Alex White (Dublin South, Labour) | Oireachtas source

I realise it is not the practice to draw attention to that. I was actually making a positive point about him. I was in Sligo recently and spent two and half hours with a group of general practitioner trainees. I heard their perspective on the world and on their prospects as GPs, as well as their criticisms and concerns with regard to the system. It was a useful engagement for me, as Minister of State, to hear what they had to say and it will certainly inform my thinking and knowledge on the issue. There is a capacity issue as well and we must keep that very much to the fore as we continue to implement the system.

Senator Burke made a point about a universal system. I address the point with respect to my friend Senator Barrett as well. We have known each other for many years and we may have had this conversation in other areas of public policy, not only with regard to health. I repeat my view. All the evidence suggests that to have a properly functioning primary care system we must have a universal system. We must remove the barrier of fees. We must have a system that we can manage as a whole. We must take away the notion of a commercial relationship between the individual and the doctor. It is a question of public health as much as anything else. I accept that it is a distributional question from an economic point of view. The term "rationing health care" is awful but we know and we all accept that we ration health care. How do we ration it? The rational way to do it is for everyone to pay into the system according to our ability to pay so that it is there for us when we need it. It is a universalist approach. Senator Barrett would not necessarily share that view intellectually, but I believe in the fundamental principle that we should all pay in as a community, whether it is through taxation or social insurance, and build up a proper system so that it is available for any of us when we need it. This should provides a proper basis for the types of preventative strategy that we need in our primary care system. It is accepted throughout the world that such strategies are the only way to fund our health services and system in the future. It will be necessary to have proper health and well-being realised as much through preventative strategies as through caring for people when they become ill, which is the most immediate preoccupation of any health service.

Senators Burke and Noone raised the issue of possible nominal charges. Co-payment is a controversial area in health care. I do not exclude the possibility. Earlier this year at my party conference I made the point that it is something we should not take off table. Then I found myself on the front page of one of our national newspapers the following day supposedly announcing that it would happen. One of the problems with the environment we live in at the moment is that we cannot even canvass public policy options, accept that there may be a case for them and then debate them. If we do so, we are suddenly on the front page of the newspaper of record as if we have announced that the Government has decided to do something when, in fact, the Government has made no such decision. We must have an intelligent debate on the matter. There is a case for nominal payments in some situations, but I do not believe there is a good case in respect of children. We have no intention of providing for co-payments in this legislation for those under six years. I do not favour it for children up to 18 years of age. I believe children up to 18 years of age should go free, if I may use that phrase, but there may be a case to be canvassed for the broader population. There are countries in Europe which essentially have free systems but with nominal co-payments.

I will have to come back to Senator Burke on the nursing homes scheme and the particular case that he raised because I am not fully familiar with it. I can certainly do that for him. It is not germane precisely to the contents of this Bill. It is a separate issue, but we could try to get some answers on the matter.

I welcome what Senator van Turnhout has said and I entirely agree with her that one of the lessons from the recent controversy is that we should have a rules-based and rights-based system such that people know where they stand. We must get away for all time from the business of form-filling, as mentioned by Senator O'Brien, from the notion of discretion and the notion of who exercises discretion and in what circumstances. We must get away from a situation in which people have to fight for the health care they need when they become ill or where there is an emergency or a sick child. Our system should not work that way. Again, I make the point that a universal system would mean that we all pay in advance and in accordance with our ability to pay so that we have a proper system in place that is available for people when they need it. Senator van Turnhout is correct in this regard. The Pfizer survey also made the point that there is significant support for this measure, and I welcome that. I put it to the Senator that this provision will comprehend all children under six years. Eligibility will depend on ordinary residence. We are not seeking to import the other regimes of habitual residence and so on.