Billy Kelleher (Cork North Central, Fianna Fail)
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74. To ask the Minister for Health his views on the introduction of universal health insurance; the timeframe for its introduction; and if he will make a statement on the matter. [36531/14]

Billy Kelleher (Cork North Central, Fianna Fail)
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One of the central policies in the programme for Government is universal health insurance. On 2 April the Taoiseach and the then Minister for Health published a White Paper on universal health insurance. It was light on detail and unclear as to what was intended with regard to the funding model, but on taking office the Minister rode back to a certain extent from that commitment to universal health insurance. What is the timeframe for the introduction of universal health insurance? Has it been put on the long finger or dropped?

Leo Varadkar (Dublin West, Fine Gael)
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I am committed to a major agenda of health reform in line with the commitments contained in the programme for Government and our policy statement, Future Health. I want to push ahead as soon as possible with key reforms in areas such as extending GP care without fees on a phased basis, improving the management of chronic diseases, implementing key financial reforms, including the money-follows-the-patient model, and establishing hospital groups as a critical enabler of improving patient quality and efficiency. These are big milestones on the road to universal health care.

When I became Minister for Health I reviewed our progress to date and the timescales for implementing very important reforms, including universal health insurance, based on universal entitlement to a single-tier health service that is based on need and not on financial means. While I believe it will not be possible to introduce a full UHI system by 2019, as envisaged in the White Paper, I want to emphasise my commitment to implementing these reforms. In order to do this I want to examine some key elements further and then decide on the best way forward, but this should be considered as a refocusing of our reforms, not an abandonment of them.

In regard to UHI, my Department initiated a consultation process on the White Paper following its publication. An independent analysis of the submissions is under way and I expect to receive this report in the next week. I will then publish it at a later date. My Department has also initiated a major costing exercise to estimate the cost of UHI for households, employers and the Exchequer and is working closely with the ESRI and the Health Insurance Authority. Initial costings should be available in the first quarter of 2015.

The independent thematic analysis of submissions from the consultation process on the White Paper and the results of the major costing exercise on UHI will assist in charting a clear course towards the objective of creating a universal, single-tier health service.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is clear from that reply that UHI has been parked, but can the Minister talk about universal health care? The central policy is the introduction of UHI. It is evident from the Department of Public Expenditure and Reform and others bodies, including the Health Insurance Authority and those providing cover in the marketplace, that this will increase the cost to ordinary families. It will not be progressive. Middle-income families will have to pay extraordinary sums of money for compulsory health insurance if it goes ahead as envisaged by the previous incumbent and the proposals published in the White Paper. I am beginning to wonder if this is an election ploy, because the Minister knows he is in a cul-de-sac when it comes to the funding of the health services, and that UHI will be a major financial burden on middle-income families. He is slowly trying to let this policy wither and die. It is evident from the Minister's answer that there is no commitment to UHI. Will he not do the decent thing now and say that he is parking UHI and examining other options with regard to the provision of universal health care, which is fundamentally different from UHI?

Leo Varadkar (Dublin West, Fine Gael)
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To be clear, we are not parking UHI; that is not what I said. I spoke about universal health care and universal health insurance. To me, universal health care includes a number of dimensions, for example, access to general practitioners without fees, which will be tax-funded, and access to primary care.

It also includes health insurance for everyone across the hospital system, which could be extended into primary care.

A public consultation was held on the White Paper and I will have it and publish it within weeks. At the end of quarter one 2015, I will have the costings for universal health insurance and at that point, instead of speculating about it, we will know what it will cost the Exchequer, employers and individuals and then we can take the debate from there. Practical progress is happening.

I am interested to know what is Fianna Fáil's policy on universal health insurance and universal health care. I have heard Deputy Kelleher speak on the radio about how we need to make the public system better and the private system better too. It seems the Fianna Fáil remains, as it always has been, committed to a two-tier health service, which marks a great contrast between Fianna Fáil and the parties on this side of the House, which are committed to a single-tier health system, even if it takes time to make it happen..

Billy Kelleher (Cork North Central, Fianna Fail)
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We stated quite clearly that we were opposed to the universal health insurance model and committed to a taxation based model. The principal reason we are committed to a taxation model is that it is progressive. Those who have most and earn most pay most and contribute most to the health services in this country. The universal health insurance model was the opposite of that, which is why the Government is slowly letting it wither and die. It knows that the model will place an extraordinary burden on ordinary families. If the Government was so committed to it, one would think it would do more research prior to the election so that we would have a rough idea how much it will cost, as opposed to the opaque plan with no clear costing or policy on how to get there. That is the problem.

We have great difficulties in funding the health services but we must establish the fundamental principle of how to fund it in the first place. We still do not know the view of the Government on how it will fund the public health system today, tomorrow and into the near future other than universal health insurance at some stage. We support the concept of universality when it comes to GP access but as I said to the current Minister and the previous Minister people cannot fund universality by taking it from those who do not have. That is clearly what the Government is doing. In respect of general practitioner access, it is taking medical cards and other services from people who do not have them. The Government must get its priorities right. The vulnerable and those who need medical care the most must be the priority. Those who can afford health care can be worked into the system but not as the priority, as an election gimmick or as a way to buy votes in the coming 18 months. That seems to be the tenor of the Minister's comments. The Minister is becoming very political in looking at cohorts that may reward the Government electorally. It is the wrong thing to do.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy is quite incorrect. More people in Ireland have medical cards than ever before and more people have GP visit cards.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is based on income, not sickness.

Leo Varadkar (Dublin West, Fine Gael)
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The discretionary medical cards that were withdrawn have been restored to those who lost discretionary medical cards and have a medical illness. What Deputy Kelleher is saying is incorrect. However, he let the cat out of the bag about the Fianna Fáil policy because he said his party is committed to universal health care and wants it to be tax funded. How much will it cost and who will pay for it? What tax increases is Fianna Fáil proposing? Everyone else in the country is talking about the potential for tax reductions but Deputy Kelleher has indicated that Fianna Fáil policy-----

Billy Kelleher (Cork North Central, Fianna Fail)
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What tax increase?

Leo Varadkar (Dublin West, Fine Gael)
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The fact that Deputy Kelleher must interrupt me throughout my response indicates the extent to which he is on the run.

Timmy Dooley (Clare, Fianna Fail)
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Will the Minister go back to the Department of Transport, Tourism and Sport?

Leo Varadkar (Dublin West, Fine Gael)
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Deputy Kelleher has announced in the House that Fianna Fáil is committed to tax-funded universal health care, which will cost several billion euro. Anyone who can add knows that. How will Fianna Fáil impose the additional several billion euro of taxes on the Irish people?

Billy Kelleher (Cork North Central, Fianna Fail)
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Progressively.

Leo Varadkar (Dublin West, Fine Gael)
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Over what limit?