Pearse Doherty (Sinn Fein)

This Bill does not do anything to guarantee the future of the VHI as a statutory corporation for which the Government has a special responsibility. The Government is pursuing a privatisation agenda in the health service and has maintained and developed the two-tier, public-private system. This is the context within which the House is discussing the Bill.

Sinn Féin has called for the establishment of a health funding commission which would assess all funds and moneys currently being spent on the health service by the Government and citizens in the form of health insurance premiums and user fees. While we do not know the total expenditure on health services, we know that this money is not being used to the best effect because it is being applied inefficiently and inequitably in a two-tier system. Approximately 70% of the population pay for health care twice, once through taxes and a second time through personal health insurance or direct user fees for general practitioner services, medicines and health care. Meanwhile the proportion of the population with medical cards is declining. This complex and inefficient funding system has been used by successive Governments to underpin the grossly inequitable, two-tier, public-private system. The system of health apartheid is being reinforced by the Government's private, for-profit hospital co-location scheme.

The Government's fundamentally flawed policies and gross mismanagement of the health services have resulted in more and more people having to take out personal health insurance for themselves and their families. Many of the people in question are on relatively low or moderate incomes and do not qualify for medical cards. They are concerned about facing long waiting lists and poor health care outcomes if they must rely solely on the public system. They are paying on the double for health care through taxation and PRSI and through private health insurance. Many fall between two stools because they do not qualify for medical cards and cannot afford private health insurance. The Government should immediately establish a health funding commission to plan for the transition to a fair and more efficient system. The only way forward is taxation based on the ability to pay and top quality health care based on need alone and delivered to all equally, regardless of income.

As recommended yesterday, I will take this opportunity to address an issue I raised then, namely, the decrease in HSE payments to pharmacies from the start of next year. The Minister is aware of an escalating situation, namely, pharmacists are threatening to withdraw all services to medical cardholders from 1 December. The situation will be acute in highly disadvantaged areas and areas where most of the population depends on medical cards. For example, Donegal has a high rate of medical cards per capita, accounting for some 80% of the population of a number of communities. Pharmacists have informed me of how they are threatened with going out of business before the end of the year. Many would need to merge in central and urban areas.

Will the Minister re-examine the issue to ensure those in the medical card system are not deprived of what the Government has offered them throughout the years and that rural communities, especially those on the west coast, will have pharmacies on their doorsteps? A Donegal pharmacist told me that if the decision is implemented in December, he will close. The nearest pharmacy is 75 km away. A pharmacy on Achill Island will close because all its patients are dependent on medical card subscriptions. The nearest pharmacy is 100 km away. This is not only an issue of health but also of supporting rural communities. Will the Minister examine the matter?