John Gilroy (Labour) | Oireachtas source

The Minister of State is welcome to the House and it great to see her back here again. The Health Act is probably second only in complexity to the Tax Consolidation Act and it is therefore necessary and appropriate that it would be reviewed and updated from time to time. I would have preferred if these reviews did not come as part of the budgetary process and that they formed a stand-alone review of the various schemes under the Health Act.

Every Member who was a politician prior to the nursing homes support scheme being put in place would know that the greatest amount of our time as politicians was consumed in assisting people who were trying to access the services for long-term and ongoing care for their elderly relatives. Since the scheme was introduced it has provided a very good solution to what seemed at one time to have been a rather intractable problem for politicians but mainly for patients. That the nursing homes support scheme is in place is a positive development.

The Opposition has said that it has some concerns about this measure. We all have concerns when the mere mention of increasing costs comes to the fore. That is something that gravely concerns us. I think it is reasonable to expect that the asset contribution might increase. I read during the week that people who were born in the 1960s might now have a reasonable expectation of living to their 85th year. That represents an increase in the average life expectancy of nearly seven years over a generation. Arrangements need to be put in place to ensure the sustainability of this scheme but it would have been better if it did not come as part of the budget, which might give rise to the accusation that this measure is merely a revenue-raising initiative. Of course it is not, it is part of a move - a Band-Aid move as it appears to Senator Crown, and indeed often to more of us as well - in the direction of the universal health insurance scheme that we are committed to bringing in. It is important that this would be acknowledged. Health is about public health but it is also about public confidence in our health system. If we cannot have a public confidence in our health system, we are in trouble and the undoubted problems that exist will become exacerbated as people lose confidence in our system.

I want to focus on that part of the Bill and also on the idea that private patients should pay for beds in public hospitals through their insurance or otherwise. It is a matter of social justice, social equity and social solidarity that would happen. Approximately 50% of the public are covered by a medical card insurance and 40% are covered through the medical health insurance scheme. If the system is as equitable, democratic, fair and as republican as we might like it to be, we must ask ourselves why people feel it necessary to have health insurance. We saw the leader of Sinn Féin recently express a lack of faith in our services when he twice used the private services of another country to access medical treatment.

There is undoubtedly a benefit in having private health insurance because otherwise why would one pay money for something that was not necessary? Private health insurance might well be one of the reasons for the ongoing and traditional historical legacy of the two-tier health system, which do not enjoy in this country but with which we have been landed. It is reasonable that a private patient accessing public services would be required to pay for those. I think that any reasonable democrat would have to agree with that.

Notwithstanding the pragmatic idea that as health insurance premia rises people will leave due to economic constraints. That is a problem. Insurance companies need to get with the programme.

Recently the mother of a young man in Cork told me that her son developed chest pain while playing rugby a year ago. When he was assessed it was discovered that he had a serious complaint that could be corrected by a medical procedure. Unfortunately, the 15 year old boy could not access treatment under the public scheme due to a waiting list of two years which would have meant that he could not play the sport that he loves for two years. Presumably he would have reached 17 years of age before undergoing the operation and have had to wait a further six months before being allowed to play rugby again. The family had private health insurance so decided to use it to cover the cost of his two-night hospital stay. I shall outline the timeframe. Let us say he was admitted to hospital on Monday night, the procedure took place on Tuesday and he was discharged on Wednesday. The bill amounted to an unbelievable €17,000. At the time I was informed that a family consisting of a couple and their three children could travel to Florida and stay three weeks in a top grade hotel for €5,000. That puts the hospital bill in perspective. There must be room for savings. My example proves that insurance companies could do better and that the negotiation skills of hospital administrative staff or the people in the service responsible for pricing must do better.

My party will have plenty more to say when we debate amendments at Committee Stage but I shall leave it at that for now. We must acknowledge that there are concerns. The previous Administration introduced the nursing homes scheme. When my party was in Opposition it may have criticised the scheme in its initial stages. However, my party acknowledges that the scheme has been beneficial, that it is one of the better schemes and provides the widest range of services for older people.