John Gilroy (Labour) | Oireachtas source

It has given rise to the two-tier system. I was going to say "that we enjoy in this country", but we do not enjoy it at all. If we traced the evolution of the health insurance market in Ireland, we would see that it closely paralleled the rise of inequalities in our system. I have private health insurance. I might be called inconsistent, but I would fear for my life and the lives of my family members if I did not have it.

A serious argument can be made that the standards of care for private and public patients in public hospitals are not the same. Some claim that the value of having private health insurance is access to the system as opposed to the quality of care received therein.

I will draw the Minister's attention to a Medical Council hearing during the summer at which the person appearing before it, a surgeon, was subsequently adjudged to have been guilty of poor professional practice. He stated that, had he realised that the patient he was treating was a private patient, he would have treated the patient himself. It went unremarked by the Medical Council and the media at the time, but the possibility that this was the prevailing attitude in the system was drawn to my attention when the Bill appeared before us in recent days.

Recently, I spoke to a woman whose young son needed to attend a private hospital for two nights and was charged ¤15,000 for accommodation. One would get a two-month holiday to Hawaii for a full family for that type of money. Anecdotally, it seems to be standard practice that private health insurers do not challenge the costs presented to them by the hospitals. Nor do the people paying the premia challenge them out of fear that they might lose their cover.

I must confine my comments to the Bill. In so far as we are pragmatists and it is politically expedient to support private health insurance, we will do just that. In providing a statutory basis for the health insurance market, we are protecting a core principle of the system. While that system is flawed, it is the one we have and insurers charge the same premia irrespective of people's ages and health status. According to Senator Barrett, there is literature to the effect that age is not an increasing risk. Intuitively, one would believe that to be wrong.

I do not want to keep prefacing everything I say when speaking in favour of this model, as it has served us well in terms of the intergenerational solidarity that this country enjoys, but I must point out that we are only referring to the sector of society that can afford private health insurance. Younger and healthier people generally use the health insurance system less than older people do. This is due to accumulating risks as people grow older. Everyone understands that younger people will benefit as they grow older and accumulate their own health risks. This is the basis of community rating and, in so far as it goes, it is equitable and desirable, if "equity" means anything in our society.

In affirming access to health insurance, the Bill is of some importance. The risk equalisation scheme eradicates in a fair manner the differences in health insurance costs that arise due to variations in health status among policyholders, where it is often the case that persons with accumulated health risks are sometimes over-represented in the schemes provided by certain insurers. The Minister stated that VHI still held 57% of the market. That is remarkable. With such a share, I wonder whether the other health insurers benchmark their costs and services against the major provider of health services.

The ¤1.92 billion in the schemes is an extraordinary sum of money. Do we have up-to-date figures for this or last year regarding the number of people withdrawing from schemes due to the economic crisis and what impact that will have on costs for those who remain?

A few years ago, one of the main providers withdrew from the Irish market and presented risk equalisation as a problem, notwithstanding the fact that it made plenty of money before it withdrew. Many concerns were loudly expressed, with some commentators stating that it made no economic sense for providers to subsidise competitors' policyholders. We are still hearing that argument in the House today, although it is dressed up in a different language. If we stripped away the veneer, we would see what was really being said. The argument has more to do with an ideology, and many of those making it might not care to recognise or admit that the idea of intergenerational solidarity finds infertile ground among those who would see health and health insurance as a commodity rather than an essential public service. The Bill seeks to ensure intergenerational solidarity, a principle that must be at the core of our consideration in framing this legislation.

Most of the changes proposed in the Bill are technical in nature and I look forward to discerning the Minister's intention in this regard on Committee Stage. Notwithstanding my mention of my dislike of private health insurance, I have a number of questions. How will the role of current health insurers evolve when we start moving towards the introduction of a universal health care scheme? I support that model, as it is has the potential to revolutionise how we deliver health care. The Labour Party proposed it prior to the 2007 election and mentioned it before the 2002 election, albeit in a less evolved manner.

A solid and sound legislative foundation is essential for the introduction of universal health care and this Bill will underpin the system's basis in that regard. I would welcome it if the Minister addressed the points and questions that I raised. Of course, we will support the Bill.