Dáil Éireann debate -
Tuesday, 27 Mar 1979

Vol. 313 No. 3

Health Services (Limited Eligibility) Regulations, 1979: Motion.

Minister for Health (Mr. Haughey)

I move:

That Dáil Éireann approves the following Regulations in draft:

Health Services (Limited Eligibility) Regulations, 1979,

a copy of which Regulations in draft form was laid before Dáil Éireann on 14 March 1979.

The purpose of these regulations is to change the rules governing limited eligibility for health services with effect from 6 April 1979.

At present, persons with limited eligibility for health services are persons, other than those with medical cards, whose rate of pay or income is within a limit of £3,000 or, in the case of farmers, whose valuation is £60 or less. There are many exceptions to this definition, however, related to the type of work performed, social welfare insurance status and other factors which have little relevance to a person's ability to pay for health services.

The health services which are specifically available to those within the present definition of "limited eligibility" are:

—hospital services, both in-patient and out-patient, together with subsidies towards the cost of maintenance in approved private hospitals and homes;

—maternity and infant welfare services;

—a drug subsidy scheme.

The effect of the draft regulations now before the Dáil will be to allow benefits within this range to be extended to the entire population. The delineation of the benefits to be available to each group of the population will be made in separate regulations under section 72 of the Health Act, 1970. These regulations will not require the prior approval of the Houses of the Oireachtas, but I think that I should at this stage tell the House of what I intend to include in these regulations, as well as what is dealt with in the draft before the House.

The combined effect of the two new sets of regulations will be that services will be available for three categories of the population.

Category I will consist of persons with medical cards who have full eligibility for all health services. No change is being made in the composition of this category or in its entitlement to health services. Somewhat less than 40 per cent of the population is in this category.

Category II will consist of all persons, other than those in Category I, whose income in the year ending 5 April 1979 was less than £5,500. Persons in this category will be entitled without charge to the full range of "limited eligibility" services, that is hospital in patient and out-patient services, maternity and infant welfare services and the drug subsidy scheme. About 45 per cent of the population is in this category.

Category III will consist of persons whose income in the year ending 5 April 1979 was £5,500 or more. Persons in this category will be entitled to hospital services on the same basis as for those in Category II except that they will be liable to pay consultants' fees. They will also be entitled to participate in the drug subsidy scheme. Somewhat over 15 per cent of the population are in this category.

In addition to the services which I have described and which will be available specifically to persons within the relevant category, there are services at present available to the entire community without reference to income. These include in particular:

(1) immunisation and diagnostic services and hospital treatment for infectious diseases;

(2) hospital in-patient and outpatient services for children suffering from mental handicap and mental illness and from a number of other long-term conditions;

(3) prescribed medicines without any charge for all persons suffering from a number of long-term diseases and disabilities.

These services will continue to be available to the entire population.

These changes in entitlement to health services are being made in association with the introduction of a system of income-related health contributions as provided for in the Health Contributions Act, 1979. This system, which will operate from 6 April 1979, will change the present system of flat-rate health contributions to one which will be income-related. The rate of contribution will be 1 per cent of income subject to a maximum contribution of £55. Persons in Category III will pay the maximum contribution. Persons in Category II will pay a contribution which will be graded with size of income: the smaller the income, the smaller the contribution. Persons in Category I will not be required to pay any contribution.

The changes which I now propose to make represent a major extension of entitlement to health services. At present an income limit of £3,000 operates for purposes of entitlement to hospital services and other "limited eligibility" services. Under the new arrangements this limit will be abolished.

(1) for hospital in-patient and outpatient services, other than consultants' fees;

(2) for entitlement to subsidies towards the cost of maintenance in approved private hospitals and homes;

(3) for the right to avail of the drug subsidy scheme.

In future everybody will be able to avail of these services without reference to income.

At the same time the £3,000 limit is being increased to £5,500 for purposes of entitlement to the services of hospital consultants and to maternity and infant welfare services from general practitioners.

This new limit of £5,500 relates to income for the year ending 5 April 1979. It will apply throughout the following year, that is during the year up to 5 April 1980. Before that date it will be reviewed having regard to changes in incomes and it will be increased again if circumstances warrant this.

This limit of £5,500 will also apply to farmers. In their case income will in most instances be calculated by reference to rateable valuation.

In the case of a married couple, each of whom has a separate income, the entitlement of each will be assessed separately. I have given some thought to the question of the entitlement of children in such cases. I have decided that if each parent, on an individual assessment, is deemed to be in category II, the children will also be eligible for category II services, even though the combined incomes of the two parents may exceed the £5,500 limit. If, on the other hand, either parent is in category III, the children will also be regarded as being in that category. To arrange it otherwise would be inequitable in relation to families in which only one parent has an income.

I have had a number of discussions with the Irish Congress of Trade Unions and with the medical organisations concerning this limit and its operation. I had originally proposed that the limit should be fixed at £5,000 but having regard to the increase in average industrial earnings shown in the latest figure available, that is March 1978, and having considered representations which were made at the meetings with congress, I increased the limit to £5,500. This means that 83 per cent of the population will be within the limit. In considering this limit it should be borne in mind that eligibility in any year will be based on earnings in the previous year.

I believe that these arrangements provide the right mix of public and private health care systems for the population having regard to the excellent service provided by the Voluntary Health Insurance Board. As 700,000 people participate in the board's schemes and this number is increasing all the time, it is clear that a large section of the population want to have the option of private care.

Finally, on the limit chosen—£5,500 a year—I would point out that it is a very real improvement on the present figure of £3,000 a year. Were we to have adjusted that on the traditional basis, it would have become merely £4,500 a year.

As well as being a major extension of eligibility, the changes which I now propose will remove a number of complexities and anomalies which had developed in the present rules of eligibility. It was necessary to adapt the rules at various times in the past to meet the requirements of changing circumstances. As a result, the criteria of eligibility have become complicated and many people have difficulty in understanding their entitlement. There is also the fact that the eligibility rules, as originally devised, made a distinction between manual and non-manual workers and between different categories of social welfare insurance. Whatever justification there may have been for these distinctions in the past, they are now totally irrelevant to the question of ability to pay for health services will be removal will mean that the question of ability to pay for health services will be decided by reference to actual income and this criterion will apply uniformly for the entire population.

It is inevitable that if these anomalies were to be removed some people must lose part of their present entitlement. This is unavoidable if the same criteria of entitlement are to have equal application for everybody. There is no reason, however, why this loss of entitlement should cause serious problems. The major part of hospital costs is the charge which may be made by the hospitals. In some cases this can be a serious burden on an individual but, under the arrangements which I am now introducing, nobody will be forced to meet this charge. In addition the hardship provisions, under which the chief executive officer of a health board can arrange for the provision of services in any case which would result in hardship, will continue to operate.

There is also the very important fact that the Voluntary Health Insurance Board is revising its scheme of insurance to provide that insurance cover for medical fees will be available to everybody. For a modest premium any person who wishes to do so will be able to fully insure himself against the risk of any medical expense which might arise during a spell of hospital treatment. The board will also provide that current restrictions, related, for example, to age or to existing medical conditions, will be waived for a time to enable everybody to avail of this insurance cover.

The value of voluntary health insurance is clearly seen from the fact that over 700,000 people are now covered by this form of insurance. What I would like to stress in particular is that voluntary health insurance should not be the prerogative of any one sector of the population but should be capable of being availed of by all. The revised schemes offer many benefits and choices and I would urge everybody to study what is being offered to see what is available to suit their circumstances and needs.

As the Members of the House may be aware a similar resolution was moved in the Seanad last Thursday where the new arrangements were welcomed. This welcome was based primarily on the real improvements which are being made in entitlement to health services. A number of speakers were also impressed by the link being forged with the Voluntary Health Insurance Board and the fact that the new insurance arrangements being offered by the board will complement the public health cover from which nobody need be excluded.

It can be seen, then, that the changes which I now propose to make will have two important consequences. In the first place, they involve a major extension of entitlement to health services which will ensure that in the future nobody need fear the financial consequences of serious illness. In the second place, they will remove the inconsistencies and inequities which have developed in the present rules of entitlement: everybody should be clear on his entitlement and nobody need feel that he is being treated unfairly relative to the rest of the community.

Mr. Boland

The Minister for Health has a peculiar panache for making that which is tarnished silver appear to have a golden hue. With that particular talent he can manage to represent a scheme which has inbuilt inequities and new anomalies, in return for abolishing existing anomalies, to be a comprehensive, all embracing one. We have discussed the changes in the entitlement for health and hospital services several times already in the House. This is one of the regulations arising on foot of the passage of the Health Contributions Act. I would have thought that by now the Minister would have desisted from representing this scheme as being comprehensive in nature or uniform in the benefits it gave all sections of the community. However, in the very last sentence of his introductory remarks the Minister said:

......they will remove the inconsistencies and inequities which have developed in the present rules of entitlement: everybody should be clear on his entitlement and nobody need feel that he is being treated unfairly relative to the rest of the community.

I propose to point out the sections of the community who will feel, and indeed feel already, they are being treated unfairly. Some of them rightly feel they are losing some of their entitlements; others feel they are being asked to pay more for less. I do not see how anybody, even somebody with the peculiar talent for representing everything as a perfect improvement as the Minister, could represent to those people that they were not being treated unfairly relative to the rest of the community.

It is somewhat disappointing that at this stage in the development of our economy we see a change being brought about in the eligibility for hospital services, which still has a relatively low income limit applied to it, and that that scheme should be represented as being comprehensive or all-embracing. Following complaints voiced in the House, by some representative organisations and indeed by the Irish Congress of Trade Unions at the fact that there was a £5,000 cut-off on income and that people earning more than that would not have the same eligibility as those earning less, the Minister was moved, with a rather smaller than usual fanfare of trumpets but nonetheless strident attempt at sounding a note of self-congratulation, to announce that he was increasing the limit from £5,000 to £5,500, an increase which must be described as being of a derisory nature at the stage it was introduced, at a time when the Irish Congress of Trade Unions were asking the Minister, as an interim step to abolishing the income limit completely, to raise the limit to between £8,000 and £9,000. Instead of that the Minister raised the income limit in the order of £500 for income-earners and, curiously enough, made no attempt whatsoever to raise the valuation limit in respect of farmers. Therefore, the strange multiplier peculiar to the Minister for Health in relation to assessment of farmers' incomes, which equated £60 valuation with £5,000 income, has been changed even before it came into operation to one equating a £60 valuation with an income of £5,500. I do not see the equity of that. If one limit is to be changed then surely all limits must be changed.

There are several categories which clearly suffer as a result of the scheme. Under the present arrangements all manual workers, irrespective of their income, pay 50p per week and are entitled to full hospital services but under these regulations manual workers earning in excess of £5,500 will be obliged to pay £55 per year, more than twice their present contribution. In return for that they will get the same services they enjoy at present by with the important exclusion that they will in future be obliged to pay for all consultants' fees in hospitals. They could amount to a considerable cost and the only recourse open to such workers is to insure with the VHI or some other body against that cost. The Minister suggests that people need not feel they are being treated unfairly, relative to the rest of the community but in fact they are losing a benefit which they have had for years.

In pursuit of the same negation of the principle that what one has one holds, the Minister has also, in his wisdom, decided to exclude those earning in excess of £5,500 who, as voluntary contributors were covered for hospital services, from that entitlement. The situation with regard to voluntary contributors was that when there was an income limit in respect of social welfare contributions those who exceeded that limit were allowed an option to continue to make voluntary contributions which gave them a continuation of certain social welfare entitlements. They were allowed to opt to pay a contribution which covered them for hospital services. A number of such people, when the income limit for social welfare purposes was abolished in 1974, found themselves once again paying social welfare contributions. Representations were made to the Minister for Health then on the lines that such voluntary contributors should be allowed a continuation of their entitlement to hospital services, irrespective of the income limit at the time, because they had traditionally paid a health contribution when below the income limit and afterwards as voluntary contributors through choice. It was put to the Minister that such people ought to be allowed to continue to pay a health contribution and have an entitlement which they traditionally enjoyed. The Minister recognised the validity of that argument and allowed the continuation of the entitlement for hospital services to those voluntary contributors.

However, those voluntary contributors, who have been entitled to free hospitalisation services in public wards over the years, if they earn more than £5,500 will no longer be covered for consultants' fees from 1 April. Again, the Minister said those people need not feel that they are being treated unfairly relative to the rest of the community.

The Minister is consciously and deliberately removing their entitlement to that benefit and I do not see how they can be represented as being treated equitably. The Minister is creating further inequity in the health service. I am not sure how our courts would view a situation where people who traditionally had been insured by the State in return for contributions were now being asked to pay an additional sum of money but were being told that they would get less in return for it than they had heretofore. That applies to voluntary contributors and to manual workers earning in excess of £5,500. I am not sure if the validity of the Minister's concept of social justice might be challenged in the courts but it would be interesting to see whether our courts would be in agreement with his concept of social justice.

Many of the voluntary contributors I am speaking of are in the public service, and in the civil service in particular. They will now find themselves getting less cover in return for the payment of an additional sum of money. It can hardly be stated that they are being treated fairly. It is well established trade union practice—I thought this applied also in relation to dealings between the Government, as employers, and civil servants—that any benefit an employee had he held; his position could not be materially worsened. When the new health boards were being created in 1970 and certain officers of the former health authorities were being appointed to those eight new boards it was clearly stated that any benefits those officers enjoyed would have to be continued. However, in this situation thousands of people who work in the public service and are entitled to free hospital services, including the cost of consultants, are now to lose their entitlement in relation to the services of consultants. That is a direct negation of the principle that anybody in the public service could not have his position worsened relative to other persons. That will also happen in relation to manual workers earning more than £5,500. That is not acceptable to our party.

During the Committee Stage debate on the Bill dealing with health contributions the Minister introduced a late amendment to deal with the situation where a husband and wife are earning. It was at that stage that we discovered that both income earners would have to pay a health contribution although the amount of entitlement would not be any greater. The entitlement to a family where a husband is the sole earner extends to the entire family but in the case where a wife is also working the entitlement will still apply to the family although she must pay a contribution from April. That family will not be treated fairly and equitably in relation to other families. We asked the Minister to tell the House the position in relation to a two-income family where one of the earners was being paid in excess of £5,500 and the other less than that amount. We pointed out that if the children of that family were assigned to the income earner who was being paid less than £5,500 they would be entitled to full hospitalisation cover, including consultants' fees, but if assigned to the other earner who was paid in excess of £5,500 it appeared that they did not have cover for such fees. As well as being charged twice in the State scheme they had to face the additional burden of having to insure the income earner in excess of £5,500 and the children. The Minister was upset at the fact that this point was made but, eventually, he conceded, as reported at column 1611 of the Official Report of 21 February 1979:

I will be making regulations later, before 1 April, which will deal with eligibility. Those regulations will have to come before this House positively. They will not be the sort of regulations that go by default unless somebody moves to annul them. I would have to come here and propose these regulations. At that point Deputies O'Connell and Boland will have ample opportunity to go into the eligibility side of things. I said to Deputies O'Connell and Boland that as of now I am considering and examining what the situation of children will be in their interests. I want to make sure that whatever eligibility regulations we apply to children will be to the children's advantage. Will Deputy O'Connell accept that?

Dr. O'Connell: Most certainly.

We will discover soon if Deputy O'Connell accepts what the Minister eventually came up with. The Minister is now suggesting in his regulations that "a person who is without full eligibility shall have limited eligibility for services under this Part". It does not appear to me that the new regulation specifically deals with the situation of the children in a two-earner family where one person earns in excess of the income limit and the other earns less than it. This matter is dealt with in the explanatory memorandum but I did not think that anything in an explanatory memorandum formed part of a statutory instrument.

We are told in the explanatory memorandum that where a husband and wife have separate incomes the eligibility of each will be assessed separately. I have pointed out how that does not appear to be a fair way of dealing with that family in comparison with the family next door who are a single-earner family. The explanatory memorandum further states that if the income of each is within the limit of £5,500 both they and their children will be eligible for full cover for hospital services. This means that if the income of each income earner is less than the limit the children will be entitled to full cover, including consultancy charges. If the income of one of the two earners is over £5,500 not only does he or she not get cover for consultancy services but the children will be denied cover for those consultancy services. The second income earner, who is earning less than the limit, will be told that each earner will be entitled to full cover but the children will be excluded from full cover because one of the earners is over the income limit.

The position of the children in that family is materially worsened. On 21 February last the Minister endeavoured to convince Deputy O'Connell that he was examining what the situation of the children would be in their interest. He said he wanted to make sure that whatever eligibility regulations are applied to children would be to the children's advantage. I do not know if Deputy O'Connell accepts that but I certainly do not. The eventual solution the Minister arrived at is clearly not to the advantage of the children in that family.

I have already referred to the situation in relation to farmers in the valuation category from £60 to £66. I would have thought that, even with a shift upwards in the income limit for income earners, there would have been a comparative upward shift in the valuation limit for farmers to include that section of farmers on a valuation basis if the Minister's multiplier is equal. That has not been done. Although the income limit has been increased from £5,000 to £5,500 the valuation limit has not been increased from £60 in resepect of farmers. It appears as if the farmers in the category from £60 to £66 valuation will not now get full eligibility although on the basis of the previous multiplier those farmers would have had full eligibility.

There are some pensioners who have two pensions, a contributory old age pension and a pension from their employment to which they have contributed during their working life. The combination of both those pensions can sometimes put those people within the tax net. I do not believe that pensioners in that situation should be included in the tax net. Under the Minister's health scheme that type of pensioner will have to pay the additional charge. I do not consider that those people are being treated equitably.

The one saving grace in this entire situation is that the Voluntary Health Insurance Board have rejigged their cover and the level of benefits they are prepared to pay to their members. A number of people who previously had no need to insure with the VHI, the manual workers over £5,500 and the voluntary contributors over that figure, will now be obliged to contribute to the VHI. Let us see how the situation of the category who were formerly VHI members has materially improved. A married couple with two children who were insured with the VHI for private room treatment in a hospital or nursing home and for consultancy charges pay approximately £180 a year. I can give an example of my own case. I pay, through a group scheme in the House. £184.68 per annum to cover my wife, my two children and myself for private room treatment. From the beginning of next week, if I want to retain the same level of cover through the combination of the State's scheme and VHI units under their rejigged system. I will have to pay the VHI £184.74, an additional 6p. I will also be obliged to pay £55 a year into the Minister's scheme in return for which I appear to get mythical benefits. I am giving my own example because it is the one which applies to most people earning over £5,500 who have been insured with the VHI up to now. Those people will discover, if they want to retain the same cover they have had up to now, that they will be paying the VHI the same premium and also £55 into the State fund which is not allowable against income tax.

In relation to many people earning over the income limit the benefits which will accrue to them are rather illusory. It would be better if we looked at this in a realistic way. Obviously, in an insurance scheme on an income-related basis those who earn more will pay more and will to some extent carry the cover for those who earn less. This party are not opposed to the concept of an insurance scheme. We introduced the concept of insurance cover for hospital services many years ago. This has always been a cornerstone of our health policy. The principle under which the VHI operate was enunciated by my party in Government many years ago.

The concept of changing from one inequitable health scheme to another and representing it to be a comprehensive scheme whilst still introducing into it an inadequate income limit does not appear to us to in any way bring about a comprehensive scheme. Is the Minister claiming that a husband and wife with no children who earn £5,450 per year and who pay less than £55 per year in return for complete hospitalisation cover are not getting a better deal than a family with five or six children where the income is £5,510 per year? A husband and wife with no children or an individual who earns £1 less than £5,500 per annum will be entitled to complete hospital and consultants' cover whereas a family with five or six children, where the income is £2 in excess of £5,500, will have to pay the same amount of money into the State scheme but will not be covered for consultants' fees. This is despite the fact that a large family are much more likely to avail of hospital services and to be liable for consultants' fees than an individual. Is the Minister suggesting that a large family should not feel they are being treated unfairly relative to the rest of the community?

There should be a comprehensive hospitalisation scheme on an insurance basis, as has now apparently been accepted by the Government. It should be on an income-related basis. If the concept of a no-income limit cannot be introduced at present, the reasonable call by the ICTU that the income limit be in the order of £9,000, pending its complete abolition, should be accepted.

Mr. Haughey

Will the Deputy state what percentage would be excluded with the income limit of £9,000?

Mr. Boland

I know that the people who are being excluded from cover for consultants' fees represent 15 per cent of the population, according to the Minister's figures.

Mr. Haughey

What percentage would be excluded on the £9,000 basis?

Mr. Boland

I have not the figures but I imagine only a small proportion would be excluded. I should imagine that something in the order of 10 per cent of the figure of 15 per cent mentioned would be included if the figure set by the ICTU were accepted.

Mr. Haughey

There would be no point in having a limit of £9,000. We might as well have no limit.

Mr. Boland

I imagine that those people with incomes between £5,500 and £9,000 and who will have to pay £3.50 per week to the VHI as well as paying £55 per year to the State will be extremely interested to learn that the Minister for Health considers there would be no point in increasing the limit from £5,500 to £9,000.

Mr. Haughey

There would be no point in having a limit of £9,000. We might as well have no limit.

Mr. Boland

I accept entirely the principle that there should not be any limit and if the Minister wants to propose that to the House I am sure he will get the entire agreement of the House. Then we could claim—as the Minister has claimed unfairly—that we have a full, comprehensive insurance cover for hospital services. If the Minister is working towards that end I should have thought that the suggestion of the ICTU that the income limit be raised to between £8,000-£9,000 was a reasonable one as an interim measure.

The increase from £5,000 to £5,500 is of a derisory nature. Families who are marginally above that income limit receive less entitlement than an individual. Voluntary contributors will have an entitlement that they traditionally enjoyed removed from them if their income is in excess of £5,500. Manual workers with an income in excess of £5,500 will have an entitlement that they traditionally enjoyed removed from them despite the fact that they will have to pay twice the amount they pay at present. For all of those reasons I want to give notice to the House that we will oppose the introduction of these regulations. We will vote against them.

Mr. Haughey

The Deputy is very foolish.

Dr. O'Connell

Having heard what the Minister and Deputy Boland have said, I am more convinced than ever that there is a need for us to be more courageous and to bring in a full, comprehensive and free hospitalisation scheme. Anything less is merely papering over the cracks. It is merely a cosmetic exercise and is not eliminating the inequalities and the areas of discrimination that will exist with the in troduction of these regulations. Indeed, I can see more and more anomalies arising as time goes by. There is a point in the Minister's speech which brings this home forcibly. Within a year the anomalies will become more apparent.

We are wasting the time of the House and involving the Exchequer in enormous costs because of the administrative obstacles that will be placed in the way of the implementation of this scheme if we decide on this cosmetic operation to tackle the health service. The Minister has been bold and courageous in many areas and I would have thought he would have taken his courage in his hands and have come forward with a proper comprehensive health scheme.

Such a scheme was mooted before. It was argued that the doctors were opposed to it but I do not believe they were. There was a shadow-boxing exercise in operation at that time but there were no proper, positive constructive proposals before them. I was close to the scene and was reporting on it regularly and I was convinced that a comprehensive hospitalisation scheme could have been introduced if the Department and the medical profession got down to determined discussions. Unfortunately that one opportunity was lost and that was a tragedy.

It has created serious problems for many sections in the community. I do not doubt the Minister's sincerity in trying to remove the anomalies but I am not too happy with the cosmetic exercise he has put forward in trying to paper over the cracks. It will create more anomalies and further problems. Next year we will be wasting the time of the Dáil in tabling parliamentary questions bringing to the Minister's attention the anomalies that have arisen and the serious hardships that have been caused to the people concerned.

There is no doubt that there is a demand for a full comprehensive hospitalisation scheme. We should not waste money in trying to operate the scheme at the moment. It will cost the State an enormous amount in trying to determine eligibility. There is the fiasco at the moment where the local government union say they will not co-operate in deciding who is eligible while the Medical Union say it is not their problem. This row is developing because the Minister is not taking his courage in his hands. He has said that 83 per cent will be covered. Why do we not go ahead and introduce a comprehensive scheme?

Will the Minister tell the House whether there is any suggestion that the EEC may be telling the Government that only private health insurance is the policy of the EEC? The more I study this matter the more I am inclined to believe that this may be dictated to us by the EEC. The Minister's suggestions may have been over-ruled by the EEC and I would like a statement from him to that effect.

From examining the health services of the EEC countries I have come to the conclusion that private health insurance is becoming the policy of these countries and I am wondering why, because it does not make sense. People in need of hospital care should not have to worry about the cost and the only way to avoid that worry is to make it free. This would not eliminate the opportunities for private hospital care, if some people opted for it. It would not lower the income of doctors or consultants because many people would opt for private hospital care. If they want to opt for it, they are entitled to do so but in my view we should make available a free hospitalisation service for all and this is not what the Minister is providing.

I do not agree with the Irish Congress of Trade Unions that we should increase the limit to £9,000. I am disappointed they have not come out strongly and courageously and said they will not accept less than free hospitalisation for all. They are tinkering with the system. Their sincerity is in doubt. I would like them to speak out boldly on this one issue. That is not what they are doing. To set a limit of £8,500 or £9,000, to me is nonsense and is not tackling the problem. It is creating a two-tier system which is wrong. I am surprised they are not making their voices heard more loudly on this issue.

The present limit of £5,500 is completely unrealistic. It will not solve the problem but will create problems for many people. We are talking about a limit of £5,500 gross which is completely different from the net income. People earning £5,500, £70 a week net, will be asked to pay consultants' fees—up to £50 for an operation for an appendix. Has the Minister set limits on these fees? No. No one knows what they are. It is very wrong that we should allow this to happen. These people will have to bear the burden of hospital fees and consultants' fees, be they medical, surgical or gynaecological.

It is a serious indictment of us as politicians that we allow it to happen, no matter what Government are in power. Strong forces should be making their voices heard when speaking against this matter. This limit of £5,500 is not realistic when one realises the amount of income tax being deducted. I asked the Minister to whose income would the children be attached for the purposes of benefit. He answered by asking if I did not want the rights of women established and had they not the right to pay? I replied yes, but what about the children? He said he would see they were fairly treated. What he is saying is that those children whose parents earn more than £5,500 will pay. He is saying that the treatment they get, because they are paying for it, will be to their advantage, that they will not be harshly treated. Is he implying that children whose parents earn less than £5,500 will not get the proper treatment?

Mr. Haughey

I cannot win with the Deputy.

Dr. O'Connell

The last time we debated this motion I asked seriously, why not give the children the advantage of the lower paid in a two income family? The Minister said they would not be harshly treated, that it would be to their advantage. The Minister is now changing his mind completely and has gone back on his word, which is on the record.

Mr. Haughey

I have not.

Dr. O'Connell

Yes, the Minister has.

I will put on the record how the Minister answered me on this issue. A very serious question has arisen here. The Minister said those children would not be treated harshly and that he would see it would be to their advantage. At column 1611, Volume 311 of the Official Report the Minister said:

I will be making regulations later, before 1 April, which will deal with eligibility. Those regulations will have to come before this House positively. They will not be the sort of regulations that go by default unless somebody moves to annul them. I will have to come here and propose these regulations. At that point Deputies O'Connell and Boland will have ample opportunity to go into the eligibility side of things. I said to Deputies O'Connell and Boland that as of now I am considering and examining what the situation of children will be in their interests. I want to make sure that whatever eligibility regulations we apply to children will be to the children's advantage. Will Deputy O'Connell accept that?

The Minister said he wants to make sure that whatever eligibility regulations we apply to children will be to their advantage. In a two income family, where one income is over £5,500, is he implying that because those children pay, it will be to their advantage? If so, he is saying that children of parents under £5,500 income limit, will be getting second-class treatment. This is a very serious danger. There is always the danger that any person in need of medical care who will not pay consultants' fees may be in danger of not getting the treatment he deserves.

Mr. Haughey

I reject that.

Dr. O'Connell

There is always that danger.

Mr. Haughey

That is a slur on our consultants.

Dr. O'Connell

It is not a slur.

Mr. Haughey

It is. The Deputy is suggesting——

An Leas-Cheann Comhairle

The Chair finds itself in difficulty here. One of the things we cannot do in this House is attack people outside the House who have no right of defending themselves. Consultants would be a very small and identifiable group.

Dr. O'Connell

I am not condemning consultants; the reverse is the case. What I am saying is that the Minister, by virtue of these regulations, is building into this system the temptation to treat the person who pays the consultant ahead of the person who does not.

Mr. Haughey

The Deputy is saying that a consultant will treat a person better if he is paid. That is a slur on the medical profession.

Dr. O'Connell

May I continue?

An Leas-Cheann Comhairle

Deputy O'Connell, we need to be careful how this is phrased.

Dr. O'Connell

It will be a very serious distortion of what I am saying if it is suggested that I am condemning consultants, because I am not. I am saying the Minister is building into this scheme a situation whereby of two people, one would be eligible for free consulting care and the other would have to pay for it——

Mr. Haughey

That is the way at present.

Dr. O'Connell

It is not the way at the moment with regard to manual workers, they are entitled to it no matter how much they earn. I said in this House before that there is a danger that if a man with an income under £5,500 applies for a bed, he will get the bed and the consultants' services free but the man earning over £5,500 will have to pay the consultant out of his own pocket. Human nature being what it is, we should not put a consultant in such a dilemma where he might be tempted to give preference to a person who will pay him directly into his pocket. The Minister is building this into his scheme and it is a very dangerous situation. In every profession—architecture, accountancy, engineering and so on—there are people who might be inclined to consider monetary reward above all else. It is not inconceivable that a person might give preference to somebody who is paying him directly, and the Minister has no right to build that into his scheme.

The Minister said that it would be to the advantage of children. The Minister is going back on the promise he made me: "I want to make sure that whatever eligibility regulations we apply to children will be to the children's advantage. Will Deputy O'Connell accept that?" Is what the Minister is now proposing to the children's advantage? It is not; it is very much against them. The Minister asked me if I was trying to deprive women of the right to pay in their own right and I said I was not. It was I who posed this problem which neither the Minister nor his Department had considered. That is just one anomaly and neither the Minister nor his Department even thought of it.

Mr. Haughey

Rubbish.

Dr. O'Connell

If the Minister had thought of it, would he not have brought it to the attention of the House? The Minister suddenly realised——

Mr. Haughey

That is wrong.

Dr. O'Connell

The Minister should explain the position of children. The Minister said he would think about it and hoped to come up with an answer that would be to the advantage of children.

Mr. Haughey

The Deputy keeps asking me questions but he will not let me answer them.

An Leas-Cheann Comhairle

The Deputy should not ask questions and the Minister should not answer them during the debate. The Minister will be replying The Deputy may pose questions but may not ask them across the floor of the House.

Dr. O'Connell

The Minister has gone back on his word if his statement is true.

The Minister is involved one way or the other and I am asking him to clarify the situation in his reply.

Mr. Haughey

Have it your own way.

Dr. O'Connell

It is a serious problem. In a situation where a husband and wife are both earning and the wife is earning under £5,500 per annum and the husband is over that figure, the children will be unfairly treated. They are discriminated against and that is wrong. Something positive must be done about this. I would admire the Minister more if, in his reply, he said he was wrong in this, that he gave an assurance to the House and he was now going to honour it. What the Minister is doing at the moment is not to the children's advantage.

There is also the question of the ambiguous statement that it will apply to the 15 per cent who are outside the eligibility limit. The figure of 15 per cent has been bandied about for a long time. I have tried on numerous occasions to get some indication from the Department how they arrived at this figure in respect of people who are not entitled to any hospitalisation services under the Health Acts. I have not been able to get any information about this. In one part of the Minister's speech he said it was 15 per cent and in another he said it was 17 per cent. Eighty-three per cent of the population will benefit. There is an anomaly here. If we could find out exactly what proportion of the population is involved we might be in a better position to see whether it is worth putting in all these regulations to extend the scheme. It may be that only 10 per cent or 12 per cent are covered. I have tried to get the figure from the Department of Health and the health boards, but nobody knows it. The Minister should clarify what proportion of the population is presently entitled to hospitalisation services.

The Minister may think he is appeasing a certain group, but consultants would be more than happy to discuss with the Minister the terms for a full free hospitalisation scheme. They would give it their blessing and fully co-operate in such a scheme. It is wrong to suggest that they are opposed to it. When the proposal was first mooted all they asked was that consultation should take place with them. That is normal trade union practice: if one wants them to operate something, one has consultation with them. The Minister should think again and stop doing a cosmetic job on the health eligibility scheme. He should say "I have tinkered around with this for long enough. The administrative costs are enormous and it is not serving the purpose we all want it to".

Deputy Boland has stated that his party are in favour of a full free hospitalisation scheme. The word "free" is a misnomer because it must be paid for. The means of paying for it could be open to discussion. We, in my party, are united in wanting a comprehensive hospitalisation scheme. With this side of the House united on the issue and the Minister knowing he could win the acceptance of members of his party to the scheme, is there any reason why we cannot extend the insurance or have it by means of direct taxation or a combination of both? The Department of Health and the health boards would be rid of all the headaches associated with determining eligibility.

A British executive with a salary of £2,000 or £3,000 a week can come over here and enjoy full free hospitalisation under EEC regulations. Yet a person with a salary of £5,500 a year gross, or £70 after payment of taxation and other expenses, has to pay consultants' fees. That is a grossly unfair situation. There is something radically wrong with a system that allows this to happen. I do not begrudge the British the service, but why are we not entitled to the same benefits?

The Minister in his speech said:

There is also the very important fact that the Voluntary Health Insurance Board is revising its scheme of insurance to provide that insurance cover for medical fees will be available to everybody. For a modest premium any person who wishes to do so will be able to fully insure himself against the risk of any medical expenses... The board will also provide that current restrictions, related, for example, to age or to existing medical conditions, will be waived for a time to enable everybody to avail of this insurance cover.

The Minister said that the conditions will be waived, but he added "for a time". That is the crunch—there is a trick there. In six months a young man might get a stroke or a heart attack and he might find he will not be covered by VHI.

Mr. Haughey

That is incorrect. The Deputy should not be making these malicious, fallacious statements.

Dr. O'Connell

I am reading what the Minister said.

Mr. Haughey

Once a person is in the scheme he is in it. The Deputy knows that.

Dr. O'Connell

I do not wish to make accusations against the Minister—I have great respect for him.

Mr. Haughey

The Deputy has already said it is a trick.

Dr. O'Connell

The Minister should allow me to continue. I have great respect for him, but he may be missing the point. If the Minister can prove that what I am saying is wrong I will be glad to apologise to him. What I am saying is that the trick lies with the VHI, not with the Minister. The Minister said:

The board will also provide that current restrictions, related, for example, to age or to existing medical conditions, will be waived for a time to enable everybody to avail of this insurance cover.

I would have been satisfied if the Minister had put a full stop after "waived", omitting "for a time". Perhaps I should sit back and let the Minister deal with this point.

Mr. Haughey

Once the existing medical conditions have been removed anybody who comes into the scheme in the period ahead will not have these conditions applied to him again.

Dr. O'Connell

Then the wording in the Minister's statement is wrong. I suggest what "for a time" should be removed.

Mr. Haughey

It will be waived permanently in the case of any individual who joins the scheme in a certain period of time. I do not know how long the period will be. The object is to get as many people as possible into the VHI and to waive these conditions for entry. Once a person is in, these conditions will never be reimposed in respect of him.

An Leas-Cheann Comhairle

We cannot proceed by way of question and answer.

Dr. O'Connell

I am only seeking clarification—I want to be able to quote the Minister later if I am approached. If a person is suffering from chronic illness and if he applies for VHI cover, can the board say to him: "We will cover you for everything but the condition you are suffering from"? Can the Minister give me an assurance that that will not happen?

Mr. Haughey

I can give the Deputy that assurance.

Dr. O'Connell

Can a person suffering from chronic illness be assured that his application for entry will be accepted?

Mr. Haughey

If he applies within the initial period which is now about to be established.

Dr. O'Connell

Now we are achieving something. Could the Minister say something about the time limit? This is important from the point of view of the entire public. Would the Minister say two years?

Mr. Haughey

We have not settled on how long these conditions will be waived. It may be a year.

Dr. O'Connell

Make it two years. This is important for the entire public. There are many people who may have chronic illnesses and who would want to be insured. Will people who are now 66 years of age, or perhaps 70, or perhaps 75, be covered? What is the age limit?

Mr. Haughey

The age limit for this preliminary period will be waived.

Dr. O'Connell

My fear is that we would be building in another dreadful anomaly to replace the one we are trying to eliminate. Two years is a very short time.

An Leas-Cheann Comhairle

The motion has nothing to do with the VHI scheme.

Dr. O'Connell

The Minister very courageously came in to help to eliminate some of the anomalies. I would be afraid that in two years we will have serious anomalies again and we will be wasting the time of the House trying to deal with them.

I would point out that from April about 20,000 manual workers will lose their rights under the social welfare scheme. I do not think we have the right so to deprive them. The VHI scheme will not be the answer. The problem is getting worse and worse. The Minister would have the admiration of the public and the support of the House if he took his courage in his hands and introduced a full comprehensive hospitalisation scheme. That would ease the anxiety of thousands of people. The Minister is not easing their anxiety by this, he is merely creating more problems and a dangerous situation.

Many old age pensioners who have a supplementary pension are being harassed by the Revenue Commissioners for health contributions at the moment. There are hundreds of people in my constituency in this situation, and I have written to the Revenue Commissioners on numerous occasions to have it established that they need not pay the health contribution. However, in a few days time because of this legislation, they will have to pay the health contribution and this will lower their standard of living again. This is grossly unfair. The Minister recognises the plight of these people; he showed his recognition yesterday by making a plea on the radio on their behalf. The Minister stressed that we as a community must ensure that these people do not suffer unnecessarily and that we must do everything we can for them. I admire the Minister for doing his best to ensure that these people get their pension entitlements. Can an income limit be written into these regulations? Can we eliminate these people from the net?

Mr. Haughey

Contributions are not involved in these regulations at all.

Dr. O'Connell

They are involved.

Mr. Haughey

That legislation has already been passed.

Dr. O'Connell

That does not stop me from appealing on behalf of these people. If the Minister could in some way arrange to eliminate these people from having to pay health contributions, he would win the admiration of my party. It would be appreciated very much if the Minister could instruct the health boards to consider cases in a certain income bracket for instance. Will the Minister consider that?

I do not consider the rateable valuation of a farm as an accurate means of assessing the means of a household. The rateable valuation is not comparable to the £5,500 earnings of the average industrial worker. There is a great disparity between the two. Will the Minister when replying tell me how he decides that a rateable valuation is equivalent to the £5,500 income of the average worker? The Minister's answer might enlighten me, as I am puzzled as to how one can be related to the other.

Will the Minister give me some indication as to what it would cost the State to provide the drugs subsidy scheme under these regulations? Has the Department worked out the cost? I wish to know how it will operate so as to be in a better position to assess the value of the scheme in terms of what it will cost the State and so on. When the Minister talks about providing beds under this scheme he talks about it costing so much per day or per week in a teaching hospital or a local health board hospital. When we put down questions in relation to the cost of a public bed in a teaching hospital we get an inaccurate figure in reply. The cost of the bed is given at an inflated value.

An Leas-Cheann Comhairle

The Deputy appears to be widening the scope of the debate and we are getting into contributions and costs of various items that do not arise in these regulations.

Dr. O'Connell

The Chair is missing the point. I am talking about what a person is getting under this scheme, which is, a free hospital bed. That is clearly what is outlined here, so I am within my rights in talking about it.

An Leas-Cheann Comhairle

The Deputy would not be within his rights in discussing the costs involved in hospital beds. It does not arise here. It arose on previous Bills and legislation.

Dr. O'Connell

It arises in relation to the free hospitalisation and treatment for those earning under £5,500 per year and free beds for those over £5,500 per year. About 20,000 manual workers are being deprived of their rights under this. They will be told that in return they will get the benefit of the drugs subsidy scheme. I would like to know what this scheme will cost the State and what the State will have to pay out for hospital beds for those who are presently not entitled to them. In computing that cost we will have to know the cost per hospital bed in a teaching hospital. In reply to Parliamentary Questions we have been given a grossly inflated figure which does not relate solely to the cost of a hospital bed, but includes the cost of out-patient services in a hospital. In working out the percentage of the population that will avail of hospital beds during a year I must work out the cost, and to do that I must know these figures. I am not deviating from the subject of these regulations in discussing this; I am relating my contribution very closely to what the Minister said.

The Minister says that the VHI provides an excellent service but it falls far short of what it should provide. It does not provide adequately for the public. It is wrong to think that when we opt for the VHI we are getting a perfect service. The VHI is a very costly system. It is not fair to ask a person with a low salary of about £70 per week to pay out a big slice of his income to cover himself and his family under VHI. It is incumbent on us to ensure that these people do not have to bear the burden of paying for hospitalisation. To ask them to pay for it is grossly wrong. There are 20,000 people who enjoyed this benefit up to now and who are now being deprived of it. I am firmly convinced they have a case in law against the Minister and against the Department of Health. I will be very anxious to see a test case being taken to establish their rights. Have the Minister's Department considered the legal implications of what they are doing? Is he satisfied members of the public have no case in law against him? It is important to mention that.

The Minister said these arrangments provide the right mix of public and private health care systems. These regulations, placing as they do a serious burden on this section of the community, are not a proper mix. They are an unbalanced mix. They will not solve our problems. They are merely covering over the cracks. They are creating problems for us in a year's, two years' or three years' time. I would have great admiration for the Minister if he said in his reply this is the first step on the road to free hospitilisation and he hopes to come back to the Dáil in a year or two years and extend it to the entire population. We and the community would then have something to look forward to. The Congress of Trade Unions would say it had their blessing if they knew it would not continue at this level but would embrace the entire population in, say, two years? None of us would then be critical of the Minister.

Minister for Health (Mr. Haughey)

Perhaps it is my own fault, but the Deputies who have spoken seem to be under a misapprehension as to exactly what is involved in these regulations. In order to be helpful to the House I described what the combined effect of this regulation and other regulations which have been made or will be made will be. In fact, all that is involved in this regulation is the extension of hospital services to the entire population.

Deputy Boland indicated that he will vote against this regulation. He would be very foolish to do that. I am probably not acting very cleverly politically in pointing this out to him but, if he leads the Fine Gael Party into the division lobbies against a regulation which does no more than extend free hospitilisation to the entire population, he will not be doing his party a very good service. It will not redound to his party's credit in the futu.

Mr. Boland

I should like to thank the Minister for that gratuitous advice.

Mr. Haughey

I am just putting it straight to the Deputy. This regulation simply extends eligibility for hospital services to the entire population. No matter what Opposition Deputies may say, no matter what carping criticism they may devise, no matter what anomalies they may attempt to see, that is a major step forward in our health services. All those people who up to now have looked with fear and trepidation at the bill they are likely to get for a stay in hospital will have that fear and trepidation removed from them. I do not think all those people will thank either Deputy Boland or Deputy O'Connell if they oppose this regulation, whatever else they may do about the health services.

Up to now, in all the health services the greatest single burden that could be placed on any individual was the cost of a stay in hospital. Deputies understand and admit that openly. There are other costs in the health services which people are worried about and against which they endeavour to protect themselves but, above all others, the one fear people had was the cost of a hospital bill arising out of a serious illness. Deputies who have spoken have chosen deliberately to ignore that a major step forward is being taken here by the passing of this regulation. As I say, they would be very foolish politically, and in every other way, if they opposed the passing of this regulation through the Dáil.

A number of questions were raised by Deputy O'Connell. The first I should like to deal with is the question of farmers. The question of the £60 valuation being equivalent to the cut-off point for limit or eligibility goes back over many years. In my recollection the original limit of £50 set in the 1954 legislation was increased to £60 poor law valuation around 1965 or 1966. That is the traditional figure of eligibility for limited eligibility services. Up to now it was equated with £3,000. That would give you a multiplier of £50. If you equate £3,000 at £60 valuation, that automatically gives you a multiplier of £50.

Following through in the existing traditional practice, we are equating the £60 poor law valuation with the £5,500 limit, which gives you a multiplier of £93 per £1 valuation. It is the intention that the £60 valuation would be equated each year to the increased limit for eligibility of Category II. All we are doing there really is following on with the existing traditional relationship.

Deputy O'Connell also raised the question of pensioners. It is my intention to look sympathetically at the position of pensioners, particularly those on low pensions. Deputy Boland and Deputy O'Connell both made play about the question of children and their eligibility. What I am proposing is very fair and in the interests of children. If there is a two-income family, say a husband and wife with incomes, it could be argued that you should take the combined effect of those incomes to decide the children's eligibility. Almost invariably the combined incomes would be over £5,500 and, therefore, the children would not be eligible.

What I am saying in effect is that even though there are two incomes, as long as they are both under £5,500, the children qualify for Category II eligibility. If there are two incomes and one of them is over £5,500 the children go into Category III. That is a perfectly fair line of demarcation. We are including it in the arrangements now and, as the scheme develops, it can be looked at at any stage. To get the scheme under way, it is a reasonable line to draw at this stage.

Deputy O'Connell was worried about the percentage of the population to which I have been referring more or less continually in all the discussions which have being going on over the past six months or so. These are the best estimates we can make. Most statisticians would agree with them. They are pretty accurate. Somewhere around 83 per cent to 85 per cent of the population will now be covered between Categories I and II. I do not think there is any argument about that figure. Most statisticians and those who study those matters will agree that is the right percentage.

I want again to recommend this regulation to the House. It is the last step in a long process, which has being going on for over 12 months, in trying to bring about a major comprehensive improvement in our health services. When the whole scheme comes into operation on 6 April we will have moved very far forward if not all the way in ensuring that nobody in our population need be denied any medical attention which he or she needs because of inability to pay for it. Taking the whole lot together—the general medical services, the hospital eligibility provisions and the voluntary health insurance schemes—we will have provided a very comprehensive system of health care for our entire population.

I was trying to be helpful to Deputy O'Connell in answering questions about the voluntary health insurance schemes. I want to emphasise that it is not my function to lay down the conditions of the different health schemes. The Voluntary Health Insurance Board are independent in the exercise of their functions and I think everybody in the House agrees that they have discharged those functions very efficiently and very well; they have provided a wonderful service, an increasingly improving service for our people since they came into operation. What conditions they choose to lay down and the type of schemes they decide to devise are entirely matters for them.

They have been at great pains—and I want to pay tribute to them—to dovetail their new series of schemes in with these new regulations which we are providing. It is because of that they have made a number of special provisions. One of those is the provision in regard to exempted illnesses and the age limit. There are others of that sort.

In order to get as many people as possible into the voluntary health insurance scheme, the board propose in addition to the very attractive schemes which they now have, to waive for a limited period a number of limitations which have applied up to now. In a sense it is a recruitment drive with these special incentives. What the Voluntary Health Insurance Board are offering is a very desirable and important thing. My understanding of the position is that anybody who joins now in this limited period when these limitations have been waived can remain a member for evermore with those limitations gone so far as he or she is concerned. Most of the limitations apply to entry and if they are waived for entry that is the end of the matter; one is then a member of the Voluntary Health Insurance Board and stays in it for the future. These are matters which I am answering in an endeavour to be helpful to Deputy O'Connell but they are not, strictly speaking, matters in which I have a say—they are really matters for the board. As I understand it, that is what they propose.

Again I would like to urge everybody in the community, and particularly anybody who is in the role of head of the household—although I know that phrase was under attack here today—and who has, as husband or wife, responsibility for a family to direct his or her attention now to what the Voluntary Health Insurance Board are offering, what the schemes are and what the benefits are and to consider seriously joining up in this period which is being set aside for recruitment on very favourable conditions.

Once again I want to say that this regulation is simply designed to extend free hospitalisation to the entire community. As Deputies know, at present anybody who has over £3,000 per year—the vast bulk of the population except for a limited number of manual workers—has to pay the full cost of his hospital bills, the cost of the stay in hospital which is the big element, and consultants' fees. In the first instance we are making large inroads into that by raising that £3,000 to £5,500. The vast majority of the community can in future be assured that if they have serious illness their entire hospital costs, including the consultants' fees will be free. Even that section of the population which is earning over £5,500 will have free hospitalisation. The main bill, which is the cost of the stay in hospital, will be now covered and it is that bill which has been crippling most people up to now.

In addition, those earning over £5,500 will now come under the drugs refund scheme. These are major improvements and they are given effectiveness by this regulation here before us. If Fine Gael want to vote against that they are welcome to do it but they would be very foolish to do so.

Mr. Boland

The Minister may give advice to the Taoiseach. He need not give us advice at all.

Mr. Haughey

I feel compelled to say that it ill becomes any member of the Coalition parties to attack and criticise what I am doing here now because during their whole period in office they were——

Mr. B. Desmond

The Minister is taking limited eligibility away from people.

Mr. Haughey

——stultified; they stagnated; they did nothing; they kept the old situation there as it was and they failed to bring in any improvement whatsoever. Now when I am bringing in major improvements in the situation they have the nerve——

Mr. Boland

The Minister should advise the Taoiseach about the levy. We will take our own counsel.

Mr. Haughey

——the political gall to get up here and criticise me and tell me that I am not going far enough, that I am creating anomalies and so on. The general public just do not believe that and I know from conversations I have had with the Irish Congress of Trade Unions and others that they would all like me to go a bit further but they all say that this is a major improvement and they welcome it. If the Opposition parties decide today to vote against it, the best of luck of them.

Mr. B. Desmond

Has the Minister any change of heart at all in relation to the position of voluntary contributors and their limited eligibility, as this appears to be a major crux? At present it could in fact nullify a good deal of the operation of the scheme. Is there any prospect of a change of heart in that regard?

Mr. Haughey

The Deputy did not take any part in the debate.

Mr. B. Desmond

The Minister knows perfectly well that long time contributors such as myself are losing eligibility. I do not, on the basis of personal self-interest, wish to raise the point but I will vote against this regulation.

Mr. Boland

In relation to voluntary health insurance, I understood the position in relation to the waiving of restrictions to be as the Minister outlined in his speech on introduction. Yet I am concerned to see the new rules published by the VHI which say on the front that they are applicable to registration date or first renewal date or on after 1 April 1979. Those restrictions are set out and they say no benefit is payable for illness or injury arising before the date of registration. This begs the question as to whether someone who is allowed to enter with a restriction waived will find after the date of first renewal that he is no longer covered for that illness. The VHI have not made that clear in their rules.

Mr. Haughey

As I understand it, this is not the intention. The intention is that the limitations are on entry and once they are waived on entry a person is in and the limitations will not be resurrected.

Mr. Boland

I understood also that that was the case but it is not clear from the rules. Is the Minister not prepared to deal with the question of voluntary contributors?

An Ceann Comairle

The Minister has concluded.

Question put.

The Dáil divided: Tá, 58; Níl, 42.

Tá

• Ahern, Bertie.
• Andrews, David.
• Andrews, Niall.
• Aylward, Liam.
• Barrett, Sylvester.
• Brady, Gerard.
• Brady, Vincent.
• Briscoe, Ben.
• Browne, Seán.
• Callanan, John.
• Calleary, Seán.
• Cogan, Barry.
• Colley, George.
• Collins, Gerard.
• Conaghan, Hugh.
• Connolly, Gerard.
• Cowen, Bernard.
• Daly, Brendan.
• de Valera, Síle.
• de Valera, Vivion.
• Doherty, Seán.
• Faulkner, Pádraig.
• Filgate, Eddie.
• Fitzgerald, Gene.
• Fitzpatrick, Tom. (Dublin South-Central).
• Fitzsimons, James N.
• Flynn, Pádraig.
• Fox, Christopher J.
• Gallegher, Dennis.
• Haughey, Charles J.
• Herbert, Michael.
• Hussey, Thomas.
• Kenneally, William.
• Killeen, Tim.
• Lalor, Patrick J.
• Lawlor, Liam.
• Lemass, Eileen.
• Lenihan, Brian.
• Leonard, Jimmy.
• Leonard, Tom.
• Leyden, Terry.
• Lynch, Jack.
• McCreevy, Charlie.
• McEllistrim, Thomas.
• MacSharry, Ray.
• Molloy, Robert.
• Moore, Seán.
• Morley, P. J.
• Murphy, Ciarán P.
• O'Donoghue, Martin.
• O'Hanlon, Rory.
• O'Kennedy, Michael.
• Tunney, Jim.
• Walsh, Joe.
• Walsh, Seán.
• Wilson, John P.
• Wilson, John P.
• Woods, Michael J.
• Wyse, Pearse.

Tellers: Tá, Deputies Briscoe and P. Lalor; Níl, Deputies Creed and B. Desmond.

Question declared carried.

Barry, Peter.Begley, Michael.Belton, Luke.Bermingham, Joseph.Boland, John.Bruton, John.Burke, Joan.Cluskey, Frank.Collins, Edward.Conlan, John F.Cosgrave, Liam.Cosgrave, Michael J.Creed, Donal.Crotty, Kieran.Desmond, Barry.Donnellan, John F.Enright, Thomas W.FitzGerald, Garret.Fitzpatrick, Tom (Cavan-Monaghan).Hegarty, Paddy.Horgan, John.

Kavanagh, Liam.Keating, Michael.Kelly, John.Kenny, Enda.Kerrigan, Pat.Lipper, Mick.Mannion, John M.Mitchell, Jim.O'Brien, Fergus.O'Brien, William.O'Connell, John.O'Donnell, Tom.O'Keeffe, Jim.O'Leary, Michael.O'Toole, Paddy.Quinn, Ruairí.Taylor, Frank.Timmins, Godfrey.Treacy, Seán.Tully, James.White, James.