Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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84. To ask the Minister for Health the process for drafting the White Paper on Universal Health Insurance including membership of teams; the timeframe for same; and if he will make a statement on the matter. [22559/13]

James Reilly (Dublin North, Fine Gael)
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The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance, where access is based on need, not on income. Under UHI, everyone will be insured and will have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

The Department is preparing a White Paper on universal health insurance which will provide further detail on the UHI model for Ireland in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance. Broadly, this involves the development of detailed policy proposals covering issues such as the design of the UHI model, the scope and composition of the UHI basket of services and funding and financial support mechanisms for UHI. More detail in relation to the overall process for producing the White Paper, including the projects, studies and policy appraisals that need to be undertaken, is set out in the preliminary paper on UHI, The Path to Universal Healthcare, published by the Department in February 2013 and available on its website, www.doh.gov.ie.

A special UHI design team has recently been set up to oversee and support the work involved in the design of the UHI model and the preparation of the White Paper on universal health insurance. The membership of the UHI design team comprises officials of the Department of Health, Department of Public Expenditure and Reform, the HSE, the Health Research Board and the implementation group on universal health insurance.

The work involved in UHI design is both complex and technical and demands a wide range of legal and financial expertise. Accordingly, it is envisaged that the design team will be supported by specialised expertise at appropriate junctures. To this end, the Department has recently engaged legal expertise to support deliberations in relation to the design of the UHI model. Work on the development of detailed policy proposals is proceeding with a view to publishing the White Paper as early as possible.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There has clearly been little or no meaningful progress on the White Paper on universal health insurance. Without this we have no clear indication of the anticipated relationship between hospitals and insurers and the crucial purchaser-provider relationship. That has consequences for all hospitals when it comes to services.

Would the Minister accept that the future role of hospitals will be determined not by Professor Higgins but by these competing private insurers? At the end of the day, they will be the determinants of the level of service provided at any of the hospital sites.

There is no evidence for - and in fact, there is growing concern about - the Minister's preferred model of multiple competing insurers. There is no proper debate on alternative models. The model to which, by all accounts, the Minister is married will drive costs up rather than down. Greater efficiencies would be gained through the single insurer approach. Is it well past time for the Minister to draw a breath on this and consider all of the possible alternatives? His approach, I fear, will not succeed.

James Reilly (Dublin North, Fine Gael)
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On the one hand, we do not seem to be going fast enough, but on the other hand Deputy Ó Caoláin wishes us to draw a breath. I had to point out to him that a paper was produced by the universal health insurance group in February.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Where is the White Paper?

James Reilly (Dublin North, Fine Gael)
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The White Paper is under-----

Billy Kelleher (Cork North Central, Fianna Fail)
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A Ladybird book would have more information than that.

James Reilly (Dublin North, Fine Gael)
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When it comes to Ladybird books, and Tweedledum and Tweedledee, we all know to whom we should refer.

The reality here is that we are undertaking a sea change in the way we provide care and how we fund it. It is a fundamental shift, moving from hospital-based care to a primary care model and from a tax-based system to an insurance-based system under which those who cannot afford all of the cost are subsidised and those who cannot afford it at all will be paid for by the State, but everybody will be treated equally. There are some who would like to see a continuation of the old ways, with a virtual health service for those who cannot afford to pay for it and the ability to queue-jump and have the service one wants if one can afford it. That is not the way to run an egalitarian society or one in which everyone is equally cherished regardless of his or her income.

Timmy Dooley (Clare, Fianna Fail)
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What?

Billy Kelleher (Cork North Central, Fianna Fail)
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An egalitarian society-----

Finian McGrath (Dublin North Central, Independent)
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The Minister is turning left.

Billy Kelleher (Cork North Central, Fianna Fail)
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Has there been a major change?

Peter Mathews (Dublin South, Fine Gael)
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Deputy Ó Caoláin has 20 seconds.

Alex White (Dublin South, Labour)
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The Progressive Democrats health policy.

Seán Fleming (Laois-Offaly, Fianna Fail)
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Deputy Reilly is going socialist.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have got 20 minutes; is that correct?

Timmy Dooley (Clare, Fianna Fail)
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Deputy Alex White must have written the answers.

Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Reilly is the funniest socialist I ever saw.

Timmy Dooley (Clare, Fianna Fail)
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He has the beard and moustache, although that is about as far as it goes.

Peter Mathews (Dublin South, Fine Gael)
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The Deputies should calm down.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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On the national children's hospital, that is a product my party supports. That is why we want to see it expedited.

On the national insurance approach, my party wants to see such a universal process in place, but not under the model the Minister is proposing, because we do not have faith in it. It is a reasonable position for us to take. We are not convinced. Does the Minister recognise that there is growing international evidence that discounts the claims he has made about the approach he has championed here over these past couple of years? It is not only that the Minister does not have a White Paper but that at the end of the day he does not even have a good idea.

James Reilly (Dublin North, Fine Gael)
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May I respond? There are two minutes left.

Peter Mathews (Dublin South, Fine Gael)
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The Minister has ten seconds.

Finian McGrath (Dublin North Central, Independent)
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Deputy Reilly should go back to the day job.

James Reilly (Dublin North, Fine Gael)
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Deputy Ó Caoláin talks about not having faith in the Government's system. His leader does not appear to have faith in the system on this side of the Border or that in Northern Ireland when he chooses to use the free travel provided to him by a benefactor to avail of whatever the insurance sector seems to provide in the United States for his own treatment. Deputy Ó Caoláin's words ring a little hollow.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What has that got to do with the question I posed to the Minister on universal health insurance? Is that the best he can do?

Peter Mathews (Dublin South, Fine Gael)
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There is still one little gem left - Question No. 85.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Make no mistake; there is no gem in dealing with the Minister, Deputy Reilly.