurodiverse children. It is utterly broken.

This Bill is a technical one. It is a risk equalisation Bill and a complicated one in many ways but it supports an insurance system that is being presided over by companies making huge profits off the top of bills and premiums that are going up and up while the service is diminishing.

We need Sláintecare. We need it to be delivered as soon as possible. There is a creeping sense within the health system, the public and the political class that this Government is not truly committed to the delivery of Sláintecare. It feels as far away now as it did when it was first decided and agreed upon not seven years ago.

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