John Crown (Independent) | Oireachtas source

I move amendment No. 3:

In page 4, after line 42, to insert the following:“Insertion of new section 7I to Principal Act

4. To insert a new section, after section 7H, of the Principal Act:

“7I. Any health benefits undertaking may, if they decide that it is in their commercial interest, reduce the premium offered to any individual who avoids behaviours which are known to have negative health effects.”.”.

As is well known, probably since before the Minister was in medical school, I have been an advocate for a model of universal insurance in this country with competing companies, most of which, I would hope, would be not for profit. I am a great believer of models such as the ones that exist in Germany, Israel and several of the other countries of north-west Europe of dependence on a model of social insurance where the profit motive is not what drives the insurance companies but where there is a more efficient link between activity and reimbursement. It is called money following the patient.
As a society we are all in it together and I believe people should have a level playing field when it comes to accessing health insurance. For that reason I am a major supporter of community rating. We should not be able to charge people more if they are older and less if they are younger. We should not be able to charge people differentially according to their family history. People cannot pick their genetic background. These are the cards one is dealt by genetics and chronology.
However, there are some things that people can pick regardless of any other circumstance in their lives. The very extreme example is smoking. People can choose to become smokers or not to become smokers. People who choose to become smokers overwhelmingly become addicted as children if they remain smokers during their adult years. I believe there are very few rational adults, armed as we are with the health risks associated with smoking, who would make a decision while adults to take up the habit for the first time although it does happen.
However, I do not believe it is contrary to the spirit of community rating to allow health insurance companies to analyse, perhaps with some type of ministerial oversight or some type of commission oversight the issue of wholly avoidable bad health behaviours. It should allow people to be incentivised. It would not only make sense from the companies' point of view, but would make sense from society's point of view to allow people to be incentivised by giving them a smaller health insurance premium if, for instance, they were non-smokers.
I know that with some of the other risk factors that are avoidable it is a bit trickier and I know there are nuances in it. Certainly if the principle were introduced, it would not be contrary to the principle of community rating and it would allow us to have a powerful tool in the public health sphere and also one that would be rational from the point of view of health economics.