Paul Bradford (Fine Gael)

I listened with interest to the contributions of the two previous speakers and I share some of the sentiments expressed by both of them. However, I very much disagree with the comments of Senator Norris on the BUPA health insurance group. To paraphrase what he stated, he claimed that BUPA arrived into the Irish health insurance market to feed at the trough. I wish to point out to Senator Norris and those who hold such a view that BUPA is a mutual society. It is not a profit-making agency and invests its surplus in health care projects across the globe. It does not have shareholders who benefit from the profits of the industry and I am glad that BUPA arrived in Fermoy. It opened up the Irish health insurance market. Without BUPA we would not have had the Quinn Group, without whose entrance we would not have VIVAS. Without those companies we would not have competition and the VHI would have continued to enjoy total dominance. My only disappointment about BUPA is that the mishandling of the risk equalisation policy resulted in BUPA leaving the Irish market which was a grave disappointment. It was bad news for the Irish health care industry and I wish it had been handled differently.

I agree with Senator O'Malley's comments on the need to foster and encourage further health insurance competition in the Irish market. By international standards, notwithstanding Ireland being a small country, it is quite extraordinary that one company still has almost 70% of the business. In every walk of Irish life we have seen that where there is such dominance by one company it is bad for the consumer and I hope that further competition will enter the Irish market.

The Bill we are debating today is a continuation of the ongoing debate on risk equalisation that we have been having for the past decade. I contributed to the debate in both Houses because I felt from day one that the way risk equalisation was being introduced was unhelpful to competition and needed review and change. It is a pity it took so long and ended up in the Supreme Court. I support the concept of community rating, as I am sure do all my colleagues, but the heavy-handed approach we apply to risk equalisation has resulted in the mess we are in now.

There is one aspect of the Irish health care industry on which we need to concentrate and that is the cost of health care. It is great to have private health insurance companies footing the bill, and the more companies, the better. However, we must ask why the cost is so high. Why is health care in Ireland so expensive in comparison with most other countries, not only in the European Union but worldwide? Last year, I was in Italy for a social occasion and I had to attend a doctor to obtain a prescription for antibiotics. I was in a small village and I was pleasantly surprised to find a doctor readily available in a local health clinic. To the best of my knowledge, the bill for the consultation for his writing of the prescription was €20 and the prescription in the local chemist cost me €4.50. If it was here, the bill would have been €70 or €80, I would have been made feel under a compliment to walk in and meet a doctor so easily and the prescription in the chemist shop certainly would have cost €20.

While we are debating health insurance it is important, necessary and fundamental to consider the other side of the equation, which is how much we spend on health services and what type of value for money we get. We have to ask ourselves why Irish health care is the most expensive in the world. Why does it cost €60 or €70 to visit a doctor? Why does a prescription cost so much more than in any other country?

A debate will take place today in the other House on the difficulty that the Minister is having with the pharmacists. I am very sympathetic towards the Minister's proposals in this regard because the taxpayer and consumer in this country have been ripped off as far as health care is concerned. While I welcome insurance policies in one sense, in another they are almost covering up the core problem, which is the cost of health care, and we need a very fundamental debate on this.

We all acknowledge we need more hospital beds, step-down facilities and community care facilities. However, we may also have to examine the training of general practitioners and the number of GPs we have. Why is it such a closed group? Measures have been taken by the Minister for Health and Children to increase slightly the number of persons training for a degree in medicine and the college entrance procedure has been changed. It is hoped this will result in additional GPs coming on stream. Until such time as we change the supply and demand equation, health care providers will remain in a position to charge exorbitant fees. That is a very fundamental part of the debate, not only on health insurance but on the provision of health care. It needs very thorough examination and, more importantly, it needs action by the Minister and his Government colleagues.

I appreciate the legislation is interim and I suppose it is an emergency measure. I was surprised that so many people expressed surprise at the Supreme Court decision on risk equalisation. The risk equalisation policy, as it existed previously, looked to me at though it could have been written by the VHI itself. It appeared to be a policy that was absolutely detrimental to the little bit of competition that had arrived into the Irish market and would ensure that no further competition would enter the market. We now have to go back to the drawing board. Yet, what we are doing here by way of levies, taxes and charges is not dealing with the fundamental problem of the cost of health care provision.

I was interested in what Senator O'Malley said, namely, that there should be universal health care and that the public system should be so sufficient, efficient and effective that it should be the answer to everybody's problems. In an ideal, utopian world that would be the case, but it is not the case in this or any other country. There will always be a degree of necessity for private health insurance and health care, and it should be possible that it sits complementary to the public system. The Minister of State is aware of the Fine Gael policy announced relatively recently on universal health care, which is the result of a process of long debate within the party. It is worthy of serious consideration.

I heard Senator Norris refer to the Canadian model of health policy. Somebody else mentioned Australia. We have toured the world over the past ten years and heard about marvellous systems in country A, B or C, but when one investigates them they are never as marvellous as it would appear and there are always problems. The core of the problems which need to be tackled are the fact that a GP visit costs €60 or €70 and medicine prices are so high. Senator Norris mentioned that health care is not a privilege and he is correct. It should not be a privilege but should be enjoyed freely and easily by every citizen of the State, who should have ease of access to it, but sadly that is not the case today.

With regard to the legislation before us, I appreciate why the Government had to respond in some form to the court decision. However, since 1998 or 1999, when the first piece of political thinking on risk equalisation was debated in the other House, we have not got it right. We have been stumbling from one solution to another and this is a case of a Band-Aid being applied to a much bigger problem. The passing of this Bill does not deal with the fundamental cost issues at the core of the crisis in Ireland.