Victor Boyhan (Independent) | Oireachtas source

I thank the Minister of State, Deputy Finian McGrath, for coming to the House and for giving us a comprehensive review of the Health Insurance (Amendment) Bill 2018. I welcome the introduction of this Bill. Ordinarily it is an annual Bill that deals with the amount of risk equalisation credits to be paid from the risk equalisation fund in respect to age, gender and level of cover from 1 April 2019. Substantive changes are being sought to both the operation of the VHI and to the corporate governance of the Health Insurance Authority and I welcome the clarity with which the Minister of State set them out today. After years of surging health costs, we should pause to remember that Fine Gael has been in government for the past seven years and one of the big issues in its campaign during the previous election was this great promise of universal health care. It is a bit like the universal social charge, USC. When one googles the words "we will abolish USC", one finds them all over the place and yet people come in and out of here as if there is no problem. Fine Gael also broke a promise that it would provide universal health care. Why do the public pay for private health insurance? What are they getting for it? Why are people waiting for years to get a health service? I am a proud member of the VHI. It is not a choice any more as I have to have health insurance. Most of us, if we can afford it, will pay for health insurance because one has to have it. I would like to spend my money on other things.

There was the great promise of universal health care, but suddenly the party walked away from it. Whenever the election is called, and I do not want to deviate from the discussion on the Bill, we will have to ask who broke the promises? Who spoke about the abolition of the USC? Who talked about universal healthcare? Who talked about no more people waiting months for cataract operations? Who talked about rehabilitation beds being opened for people who want essential rehabilitation? I am mindful of the only six beds designated for children at the National Rehabilitation Hospital in Dún Laoghaire being closed.

We have to talk about the VHI and private healthcare which is essential for people because they have no choice. We have to ask ourselves what we are doing about healthcare. Where are we in terms of a Republic that talks about equality of opportunity, supporting the vulnerable and enabling and assisting people who need critical care and home care packages? Somehow the private sector is doing one thing while the public sector is doing something else. We have to come together to provide proper decent healthcare for everybody. That is the challenge for people. I accept the potential of Sláintecare and the acceptance across the political divide it will be important as we go forward.

I do not want to be negative as I know the Minister of State, Deputy Finian McGrath, is a very positive person who gets things done. I acknowledge that he is very focused and does not get sidetracked. I know it is as frustrating for the Minister of State as it is for me and Members of the Seanad. Healthcare is going to be one of the big issues people in the public realm will have to stand over and be held accountable for. Whenever this election happens, the people will be ready and will demand accountability from the political masters who promised them they would fix the healthcare service which is far from fixed.

After years of surging health insurance costs, I welcome the fact prices are finally beginning to level off. In the case of the VHI, its customers have seen cuts in their insurance premiums. Indeed, I received a cheque for €50 in the post, a rebate from VHI. I was thrilled. This move has forced others to follow. I understand Laya Healthcare and Irish Life Health have also reduced their premiums, with a typical family saving €270 a year. Competition is good in the health sector; it is good in every sector. I am glad to see people are tackling the cost of healthcare. That is important.

I was alarmed, however, to read recently that according to a survey by Dermot Goode of totalhealthcover.ie "older people are paying double what they need for health insurance because of what he describes as their unwillingness to switch providers. Why are people unwilling to switch providers in the health insurance market? I know why. I switched a few years ago because I was saving some money but trying to get back into the VHI was another matter. There was a cost and I was not getting the same coverage. Older people who are not familiar with different companies chose to stay with the familiar, safe and predictable service. There are no policies where one can compare like with like.

I was a director of the National Treatment Purchase Fund, NTPF, for two terms and I know more about private health cover than most and how the NTPF would negotiate with the private health sector as part of its remit to provide beds and services for patients who were classified as the longest on the waiting lists. That was the principle then, but it may have changed somewhat. The prices the NTPF can secure versus the cost of the procedures for those with private health cover are different. Casemix compares the cost of procedures in the context of the private and public sectors and it is worth looking at that but that is an issue for another forum. We need to be mindful of costs and value for money but ultimately it is about people's healthcare. We have to ask ourselves why are people unwilling to change. I suggest one of the reasons relates to simplification, plain English, plain speaking and comparing like with like. No two policies are the same and that is an issue we need to look at in the broader debate on private health cover. What service are people getting for the money they pay? Where can they see comparisons because no two policies are alike? The policies are deliberately designed by these private companies to be different so that one cannot compare like with like.

I welcome the Bill as it will increase the number of members on the board of the Health Insurance Authority. The view in the past few years has been that we should have tighter and small boards, be it in the private sector or the public sector. I think at last we are realising that small boards are not necessarily good boards and the smaller the board, the tighter the outfit is and sometimes one does not pick up some of the problems.

I was a member of another board, which I will not mention, that was the subject of great debate a few weeks ago. We are now seeing the company being wound down and a number of issues of concern being raised. I think the bigger and the more diverse the board membership is, the better for corporate governance per se. I welcome the fact the Minister is increasing the number of board members on the Health Insurance Authority. It is important that we ensure that the Health Insurance Authority promotes customer choice because this has to be the backbone of all this. Customer choice increases information so that young and older people are not paying above what they ought to be paying for the cover they need. Some policies are for cover way in excess of what people need. Again people cannot get independent information.

I look forward to the Minister of State's response and ask him to respond to two issues. The first is the rationale behind the VHI's coverage capacity internationally. On the face of it, I welcome it and think it is good, but what is the rationale for it? The second issue is the increase in number of board members of the Health Insurance Authority and the reasons for it. Some years ago before I became a Member of this House, the VHI was in dire straits but now it is a stronger and better organisation. It is leaner and keener and it is a great tribute to its chief executive, chairman and staff. The VHI is now at the cutting edge. It is very professional, very slick, keen and competitive and it is an organisation we should be justifiably proud of.