John Crown (Independent) | Oireachtas source

I move amendment No. 2:

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 medication which is available to a public patient, and is approved by the National Center for Pharmaeconomics, and is deemed necessary for treatment of a patient by a medical practitioner, must also be made available to those patients who hold a health insurance contract, the cost of which will be borne by the health benefits undertaking with whom the patient holds a health insurance contract.”.”.

I welcome the Minister and at the outset wish to congratulate him on his speech last night. It was a rare example of clear political thinking and leadership and I think he deserves great credit for it. He managed to take a complex issue, distil away a lot of the emotion, and talk about the hard issues we will have to discuss without bowing to the whims of extremists on either side. I salute the Minister for it.
I will slightly disagree with the Minister, however, when he said that clearly something would be necessary to replace the eighth amendment. The Constitution ticked along very nicely for 46 years or so before the eighth amendment to the Constitution was introduced. My own belief is that if the will was there and if the will of the people was simply to remove it from the Constitution, to repeal it, there would probably be some fine-tuning with certain aspects of legislation which were formatted after the amendment came into effect and reflecting the strictures placed on them by the amendment, but in general these should be legislative rather than major constitutional issues. This does not mean that I am pro-abortion, anti-life, pro-choice or anything of the kind. It merely states that the appropriate form for very nuanced, often technically, scientifically, medically and ethically complicated issues is in well-contrived legislation. I do not feel there is any reason that should not be the goal that we are aiming for and that people of goodwill, who are occupying what I believe is the genuine middle ground on this, would actually see this.
With respect to the business at hand, it is one of those funny things that people say not to be too personal when doing stuff in the Chamber, but because of my day job, I do actually see examples of things which I have the opportunity to highlight in a legislative forum, and this is one of them. It has become apparent to me that there has been an appropriate and increasing scrutiny of the cost of drugs used for various illnesses, and not just drugs but also treatments and tests, and an appropriate degree of scrutiny on things like cost-benefit analysis, quality, adjusted life years, incremental costs and effectiveness ratios. I totally understand this. I have written on health economics. I am not one of these naives who believes doctors operate in an economic vacuum and that there is not an opportunity cost on some other part of the health service for every penny that we spend on care for cystic fibrosis or cancer or diabetes.
That said, I do believe there are a number of remediable dysfunctions in the way the private insurance market is interacting with the question of procurement of drugs. I have seen it most specifically in cancer drugs, but I believe it happens in other areas. There are certain drugs which are approved by some companies and not approved by others. One could state that in a competitive market, with a truly informed class of customers, this should not be a problem. People will elect to purchase product A versus product B. The reality, however, is that this is not the way these things are decided. People do not know in advance that a particular cancer drug, cystic fibrosis drug or drug for macular degeneration may not be available to them on the insurance. As a result, it is a distorted market. Completely distorting the market is the reality that there are two public entities which, in effect, become competitors of some of the private companies in this respect. One of them is their obvious competitor, the Voluntary Health Insurance, which is basically back-stopped by the State and for which the Minister acts, as he pointed out the other day, as the sole shareholder. As well as that there is the State itself, because the companies can withdraw from the emotional aspects of the debate about a potentially life-prolonging and life-saving drug by saying they will not get it, often in situations where the State will do it.
My own sense is that when people pay extra money for health insurance in addition to the money they pay in their taxes which subsidise the general health system of the entire country, perhaps they should expect that they will be given at least the same standards of care and the same access to newer treatments and technologies as they would have if they were to go through the public system. This strikes me as being an extraordinary example of the ability of the companies to cherry-pick in a very subtle way. They have these two distorted competitors who act at a certain disadvantage to them because they, unlike the private insurance companies, will have a degree of public accountability and public answerability.
For that reason, I ask the Minister to consider this amendment. This is not a carte blanchefor any doctor to prescribe any drug to any patient. This is very specifically an attempt to make sure there is an equal playing field on access to some of these new treatments and that there is not, in fact, an incentive on two companies to decant patients' demands back either to the VHI, if it is a non-VHI policyholder, or back to the State.