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Health Insurance (Amendment) Bill 2012: Report and Final Stages (Continued)

Tuesday, 4 December 2012

Dáil Éireann Debate
Vol. 785 No. 1

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(Speaker Continuing)

[Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher] The other reason for the decline in the number of young people taking private health cover is that they are unsure of what universal health insurance means. The Minister says he has a target of providing universal health insurance by 2016. In the meantime, people will ask why they should take out private health cover other than to ensure it will be there for them if they get sick. What other benefit does it give? Does having cover allow a person to build up loyalty with an insurance company? People take out private health insurance for a number of reasons, but they do so primarily because they expect a loyalty bonus if they remain with a particular insurance provider.

I ask the Minister to look on this amendment favourably, even at this late hour. I accept that he cannot accept the amendment but can he give a commitment, at policy level, to ensure that young people see health insurance as beneficial until we move to mandatory health insurance?

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I take on board what the Deputy is saying. Insurers are locked in competition for younger customers because that is where they make their greatest profit. For that reason, they will not cut prices too much. We want to encourage them to reduce their costs so that they are in a position to cut their prices.

We have already undertaken to discuss lifetime community rating with insurers. People take out insurance for the cover. In my experience, they also take it out because they want to have a one-to-one relationship with the treating consultant, which they sometimes feel they do not get in the public health service. That is something we are in the process of changing by having more consultants in hospitals. The new Labour Relations Commission agreement is about ensuring there are more consultants and senior decision makers around at all times.

I hope that clarifies matters for the Deputy. I am afraid I will not be accepting the amendment.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher There is no point in my saying much more. Other Members want to discuss their amendments.

  I cannot accept the Minister's argument although I know it is put in good faith. We need to have something in policy that supports the concept of intergenerational solidarity. My amendment would achieve that.

  Amendment put and declared lost.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I move amendment No. 2:

In page 4, line 35, to delete “old.”,” and substitute the following:

(e) the imperative to ensure that all persons receive, in due time and to the highest standard possible, health services on the basis of need alone and not on the basis of ability to pay.”,”.

As I stated on Committee Stage, the Government's reform strategy is flawed because it is based on competing private health insurance companies and will represent the effective privatisation of the health services. The Minister's strategy has no basis in rights as it contains no commitment that patients will be guaranteed in law that they will receive basic essential health care. That is a core principle of mine. One of the core positions of Sinn Féin is a commitment to universal entitlement to health services on the basis of need, and need alone. Instead, the Government's strategy relies totally on regulation of the insurance industry, mainly through the legislation before us.

  The purpose of my amendment is to set down a marker for citizens and to enshrine a commitment in law. Insurance companies must be made aware that there is an imperative for the State to ensure that all persons receive health services in due time, to the highest standard possible and on the basis of need alone and not on the basis of their ability to pay or the size of their bank balance.

  Sinn Féin sees the amendment as a first step and would build on it, introducing separate rights based legislation and a rights basis for health care. That is necessary and, arguably, needed now more than ever, given the Government's approach to an insurance based model.

  In the absence of the principle recognised in our amendment and its reinforcement in rights based legislation, which Sinn Féin is committed to, private insurance companies would be given too great a role in determining the level of basic health care services available to citizens. That is where we are going. Private insurance providers would have a critical role in determining the level of basic health care for each citizen.

  The Fianna Fáil regime of 14 years' duration promised to introduce an eligibility for health and personal social services Bill. The Minister and I, as Opposition spokespeople on health, repeatedly requested advice on the progress of the Bill. Of course, it never saw the light of day. The Bill would have been hugely important. It would have placed the citizen's right to access health and personal social services in law. The Bill did not see the light of day under the former regime and there is no indication that it will re-present under the Minister's stewardship.

  I refer again to a report recently published by the IMPACT trade union. The report had not been prior-studied when we debated the Bill in the select committee. I made reference to the report on that occasion but I do not think the Minister had access to the detail of it. The report was an analysis of the Government's proposed reforms and concluded that the Government has based its approach to universal health insurance on policy in the Netherlands, which the Minister repeated in his reply to me on Committee Stage. In that country, a system of competing private insurers has created an inequitable and inefficient system of funding with different tiers of entitlement. That is hugely worrying because this is the system the Minister and his Cabinet colleagues have lauded repeatedly. The idea of different tiers of entitlement is what we are, supposedly, trying to avoid and get away from when we commit to universal access to health care on the basis of need, and need alone. Why and how can there be different tiers of entitlement?

  I appeal to the Minister, as I did previously, to consider the amendment.

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