Brendan Ryan (Labour)

I will be a good deal less colourful. I agree with the core of what Senator Norris said. I am at a loss to understand how a blinkered economic commentariat in this country and other countries can talk about competition as an inherently good thing in the provision of health care. I have written to newspapers and I have said it in the House on many occasions that if market efficiencies make for good health care, why has the United States the most expensive health care system in the world by a factor of nearly70%? Between 15% and 17% of US gross domestic product is spent on health care. We spend 7% or 8% — the Minister can correct me on that. Even on a gross national product basis, the US spends nearly twice as much. The outcome of that is a lower life expectancy than most of western Europe and a spectacularly higher incidence of infant mortality than the rest of the comparatively wealthy world. That is a fact. I am a pragmatist. What works is what matters to me and I have no patience with ideology of left or right on these issues. The US health care system, the most market-based in the world, does not work.

The liberal market model of a competitive market is based on a number of assumptions, one of which is that the withdrawal of one participant from the market will not affect the market. The flurry of activity we had in the past six months makes it clear that the withdrawal of a participant from the market has a profound effect on the market. The two basic platforms are, first, the assumption that there is something like a market and, second, that it is an acceptable model to describe the way to deliver health care. Both of them are at variance with the facts, not with my ideology. The fundamental problem is the belief concerning market discipline, whatever that means.

People talk about efficiency in health care, for instance. It is a fact that 50% of all health care expenditure in the United States is spent on people in the last six months of their lives. If we want to be brutally efficient, let them die six months earlier and half the budget will be saved. Effectively, that is what many of the health maintenance organisations, HMOs, are doing in the United States because a bureaucrat, not a doctor, decides what treatment is appropriate.

Are we moving in that direction? I read in The Irish Times today a commentary from the Barrington report which mentioned dividing up our health care system into three: the public system, community-rated health insurance and luxury health insurance, which is not community-rated. I do not know what efficiency that might create other than to reassure the super rich that they will have a health service all to themselves which they can pay for at whatever exorbitant rates they are charged, and it will not be competitive.

The idea that the market is an appropriate way to allocate resources in health care efficiently, and that must be defined properly, is at variance with the facts. The European health care systems have their limitations but they deliver better quality health care for ordinary citizens than the alternative model, which is the US model of privatised health care based on private or no insurance and an appallingly inadequate public health service. That is the evidence, so what are we doing here?

I am numerate and can handle numbers and figures. However, this is as confusing a statutory instrument as I have ever read. The explanatory memorandum, like many before, says the same thing in a separate language. Assuming the Minister is telling us what is in it, it amounts to an attempt to restore some kind of community rating. Underlying it is the belief that a health service would be better if it were based on a competitive market model. One cannot have such a model in a publicly owned health service or at least where the dominant force is publicly owned. The underlying belief is that we must privatise the health service to make it efficient. That is a very dangerous route to go, which is what worries me about this measure and why I am unhappy about it. It is a bad idea and pushing it through the Houses of the Oireachtas in two sessions, each lasting 40 minutes, is the wrong way to deal with something that is very complicated and quite serious.