Sean Barrett (Independent) | Oireachtas source

I welcome the Minister back to the House. I hope the evening we had yesterday, taking his Public Health (Standardised Packaging of Tobacco) Bill 2014, will prove to be successful.

On this occasion it is an honour, as always, to second Senator Quinn's Bill. I believe it has huge merit. I believe it is the right thing to do.

There are so many problems arising in this area, not least, for instance, according to the Department's website, that the Minister appoints both the board of the VHI and board of the HIA, which is currently the regulator for the sector. That would strike me, in sporting terms, as though one of the teams got to choose the referee for the matches on various Sundays.

I note also a concern of the Minister, of ours and of the IMF, that the health budget is 8.7% of gross national income and the comparator countries do it for 7.3%. I cannot think of a stronger advocate than the Minister when the health insurance premiums were rising in that he asked the health insurers to compete with each other and to do deals, and asked them to question whether the number of tests were necessary. All the Minister was saying was certainly music to my ears in the House. We need to do that. On an indexed basis, we are spending 20% more. Our index would be 119 compared to the OECD countries' average of 100, and many of the OECD countries have older populations than we do. There is a problem.

A question that occurs to me, on which the Minister agreed when we raised it in the past, is how come, between the last recession in the mid to late 1980s and the peak, we doubled the number of staff in the health service. It went from 55,000 to 110,000. The Minister had to, as part of the arrangements with the troika, bring it back to 103,000. Surely, the other question is what on earth did we get for the 55,000 extra staff recruited over that 20 year period which have given us this extremely high-cost system which this Bill attempts to address.

One can do a certain amount - I do not mean that in any patronising way. One can perform the actions that the Minister has, but it is difficult to do and the Department of Health is known as "Angola" for that reason. There is considerable criticism of measures which are necessary in the financial interest of the Minister every time he tries to do that.

Looking at the Milliman report, given the average length of stay for a treatment of 11.6 days for VHI members and 3.7 days for best international practice, one can see the numbers of noughts mounting up. That amounts to 20,000 extra hotel costs incurred. I fully support the Minister's attempts to move procedures to outpatients and GPs. However, if we pay hospitals more for keeping patients in longer and VHI with the State guarantee is seen as the easy way to do that, it will be impossible to reform the system.

Unless we implement reforms such as those proposed by Senator Quinn compulsory health insurance will be about as popular as water charges. Mr. Ben Dunne once said in respect of water that if 40% of the stock disappeared from one of his shops, he would not blame the customers. This will become a burdensome and annoying tax unless we reform health insurance. As we used to say when the then Minister for Transport, Jim Mitchell, both owned Aer Lingus and regulated the market, such wisdom is not given to mere mortals. The European Court of Justice decision to which Senator Quinn referred, as well as the ruling in the Supreme Court, requires us to attempt to achieve the results sought in this Bill. In 2011 the European Court of Justice ruled that the current arrangements whereby VHI is treated more favourably than other health insurance providers is discriminatory.

Let us keep this Bill on the Order Paper. All of us seek a more efficient health service. I am supporting the Bill because I want a company to be able to say to the Minister that it charges smaller premiums for health insurance because it can treat old and young people at a lower cost than the VHI. Please allow it to continue to do so and do not require it to bring its costs up to the level of the VHI. Without much evidence, the VHI has always stressed that it has a large number of older customers and that companies which recruited young folk into health insurance were in some way cheating. If we can show that company X can do a better job for the Minister and the rest of society at a cheaper cost for young and old people, let us give it a try. Health insurance is a financial service. The Minister should give responsibility for it to the Central Bank rather than involve himself in appointing directors to the referee board of the Health Insurance Authority and to one of the competing health insurance companies.