Feargal Quinn (Independent)

I welcome the Minister of State and congratulate Fine Gael on putting down this worthwhile motion. For two reasons, I am tempted to say that in an ideal world we would not allow private medicine to exist at all.

The first reason is perhaps of lesser importance, but it is significant nonetheless. The existence of private medicine means that none of the movers and shakers in our society need experience the difficulties that public medicine can bring. I doubt very much if any Member of this House, or indeed of the other House, fully depends on public medicine for his or her needs.

This allows us to tolerate shortcomings in the provision of public medicine that we would never tolerate if we had to go through the public system. It is one thing to read about and to empathise with the situation that other people find themselves in, it is quite another to experience these things for oneself. The existence of private medicine is something that allows us to wring our hands at what goes on in the public area, while at the same time we tolerate its continuance.

The second reason is that a two-tier medical structure creates a two-tier society with life or death consequences. It is a shocking indictment of this country that the further up the socio-economic scale one happens to be, the healthier a person one is. This applies to the ultimate sanction of death. The better off one is, the longer, on average, one lives. The further down the socio-economic scale one is, the more likely one is to contract and die of a whole range of diseases.

Professor Ron Hill of the department of political science in Trinity College spoke to the Committee on European Affairs today and pointed out that life expectancy in Russia has dropped dramatically in the past 20 years. In Russia, a man's life expectancy is now in the late 50s and a woman's in the mid 60s. It appears that this is a result of the destruction of the state health system after the collapse of communism. Similarly, infant mortality has jumped in this period.

There are many reasons for the disparity in Ireland, but some of the most important relate to the availability and quality of medical care. I do not mean to suggest that the quality of medical care in public hospitals is in any way inferior to that in private ones, but a crucial element in successful medical care is identifying and treating problems early. A public system that makes one wait for diagnosis and treatment is a system that will inevitably have worse outcomes than one which offers instant diagnosis and immediate treatment.

Both of these are good arguments against private medicine, but there are arguments on the other side as well. An important point is that private medicine creates competition in the provision of services. I believe that competition is a good thing and is a necessary factor if we are to provide efficiency and quality in any marketplace. I disagree with Senator Ryan on this point. I have had experience of attending private hospitals in the United States and I was impressed by the service delivered. I was also impressed that, unlike what I expected to be the case, I was not overcharged when I had to go to hospital there.

If we banned private medicine in the morning and brought it all under the umbrella of the State, we would create a monster monopoly, which I very much doubt would be in the public interest. Another argument is the difficulty of getting from where we are now to that point. We have a mixed public-private medical system here and it has served us for many years, although I am not sure it has served us well. Even if we wanted to, I am not sure that in practice it would be possible to move from what we have to a single system. All of this leads me to conclude that our mixture of private and public medicine is something that is probably desirable and is not likely to change in the foreseeable future.

However, that does not imply we should sit back and allow the balance between the two sectors to take any shape the marketplace may determine. In other words, I would be worried about the marketplace being the only element determining that. We need a to establish a careful balance to ensure that, to the maximum possible extent, the two parts of our medical provision complement each other in the interests of the country as a whole.

I welcome the Tánaiste to the House. I recall from my university days a principle in economics called Gresham's law. Gresham's law argues that bad money will always in the end drive out good money. When it comes to co-operation between the public and private sectors, the same kind of principle applies. Marketplace economics tends to win out in the end. When we reflect on what has happened here in the past decade or so, we tend to find that when the public and private sectors get into bed together, the private sector always fares best in any such encounter. Whether such partnerships apply to airlines, hotels or other sectors, invariably the private sector wins.

Therefore, we are right to be wary of partnerships between the public and private sectors. We do not seem to have yet devised a way of operating that guarantees the public interest will not end up being sacrificed on the altar of private profit. I am sure there are as much brains in the public sector as in the private sector, yet the public sector does not yet seem to have found a way to manage this issue successfully. I am not only referring to medicine but to public-private partnerships in sectors in general.

We need to be particularly careful when it comes to making available to the private sector public sector assets that are in short supply. This is a crucial aspect. This is a dangerous game, because it usually tends to have a zero-sum outcome in that what one side gains, the other side loses.

When we talk about using public hospital lands to build private businesses we are not, therefore, talking about a normal commercial operation. Those lands are a rare and valuable asset, which may not be fully used by the public sector now but may very well be needed at some point in the future. There can be no doubt in anyone's mind that in the future the public medicine sector will need to expand greatly, even if it is only to keep step with the increasing demands an ageing population inevitably will bring. Our population is ageing, and the signs are that our people will need more medical treatment. Even though we may not need public hospital lands now, we may need them in the future.

For public hospitals to sell off some of their lands now for a short-term gain, which will largely profit private rather than public interests, appears to be a policy that sells future generations short. While Senator Glynn made a good case for doing that, I take a long-term view. We risk creating a situation in which we undercut what our children and grandchildren will wish to do by giving away what should have been an asset that was preserved for their needs.

We need to establish a careful balance between the private and public medical sectors. Preserving such a balance is best achieved by refusing to sell off public hospital lands, and for that reason I am pleased to support this motion. I understand the other point of view, which Senator Glynn explained very well, but on balance we need to be careful in regard to such a policy, and taking account of the long term, I support the motion.