Déirdre de Búrca (Green Party)

I congratulate the Leas-Chathaoirleach on his election. I thank the Minister also for her overview of the Voluntary Health Insurance (Amendment) Bill 2007. As other speakers have said, this Bill is about changing the corporate status of the VHI. It is a rather technical Bill. The Green Party broadly supports its thrust but we see the Bill as significant in that it may be the necessary precursor for the privatisation of the VHI. While the intentions of previous Governments in regard to the privatisation of the VHI have not been clear, we are aware the VHI board has indicated its preference for the privatisation of the company.

This is a significant question for us as a party and a member of Government because to date the VHI has been a significant player in the health sector and controls approximately 80% of the market. A monopoly position is anathema to some but it is not unusual. In Canada there is one health insurance provider and the system works efficiently. As we know, Ireland has a unique hybrid health system with a mix of public and private. Our responsibility as legislators is to get the right balance between the two. The Bill could tilt the balance towards private medicine as opposed to the public system. It makes the VHI more commercially autonomous, and allows it to stand on its own two feet and enter into alliances with other suitable partners.

The Minister has outlined some of the specific provisions. The Bill removes the derogation for solvency so the VHI will have to carry its own solvency reserves like other companies. It will also allow for the expansion of VHI services. While I appreciate Senator Quinn's point in this regard, it would be welcome for the VHI to expand into other areas, as has already begun to happen, certainly in regard to providing cover for alternative health treatments. The Bill will allow the VHI to acquire and manage subsidiaries to operate its business, and also to borrow money and increase its capital reserves. This is very different from the way the VHI has operated to date.

The difficulty is that there has not been a full and frank discussion on the future of the VHI and whether it will remain a State health insurance system or become a private health insurance company. No reference is made to this in the current programme for Government. One of the advantages we would see in having a State company is that the State, through the Government, could ensure our public health system was protected.

Sometimes when we talk about private and public health care, we do so as though the only difference is who delivers the care. In fact, a totally different ethos applies to public health care than that applying to the private health care system. With private health care or for-profit medicine, access and the quality of care patients receive is based on the ability to pay whereas the ethos of the public health system is entirely different and is much more about equity of access and quality of care. We must be realistic and accept that if the health market is becoming increasingly privatised, it will be difficult for the public health system to be protected and not become undermined. We need only look at countries such as the United States where the private sector has a much more dominant position in the health care system and the state of the public health system leaves much to be desired.

We are at a significant point with regard to discussing and making decisions about the future of the Irish health care service. The future of the VHI and its status as a private or public company is an issue of major importance to Irish citizens. Although we are a young State, we have a rapidly ageing population and this is likely to be a greater problem in the coming decade or two. At this time, 52% of the population has private health insurance cover as opposed to 12% in Britain, so the VHI's future is of interest to all of us, especially legislators. While the Green Party supports the Bill, we hope for a much fuller and more frank debate in both the Dáil and Seanad on the issue of the future of the VHI.