Maire Devine (Sinn Fein) | Oireachtas source

The greatest deficiency and most damaging factor in the Irish health system is the absence of universal health care. There is an incurable reliance on a two-tier system. The Fine Gael and Fianna Fáil parties are responsible for building this inadequate health service over decades which has led to our poorest citizens suffering and dying because of their inability to pay. Disturbingly, we have built a public health service which survives precariously on life support due to private sector intervention at huge cost to the taxpayer.

I read with interest the Minister for Health's response to the debate on Second Stage in the Dáil. One thing that struck me in his remarks was his reference to risk equalisation and that if we did not advance this, we would be "leaving some of our sickest and some of our most elderly citizens who access private health insurance" exposed. He said this legislation would "protect them from much higher premiums were we in a risk-rated free market type approach to this". The Minister took issue with some speakers who criticised private health insurance and its influence on the development of a universal system. His remarks were that "we cannot close our eyes, put our hands over our ears and pretend that almost 50% of our citizens do not have private health insurance".

We cannot not support the passage of this legislation, but we wholeheartedly reserve the right to criticise the flawed model upon which the two-tier health system is currently based and which creates and entrenches deep inequalities. It is clear that it is the poorest and sickest who find it hardest to pay charges no matter how small those charges are and who find it harder to negotiate access. It is also the poorest and sickest who have to wait longest for care. Care should not be provided based on ability to pay. The fear of being left high and dry in an hour of need is what drives 50% of our people to private health insurance. This is not acceptable.

Reference was made to the 100,000 people coming back into health insurance.In the horrific years of austerity, health insurance was the first thing to go in people's budgets as they tried to survive the bills. Now they are coming back in, but the burden placed on the health service over that decade was enormous. We are still suffering from it now.

We should be building an all-Ireland public hospital system that will look after our citizens on the basis of need and regardless of wealth or location. The Department does not collect specific data on the cost to the Exchequer of operating a private system of health care. If we are investing in the NTPF without recourse to what could be done to enhance services in the public system or if we are enabling a private insurance market, we must have some idea of the cost of the two-tier system for the Exchequer. Last week, my colleague in the Dáil, Deputy Louise O'Reilly, asked for the data relating to the number of treatments commissioned from the private sector versus the number of treatments carried out; the number, type and value of services and surgeries commissioned from the private sector and the number, type and value of those carried out; and the cost and savings to the State of services and surgeries carried out by the private sector. This is important information when discussing capacity issues in the public health system, but Deputy O'Reilly was advised that the detailed information sought was not available at the time, that the NTPF had been asked to provide the information requested and that it would be forwarded to her. At a time when the Minister is reactivating the NTPF, allocating €20 million to it and with that figure to rise to €55 million in 2018, and when contracts are being entered into with the HSE, he does not have available to him data relating to the efficiency and value for money of embarking on this course. One need only look to the various reports that were produced in England recently to see that this course did not increase capacity.

Align all of this with the fact that the full capacity protocol was deployed an amazing 2,300 times across a 321 period in 2016 across 26 hospitals. The protocol of last resort is being used with such worrying frequency that alarm bells must be going off in the Department of Health about the lack of capacity. Despite the Government's rhetoric about the largest investment in health in years, it appears that it is not enough. International research definitively shows that insurance based systems are more expensive and cause inequalities. In Ireland, 45% of the population have private health insurance, yet it contributes less than 10% to the overall budget. At a meeting of the Committee on the Future of Healthcare, Dr. Sara Burke explained that this is due to the fact that private health insurance in Ireland largely insures somebody for inpatient or day case elective hospital care. It does not cover most other matters, such as most outpatient care, outpatient appointments with specialists in the first instance, the cost of drugs and most primary care payments. This is a blatant example of poor value for money. It shows that the public system is subsidising the private system, because while 45% of the population has private health insurance, the majority of the expense of health care is not paid for by private health insurers. This was an issue for the Minister, and there is a new charging regime for private patients in public hospitals. However, if private insurance is only providing one link in the chain, with the rest left up to the public sector, it means we are subsidising the private sector. That sector cherry picks and takes the best and most profitable parts, leaving the public health service to pick up the pieces. It is called privatising profits and socialising losses.

How far have we come since Susie Long's untimely death? How is promoting private health insurance a step towards universal health care? It is not. Our public services are under-funded, they cannot retain or recruit staff and there are chronic waiting lists of almost 500,000 at the last count. I hope the next time the Minister comes to the House with a Bill such as this, there will be a plan for untangling the marriage of public and private health systems. We will not support this Bill.