David Cullinane (Sinn Fein) | Oireachtas source

I move amendment No. 6:

In page 4, line 35, to delete "old."," and substitute the following:"old,
(e) the imperative to ensure that all persons receive, in due time and to the
highest standard possible, health services on the basis of need alone and
not on the basis of ability to pay.",".

The Minister will recall that during my contribution on Second Stage I mentioned that my vision, and that of my party, of how health care should be delivered in this State is radically different from his. His position and that of his party is based on the Dutch model and he is of the view that opening up our health service to the private health insurance market is the best way to deliver equity in our health system. I do not believe that is the case. Health care should be delivered on the basis of need. It should be free at the point of delivery, funded through general taxation and delivered on the basis of need alone and not on somebody's ability to pay. I gave the Minister the figures on Second Stage showing that many health insurance companies are seeing a drop in the number of people taking out private health insurance. That is obviously because many people cannot afford to pay for it. Every year, at least once if not twice, we hear that private health insurance companies are increasing premiums and effectively pricing people out of the system.
The Minister said several interesting things in his exchanges with Senator Barrett. If one considers the term "health insurance market", one can see that we are going down the American road of regarding people as consumers or customers and not as citizens or patients who need to be treated. That is the thrust of this Government's policy. There is no doubt that private health insurance is institutionalised queue-jumping. People who can afford private health insurance can jump the queue and get better and faster treatment than someone who must depend on the public health service. The Minister was very vocal in objecting to many of the cuts imposed by previous budgets and governments but every time that I and other members of my party mention cutbacks in the health service, the Minister says we are obsessed with inputs and not outputs. Inputs are important. Spending money on health care is important, as is making sure our public health system is equipped to meet the demands of citizens. When the ability of the public health service to deliver high-quality health care on the basis of need and in a timely fashion is reduced by cutbacks, I make no apology for making those points about cutbacks in our health service.

There is always a ding-dong between Government and Opposition, and the Minister would have made the same arguments in Opposition about consultants carrying out their private practice in public hospitals and availing of taxpayers' money to do so. That is only possible in a two-tier system when the whole health care system is opened up to the notion that people are customers. The Minister said he wants a fair, market-driven process. That is an oxymoron. It is not possible. We will not be able to achieve it. The Minister said in his exchanges with Senator Barrett that he wants a fully regulated system. We will not be able to achieve that. He is trying to do something that goes against the grain of how a market system works by trying to force the market to do things it does not want to do. I support the risk equalisation measures as covered in this Bill, but only because it is a sticking-plaster solution, not because it is a long-term solution. I do not believe we can move to a situation in which we genuinely have a health system which is delivered free at the point of delivery or, if not free, on the basis of need. That will not be possible if we open up our health service to the health insurance system.

The Minister claimed he wanted to have a fair market-driven process. A fair market-driven process is an oxymoron, as we will not be able to achieve it. The Minister, in his exchanges with Senator Sean D. Barrett, claimed he wanted to have a fully regulated system. However, he is actually forcing the market to do things it does not want to do. I support the risk equalisation measures but only because it is a sticking plaster solution. I do not believe we will have a health system which will be delivered free and on the basis of need if we open up the health service to the health insurance system.

The Minister will establish hospital groups and trusts. I do not understand how he wants private health insurance companies to compete against each other, as well as hospitals competing with each other. He talked about the money following the patient. How will this work in practice? Many of the larger hospitals will see this as an advantage when they attempt to gobble up many of the services delivered by smaller hospitals. Patients should receive health care as close as possible to where they live. To this end, we need regional and specialised services. There is a concern that tertiary services will be delivered in places such as Cork, Dublin and Galway, while services elsewhere will be diminished.