Brendan Ryan (Labour)

I listened to the debate about competition, health insurance and related matters and then I saw the complexity of what has to be done in terms of risk equalisation and preserving both community rating and lifetime coverage. It is as well to consider whether competition via multiple insurance agencies is necessarily the best route. I do not have an ideological issue about competition; I have no problem with it in many cases where one has a real market in commodities or services without extra overtones. However, I am sceptical when it comes to health care

If one went through a first year economics textbook one would find so much that is different about health care that the assumptions on which an efficient, competitive marketplace is supposed to operate would fall apart. That is what the Minister is learning from all the lobbying that is taking place. There is a strong suspicion that the second company in the Irish health insurance market is not in a position to make money, but that it ultimately will have to deal with risk equalisation. It has fought a ferocious battle on this issue with intensive lobbying, as the Minister knows, localised in the Cork region to persuade those in that area of the threat to jobs if risk equalisation comes is forthcoming.

I still hold many left wing views, but I have never had a problem with competition. With regard to the development of the health insurance market in the United States – which has the most expensive health care system in the world – that country spends 13% to 14% of its gross domestic product on health care. This means that one dollar in seven of the GDP of the richest country in the world is spent on health care. What is the outcome? They have lower life expectancy than virtually all the European countries, Ireland excluded. I blame the Minister for many things, but Irish people's life expectancy is the result of factors other than the bad health service.