Maire Devine (Sinn Fein) | Oireachtas source

The main deficiency in our healthcare system is the absence of universal healthcare. I support Senator Boyhan raising this in the debate. Sinn Féin repeatedly raises the inherent inequality in our health system during these debates every year and each year the inherent inequality has been allowed to flourish. Rather than navigating a way out of reliance on a two-tier system, it appears that oxygen has been given to the private sector at the expense of vital investment in public health services. This Bill is a prime example of that.

Insurance premium income in 2017 was €2.66 billion and premiums per person rose by an average of 3.7% in that year. The number of insured people at the end of 2017 was 45% of the population. That number had gone down following the economic crash and is now climbing again. Last Friday I took a friend to the hospital. There was not even standing room in the emergency department. This person did not have health insurance but has vowed to get it this week. It is not a choice but something that is imposed. People will scrimp and save for it when they see no standing room in an emergency department.

Some 21% of people over 60 years of age have private health insurance. It is a fair assumption that healthcare needs increase as people get older, but it is also fair to argue that most young and middle aged people simply cannot afford health insurance. In summary, we are discussing middle Ireland, the people who can just about scrape enough together to pay for health insurance out of fear or those who cannot afford the payments. However, what aspect of insurance is fair? By its nature it is making a profit from the suffering of others.However, as far as I can see, this Bill every year, year in year out, is about taking the risk away from insurance companies. I know it is aimed to be Exchequer neutral but then why are we involved? Why are we discussing and meddling in the private sector? It is because our public health system is in a state of emergency.

Last year we tabled an amendment that would require the Department to produce a report on the impact of this legislation, specifically to address concerns that insurance companies would use this legislation to sneakily hike up their premiums. The Government rejected this amendment, leading to ongoing protection of private companies from scrutiny because they are propping up our failed health system.

Twice a year the Health Insurance Authority issues a report to the Minister on its evaluation and analysis of these returns. The second report includes recommendations on the amounts of the risk equalisation credits and the amounts of the community weighting levies. Why can a new section not be requested to monitor premium hikes under the guise of this legislation? We will consider tabling this amendment again as insurance costs are at unbearable rates for ordinary people. We need to address this head on. The authority assesses if any insurer has been over-compensated by the risk equalisation scheme, enabling it to earn in excess of a reasonable profit but what is a reasonable profit and how do we determine what it is?

I would also ask for some clarification on the newer parts of the Bill. Can the Minister of State outline the rationale for the increase of the number of Health Insurance Authority board members from five to seven under section 3? Senator Boyhan welcomed that but what pushed the increase in the board members from five to seven?

What is the rationale for both changes proposed under section 6? Why does the VHI wish to now sell without an intermediary? What are the benefits and possible risks of this change? While I imagine the removal of the necessity of ministerial approval is to save time and remove some red tape, how can we ensure there is still proper oversight? I would appreciate if the Minister of State could address this concern.

The issue of health insurance is not about the equity of premium; it is about the inability to pay or provide. That is what we should be discussing here today. The argument will be, as it has been year in and year out, that risk equalisation benefits ordinary people who may be more frail and more of a health risk than their neighbour, but we would not need this benefit if all of our citizens had access to a proper functioning public health system, universal health care. That is the real risk we should be managing today.