Trevor Ó Clochartaigh (Sinn Fein) | Oireachtas source

Cuirim fáilte roimh an Aire. Cé go bhfuilimid ag tacú leis an mBille, tá roinnt deacrachtaí againn leis an treo ginearálta ina bhfuil cúrsaí sláinte ag dul ó thaobh na polasaithe éagsúla. Déanfaidh mé soiléiriú ar sin.

This Bill is a follow-on from the Health Insurance (Amendment) Act 2012, very important legislation which significantly updated the regulatory regime for the health insurance sector in the State. The 2012 Act introduced a permanent risk equalisation scheme from 1 January 2013. That scheme makes possible the scheme of community rating which ensures all consumers are charged the same premium for a particular health insurance plan, regardless of age, gender or health status, thus preventing price discrimination against those more likely to require medical treatment.

The Health Insurance (Amendment) Bill 2013 has as its main purpose specifying the amount of the hospital bed utilisation credit and the amount of risk equalisation credits in respect of age, gender and level of cover payable to insurers from the risk equalisation fund from 1 March 2014. Sinn Féin has consistently argued that as long as we have the type of health insurance market and health funding system in place in the State, the regulatory regime provided for in the Bill will be necessary. It involves a complex system of risk equalisation to support the community rating principle. This entails the transfer of compensation from insurers which carry lighter risk burdens to those which carry heavier risk burdens. All of this requires regulation, monitoring, enforcement and penalties for infringements. Without such legislation, the unregulated market would discriminate against the old and the sick or any other group or individual insurance companies decided were a greater risk. This legislation is, therefore, supposed to be protection against the working out of the raw profit motive in the health insurance sector. It is supposed to be based on solidarity between generations and between the healthy and those who do not enjoy good health. This is welcome in so far as it goes, but Sinn Féin would go much further, extending the principle of solidarity to the way we fund, organise, structure and manage the entire health care system.

The cost of health insurance premiums is rising and there is real concern this legislation will inevitably lead to further rises by as much as 15%. The Minister stated it is up to insurers to decide their own pricing plans and insurers can reduce their outgoings under the scheme by taking on a fairer share of older customers, but he admits this is not happening. That is clearly the case. As has been stated, VHI holds 89% of the market share of those aged over 80 compared to only 6% held by Aviva and Laya Healthcare. For the 70 to 79 year age group, the equivalent figures are 78% for VHI and 9% and 12% for the others, respectively. Clearly, this is not sustainable.

The option of health insurance has become a luxury that is no longer affordable for many thousands who previously held it. In 2008, 2.3 million people had private health insurance. In 2012 this figure had dropped to 2.1 million; more than 60,000 people dispensed with private health insurance in that year alone. Those who have dispensed with health insurance because they can no longer afford it are dependent on the public health system that is under attack from the Government's failed austerity strategy which it happily embraced when it took over from the previous Government.

The State continues to heavily subsidise the private for-profit health system with private beds in public hospitals, a fast-track to care for private patients, while public waiting lists grow, and the dual working of hospital consultants in the public and private sectors. The Minister claims the Government is making progress towards its ultimate goal, which he describes as a single tier patient-centred system of universal health care for all. However, this is to be achieved by a market-based universal health insurance system, which is where the big gap presents. According to the Minister, the maintenance of a healthy and functioning private health insurance market is an essential step in the transition to this goal. The Bill is, presumably, one of the steps he deems necessary in this transition. The Government wants to move to an entirely health insurance-based system of funding in managing and delivering health care.

Like its 2012 predecessor, the Bill is based on the recognition that there must be social solidarity within the insurance sector. In that context, why will the Minister not extend social solidarity across the entire health care system? If one takes the concept of solidarity to its logical conclusion, one will move to a system of universal provision of health care based on need alone, not ability to pay. The question that arises is how to pay for such a system to ensure the best possible care for all who need it and achieve the best value for money. The Government is proposing to introduce universal health insurance, with the State subsidising those who cannot afford to pay insurance premiums. The State will still have a huge regulatory, managerial and funding role. Why then give private for-profit insurance companies such a central place in the system? What contribution will they make? They are funded by the consumers who buy their products. The insurance companies, on behalf of policyholders, will buy services from private or public hospitals or other service providers. In addition, they will have to make a substantial profit in the process in order to satisfy both their hunger for such profit and the interests of their respective shareholders. The Minister has recognised the failure of the insurance companies to reduce their outgoings and address their cost base. Why not cut out private profiteering from the entire equation and retain the money in the health system and any surplus thereafter in the pockets of citizens?

The Government should re-examine its position. People's ill health, the requirement to provide health care and the protections necessary are not the basis on which profits should be made. The bottom line for citizens is that when they need health care, they need it promptly. They also require the best care possible.