Tuesday, 24 November 2015
Universal Health Insurance
The Senator raised a few points. He touched on some of the issues, including whether to have a Dutch, Canadian or, as he mentioned, British model. Whatever we do, we need to have an Irish model because everyone's model of health care is different. Whatever we do will have to suit our circumstances and needs and have regard to the point from which we are coming, which is crucial to all of this.I certainly hope to know the outcome of the research on the cost of meeting unmet demand in the health service next year. I do not have a date for the funding model, but I still hope to have it next year. That does not mean, however, that we will go ahead with it. As I mentioned, we have to make sure there is adequate capacity in the health service, that we strengthen primary and social care provision and put in place the reform structures and financial reforms needed before we change the funding model. Otherwise no funding model will work. It will take more than five years to do these things, which means that I do not anticipate the next Government, if my party leads it, being able to change the funding model for health care substantially.
It is also important that we face up to a few things to which we may not want to face up. Any system of universal health care, no matter where it is in place, whether it be the NHS in Britain, the Dutch system or the Canadian system, involves some rationing. Universal health care systems involve waiting lists in some form, telling people they have to wait because there is somebody with higher priority ahead of them or that they cannot receive some drug or treatment because it is not considered to be cost effective. That is why in every democratic country in the world there is, to some extent, a two-tier system. We allow people to spend their own money on health care if they want to. Even in Britain, where access to health care is very good, 10% or 15% of the population have private health insurance policies with BUPA in order that they can skip queues, choose a consultant or access treatments that are not considered to be cost-effective for the general population. We need to be honest about this in the debate.
Compulsory health insurance schemes can work and do in other countries, for example, in Holland. However, they are expensive. I am not sure having a system of compulsory health insurance would be right for Ireland. What would we do if people refused to pay? Would we fine them or tax them as happens in America if they do not take out insurance under Obamacare? Would we jail them? If they continued to refuse and turned up looking for treatment, would we then refuse them? I do not think we would that in Ireland which is different from other countries. In European countries compulsory health insurance systems have tended to build up over time. Usually an employer pays for insurance for an employee at first and then people subsequently pay for themselves. We do not have that tradition in Ireland and I do not think it would be right for us for these various reasons.
No matter with what funding model we end up in the long term, we first need to address the four major deficit areas. We need to make sure there is enough capacity; strengthen primary and social care provision; put in place reformed structures and achieve financial changes which are also important.