Amendment No. 1 is in the names of Deputies McManus and Ó Caoláin.
Health Insurance (Amendment) Bill 2003 [ Seanad ] : Report and Final Stages.
An Leas-Cheann Comhairle
I move amendment No. 1:
In page 6, to delete lines 42 to 47 and in page 7, to delete lines 1 to 5.
I tabled this amendment due to a change that is being proposed by the Minister in this Bill. The original proposal, when setting up the Health Insurance Authority, was that the costs of establishing the authority would be recouped over time by way of levies on the insurers. The running costs of the authority are to be met by levies and it would seem logical that any establishment costs would also be paid for in the same way. When this was being proposed, in the 2001 Act, there appeared to be a limitless supply of money. Now we are living in much more straitened times and yet the Minister is seeking to introduce a change whereby the public, rather than the insurers, will cover the costs of the authority.
I am sorry that the Minister for Finance has left the Chamber because he would have been interested in what I had to say. We are talking about approximately €500,000. When I raised this on Committee Stage, I was astonished, and would still argue vehemently against a decision made then by the Bills Office, to learn that my amendment would incur a cost on the people. I was trying to ensure the insurers carried the cost rather than the people of Ireland who the Minister appears set to ensure will bear the cost.
I have tabled a more simple amendment on Report Stage, as I indicated I would, which does not create any difficulties in terms of a charge on the people. It is simply to delete an amendment which is being put forward by the Minister.
The Minister argued on Committee Stage that this change is only an option for him, that he can choose to levy the insurers to repay the costs or simply pay the costs from Exchequer funds. According to the terminology used in section 7, the money for the establishment costs of approxi mately €500,000 "shall not require to be repaid" by the insurers by way of levy. In legislation, we know that "shall" means shall. I have been a Member of this House for over ten years and I have some experience of what "may" and "shall" mean. It is clear to me, from reading this Bill, that in this instance "shall" means that the money put in by the Department does not have to be repaid by the insurers.
Obviously the Minister has succumbed to lobbying from the authority. Be that as it may, the original intent at a time when money was less scarce was that the authority would be established and the money would be recouped from the insurers. In this instance, we are talking about a small amount of money, although to many people €500,000 would not be a small sum. At a time when disabled children are unable to get hot meals; when A&E departments such as that in Tralee General Hospital are closing down due to cutbacks; when cancer patients are unable to access necessary care; when children must wait an inordinate length of time to access psychological and speech therapy services; and when there is suffering as a result of cutbacks which have come about as a result of a Government policy to win the last election no matter what and then institute severe cutbacks where people are most vulnerable, whether in education, health, social welfare or elsewhere, it is inconceivable that when legislation has already been passed setting up a system of repayment, the Minister is now withdrawing from that arrangement and simply saying that the people, rather than the insurers, should carry the cost. I would ask the Minister at this late stage to accept this amendment to delete this change which he has introduced.
We discussed this on Committee Stage. I again point out that we are talking about approximately €508,000 which was advanced by the Department to the Health Insurance Authority for its establishment. Of course the authority is now funded in respect of its operational costs by a levy on the premium income of those registered health insurers. In passing, I would say that any costs which are passed on to the insurers are ultimately passed on to the consumers of health insurance and those who are insured. The measure is an enabling provision. It allows the Minister to have the option of seeking the repayment of all or part of the advance originally given to the authority.
As I pointed out on Committee Stage, the White Paper on Private Health Insurance provided that the authority's establishment costs would be funded by the Exchequer. The rationale behind that at the time was that this was an important public service which needed to be carried out arising from a Government regulation in the common good regarding voluntary health insurance.
On the one hand, the authority feels strongly about it. I take on board what the Deputy has said and the concerns she articulated. Our advice is strongly of the view that this is only an enabling provision and that the word "shall" appears towards the end of the section, and that that subsection is wholly dependent on a determination in the first instance by the Minister for Health and Children, with the consent of the Minister for Finance, of an amount to be waived, if any. The option to claw back the €500,000, or part of it, over the coming years still remains.
It is a matter which we will keep under review and which the legislation allows us to keep under review. If the authority builds up sufficient reserves into the future, then this may not be as big an issue for the authority or, indeed, for anyone. I would bear in mind the comments that have been made by Deputies on the overall issue of whether we should claw back some of the money that was advanced for the establishment costs.
I am deputising for Deputy Ó Caoláin, who is my party's health spokesperson. His absence is not meant as an insult. He is on other important business at Hillsborough this morning.
This amendment has been put forward by my colleague, Deputy Ó Caoláin, because Sinn Féin does not believe that the cost of establishing the Health Insurance Authority should be borne by the State. Although the authority is a public body, it is regulating a profitable private sector which should be required, as originally envisaged, to pay for the cost of establishing this authority. As the ongoing operational costs of the authority are funded by proceeds from a levy on the premium income of registered insurers, there is no justification for the State having to bear the establishment costs, particularly at a time of widespread cutbacks and the under-funding of the health service. In that regard, I support the Minister in his alleged disagreement with the Minister for Finance. I know that support would have considerably more value if I was on the other side of the House, but the Minister should know that we do not disagree on everything.
Sinn Féin does not support the private health insurance model as a means of financing the health service and cannot support any measures that subsidise private health care companies. We are strongly opposed to the Government's pursuit of policies that will lead to the privatisation of the health service. We are opposed to the range of State incentives and supports that have made private health insurance an attractive option for those who can afford it. Private health insurance is not a solution and should not be seen as a solution to the crisis in the health service, nor should the Government seek to abdicate its responsibilities in the provision of health care for its citizens by encouraging more people to take up private health insurance. I refer to the NESF report on equality of access to hospital care, which states: "A critically important role for the State is to act as guarantor in the availability of a satisfactory level of health care to all its citizens, irrespective of means."
Health care must not become a mere market commodity. A vigorous and competitive private health care market does not mean that all citizens will be able to avail of health insurance. For example, in the USA there is a high level of competition, yet many people are still without cover. Those who are either low income or high risk cannot afford private insurance. As a result, access to health care in the USA is highly inequitable. Market forces in health care work only for those who are wealthy enough to pay for it. The British NHS, once one of the most comprehensive health care systems in the world, has never recovered from the attempts by the Conservative Government under Margaret Thatcher to impose market forces on its delivery. I urge this Government not to follow the flawed health care policies pursued by successive right-wing Governments in the USA and the UK.
The Minister is being disingenuous. He knows that this money will not be recouped from the insurers if his amendment takes effect. At the moment, the status quo is that it does have to be recouped. The Minister's amendment changes this so that, in effect, it does not have to be.
The health service is in crisis. The Minister is lambasting hospitals for withdrawing services to their patients because they have financial difficulties, yet he is withdrawing from his budget €0.5 million which could deliver to front-line services – in a small way, but one that would make a difference to somebody who is disabled, has cancer or is waiting to obtain treatment. He is making a choice now to ensure that legally, the strength of the current Act is diminished so much that insurers will not have to pay the money back. If they were to be obliged to pay it back, it is hard to see why he would put forward this amendment.
This is a way of ensuring that the people are paying for start-up costs of more than €0.5 million. The law says at the moment that this money should be recouped from the insurance companies, which are hardly on the breadline – they have a tremendous and growing market and could easily carry this cost. The Minister, however, has decided that rather than their carrying the cost, the people will have to do so, at a time when our health service is in deep trouble. There should be a recognition that services at the front line need to be preserved and that anything which interferes with that should be dealt with by the Minister. He may be under pressure from the Minister for Finance, but at the end of the day it is a question of who will win this battle. If the Minister for Health and Children is so ineffective that he cannot stand up to the Health Insurance Authority, it does not augur well for other, bigger battles.
Question, "That the words proposed to be deleted stand," put and declared carried.
Amendment declared lost.
Bill reported without amendment, received for final consideration and passed.