John Crown (Independent) | Oireachtas source

I welcome the Minister of State back to the House. When many of the minor health care reforms such as this, which are coming through the system in preparation hopefully for the big bang of the move to a fully insurance-based system, come up I find myself selectively approving of them through gritted teeth because they increasingly resemble a series of Band-Aids put over the gaping wound – I am going to start mangling metaphors here- which is our incredibly inefficient, dysfunctional, two-tier health system. As Lincoln said a house divided against itself cannot stand and that is exactly what we have. As a result there are several severe inefficiencies. Having said that, we need the private system at the moment. If it were to collapse it would cause an unsustainable burden to fall on the current public system. I speak with a colossal conflict of interest because I make most of my income from the private insurance system. I have to say that now or someone will remind me of the fact. Until we move to the model whereby everyone is treated the way a private patient is now we will be dealing with these inconsistencies. The ultimate logic of the insurance-based system is one which is socially responsive, in which people like me, who make a lot of money, pay more for the care that people who make less money will get for a whole lot less.

Let me point out one or two matters. From the coalface, there are patients who at some stage because they have private insurance get some consultation or some part of their treatment in the private system but because there are holes in the private insurance coverage here they decide to have their scans or X-rays done on the public side because they cannot afford the out-of-pocket expense and subsequent reimbursement. Increasingly we find people who go to the public system being told that even though they are citizens, taxpayers, members of our society who allegedly have the same rights as anybody else, being denied these rights and told that they must register as private patients when they go to a public hospital. That is inconsistent, irrational, and wrong. Will the new arrangements as outlined in this Bill enshrine the rights of people who wish to exercise their rights as citizens to become public patients, not skipping any queues but going in the same way as anybody else, and to continue to do that or will it be incumbent on them to exercise their private insurance which many have as a fall-back position in case they need to come into hospital? I cannot see this outlined here.

Will the new arrangements, as outlined in this Bill, enshrine the rights of people who wish to exercise their rights as citizens to become public patients, not skipping any queues but going in the same way as anybody else and to continue to do that, or will it be incumbent on them to exercise their private insurance, which many have as a fall-back position in case they need to come into hospital to receive treatment for some catastrophic illness? I cannot see this outlined here.

I cannot stress enough the importance that the VHI be sustained. I will tell the Minister of the State a story. I was hoping to have the opportunity, and no disrespect to the Cathaoirleach but when I raised this issue during the past two days the Leader of the Seanad suggested that I raise it in this debate as it is somewhat relevant. Several of the commercial private health insurers have made a decision not to cover those people who have been diligently paying their premia to them, sometimes for many years, for cancer drugs. I do not refer to exotic, obscure, dubiously beneficial cancer drugs but to cancer drugs which have been approved for public patients through the national cancer control programme's approvals process and by the VHI. It is troubling to me that in meetings with delegations of oncologists recently some of them were happy to say that they had never paid for one of these drugs. The drug in question is ipilimumab. I am sorry if I sound reduplicative but malignant melanoma is a condition which when I was a medical student we thought of as being a rare condition but it is now quite common in Irish people because of our fair hair and fair skin and the fact that God designed us for living under grey skies and never seeing the sun, and it is a disease to which we are uniquely susceptible.

The incidence of this dreaded disease doubled between 1998 and 2008 from 400 to 800 cases. It is likely that it has increased substantially since 2008. More troubling, the number of people who present with secondary malignant melanoma, which is generally not curable, also doubled during that period. This was a disease that had a ferocious reputation, when it was secondarily spread, for being highly resistant to chemotherapy and to other drugs and one which in recent years has become moderately sensitive to some of the newer drugs that have emerged, one of which is ipilimumab. It is not a panacea or a miracle drug but for a minority of patients who get it, it is a drug which can produce extraordinary results. Now we have insurance companies saying they will not cover it.

I have had patients on the private side come to me who I have had to send over to the public side following a process of appeal to their insurance companies. I will go on record and say to anybody listening to this debate, and as usual our colleagues from the journalism galleries are not present, that I do not believe anybody should take insurance with GloHealth or with Aviva. If they are thinking of changing from VHI, they should not do so because these companies have now decided that they will not provide cancer drugs to their clients. Laya Healthcare Ireland has not taken an official position to approve the treatment but on a case-by-case basis it has grudgingly approved it for individual cases. Sadly, some of the insurance companies, which are not-for-profit insurance companies, which represent members of the public sector and the allied public sector such as the Garda and the ESB, have also been extremely difficult on this issue.

What I find troubling, and I would like the Minister of State to convey this to the relevant Ministers, is that there is strong circumstantial evidence that anti-competitive practices have been practised by the private insurance companies. I find it odd that a group of them simultaneously decided they will not approve a drug and quote the fact that the other companies will not approve the drug. When I pulled one of them up on this a month or two ago I said that what they are saying they did sounds suspiciously cartel-like to me. I said that when a group of people who are supposed to be competing on the grounds of cost and service decide, apparently collectively, to deny an essential service to people, this is anti-competitive. I would like the Minister for Health and the Minister with responsibility for trade who oversees competition to inquire of the companies if any such collusion has occurred because if it has, I believe it is illegal. In the meantime, I do not know what pressure can be brought to bear on these companies because these drugs - which are expensive, for which approval in the public system was hard fought and having regard to people who have paid taxes and their health insurance premia - are now being paid for out of the public purse and I think that is wrong. Insurance companies that market themselves as providing choices and who then deny the choice to patients are behaving dishonestly.

I also draw the Minister of State's attention to the fact that Aviva, which has a substantial UK presence, states on its UK website that it will never deny any cancer drug to any patient which is approved. Clearly, it is practising by different rules in the UK and in Ireland and, conceivably, it is practising by different rules in Northern Ireland and in Ireland, although I cannot verify that.

There are a number of troubling issues. Fundamental reform of our health service will make many people with the most vested interests very unhappy. I am referring to the health service administrators, HSE executives, civil servants, a cadre of hospital managerialists who have emerged, and all the PR companies for all of the agencies. It will make them unhappy because if the reform that was promised prior to the election occurs, it will empower patients to make their choices and it will disenfranchise many bureaucrats. I ask the Minister of State not to take this pejoratively, but we have a Band-Aid over the knee approach to reform.