Health Insurance (Amendment) Bill 2012: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

This is a complex and technical Bill. I acknowledge that the Government has no option but to legislate for this issue, but I have mixed feelings about it. It is difficult to see where this legislation fits into the overall scheme of reform of the health service. I would like the Government to provide a road map for these reforms. A universal, single tier system may not be possible within the lifetime of the Government, but there needs to be a time line. We could soon be at a tipping point with regard to the viability of the private health insurance market. Many people - young people, in particular - are ceasing to pay into private health insurance plans. This leaves older people or those with chronic illnesses to absorb most of the costs. Social solidarity is essential if the provisions of the Bill are to be viable.

There is a pecking order in family finances as people prioritise mortgage repayments and heating and food bills. Where there is indebtedness and falling income, health insurance is lower in the pecking order, particularly among the healthy. I am concerned about this.

It is positive that the Bill establishes criteria preventing discrimination against patients by charging them higher premiums on the basis of age, sex or health status. It is important that this be achieved. It requires us to establish a permanent risk equalisation scheme with levies and credits. One can envisage the VHI, for example, attracting a large number of credits because many of its customers are likely to have greater medical needs. This raises the question of whether we will be legally compliant in terms of intervention regarding the fund.

The Health Insurance Authority will have extended powers to establish and administer the risk equalisation fund. Where an insurance company incurs the cost of paying for treatment for a higher-risk patient, it will be able to reclaim some of the cost from the fund. It is in respect of those people who are most likely to end up in hospital that credits will be drawn down. Currently, the system applies only to people over 60. This Bill, when passed, will change this.

The health insurance industry has a for-profit aspect, which implies people will be lobbying for changes. One must be careful to ensure the consumer is the centre of attention rather than the industry, although I accept that the latter must be listened to in a balanced way. One must remember the industry has a motive other than the provision of health insurance cover. One cannot have social solidarity if a sufficient number of people who are not drawing on the fund are not paying into it. People with long-term chronic illnesses or disabilities and the elderly are the most likely to draw on the fund.

When the Minister is wrapping up, I would like him to outline the roadmap and timeline. If a large number of people no longer purchase health insurance cover, we will have to respond quickly. They could opt for cover in a lower category, meaning they will no longer be treated in private hospitals, thereby placing more pressure on certain parts of the public health service. The public system is already under serious pressure. People may remove themselves from the system entirely because they simply cannot pay for premiums. Has the Government determined the tipping point? The decline in the purchase of health insurance cover has gone beyond a trickle and is becoming a steady stream. If we end up with a cascade, when will there be an urgent remedial response thereto? Over the past three years, for example, 175,000 people cancelled their health insurance policies. This has serious implications. There was an overrun in the HSE to the tune of €400 million in September. The legislation is not likely to be cost-free if an additional burden is placed on individuals.

While I accept that there is a need for the Government to legislate, I have mixed feelings on supporting the Bill because we need to know how the system will be handled if we run into the kinds of difficulty it is possible to envisage at this stage. We are good at creating a crisis and then trying to unpick it. This occurred in respect of the centralisation of the medical card system and SUSI. Both crises were predictable. We are not good at putting good institutional architecture in place. The Government has not had sufficient time to deal with some of the issues that have been presented as crises requiring remediation, reform and compliance with the guidelines of EU institutions. Considerable work must be done to achieve reform and to be compliant. With legislation such as this Bill, we realise there is potential for failure. Where this failure could be serious, it is incumbent on the Government, in response to the Second Stage debate, to determine the risks and put in place a strategy to anticipate and respond to imminent problems.

I welcome the provision of a permanent risk equalisation scheme for private health insurance. It will replace the current interim scheme on 31 December 2012. No one in this Chamber needs to be reminded of the fact that hospitals and other health care service providers throughout the country are facing an extremely difficult task to stay within ever-shrinking budgets while the population expects and deserves a high-quality health care system.

Maintaining an attractive private health insurance system within reach of a large segment of the population is crucial to protecting the public health system from greatly increased volumes. The objective of the Bill is to ensure that private health insurance will remain within the scope of large numbers of people, not just when they are young and healthy but also when they are older and more at risk from illness.

The provisions of this Bill will see insurers compensated for differences in costs that may arise due to the age of their customers. Without the introduction of such a risk equalisation scheme there is a danger that people will pay vast sums for health insurance during middle age, when hopefully they enjoy good health, only to find that as old age approaches and their health difficulties increase, the cost of health insurance increases to a level they can no longer afford.

Without risk equalisation, everyone would face the possibility of being left without health cover in old age. As of December of last year, 47.1% of the population had health cover. It is interesting to note that ten years earlier, in December 2001, that figure was 48.2%. The level of health insurance in this country peaked at 51.7% in December 2008 and has been in steady decline ever since. What the figures do not show are the huge sacrifices being made by many people in an effort to ensure that they retain their private health insurance. For many families that financial burden is becoming increasingly heavy. This risk equalisation measure is vital if we do not want to see private health insurance levels go into free fall, which in turn would greatly increase pressure on the public health and hospital system.

Important provisions in the Bill before the House include open enrolment and lifetime cover. Under open enrolment, all applicants for private health insurance must be accepted, regardless of their risk, age or sex, but subject to waiting periods. Lifetime cover guarantees the right of people to renew their cover irrespective of risk factors, and it is only in very limited circumstances that an insurer can stop or refuse to renew insurance.

I commend the Minister on the timely introduction of the Bill, as it replaces the current interim scheme of age-related tax credits and the associated community rating levy, which is due to expire at the end of the year. It also fulfils an element of the Programme for Government 2011-2016, which committed to introducing a system of risk equalisation for the private health insurance market. The permanent scheme provided for in this Bill differs from the interim scheme in that it extends to cover differences between the healthier members of society and the less healthy. It also strengthens the hand of the Health Insurance Authority in a number of important respects. Health insurers will be required to notify the Health Insurance Authority of new types of contract or changes to existing ones. This Bill also gives the Health Insurance Authority and its officers power to enter premises with a warrant or permission from the owner to secure documentation for inspection and to require the production of books or records.

Under the current Bill, each age band over 60 years receives a tax credit. The cost of an insurance policy for an individual is then reduced by the amount of the tax credit and the insurance company recoups the money from the Revenue Commissioners. Policy holders continue to pay the same amount in a transparent system, and health insurers can also calculate in advance the amount they are to recoup under the new system.

The ramifications of risk equalisation are huge. For example, under the new scheme, a 75-year-old person could expect an annual policy to cost €900, while the real cost of the insurance could be as high as €3,000. The remaining portion of that bill could be recouped by the health insurance company from the Revenue Commissioners. Were the risk equalisation to be removed, how many pensioners could afford to pay almost €3,000, or €243 monthly, for health insurance? The effects of the lack of a risk equalisation scheme would not only be paid for by the elderly. Faced with the prospect of paying high health insurance bills while young and healthy only to be knocked out of the scheme by prohibitive costs when they reach old age, many more will be tempted to drop their health insurance and attempt to save the money towards the cost of health care when they are older.

The Bill is important in creating a fairer society and in incentivising those who can afford to do so to purchase health insurance. I hope it will encourage the 47% of people who currently have health insurance to continue to subscribe to their schemes.

I too welcome the opportunity to speak on this Bill. Risk equalisation has been a central plank of private health insurance from the outset. It is designed to take account of the differences in costs that arise due to the age or well-being of customers. That was relatively simple when the VHI was the only health insurance provider in the State, but with the introduction of other players into the market it has become more complicated. We need only recall the legal controversy that ensued when BUPA challenged the concept of risk equalisation in the courts. As a result of the actions of BUPA the current interim scheme was introduced, although it too was controversial. The Government’s commitment to the risk equalisation policy led to the withdrawal of BUPA from the Irish market. BUPA was then replaced by Quinn Insurance, which has now become Liberty Insurance.

The Bill will deliver on the Government’s commitment to strengthen the risk equalisation scheme. The principle involved is the provision of greater balance, which for the most part is fair. Most mainstream political parties agree with this principle but it is not true to say that healthier or younger people will pay more for their health insurance because of this new legislation. Equalisation has always been a central plank of Government policy regardless of the government in power. However, this is the first time health status has been included as a means of risk regulation in the insurance market. Until now the only factor considered was the age of the subscriber. Younger, healthier people may have to pay more for health insurance while they are young and healthy. It is inevitable that as they grow older or more infirm they will not be able to afford health insurance without equalisation measures. The idea is that equalisation benefits everybody in the long term.

The real controversy arose when other health insurers entered the market and were asked to make substantial financial contributions to the VHI. This is because the VHI has the majority of customers across all levels of well-being and, as a result, pays out by far the highest proportion of claims. People who joined the VHI many years ago are now using their services increasingly as they grow older. People are also living longer, and that inevitably contributes to increase demand for and utilisation of the health services.

It is important to ensure that there is genuine and fair competition among health insurers. The VHI should not be allowed to abuse the system or to use the system to cover up shortcomings in its operations. Administration costs should be similar across all insurance companies. The VHI has decided to increase its prices again from 22 November this year. This seems to be necessary to meet the requirements of the European Court of Justice on solvency, which are standard across the sector. The only way to reduce insurance costs, therefore, is to reduce hospital and care costs. There are many issues with regard to the way we deliver care services, judging from the past and present actions of the HSE and its inefficient handling of the recent change to home help services. It is highly unlikely that organisation is capable of doing anything more than squandering taxpayers' money at the expense of the most vulnerable in our society. Despite the fact that the HSE is overstaffed at an administrative level, all it was capable of doing was a desktop study of its customers' needs, which appears to bear no relation to the situation on the ground. Despite the fact that it has many administrators, the HSE seems unable to communicate with or even discuss cases with public representatives or people on the ground.

If the Minister and those of us in Fine Gael are to follow through with our election commitments to introduce universal health insurance at an affordable cost, we must begin by abolishing every bloc in the HSE. The organisation is unfit for purpose. Instead of promoting better health services, it is the main reason progress is not being made. We talk a great deal about how good we are at innovation in this country but I have yet to see any of that in the processes and the delivery of our health services.

This legislation for risk equalisation is an essential building block in moving towards universal health insurance, which is what the Government wants to deliver. We must now find ways in which we can deliver that. I commend the Bill to the House.

I welcome the opportunity to discuss the Health Insurance (Amendment) Bill. Health insurance is a topic that is gaining ever more discussion time and when one considers the nation's demographics it comes ever more alarmingly into focus.

While much of Europe is already experiencing the phenomenon of an ageing population, Ireland will have to wait until after 2025. None the less, Ireland's population is ageing, with the number of young adults in the country falling by 10% according to recently released figures by the Central Statistics Office. The latest census results indicated that the 19 to 24 age group was the only category to show a fall, with a decrease of 12% since the last census in 2006. In contrast, the number of older people - those aged over 65 - has increased by 14%. There are more older people now living in nursing homes - 20,000 - and in residential hospitals - 5,000 - and because those over the age of 65 use about four times the number of health services that younger people use, that could have major implications for the country. By 2030 there will be 818,000 people over 65 years of age in the country. That has significant implications for both health and social welfare, and this Bill is the Government's far-sighted response to the issue of health insurance.

The Health Insurance (Amendment) Bill 2012 provides for a permanent risk equalisation scheme to replace the current interim scheme of age-related tax credits and associated community rating levy provided for in the Health Insurance Acts. The interim scheme expires on 31 December 2012. Risk equalisation is essentially a method for compensating insurers that carry heavy risk burdens by means of payments from other insurers that carry lighter ones, and its role is to protect the current system of community rating in private health insurance.

The interim scheme is a system of tax credits which provides for a cost subsidy from the young to the old. On current estimates, the scheme will have transferred a net amount of some €275 million from younger to older lives in 2011. The estimated amount for 2012 will be €360 million. The VHI has been a net beneficiary of the scheme due to its older client base. The scheme is funded through a community rating levy, or stamp duty, charged to insurers. This amounted to €197 million in 2009, €318 million in 2010 and €343 million in 2011.

This Bill is a welcome addition to the Statute Book and I have no hesitation in commending it to the House.

I welcome the Health Insurance (Amendment) Bill 2012. Risk equalisation is an issue with which I am quite familiar as I spoke about it many years ago in the Seanad. It was one of the few issues on which we in the then Opposition agreed with the then Government. When it was first debated, it was in the heady days of open markets and value for money. I believed then risk equalisation was a fundamental cornerstone in ensuring fairness in health insurance.

I am a member of the VHI along with my mother. We find with the costs going up, it is getting more expensive and, like everyone else, we have had to check the various plans. We need to examine the health insurance system because many people are getting out of it due to the state of the economy. In turn, this is placing a significant burden on the health system. Over the years, we have thrown billions of euro at the health system but never checked the large wastes of money in it. A lot has been done in the past three years to address this but a lot more still needs to be done. When €1.7 billion is taken out of the health budget, it is a tribute to the front-line staff and those who run it that it is functioning pretty well although there still is a need for improvements.

There is much negative publicity about Roscommon County Hospital which is factually incorrect. Nearly two years on from when it was downgraded, the hospital is busier now. Before one had to wait three to six months for a procedure in Galway and Dublin while now it can be done in Roscommon. There was a meeting yesterday with the design team for Roscommon hospital which announced a €3 million endoscopy project to be located on the hospital site which will bring patients from far and near. When I hear people claim Roscommon hospital is closed, I ask them to do me a favour and call into the hospital to see for themselves what is happening there. In three years’ time, more procedures will be carried out in the hospital than there were in 2009. Sometimes we should shout from the rooftops the magnificent work being done in the hospital and across the health service. Now, we have the Galway University-Roscommon hospital group for which staff from consultants to nurses will be appointed and will be able to move around the various locations. This has happened not because the Minister ordered it but because the management and staff on the ground have worked together to achieve better efficiencies.

No matter how much money is put into health insurance, unless we tackle gross inefficiencies in the health system, then insurance will continue to become more expensive. We need to examine the provision of home-care packages and primary care centres. Primary care centres should become a cornerstone of our health system. Why do people need to clog up an accident and emergency department with routine ailments when they could be attended to in a primary care centre? The group hospitals idea is excellent. The demise of the Health Service Executive is the right approach because we need to be the masters of our own health system’s destiny to ensure whatever budgets are set for a hospital are spent in it.

Risk equalisation protects the healthy and the less healthy. I commend the Bill to the House.

I appreciate the opportunity to speak on the Health Insurance (Amendment) Bill 2012. Generally, Fianna Fáil supports the Bill’s principles but there are several issues which will have to be dealt with on Committee Stage. What is extraordinary about this legislation is that it is to come into effect on 1 January 2013 but much of its critical detail is not yet before us. Many of the figures to see how this risk equalisation scheme will operate in practice will be provided on Committee Stage in the next week or two. With just a few sitting days to go before Christmas, we will be passing this legislation which we have not seen yet with a view to it coming into operation at the beginning of next year. This short timescale is unacceptable. It is a pity we do not have the full details of the legislation as published rather than waiting for them. Inevitably, only a handful of Members will attend Committee Stage and it is not fair on the broad membership which will probably be debating the budget, the Estimates or social welfare in the Chamber when Committee Stage is taken. Accordingly, this detailed legislation might not get sufficient attention.

A key element of this legislation deals with the Health Insurance Authority, the regulator in health insurance. I believe the authority should be closed. It is a stand-alone independent quango which should be merged with the Financial Regulator. There is a convincing case for such a move. I am calling on the Minister or Public Expenditure and Reform to put this authority on the list for amalgamation, if it is not already, as part of the rationalisation of State agencies. Its 2011 annual accounts, signed of in June, stated:

The health insurance market is the largest non-life insurance market in Ireland, followed by motor insurance. Premium income in 2011 was €2.0 billion, having risen from €1.9 billion in 2010. Of the total, €109 million was accounted for by restricted undertakings.

Health insurance should be under the Financial Regulator like all insurance products.

There is no reason to have an independent, stand-alone organisation to deal with one segment of the insurance market, albeit health insurance.

Four companies are currently operating under the new Health Insurance Authority. All of them do a good deal of non-health insurance business and are regulated by the Financial Regulator in that regard. Again, we are imposing extra bureaucracy on the companies which must deal with two regulators in the insurance industry. On the one hand, they have to deal with the Health Insurance Authority and, on the other, with the Financial Regulator. This makes no sense. At one stage every time there was a new idea, a stand-alone agency was set up. If this was being done today in the cool light of day, we would not be setting up a stand-alone agency.

I will list the four companies because people are utterly confused. I have seen advertisements on television for Laya Healthcare, but I had no concept of who owned it. I believe most people do not know who owns it. I now know it is owned by Swiss Re, a Swiss-owned company which took over the health insurance part of Quinn Insurance, the part not taken over by the mutual company we see advertised on the television during the "Late Late Show". Quinn Insurance, in turn, took over BUPA some time ago. Aviva is an international company operating in the market. GloHealth is also operating in the market, although I am unsure who owns it, and then there is VHI. I am a VHI customer and have a good policy with it. It is important to have private health insurance, of which I am a supporter. Those who choose to spend their hard-earned money on health insurance are entitled to do so and should be encouraged rather than be discouraged from doing so. I have a separate travel insurance policy with VHI. If people go on a foreign holiday, they can take out travel insurance from an insurance company. The annual VHI foreign travel insurance premium works out at €70 for my wife and me, which is modest. It is a good price. I hope VHI makes money out of it and imagine it will if people such as me do not make too many claims. I assume the travel insurance wing of VHI is regulated by the Financial Regulator, the organisation led by Mr. Matthew Elderfield. Even VHI must deal with two regulators. As there is no sense in this, I call for the matter to be examined.

Up to 4% of the total private health insurance market is held by the restricted membership scheme for prison officers, members of the Garda and ESB employees. They have their own arrangements, which is fine.

Will the Minister clarify the role of the Financial Services Ombudsman? There is a reference in the annual report to a fee of €15 for freedom of information requests. It must have received one during the year. There were several thousand consumer complaints about various issues referred to in the annual report. Why must the Health Insurance Authority deal with the matter if it relates to an insurance product? Is the Financial Services Ombudsman excluded from dealing with queries on health insurance, although it deals with every other aspect? It appears to be excluded for no good reason.

The Health Insurance Authority has a staff of 11. I know nothing about them, but I imagine they are excellent and do good work. I have no doubt that they are competent in engaging in their activities, but there is no case to be made for the HIA to be a stand-alone State organisation, commonly called a quango, when there are only 11 staff. I accept that times have changed. If the Minister was to come to the House today to state he wished to set up a new stand-alone State agency with nine staff, which number would eventually grow to 11, he would be laughed out of court and would not do it. It would not make sense to do so. That concept should not be followed anymore and there should not be a separate headquarters or administration centre for 11 staff. The Health Insurance Authority should be subsumed into or taken over by the Financial Regulator. I am not suggesting, however, any of the staff should lose his or her job. They have a role to play, but the cost of administration in having a separate organisation is unnecessary in this day and age. There are linked costs for the four insurance companies in the health insurance market. They must deal with the regulator for health insurance products as well as the regulator for non-health insurance business, which puts an unnecessary burden on them. I see no reason to have a separate organisation in this day and age.

I have the annual accounts of the Health Insurance Authority before me. They are germane to the Second Stage debate because the Health Insurance Authority is the regulatory authority for the insurance companies in question. I have never seen a set of financial statements like the Health Insurance Authority statements for 2011. I say as much not because they are so bad but because they are so outstandingly good. The public should know that it receives income each year by way of a levy of 0.12% on premiums. That rate was applied on 1 January last year. Income in 2011 was €2.4 million and a little more the previous year. Expenditure totalled €1.1 million and the profit on the figure of €2.4 million was €1,338,535. There was a net profit of 55%; the figure was 57% in the previous year. No organisation in Ireland or the rest of the world should have an operating surplus of 55% of total income. This has been happening every year since the authority was set up, although the levy was reduced from 0.14% to 0.12% on premiums recently. It is clear that the levy is double what it should be. It produces income of €2.4 million which is double what is required for the organisation to do its work. The authority is not using 55% of its income to carry out its functions.

Page 33 of the annual report is striking. Although these are hard-pressed times, on 31 December 2011 the Health Insurance Authority had €5.884 million in cash in the bank. It added to this figure during the year. At the end of 2011, it had €7,337,874 in the bank. I imagine that figure is now well in excess of €8 million. There is no reason the authority should have €8 million cash in the bank, while cuts are being made to front-line health services. This cannot be rationalised or accepted. This income comes from people who are for paying private health insurance, which represents their contribution to cost of care in public and private hospitals should they need to attend them. Many are cared for in public hospitals by arrangement with consultants and the beds are handsomely paid for. There is no reason for such a cash-rich organisation to have an income double what is required. The organisation has 11 staff. The four organisations it regulates must deal with the Financial Regulator in respect of other insurance business. The case is clear. The authority should be merged with the other organisation that deals with insurance products and the 11 staff could continue to carry on their good work. We will table an amendment to more than halve the levy charged because clearly the income received is double what it should be and the surpluses are increasing every year. Next year it will have €10 million in the bank while we are cutting home help packages. There is no rational explanation for it.

I have no argument with the five directors whose fees are modest and imagine they do good work. There is a chairman and four other board members. I am not here to nitpick with regard to the staff or directors' fees. I am simply suggesting we would not set up such a body in this day and age. Instead, it would be taken over. We all agree that we must regulate the insurance market in the interests of the common good and that we need intergenerational solidarity. In previous times this was present between old and young. Now, it extends to the healthy and the less healthy. There is also an allowance depending on whether males or females are making contributions. It is important to respect the age, sex and health status of individuals and not simply focus on age. This will strengthen the legislation and I am pleased with this aspect of it.

The Health Insurance Authority's annual report is informative on the health market in general.

I appreciate the document and it can continue to provide this type of information on health insurance as part of the overall organisation I mentioned. The difficulties are set out in it. For example, at the end of 2011, VHI Healthcare had 57% of customers in the country but, according to the schedule, 90% of customers over 80 years; Laya Healthcare, formally BUPA Ireland and Quinn Healthcare, had 21% of customers and only 5% of customers over 80 years; and Aviva Health had 18% of the insurance market but also only 5% of customers over 80 years. I have no information on GloHealth but perhaps it will come into the reckoning at a future year. Clearly, VHI Healthcare has correctly been a beneficiary of the risk equalisation fund in the past.

The Supreme Court, in the earlier decision, upheld the principle of risk equalisation. It was only the methodology that, on previous occasions, was not gone about satisfactorily by the then Minister and the Department, and I think it was rushed. I stress the importance of VHI Healthcare and the other private health insurance companies.

VHI Healthcare must be far more conscious of its costs, which are far too high. It is paying far too much to the hospitals, which should not be charging such amounts. I came across a classic example of this recently when a bill was presented to me in my office. A person saw the private consultant in his private office and went into their local hospital in Portlaoise in the midlands for surgery to get a little lump removed from the knuckle of a finger. The person registered as a daily outpatient in the office, went to the operating theatre at 9 a.m. and left the hospital with the few stitches on the knuckle and went home at 9.20 a.m., and the bill that VHI Healthcare paid to the hospital and the consultant amounted to almost €1,000. The hospital automatically bills VHI Healthcare for the full daily rate and VHI Healthcare automatically pays whatever bill issues. I am aware that customers have rung VHI Healthcare furious when they have seen that a couple of thousand euro are being paid in respect of the few hours they spent in hospital and VHI Healthcare promptly told them it is none of their business as it has a rate set with the hospital and it is its financial arrangement. VHI Healthcare does not have control on the costs or on what is happening in the hospitals and some of the hospital charges are excessive, and the matter needs to be examined. VHI Healthcare needs to be making unannounced site visits to see whether the bills are presented. I do not want to delay the process of the money being paid to the hospital, but VHI Healthcare should conduct a sample audit after the fact and check with its customers whether the fee seems reasonable for what they got. In most cases it may be but in many cases, VHI Healthcare has been paying bills which should neither have been charged nor paid where a fraction of the sums concerned would have been sufficient, and that adds to the cost of health insurance with VHI Healthcare, Laya Healthcare and Aviva Health which makes it difficult.

The biggest difficulty is we need to get more young people into the health insurance market. One might ask, "Why would I start paying private health insurance?" if one was a reasonably healthy person under 40 and knew one would go into this market containing the risk equalisation formula at a later date. The cost of private health insurance will prevent many younger persons, and those with mortgages, going down that road. We all will be aware that people are making cutbacks. Health insurance is not a cut people want to make, but it is one they are being forced to make because of the cost, and it would help if VHI Healthcare's cost control was a little better.

Returning to my original point about regulation, we all will be aware VHI Healthcare must be one of the biggest insurance companies, not only in Ireland but in Europe, that is not regulated by a financial regulator because of a unique statutory process. If the company were to regulated tomorrow, the regulator would probably close it down because it would not meet the various reserves criteria necessary for future claims. We are in a situation here where the main player is unregulated and competing with players whose other insurance business and health insurance business are regulated, and we have a stand-alone regulator which should be part of the main regulator. The Financial Services Ombudsman is the person who should be dealing with complaints about all insurance products and health insurance should not be excluded from that.

An attitude I do not like which is always an undercurrent in the debate is the tendency in some way to demonise the 1.5 million with private health insurance as if they are doing something wrong by providing money for their own health care. They could go off and spend it on holidays and cars or in the pubs, but they choose to spend it on health care in case the rainy day comes when they have a heart attack or stroke and must go into hospital for a fortnight or where, if they have cancer, they will get the costs of their chemotherapy, etc., covered. There is an undercurrent against those with private health insurance. People are entitled to spend their money on health insurance.

I would not entertain the concept where, if people go into accident and emergency, as happens in hospitals across Ireland, they would be asked for their VHI Healthcare number. It is none of the hospital's business. The accident and emergency departments are for public use and for every person in the country, especially taxpayers. Most VHI Healthcare customers have paid their tax and they are entitled to a public bed. Some have the idea that the hospital should charge the private insurer. Where two patients, one of whom does not have private insurance cover, go into accident and emergency with the same complaint and both are admitted to a bed, they should be treated equally. The patient without cover would be placed in a public bed and the other person, who is put in the next bed, has paid for the public bed through the payment of taxes but happens to have a private insurance policy as well. That should not have to be called upon because the person's taxes have paid for the public bed to start with. The idea that because one is a private patient, one's private insurer should pay for one in a public bed is nonsense. The public bed is one's right and entitlement and one has paid for it, and VHI Healthcare should not be paying for public beds. I agree that where one is put into a semi-private ward or private ward one should pay the full whack but if one is in a public bed paid for by one's taxes, private health insurance, if one happens to have it, should not be called into play. If one did not have health insurance, it could not be called into play. It should be to do with the treatment given and the category of the bed, the hospitals should cease the practice of asking for VHI Healthcare numbers at accident and emergency departments throughout the country, which are public facilities paid for by all taxpayers including those with private health insurance, and those facilities should be made available through the public health system to which people have contributed their taxes. My party will be proposing amendments on Committee Stage, but we agree with the principle of and the need for the Bill.

Debate adjourned.