Marc MacSharry (Fianna Fail)

I welcome the Minister of State to the House as always and thank her for an extremely comprehensive outline of the Bill, its provisions and its context. Indeed, I do not recall one as long and as informative on an issue such as this in the past, and I thank her for that.

Fianna Fáil will be supporting the legislation. It has its origins with former Minister, Ms Harney. As the Minister of State correctly pointed out, this is an extension of that Act. We look forward to more comprehensive risk equalisation in due course. I am interested to see what way that will play out in terms of the Government's plans for universal health insurance and am interested to hear the position on those plans.

Second Stage provides us with an opportunity to raise a number of other issues. Obviously, Fianna Fáil fully supports the concept of intergenerational solidarity, community rating, etc., as the Minister of State so eloquently outlined over the past number of minutes. As I stated, we will be supporting the legislation.

Today, and, indeed, yesterday, in the media, there have been reports of moneys outstanding. There is some €162 million of unpaid debts to hospitals throughout the country by the private health insurers, according to a report today. Yesterday, in a separate media report, the Minister, Deputy Reilly suggested that some €50 million currently owed by insurers was expected to be collected. How can we preside over a €162 million bill and allow that to take place without it being paid in its entirety? If it were a business, there would be a judgment against me if I did not pay a bill for €200 to whatever service provider. I would be interested to hear the Minister of State's view on this. If there was €162 million owed by VHI, Aviva and by Quinn, then those bills need to be paid quickly. It is a considerable amount of money. Hospitals are having their funding cut throughout the country and in some instances, are being closed. I say "fair play" to Senator Whelan who secured the future of Abbeyleix, for now anyway. I am from the north west and Sligo is my local hospital. They have been trying hard to operate on an ongoing basis with budget cutbacks, etc., and have been doing that reasonably well. How can they now be expected to sustain losses when the Government is suggesting that it would be happy if one third of €162 million - some €50 million or so - will come in? How can we possibly run a service on that?

While measures are being put forward in the budget to bring in an additional €143 million whereby private patients will not be taking up public spaces, that will incentivise hospitals, which are already struggling on budgets and which, by the Minister's admission, will not get paid €162 million that they are due, to stuff the place with private patients because there will be money paid for those, and hence put the public patients at a further disadvantage in keeping them out of hospital beds.

On the wider universal health care approach and the Dutch model about which we have heard so much, I would be interested to hear the Minister's view on a statement yesterday by Mr. Michel Dutrée, the CEO of Nefarma, the Dutch pharmaceutical industry lobby group, who was here for a conference. He had strong views on that model. He stated that the Government here should think twice before introducing the Dutch-style health system because of escalating costs and a lack of choice in that system. He stated that costs of health care there would double in the next ten to 15 years if nothing was done and that Dutch people would be spending in the region of 25% of their annual income on health care, which is more than in the United States.

Mr. Dutrée also stated that under such a system one hands over one's life to the insurance companies and a public system, executed privately, is very difficult to manage. That seems to be the most up to date version of professional opinion of the Dutch service and, therefore, before we rush to create a similar model we might re-examine the position to see what is best. We are all for equality of services, risk equalisation and access to the same services as quickly, fairly and cheaply as possible but we appear to be having difficulty securing the best way forward in that regard. Naturally, the Government has all our support in its attempts to try to do that, with obvious criticisms if we disagree along the way.

The write-off of €100 million of the sum of €162 million referred to is unacceptable. It would not happen in private industry. People would be prosecuted and face the full rigours of the law to ensure those moneys were paid. The Minister might outline the Government position on that to the House.

Regarding the Health Service Executive and who is in control, I am aware the Minister was in the Dáil for this debate also when my colleague, Deputy Kelleher, would have made similar points. The Minister stated that having reappointed a new interim board of the HSE he was taking full control of the situation. We then had announcements from the HSE about not paying expenses and so on. The Minister has said that while he is not happy about that it was a decision for the HSE.

Who is in charge? I have put it to the Minister when he was in the House previously, and previous Ministers on many occasions, that the entire budget of the HSE must be taken back under departmental control to ensure the people's representatives, that is, the Government and those of us in these Houses, have an input and a say into the spending of the money. I criticised the former Minister, Deputy Harney, many times from the opposite side of the House about the fact that we had effectively sub-contracted the health service to a third party organisation which was answerable to nobody and that we could hide behind the convenient, parrot-like responses we get to all health queries, as I am sure do the Minister's own backbenchers, which state, "Thank you for your letter. Under the 2004 Health Act the HSE is now responsible for that area and I have asked the CEO to respond to you directly". I may have missed a word or two but that is the basic reply and I have received many of them, as I am sure have other Members of the House. Who is in charge? Is it the Minister when it is positive news or a new outlook and the HSE when it is bad news? We need some clarity on that.

Senator Whelan announced this morning that the Government has done a U-turn, on his advice and following other developments, on the closure of Abbeyleix community hospital on which we all congratulated him on the Order of Business. I drew the analogy between his success in attempting to do that and the failure of others in Roscommon, Cork and my own area of Sligo where pre-election promises were made by the Minister's colleagues, the Tánaiste, Deputy Gilmore, the Minister for Education and Science, Deputy Quinn and Senator Susan O'Keeffe all of who confidently submitted to the electorate of the north west that a full centre of excellence would be delivered under the Labour Party in Government. That appears not to be the case.