Brendan Ryan (Labour)

I welcome the Minister of State, although he may not welcome what I have to say.

The Civil Service, and particularly the Department of Finance, is awash with accountants whose function is to account for money. There is not a single qualified project manager working in the Civil Service. Most people would not know that there is such a qualification but hundreds of young people train as project managers and it is time they were employed in the public sector. The ESB should be in charge of public sector project management. It does so all over the world, on time and within the budget. It would do a better job than the dead hand of the Department of Finance, holding up matters and intermittently causing overruns.

On an intellectual level, I am intrigued by what the Progressive Democrats, effectively the Government, are attempting. Is there insufficient money to provide beds? Why are extra beds being provided if, as we are being told, there is no need for them? The Tánaiste and the chief executive of the HSE agree that we do not need extra beds despite much objective evidence to the contrary. Do we need these beds because the private sector promised to provide them?

At the end of this year the Government could have a surplus of up to €1.5 billion. This would build all the hospitals we need and, when the capital investment was finished, the surplus would fund the staff costs. It is impossible to believe a shortage of money is the problem. Will we save money by following this path? We may save some in the short term but we are effectively giving money away, enabling rich people to increase their wealth at the expense of our health service. We are providing them with much money and valuable sites. If we need further public health facilities, the State will have to buy sites because it has given these away. The hospitals will remain private. Will the private sector deliver a more efficient system?

There is an ideological issue, since most economic consultants build into their measurements a presumption of greater efficiency on the part of private provision. They believe that to be true universally; it is not a matter to be discussed by mere mortals such as me, since they know best. The only way to deal with that argument is to examine the question of whether private health provision is more efficient. I do not know how one measures efficiency in health provision, but I have two indices. The first is the outcomes, and the second is the cost.

In Ireland, we spend approximately 7% or 8% of GDP on health care. It is not quite as much as we like to say, since we add in things that other countries leave out. The Nordic countries and Canada achieve levels of approximately 10% of GDP. They have life expectancies among the highest in the world and infant mortality rates among the lowest, two very important indices of performance.

No one disputes that the most privatised of all health services is in the United States. The glossy image is of middle-class people attending posh hospitals with wonderful backup, but it is the most expensive health service in the world, by a factor of 60%. It takes up approximately 16% of the United States' GDP. One dollar in every six generated in the US every year goes into health care. At the end of it all, they have a lower life expectancy than the Nordic countries and a higher infant mortality rate. The baby of a Spanish-speaking mother in the United States has a lower prospect of survival than one born in Cuba, owing to the appalling American system.

Private health care does not deliver better health, and it is extraordinarily expensive. If we had time, I could explain why. Health is not a commodity regarding which the laws of supply and demand work, owing to all sorts of factors. The presumption of the Competition Authority that if consultants had no agreement on fees, people would shop around for the cheapest is a classic example. If people are seriously ill, they will shop around for the most expensive consultant, believing him or her to be the best.

Money does not work. There is no argument on the basis of funding or delivery of services anywhere in the world to show that private health care is more efficient. There is an ideological assumption that it is, since the private sector is known to be more efficient. The inconvenient fact is that the biggest health market in the world, the US, where market forces run health services to the greatest possible extent, is least efficient and poorest at delivering quality in the western world. However, that fact is conveniently left out because we all know that the market is more efficient.

I need not go into the fact that most sane people, including my wife, who is a doctor, would in most instances decline to attend a private maternity hospital. My wife would not go near a private maternity hospital when our three children were born, since she knew that if anything went wrong, they would promptly call an ambulance and ship her off to a public maternity hospital. That is true of entire areas, and as Senator Browne has said, private hospitals provide a service and serve a purpose, but they leave out the hard parts most of time. Many private hospitals have a policy of leaving out what is difficult. They will deal with routine psychiatry but not with the seriously psychotic. They will deal with what they call accident and emergency, but it will not include the seriously ill. They will deal with many other issues, and at least one private hospital to my knowledge is more of a rest home for comparatively well-off people funded through VHI than a genuine hospital, and there are many of those around the country.

I do not understand why the Government is so set on this route. I regret to say that ideology rather than delivery of a service is the bottom line. Ideology has touched the Tánaiste, in the same way that the hand of God touches people, and told her that this is better. I find it astonishing that a sensible party such as Fianna Fáil, which knows this is a bad idea and will provide bad value for money rather than better health care, has allowed itself to be bounced into this by the party that seems increasingly to be driving the Government. I am very happy to second the motion.