David Cullinane (Sinn Fein)

This is a market system which shows health care as a commodity and not as a fundamental right. We are dealing with an unfair system as regards funding and access to health care. Senator Barrett made a point that there is no proof that people could not access private health insurance from some operators. The issue is not whether people are prevented from obtaining cover but rather that the cost of cover for some of those people is driving up the cost and making it impossible for them to access cover. This is what is being addressed in this Bill and the reason I support it.

I also wish to record my support for one of the measures in the budget to increase the cost of accommodating private patients in public hospitals. The full cost of private patients in public hospitals should be applied as well as ending the practice of consultants carrying out private practices in public hospitals and making a profit on the back of the public system. All these issues need to be addressed.

The health insurance market, given the importance and often precarious nature of the market, requires safeguards and a great deal of care. We cannot allow the elderly and the sick to be exposed to market forces. They need to be buttressed with protections and supports. In particular, we need to ensure that where some providers may choose to cherry-pick their customers by offering attractive plans for the young and healthy, there is an incentive for providers not to cherry-pick and to insure the elderly and the infirm at a reasonable and affordable price. The explanatory memorandum states that the purpose of the Bill is to provide a mechanism to support intergenerational solidarity in the health insurance market. There can be no question but that this is absolutely necessary, and it is something my party fully supports. Indeed, the explanatory memorandum states: "there are incentives for insurers to design products that are attractive only to healthier lives, undermining intergenerational solidarity and the common good protections", which accords with the point I just made that we cannot allow the market to dictate what is a fair price.

This is far from what I would consider the ideal way of running a health care system. I believe, as I said a few minutes ago, that health care is a right which should be available at the point of access and funded through progressive taxation. However, it would surely be a retrograde step not to balance the inequalities created by the sheer will of the market. We are left to enact legislation to try to regulate the distortions and inequalities brought about by the private health insurance market, or at least some in that market. This is, as I said earlier, primarily a market, not a system of funding health care. Therefore, in order to maximise profits, it tends to discriminate in favour of the healthy and against the old and the sick. The State has a moral obligation to intervene to redress this balance. However, this raises the question of why the Government insists that an insurance-based system is the way forward for health reform in this State. It would be far better if the Government were to move towards a model of universal health care funded by just and progressive taxation and not an insurance-based model.

The programme for Government states: "A system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government's term of office." In the Dáil, my colleague Deputy Ó Caoláin tabled a question in which he asked the Minister the timeframe for the publication of the White Paper on reform of the health care system and the health insurance system, and the answer he got from the Minister was: "While universal health insurance is the ultimate destination of this Government's reform programme, there are a number of important stepping stones along the way and each of these will play a critical role in improving our health service in advance of the introduction of universal health insurance." He cited the special delivery unit, strengthening primary care and the money-follows-the-patient concept which he has spoken about on many occasions. He also stated that the Government had given approval for an implementation group for universal health insurance, which will have the responsibility of assisting the Department in preparing the White Paper. However, he then went on to say that the White Paper would be published within the Government's current term of office. Given the commitment in the programme for Government that this would happen early in the Government's first term, the question must be asked: when will we see these reforms?

The Minister, Deputy Reilly, the Minister of State, Deputy Lynch, and the Minister of State who is here in the House, Deputy Shortall, have strongly and rightly criticised a two-tier health system in the past. Yet that is what is apparently being maintained for the future.