David Cullinane (Sinn Fein) | Oireachtas source

-----for Sinn Féin rather than a crutch for Fianna Fáil and Fine Gael, as it has been in the past. It is an issue to which Sinn Féin is committed. If the Labour Party is committed to it, that is great and we will see what the other parties offer in the lead-up to the general election. It is obvious that we cannot move to universal health care in a single tier system overnight. It will need investment, more resources and involve a restructuring of our health services and major radical reform, but it is what Sinn Féin is committed to. While that is happening and while people wait for the Government's universal health insurance - on which we still have not got details of cost - to be delivered in terms of free GP care, they are forced to take out private health insurance if they can afford to do so. In reality, it is just another tax on middle-income and low-income families. Once one pays taxes, one should have access to vital services such as health and education and, dare I say it, water.

We still await exact details of the Government's long-promised universal health insurance proposals.

This includes details on how much it will cost and what exactly it will provide. In the interim, many people will continue to take out private health insurance because they cannot rely on the public health service when they or their loved ones are sick.

Private health insurance, PHI, was sold to the Irish people as something that would relieve pressure on the public system and increase access to state of the art treatment. In practice, it has copperfastened inequality, condemned thousands of people to waiting lists and allowed a system to evolve in which there is an incentive for some private companies and individuals to discourage efficiency in the public system in order to fill the queues of the private system. The private health insurance system requires regulation such as that provided for in this Bill. We will therefore support the Bill.

This legislation is based on solidarity between generations and between the healthy and the sick. These principles are sound ones, but they only go so far. Sinn Féin has consistently stated that we will go much further in extending the principle of solidarity to the way the entire health care system in this State is provided. This Bill outlines premiums payable by young adults and changes to hospital bed credits and to the levels of stamp duty collected. Section 2 provides for late entry loadings for those aged 35 and over who have not previously bought private health insurance. This is to encourage younger adults to take out insurance at a younger age than they might otherwise have done. Most younger adults who do not have private health insurance reportedly have no intention of taking it out, even with these measures.

The Health Service Executive has directed hospitals to charge private health insurance patients as much as possible. We welcome the recouping of these costs, but this will lead to increased premiums, a reduction in the take-up of private health insurance and a return of these patients to the public health system. Fine Gael and the Labour Party are sticking to their flawed plan of universal health insurance. We note that this is not the same as universal health care, which is what we in Sinn Féin want. There is an obvious and clear distinction. Their system would see competing private insurance companies divvying up much of the overall health spend and see administration, advertising and profit take certain stage.

We still need to know much more about the funding of universal health insurance. What is compulsory health insurance going to cost people who have neither medical cards nor private health insurance at present? Universal health insurance will see the State subsidising those who cannot afford to pay insurance premiums. The State will have a huge managerial and funding role. Why not cut out the profit of the privateers and keep the money involved within the health system and in the pockets of citizens? At the end of the day, if we move towards a model of universal health insurance, there is going to be profit made by essentially what are middle-men or middle-women, in terms of the people who supply universal health insurance. They make their profits on the back of people's health needs. It would make far more sense if we increased taxes on those who can afford to pay most, and to use those taxes in a progressive way to fund our health services and have real solidarity. One is accepting, because of the equalisation principle in this Bill, that the principle of solidarity is important. I cannot therefore understand why it cannot be extended to the health service in its totality.

I have a lot more to say, but unfortunately time is against me. I will be supporting the Bill, with all of the caveats I have expressed, but I have no confidence in the private health insurance model. I am interested in working with those who do believe in universal health care. That is the direction in which this State needs to go. Hopefully, it will go there in the future.