I move amendment No. 1:
In page 3, between lines 11 and 12, to insert the following:
2.–It shall be a function of the Health Insurance Authority to consider and report to the Houses of the Oireachtas on the extension of health insurance to the whole population with the objective of creating equality of care.".
I tabled this amendment on Committee Stage and was disappointed that the Minister for Health and Children did not accept it. If anything, that strengthens my resolve to put the case again – maybe in more detail this time – to ensure the points I am making in relation to this Bill are taken on board. It is an important Bill which can do more than what it sets out to do if this amendment is accepted.
In terms of inequality in our health service, the Government has not stated how it deals or intends to deal with what is a gravely iniquitous two tier system at hospital level which militates against public patients who are forced on to hospital waiting lists, while private patients can fast track care. It is a system that depends on hospital waiting lists for the two tier nature of it to continue. There is a built-in incentive for hospital waiting lists rather than a built-in incentive to get rid of them. Equally, at primary care level, there is a grave inequality as well in terms of the vast bulk of the population having to pay for their visit to the GP even though across Europe this would not be considered acceptable or desirable.
What we have is a dysfunctional system of health care which has a range of problems, including lack of investment over the years, difficulties in relation to fragmentation of services, geographic inequality, issues relating to management and incentives for good practice. This aspect of equity has not been addressed by this Government. There has not been a declaration as to how this Government will ensure that patients, when they are sick, will be treated as sick people rather than as poor people on the one hand and better off people on the other. It is the central issue in terms of health care reform. Will the Minister accept that in setting up this insurance regulatory authority, there is a resource, a body being established, with a great deal of expertise in the area of health insurance? There is a resource there. A body is being established that will have a good deal of expertise in the area of health insurance. Apart from it being a regulatory authority, part of its task should be to assess the benefits that may accrue from providing a universal insurance scheme. Such an input should not in any way override the policy role of the Minister or Government, although we have not seen much of that policy making in this regard. The body should be a resource to feed in information and direction in terms of knowing how to consider that possibility in an informed way.
I remind the Minister it is not that we are asking that this matter be considered as somehow out of sync with other countries or that this is a bizarre idea the Labour Party has taken on for reasons best known to itself. In examining the issue of health insurance, we considered the position in other EU countries. While there was not a model that could be adopted wholesale to the Irish situation, it was clear health insurance in various forms is not the exception but the rule. It is the norm.
There is a health insurance system in Austria, compulsory health insurance in Belgium, health insurance is compulsory in France, there are numerous insurance funds in Germany, compulsory health insurance in Greece, a national health service based on compulsory health insurance in Italy, compulsory health insurance in Luxembourg, a complex arrangement that includes health insurance in the Netherlands, a national health service based on compulsory health insurance in Portugal and a mix of taxation and compulsory health insurance in Spain.
We have a duty to assess the current circumstances. We have a health care system that is essentially an apartheid one which is gravely iniquitous. It has not appeared overnight and it has deepened in its inequality in recent times. Another aspect of the health system is that almost 50% of the population are taking out private health insurance. Those are the circumstances here.
Many of us might say that if one was setting up a health system, one would not start from here, but we are here. We need to move on to ensure equality is a central element that will be addressed while changes, reforms and the greater investment in our health services occur. That is not what has happened. The budget for Health, which the Minister often trumpets and of which he is proud, has doubled but the returns to the people have not. That increase in the budget has not been seen by the patient on a trolley in an A&E unit, the woman waiting for a hip replacement or by other people living in pain and suffering on a daily basis without any idea when they are likely to get an operation.
I know of a paraplegic who lives at home and cannot begin his rehabilitation because he is on a waiting list for an operation. That man is in grave pain and his family circumstances are extremely difficult in terms of providing him with care and support, but he is stuck. We all know that if he had enough money to pay for private health insurance his problem would have melted and there would be no problem in his progressing as far as he could into good health.
The Minister said on Committee Stage that it is not up to an insurance regulatory authority to consider these matters, but he can see the size of the elephant. He is too close to the problem and to the crisis management that is inevitable in the Department of Health and Children. It is an indication that the Government on entering office had not prepared to resolve key issues in the health service and that money is seen as the solution to all the problems.
The Minister will come back on that and talk about the health strategy. I am pre-empting him by saying the implementation of that strategy will be timed very closely to the next general election. Anybody who reflects on how the Minister is managing and driving policy would question how after four years in Government with unprecedented resources and wealth the Government is only now deciding to develop a policy at the end of its period of office. Due to that absence of policy there was the recent spat between the Minister for Health and Children and the Minister for Finance. The Minister for Health and Children is saying we need more money and he is right, but he is also wrong because he has not dealt with how to ensure that money will be well spent. The Minister for Finance is saying he will not give him money until he can give him value for money. The Minister for Finance is right, but he is also wrong because health reform requires money, but it also requires that we ensure such money is spent in a way that delivers equality, excellence and value for money. The three are interlinked.
I would be interested if the Government could tell me why a health insurance system such as we are suggesting will not work. I have no hang ups about it. If there is a better way I would happy to accept it, but I do not see one. I have examined and judged the current circumstances and needs and come up with the best proposal I can. I accept nobody has a monopoly on wisdom. I do not have the resources of the Department of Health and Children. All I have is a secretary and goodwill from various people who want health reform. It is extraordinary we have not had a comprehensive view from the Minister and the Department about why this suggestion cannot at least be examined by the Health Insurance Authority which has actuaries, accountants and other experts in health insurance, otherwise they would not be members of that authority. It is their purpose to carry out a task given to them by the Government to deal with the pressing issues of health reform. Tinkering around it will not solve the problem. I hope that is one lesson that has been learned by everybody.
If the Minister for Health and Children has failed to convince the Minister for Finance about how he wants to spend the money, and that is what happened at Ballymascanlon, it is difficult to see how he can convince anybody else in the community who has experience of the downside of the health service, who has waited in a chair in an A&E unit or on a trolley like the 94 year old man whose case was reported recently in a newspaper article. We need direction on this. We need a comprehensive policy that is also targeted.
It will be extremely difficult to deliver equality. We all understand that, but the first step is to make clear that the Government is committed to ensuring equality is delivered, not that more private beds are taken out of the public system or private patients are charged the full whack. That would not solve the problems. As Miriam Wiley from the ESRI said, there is a perception that equity is an even bigger problem in the current health system compared to the mid-1990s. Equity is not an easy issue to address and it is perceived at many different levels in terms of the geographical issue, the access issue, the financial issue and so on. I do not think anyone could deny it remains one of the most critical problems to be addressed.
The Government has not made its views on the issue clear even though it says it wants to address it. After four years in Government, the Minister asked very interesting questions at the launch of the health strategy. I find it remarkable that questions are being asked when the problem is so real, pressing and critical that at times people's lives depend on resolving it. Some people would be alive today if they had the money to access the health care they needed. This is why I am tabling the amendment and I ask the Minister to give it consideration. He can give many reasons why this should not be done, such as that the authority has a narrow remit or it will do this, that or the other, but he cannot tell me that if he includes this aspect in the Bill it will not happen because it is easy to set the task for the authority. This is an important aspect which must be put in place if we are to ensure we are making progress on the issue of equal access to health care.
I urge the Minister to take on board what I am saying and not lose the opportunity because of some narrow political desire to make a point or simply because he wants to hold on to this health strategy to sell Fianna Fáil at the next election.