Health Insurance: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Billy Kelleher:
That Dáil Éireann:
notes that:
- there is an ongoing and persistent increase in the cost of private health insurance, with a crisis of affordability for both individuals and families developing;
- the increase in private health insurance premiums is significantly ahead not only of inflation generally, but health sector inflation as well;
- an average of 6,000 consumers leave the private health insurance market every month;
- there is little incentive for younger people to take out health insurance;
- the haemorrhage of younger, healthier policy holders is threatening the sustainability of the private insurance market by generating further upward pressure on health insurance premiums for those who remain; and
- many of those who remain have downgraded their level of cover; and
calls on the Government to:
- act speedily to reduce costs in the delivery of both public and private health care as undertaken in the programme for Government;
- introduce lifetime community rating;
- revise the legal definition of non-advanced plans so that the 300,000 holders of lower level plans will not face a substantial rise in their health levy;
- defer the increase in the health levy which is scheduled for the end of March;
- remove children from liability to the levy;
- ensure patients who have private health insurance and pay their taxes do not lose their universal entitlement to public health care funded by the State;
- work with insurers to develop industry standard clinical pathways;
- permit public hospitals to negotiate with health insurers; and
- use its position and purchasing power as a VHI shareholder to negotiate a reduction in consultant fees.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
“strongly endorses the principal of community rating, whereby people can buy health insurance for the same price irrespective of their age or health status;
acknowledges with satisfaction the passing by the Oireachtas of the Health Insurance (Amendment) Act 2012, which introduced a permanent scheme of risk equalisation effective from 1 January 2013;
commends the Minister for Health on the measures he is taking to protect community rating in the private health insurance market and recognises the support that risk equalisation provides to maintaining community rating in the market in helping to ensure the affordability of health insurance for older people;
supports the work of the Minister for Health to ensure a sustainable private health insurance market in Ireland;
welcomes:
— the success of the Minister for Health in securing the approval of the EU Commission for the new risk equalisation scheme as a vital means of protecting the affordability of private health insurance for older and less healthy customers who are most likely to need it; and
— the notifications by insurers for categorisation of another 30 plans as non-advanced by the industry regulator, the Health Insurance Authority, to be made available to customers, with a corresponding lower rate of Stamp Duty, from 31 March 2013; after that date new products can be introduced at any time subject to meeting a 30 day notification period and requirements for classification;
notes that there is no need to amend the legal definition of non-advanced plans since they will be readily available to customers under the current definition;
supports the work of the Minister for Health to make private health insurance affordable for all who wish to purchase it;
welcomes and supports:
— the Government’s continuing work to address unacceptably high costs in the private health insurance market and shares the Minister’s concern that increases in private health insurance premiums are not justified in all circumstances; and
— the actions of the Minister for Health in requiring the VHI to address its cost base immediately, including action on the fees it pays to health professionals, auditing the volume of treatments it pays for and clinically reviewing the appropriateness of these procedures;
endorses the Government’s policy of generating additional income for public hospitals, by addressing the current subsidy enjoyed by health insurers in respect of their private patients who occupy public hospital beds;
further supports the continuing work on the Health Service Executive national clinical programmes in developing effective clinical pathways for patients that can be utilised by all health insurers; and
further endorses the actions of the Minister for Health designed to ensure a strong and competitive health insurance market as a key building block in the Government’s commitment to implement universal health insurance.”
- (Minister for Health).

I apologise as I was delayed. I compliment and thank the proposers of the motion, which is worthy. We must examine the issue. The population is ageing and, by extension, will become sicker. We discussed the costs of various issues, including generic drugs, in the term of the previous Government. I am a victim of the system myself. I was rushed to a private hospital in the city last Tuesday. I am paying private health cover for the past 20 years. Thankfully, I came out the other side but I had a nice little bill of €395. My insurance did not cover the visit. I was told that I had to go back for a scan which will cost €700, which again is not covered even though I am paying health insurance for 20 years. Health insurance is becoming more expensive and less cover is provided. It is time for someone to stop the racket, the abuse and the extortionate charges of a range of people, including consultants, to the health care companies.

I do not know how many increases we have had in the past two years. No doubt the Fianna Fáil spokesman and others have outlined the details. We must grasp the nettle and deal with the issue because private health care charges are exorbitant. We were promised changes in governance and a difference by the Government before the election. We were promised a new era of transparency and openness. However, we have a Minister who is compromised because he is involved in private health care. He is involved in a private nursing home in my county. I said it previously. I thought the Taoiseach would have moved the Minister. He is someone who should understand the brief as he is eminently qualified. I do not challenge his bona fides in that regard. However, he has a vested interest. The Minister previously acted on behalf of his colleagues to strike a lucrative deal with the Government for a group of people within his own profession.

Now the Minister is involved in property speculation. He is in charge of the HSE which employs HIQA. The latter closed down a nursing home in my county. It literally terrorised and persecuted the nursing home. When I inquired I discovered that HIQA had made only one fleeting visit to a nursing home in which the Minister has a stake. How about that for transparency and openness? Is it a case of jobs for the boys or we do what we like, not as we say? It is not fair. What is going on in health insurance is just a racket. It is disgraceful. It is going on in other areas of insurance also but it will not change until someone shouts “Stop”. People cannot afford to pay premiums. They are walking away in their droves from paying health insurance as they cannot afford it and the people who are paying are not covered when they require treatment. The genie is out of the bottle. Someone had better try to examine the situation and deal with it.

The current statistic indicates that more than 200 people per day are abandoning their health insurance policies. It is a frightening scenario when thousands of people with private health insurance are experiencing dramatic increases in 2013 with further increases of anything between 20% and 40% envisaged. More than 300,000 health insurance customers on the cheapest plans are to lose full cover for procedures in private hospitals from April onwards. In order to comply with the terms of the Government’s new risk equalisation scheme, the cheaper plans will no longer be able to offer cover of more than 60% of the cost of day care procedures in a private hospital.

The Minister’s target is to raise an extra €60 million this year by charging all private patients in public hospitals based on a charge of €1,000 a night for a private bed compared to a cost of €75 for a public bed. To put it mildly, that is puzzling. It is hard to fathom the vast difference in pricing. Alarming figures are being bandied about regarding costs for some procedures being carried out through insurance cover. Some operations require just an overnight stay in a private hospital and costs of between €1,000 and €3,000 have been mentioned. Blatant overcharging is pushing up premiums. That is a significant factor in the spiralling cost of premiums.

In 2011, the VHI revealed that more than 30 hospital consultants received more than €500,000 each from it. One consultant on the VHI earning list for his private practice, who was also on the list of a number of other health insurance companies, earned more than €1 million. A lot of question marks hang over the VHI. In 2005, it had 1.7 million customers. Now it is down to 1.2 million, yet its number of employees has increased in a steady manner since 2005. The VHI cost base is mainly due to abnormally high remuneration and increment rate. That seems to be the root cause of its insolvency. At this stage the taxpayer might be burdened by the European Court of Justice ruling that this country is in breach of its EU obligations by the exemption of the VHI from regulation by the Central Bank. The VHI has been allowed to mismanage its affairs. It has been propped up. The Minister will have to urgently intervene and call a halt to the anomaly where competitors are subsidising the company for far too long. If it is left unchecked it is heading for an increasingly expensive health insurance premium and it will accelerate rapidly the thousands opting out who are further pressurised with stretched household budgets to keep up with rising costs.

The current system of health care in this country is similar to the system in operation in Legoland and Disneyland to decide who gets to use it next. I had the unfortunate experience of going to Legoland a couple of years ago with my children. I discovered that one got to queue for hours and one got a few minutes on the ride. However, there was a way around that. If one was rich enough one could skip by the queue of people, if one had the neck and if as an adult one did not mind skipping by children to go on a ride, one could do it. Frustrating as the experience was in Legoland, it was not that serious but I could not with any conscience pay my way ahead of anyone else.

It is very cost effective.

I have adopted the same philosophy when it comes to the health care system. I do not have private health insurance. I use the public health care system. I had the pleasure – it was not a pleasure at the time but it was afterwards to get it done - of having my tonsils removed under the public system. It was difficult to get in but once one got in, it was quite good. From the perspective that one can use the system without paying for health insurance on the basis that one has paid for it through one’s taxes begs the question of whether that part of the system needs to change much. I agree in principle with the notion of universal health care. It makes sense. One of the issues that must be tackled if one wants it to work out well, because otherwise it will cost too much, is that one must get rid of the waste and overspending. The cost of drugs is the obvious case that comes to mind in the context of overspending. Another such cost is the cost of consultants. There is also a layer of middle management that we cannot afford to continue to pay to play hide and go seek. It is too expensive.

I thank you, a Leas-Cheann Comhairle for the opportunity to speak to this Private Members’ motion on the cost of health insurance and the hardship caused to many families because of the significant costs and recent increases.

The health and funding crisis touches on the broader issue of the urgent need for reform of our health services. Tonight in this debate we are dealing with the cracks and the immediate cost issue but this is not the solution if we really want a fair, efficient and high-quality health service. My own clear position is that we need a proper universal health service, with those in most need always getting priority. There should be universal health insurance across the board, paid by us all as part of our general taxation. That is my clear political and philosophical position and I believe there is support in this House for it. That is why I supported the Government's Health Service Executive (Governance) Bill earlier today.

There has been too much messing around and too much in-fighting between the HSE, the Department of Health and politicians for many years. I know it is not trendy or politically correct to say this but the Minister and his senior officials should visit Cuba and look at that country's health service and how well it works, despite being hammered by a US blockade. The Cuban people put equity, equality and justice at the top of their health philosophy and ensure quality service delivery to all Cubans, particularly the poor. I met a medical student in a bar in Havana who, as part of his training, was going out to live in villages and mountains, helping and caring for people, for his summer holidays. He told me that it was his patriotic duty to work and serve in his country's health service and that he would defend it to the end. That is the kind of spirit we need in our health service and the kind of spirit that we need to reform it.

I know there are some plans to reform our health services but hammering our nurses, doctors and those in the 24-7 Alliance is not the way forward. It is a crime and a disgrace to penalise those on the frontline because of the recklessness of senior bankers in the past. This needs to be said in the debate tonight because it is linked to the cost issue and the high price of health insurance. Approximately 6,000 people are leaving the health insurance market every month, many of whom are young people. This will threaten the sustainability of the entire insurance market. Health sector inflation is now out of control and many people are now downgrading their cover. I call on the Minister to speedily reduce the cost of the delivery of both public and private health care, as promised in the programme for Government.

Up until a few short years ago, throwing money at the health care system was viewed as the solution to its challenges and ills. We now know that this approach did not have the desired effect and in reality, ignored the root causes of problems in our health care system. If there is anything at all positive about financial constraints it is that they force a new approach and a re-evaluation and examination of not just what we spend, but how we spend it. The Minister for Health, officials in his Department, nurses, doctors and staff of the HSE have all been working to bring reform to our health service within the budget necessitated by the State's current financial situation.

Despite the detractors, doubters and cynics, we are seeing results. In my constituency, the new Galway Roscommon hospital group is proof of the benefits which the new group hospital structure can bring. In 2012 the group successfully treated more patients, faster and more efficiently, despite a reduced budget. The group successfully tackled the significant problems in the accident and emergency department and exceeded the targets set by the Department of Health's new special delivery unit. In 2012 it effectively halved the numbers waiting for accident and emergency care and achieved a reduction of over 36% in the number of patients on trolleys awaiting treatment. The Galway Roscommon hospital group clearly demonstrates that strategic and targeted use of public money always delivers better outcomes than the old practice of simply throwing money at a broken system. Fixing and reforming the system is what we must do, while simultaneously ensuring that people can continue to access high-quality health care.

Last month the Department of Health published what I believe to be one of the most significant documents it has published in many years. Unfortunately, it received very little attention in many political and media circles, who instead prefer to focus on negative stories rather than progress or plans for reform. Entitled The Path to Universal Healthcare, the document examines the current health care system, with a focus on health insurance and sets out a vision for how we will achieve a single-tier health service supported by universal health insurance, which provides equal access based on need and not on ability to pay. The overall goal is to develop a new health-insurance-supported health care system, guided by health promotion, equal access, patient safety, outcome-based rewards, as well as efficiency and effectiveness.

Specifically with regard to the health insurance market, the focus of Government will be on ensuring a fair and robust community-rated market. The concept of community rating is central to a properly functioning health care system. The health insurance market is one of the clearest examples of where government involvement and, indeed, interference with the commercial market is both fundamental and welcome. It is, put simply, positive discrimination which ensures that our citizens can access affordable health insurance, regardless of age, gender or health. Many people will be aware of community rating through the Supreme Court ruling of January 2009 which declared that the then Government's risk equalisation was based on an incorrect interpretation of the law and had to be set aside. This led to an unsatisfactory interim measure to plug the gap which the Supreme Court had found. This Government committed to finding a workable and effective solution that would be rooted in fairness among the health insurance companies and, most importantly, for citizens. We achieved that commitment with the passing of the Health Insurance (Amendment) Act last year. The Minister for Health, Deputy Reilly, and his officials have ensured that fairness remains at the heart of the health insurance market. The new permanent scheme of risk equalisation protects the community rating system and ensures inter-generational solidarity in the provision of health insurance.

Reforms are continuing apace, radically improving our health system so that it prioritises patient safety, is patient centred and delivers the best health outcomes for citizens. It will take time but I am confident that we are beginning to see the results.

I am grateful for the opportunity to speak on this motion. For the past two years, this Government has consistently striven to ensure that the cost of private health insurance for ordinary families in Ireland is kept down and our efforts in this regard will have to continue for the months and years ahead. It is a complex issue involving competition in the market place, the base cost of procedures and the pay of the professionals involved. Undoubtedly, there have been significant price rises in recent years and this, coupled with declining household incomes in many cases, has seen many families forced to opt out of private health insurance, placing an even greater burden on the public system. However, over 45% of the population is currently covered by private health insurance, greatly alleviating the burden on the public health system.

In terms of the drive to reduce costs, there have been some notable successes. The VHI, for example, has achieved cost savings of over €300 million by reducing consultants' fees and payments for procedures such as inserting stents and MRI scans. This cost-saving drive has also resulted in a large increase in the number of day-case procedures and the average length of stay in hospital has also been decreasing.

Competition is a key factor in today's private health insurance market and while there are four main players in the market, GloHealth only has 1% of the market, Aviva, 16.9% and Laya Healthcare, 21.5%, meaning that the market is dominated by the VHI, with over 56% market share. There are pitfalls to having such a large segment of the market as many older people have never switched providers and thus, while VHI has 56% of the customers, it has 67% of the claims. By offering inducements to adults with small children, companies are targeting young professionals in their 30s and 40s, ensuring their products are most attractive to people whose needs are least in terms of health procedures.

One aspect of the payment structure which has received much focus is community rating but this inter-generational solidarity is necessary is to prevent our health service, both public and private, from crumbling. There is little incentive to pay a large health insurance premium during the years that one is least likely to have to avail of it, only to be pushed out by the private system as one ages. Without community rating, very few older people would be able to avail of private health insurance and the huge pressure on orthopaedic and neurology departments, for example, all across the country would soar. The Health Insurance Authority has, in recent years, been highlighting the ease with which people can switch providers and has matched its ambitions with actions in terms of a very user-friendly plan-comparison tool allowing individuals and families to assess which plans best suit their needs and what savings can be made. That tool is something which I would encourage everyone to use before renewing their health insurance.

I believe the risk equalisation measure currently in place in Ireland has forced private health insurers to seek greater efficiencies rather than cherry-picking the best and healthiest customers, creating the leanest regime possible in terms of administration.

In these recessionary times it is true that people of all demographics are opting to leave their current private health plan or not sign up to one at all. The private health insurance market peaked in 2008, along with many other things in this society, when approximately 2.3 million people signed up to private plans. That number has declined ever since and at the moment there are 2.1 million people with private health insurance, which is approximately 45.8% of the population. These numbers are indicative of the tough times we are in but I would also venture to say that everything peaked in 2008 and what goes up must come down, unfortunately and we will seek to have a rebalancing of this in time.

The media has a large part to play in terms of the apocalyptic headlines gracing the newspapers on a weekly basis on this issue. I would argue that the media has a large part to play on many issues but that is for another day.

By all accounts, private health insurers are attempting to keep costs down as it would do them no service to raise costs and lose customers. That would be the easiest avenue to bankruptcy. Rising costs can largely be attributed to what hospitals and consultants are demanding from private insurers. I propose that the Minister, Deputy Reilly, should commission a small team of health insurance experts to conduct an investigation - lasting six month or so - into the rising health costs in Ireland. It should be at minimum expense to the Exchequer and for the betterment of the industry as a whole. There is more to this issue that must be examined more thoroughly.

The Opposition has raised some points about which most of us in the House can agree. I wholeheartedly agree that the best and most equitable health care should be provided for every individual in the State. The Labour Party advocated a Nordic model of health care prior to the 2011 election and there is commonality with the coalition partners, who have agreed to this approach and decided to pursue this aspiration, which unfortunately can only be achieved in more prosperous times. We are trying to set the bedrock in place to achieve this aspiration. Many of us social democrats have examined the Scandinavian model and seen it as something to which we aspire. It can be achieved but the Government must be serious about it and give a long-term commitment. With the current Government and those who have seen the light in the party that was part of the previous Government, we will get there in the end.

I have spoken in the House many times in the past two years about hardships, such as mortgage distress and unemployment, which affect the nation. Families across Ireland must cope with many tough decisions and cutbacks, including cuts to private health insurance. There is an old saying that health is wealth and health care is a crucial pillar in the country's architecture. Grouping private health insurance with a better service in the public system is a main priority for the Government.

I will continue to work as a backbencher to ensure that the best service can be provided and afforded by people. Health is wealth but the costs are a key component. It has been indicated that some people have received over €500,000 and €1 million in payments from private health insurance. A public bed can cost €75 per night but a private bed can cost up to €1,000 per night. Some 56% of the market is held by VHI but 80% of costs go to the company because the majority of older and sicker customers use it. There must be some kind of equalisation. The path to a universal health care system must be pursued on an equitable basis over a number of years for the betterment of all society.

I welcome the opportunity to contribute to the debate. I will deal with the specific issue of the use of private health insurance by those who are hospitalised because of psychiatric ill health. There are a few issues of great concern and public patients often have a greater opportunity to recover in the long term when compared with those who enter private institutions, although all the facilities do very good work. Of great concern is the process of follow-up after discharge from a private hospital. There is no connectivity with the HSE, and the community-based after-care system with HSE involvement can be patchy in following up psychiatric patients discharged from private institutions. There should be some follow-up by the health insurance companies in that regard.

There are two main private psychiatric hospitals in the country. Many people who use those facilities would have insurance but may not have much other money. They would have to travel to and from Dublin and pay for a consultation with a psychiatrist and treatment. The expense can be quite significant for people who access health care in psychiatric hospitals. An initiative should be taken to bring the three groups - private hospitals, private insurers and the HSE - together to examine follow-up after discharge from private hospitals. There is a difficulty.

Private insurance lasts for six months in a private hospital and if people cannot pay privately after that time, people need to be transferred to the HSE hospitals or to their communities. Treatment often lasts longer than six months. Some years ago I mentioned an experience when somebody was discharged from St. Patrick's Hospital one evening in a highly suicidal state. Her mother took this 21 year old student back to Limerick on the train and she was taken into hospital late at night. There was not much investigation of her condition and a student nurse was assigned to care for her the next morning while the patient was still in a suicidal state. The nurse left at 1 p.m. and there was not enough cover, so the patient took her life at 1.30 p.m. in the hospital. There is a difficulty around discharge and after-care when patients have been cared for in private psychiatric hospitals. The follow-up for public patients is far superior to that seen by private patients. The issue should be addressed.

In the short time I have I will make a few points.

The Deputy has four minutes.

I did not realise I would only have four minutes. At a time when the Government is driving efficiencies across the health sector, it is important for insurance companies to step up to the mark, especially with regard to sharing resources. We can see what is happening on a cross-Border basis in Altnagelvin in Derry, where there will be a €19 million investment by the Government for a shared double linear accelerator radiotherapy centre for the people in the north west. The Government is working on a shared basis and trying to drive down its cost so there must be some sort of replication in the insurance sector.

How does private health insurance cover work when we will work on a shared basis between North and South? There will be a similar process in paediatric care, where the Minister is working closely with Mr. Edwin Poots, MLA, his counterpart in Belfast, with respect to shared paediatric services. Crumlin is a possible location to treat children with special difficulties. We must have a conversation on how health insurance companies will work on a cross-Border basis.

Tied to this is the issue of the patient mobility directive, which will be transposed into law in October this year. It is almost like a liberalisation of health services throughout the European Union, with patients in this State having the possibility of utilising services in other states or jurisdictions.

We need to have a conversation on how that will work and the nature of the involvement of the health insurance companies with regard to private patients. Will it just be for the public system?

The next issue I wish to raise is close to the heart of the Acting Chairman, Deputy Charlie McConalogue. I refer to regional status for Letterkenny General Hospital, which is bringing an increasing number of people through its door. The hospital is carrying out many more procedures than it used to and the workload of consultants in the hospital is increasing by the month. More patients from outside County Donegal are attending and the hospital is becoming quite a success story. At present, the extra footfall is not being rewarded although this is the aspiration of the Minister, which I acknowledge. A hospital such as that in Letterkenny should not be discriminated against because it does not have regional status.

There is an excellent MRI scanning system in Letterkenny General Hospital. The VHI, however, does not have a reimbursement scheme in place for it. It does have a scheme for Sligo hospital, which has similar services. There are excellent facilities in both hospitals but the VHI does not have a reimbursement scheme with the one in Letterkenny. Will the Minister ask the VHI why no such scheme is in place? Can one be put in place? If so, let us do so.

I agree with universal health care. How did we get to this position whereby the cost of insurance is increasing? The cost has increased because nobody took on the vested interests, including the consultants. I have paid for health insurance, as has my mother and other members of my family. We have done so because we could and saw it as a civic duty. At many times, we did not receive care better than we would have received in the public system.

There is another form of insurance, however. At many times, consultants would say that because one had voluntary health insurance, one could be kept in hospital for a few days. This meant more money for the consultants. The insurance companies did not take on the professionals and this increased the cost of health insurance.

Another form of insurance was used in public hospitals. I believe in public hospitals. I was in Roscommon hospital a week ago for a hip X-ray. The service I received there is not inferior to the service I would hope to receive in Blackrock Clinic or Galway Clinic, to which I have never been. I believe in public hospitals. In the public hospitals, there was a form of insurance whereby consultants could be paid €500 or €1,000 if one wanted one's mother, father, brother or sister to stay an extra week. This practice was ongoing over the past 30 or 40 years. It was the way business was done in this country and it was wrong. This is why our health insurance system is at a low point. So much cash was going through the system. Anybody who enters my office tells me that this practice occurred. It occurred all over the country. There were patients with voluntary health insurance in respect of whom the consultants were able to charge the VHI. Nobody questioned this. In the public health system, there was another form of insurance, that is, nod-and-wink insurance whereby one paid the consultant or doctor €300 or €400 to keep one's mother or father in hospital. Everybody in the system knew this practice was occurring but nobody was prepared to tackle it. The Minister is now going to make the system open and transparent and, most important, he will ensure that the nod-and-wink insurance system cannot continue.

Risk equalisation in the VHI is very good. It can be blunt but the VHI is charged with catering for a much more elderly cohort than other companies. I pay voluntary health insurance but do not expect to receive treatment any better than that which I would receive in a public hospital. Perhaps that is just my opinion but I believe most people are beginning to examine their health insurance. People are asking how they can get the best cover for the money they pay. As with utility bills, such as those for oil, electricity and telephony, people are examining health insurance bills all the time. I urge people to shop around.

I examine the cost of my insurance. I have an elderly mother of 85 and I pay her insurance. While we have always had private health insurance, perhaps we would be better off using the public system, thereby saving a lot of money. If many hundreds of thousands of people stopped paying for private health insurance, however, the public health system would not be able to cope.

The Minister must take on the vested interests, who have not been taken on for the past 15 to 30 years, or even since the foundation of the State. We had an Irish solution to an Irish problem, thus putting us in our current position.

I welcome the opportunity to speak on this very important motion. It is extraordinary that in two years Fianna Fáil is returning to form. It has abdicated its responsibility and forgotten it was in Government. It never took the Department of Health and Children as it left it to Ms Mary Harney. It did not have the courage to take it.

Let me cast the minds of the Members opposite back to 2008. Some €700 was the price of a premium. Under the Fianna Fáil regime, the costs spiralled. Since 2008, more than 200,000 people have left the health insurance market. It is worth noting that at the peak, 50.9% of the population had health insurance. Unfortunately, this figure has reduced to 45.8%.

Significantly, despite all the pandering and posturing by previous Administrations, we now have a Minister who has set about creating a universal single-tier health service. The best that the Members opposite can say is that this is not happening fast enough. They ask whether there are clear pathways. They should examine the recently published document, The Path to Universal Healthcare, on which we should have a debate. For once, we are in circumstances in which we will have people gaining access to medical care not on the basis of what they can pay, who they are or where they come from, but on the basis of their needs and how they can be treated and cared for properly, promptly and decently. The model of health care that the Government and I espouse is based on this philosophy. Anybody who promulgates a different version is talking out of both sides of his mouth.

It is about time that we got real in this country regarding health care. For far too long, we have let the vested interests dominate, take over and dictate what happens. For once, we have a Minister who is prepared to drive reform and implement change. While this may take time and while we may need to go to Legoland and back, I hope that on the way to Legoland we can build the blocks on a sustainable foundation that will not collapse like the Micheál Martin-Mary Harney model that has left us where we are today.

The priority is to examine what the health insurers are doing because they all have a responsibility. Members have focused on the VHI in this debate as it is the dominant market player. It must lead the drive to reduce costs. Our main question, to which Deputy Kelleher referred last night, concerns increasing costs. The Deputy is correct that they are increasing but the current Minister is the one who has said consistently to the insurers that they must keep their costs down.

It is tough for Deputy Dooley being in opposition. When his party was on this side of the House for 14 years, he was like a little mouse. He did not budge or open his mouth.

I ask him not to open it now. If I was him, I would be embarrassed given Fianna Fáil's record in government. I would not say too much about it. I appreciate his difficulties.

Deputy Buttimer should not get caught in a trap.

I am not getting caught at all. Members opposite forget that we must never allow the Irish people to forget that Fianna Fáil led us to where we are today. That will be Deputy Dooley's legacy for eternity.

Deputy Buttimer has the opportunity to have a legacy now.

We are doing it. There has been reform of the health system. I pay tribute to those who work in our health system. We have seen better care and more changes. I will give Deputy Browne some examples of the changes because I know he wants to hear them.

I do not want to hear anything from Deputy Buttimer.

The Mercy Hospital in Cork now has a new admissions procedure so people can come in for an operation and leave the same day. The South Infirmary Victoria Hospital has reduced the length of stay for knee and hip replacements and now has a pain management unit. This was unheard of previously. Cork University Hospital has a new assessment unit and 85 new beds were opened there and in the Mercy Hospital just this week. Reform in rostering and changes to work practices have allowed for greater numbers to be seen and fewer people on trolleys. These are some of the many positive signs that the Deputies opposite do not want to hear because they just want the bad news. That is fair enough, it is their prerogative, but let us look at what we are doing in the health system, driving reform and putting the patient at the centre of the system.

It is not good enough for the Health Insurance Authority to tell people to shop around. There are more than 200 differently priced plans in the market. Let us make it simpler and more streamlined for those who want to keep their private health insurance. We face many challenges in the health insurance market and consumers are making difficult choices. As prices have increased, many have relinquished their policies, but insurers have an obligation to stop the spiral of price increases and to work with hospitals and others involved to reduce costs because they have a social objective, to make it attractive for people to keep their health insurance.

I commend Deputy Kelleher for putting down this motion. Every Member of this House is concerned at the increasing costs involved in health care, particularly with health insurance companies increasing their premiums. There is a real concern that 200 people per day are giving up their health insurance. That demonstrates the crisis of affordability for individuals and families. The health insurance companies are increasing their rates and blaming inflation but in fact these premiums are ahead of inflation generally and ahead of health sector inflation.

Like the Minister, I am concerned that 6,000 consumers are leaving the private health insurance market every month. There is little incentive for younger people to take out health insurance. This threatens the sustainability of private health insurance for those who remain within the system. Many people have downgraded their cover and there is concern 300,000 holders of lower level plans will face a substantial rise in the health levy. It is unfair that someone paying €500 for a lower level plan will pay the same levy as someone who can pay €4,000 for a higher level of cover. There is no level playing field and that is a matter of concern surrounding the introduction of this levy.

The Minister should consider removing the levy from children. Families have enough problems with school fees and paying for college education. These health premiums will be an extra cost. The percentage of the population with inpatient health insurance stands at 45.8% according to the CSO population figures for April 2012, a fall from the peak in 2008 of 50.9%. That is a matter of concern. Among the under 50s, there was a fall of 122,000. We must be concerned about that and consider ways to encourage younger customers into the health insurance market instead of putting obstacles in their way. Last year, the Irish League of Credit Unions found nearly one in ten adults with health insurance would abandon the policy because they could no longer afford it, with 31% claiming they would do that if prices increased again. An article by Charlie Weston in the Irish Independent in December outlined increases of almost 50% under a scheme the Minister is devising. If these health insurance experts say the Minister's plans will lead to a higher premium payment for families, we should take note of that and deal with the increases in premiums.

Public hospitals are charging about €1,000 per night instead of €75 for these beds. The impact will be significant and we should ask why there is never a breakdown of that €1,000 figure. These changes will have an impact because health insurers are not allowed to negotiate prices charged by public hospitals, in contrast to private hospitals, where the insurers can demand terms. There is a reluctance on the part of the health insurance companies to get involved in cover for the newer private hospitals.

I hope the reports of health insurance companies charging punitive fees for people who want to cancel a policy will be dealt with. One family I know was quoted a cancellation fee of €700. It is difficult to shop around in that situation. The CEO of VHI said people could choose wisely and save money if they shop around but it is not that simple when such punitive charges are in place.

The cost of health insurance has doubled in four years at a time when general inflation was low. Last year the inflation in health insurance was ten times the inflation rate in the health sector generally. I call on the Minister to act speedily to reduce the costs in the delivery of both public and private health care.

I welcome the opportunity to make a contribution on this important motion put down by our party spokesman last night. It deals directly with the widespread concerns of many families throughout the country who are struggling to maintain their private health insurance. The dramatic reduction in the number of people paying this insurance must be a cause of serious concern in overall health provision and the additional funding pressures that will ensue for the health sector in general. The drop of 64,000 policy holders in the last year demonstrates a dramatic loss of revenue and, according to the Health Insurance Authority, the people leaving the market are younger and healthier and those with young families. A few years ago, younger people taking out policies were growing that insurance market, a welcome development. By definition, those younger people joining the market were of significant value to community rating, which is of critical importance for an ageing population. Community rating must be protected.

Now we have a market in decline, losing people who should be the lifeblood to ensure sustainability for community rating. The younger policy holders, who are healthier by definition, are a critical ingredient in ensuring we have a sustainable community rated market.

As a society, we need to provide protection for older persons and those in ill or failing health. We must have that critical cohort of younger policy holders to ensure that necessary protection and we will not have those younger policy holders unless that age group finds health insurance attractive in its benefits and, most important, affordable. A continuing decline in younger policy holders would be detrimental to the health insurance sector.

The increase in private health insurance premia is well ahead, not only of inflation generally but of health sector inflation as well. I referred earlier to the large numbers leaving the insurance market. Allied to lower numbers is the fact that large numbers have downgraded their level of cover. All these factors contribute in a negative and, unfortunately, significant way to the further upward pressure on premia for those remaining as policy holders.

My party's spokesman, in his motion and his contribution last night, put forward a number of proposals that need urgent consideration and, I would suggest, implementation by the Minister of State, Deputy Alex White, and his colleagues in the Department. The Minister, through VHI, must achieve a reduction in consultant fees. That is one of the issues that has always been with us and that the public constantly raises with us. It is understandable that this issue is still one that needs further resolution.

A 70% increase in two years for some VHI policies is putting a terrible burden on many households already under pressure. I understand that those policies hit with such a large increase are typically those held by older persons. The latest 6% increase in VHI premia is the fifth in over two years, and this has to be tackled before policies become totally unaffordable, except for the very well off. This trend of increasing cost is causing many individuals and families to question how long more they can afford to remain in the insurance market. Of course, the same concerns exist for the policy holders of the other three private insurers as well. Subscribers giving up or downgrading their policies continue to put further pressure at an accelerated rate on those remaining in the market. Young families are under constant pressure to meet household commitments and there is a strong case to remove the €95 per annum levy from children. Such a move would help to make insurance that bit more affordable for so many families.

The Minister, Deputy Reilly, in a newspaper interview in January, spoke of his concerns about VHI's cost base but less than two weeks later VHI announced a further 6% premium rise, the fifth increase in two years - a point that Deputy Buttimer might note.

Particular attention must be paid to VHI as it is the only beneficiary of a very substantial levy. That is understandable because it has the vast majority of older policy holders.

The Minister gave a clear commitment to protect 330,000 health insurance customers with lower levels of cover from a further increase in the Government's health insurance levy this month. Now that is not being implemented. This is another broken promise, one that was only made a few weeks ago during the course of the enactment of legislation here.

Gabhaim buíochas leis mo comhghlaithe, an Teachta Kelleher, as ucht an seans an fhadhb dáirire atá againn le hárachas sláinte a phlé.

We all accept it is a serious problem when 140,000 subscribers have left the private insurance market in two years. These 140,000 will now depend on the public hospital system to look after them.

In January 2011, Deputy Reilly, speaking about increased health insurance premia, stated it is the last straw for many and that many who have been holding on have given up their insurance as a result of these proposed increases, the consequences of which will be more pressure on our public hospital system. No doubt this has been the effect. In his tenure as Minister for Health, there have been 140,000 additions as a consequence of such increases. In March 2012, the Minister defends that by stating that is the way it goes, even through he has a chance, as Minister, to influence it through legislation. When he introduced legislation, it achieved the opposite of what he intended. It has added to the cost base and to the cost of premiums of many of the companies. In fact, it has also resulted in a reduction in the benefits of many of the packages. That is the Minister's track record after two years. In fairness, the Minister of State, Deputy Alex White, is only in the Department a few months and I am happy to give him much more time to try to achieve something on it.

There is a serious problem in the market. Initially, we were told that competition would be the answer to the problem and the introduction of new market entrants would sort VHI out. In 2011, VHI's market share was still 57%. In four years, it has only fallen from 66% to 57%. It is still the dominant player in the market. It is still the player that is being subsidised by the private players in terms of many of its plans and we must look at its modus operandi.

When one compares the cost model of VHI, in terms of its running costs as opposed to the profile of its customer, against those other competitors it is completely out of sinc. Its running costs are considerable higher than those of its competitors and those running costs are passed on in the premia increases to those of us who are VHI customers. VHI is using its loyalty within the Irish market to pay off those cost increases and therefore is putting pressure on the private operators in order to do that.

Many Members referred to the flight from the insurance market of younger subscribers, in particular, young families, and specific attention needs to be paid to that. Why is it that those with no children are less likely to use the system and are not even considering taking out insurance? God forbid if they need the system, they will have to depend on an overstretched public system. It is because there are few incentives for them. The Government, through the legislation passed before Christmas, through extra levies, is adding to the cost for children. It has a chance of doing something on this, by stating to families that in one area the Government can control - the cost of health insurance through levies - it will reduce the levy on children or get rid of it altogether when it comes up for payment in a few weeks time as a signal of the Government's interest in their position as families in terms of the running of their households and as a statement that the Government wants people to try to have health insurance. Instead, the advice coming from the Government benches is to shop around. Like Marie Antoinette, those who sit on the benches opposite suggest those who shop around will find it.

As, in fairness, Deputy Buttimer stated, it is difficult to shop around when there are tens of plans available. It is utterly confusing and nobody seems in a position to explain to the consumer what is in certain plans and not in others. Instead of telling consumers to shop around, let us work with the market and tell insurers to simplify their offer, take away all the frills and elements that confuse the marketing of the offer, and give consumers direct information. They should do consumers that favour alone. That is something that has not properly happened. There is still this mirage of plans with which consumers are utterly confused. Unfortunately, in many cases it is only when subscribers go to use their plan that they realise its deficiencies. That also needs to be addressed.

An issue that applies with all of the companies is the delay in paying hospitals for services that have been provided. At every HSE quarter meeting, it is pointed out that there is money outstanding from various insurance companies to hospitals and the HSE generally for services that were provided, and it tends to be a substantial sum. In HSE west, at one stage the sum was in the teens in terms of millions of euro, much of which dated back a long time. That was due to disputes over the filling of forms because consultants would not fill out forms properly, and that is not right. It means that hospital beds had to be closed and services had to be withdrawn from companies which have the money and will not pay it. That is an issue these companies need to address as a matter of urgency. The Department needs to flex its muscle in this regard and not have a situation, as is the case every year, that when we come into August and September cuts must be made to the health budget.

Some of those cuts happen because some of these large companies that have the money will not pay the HSE or pay the various hospitals on time. It is March and we can stop that from happening now. That is one easy way to resolve the challenges in the health budget and there are not too many other ways.

The tenor of debate from the Government side has been phenomenal. There is an unbelievable loyalty in Fine Gael to the Minister, Deputy Reilly. One will not see that in the O2 tonight with all those screaming fans of One Direction. For Fine Gael backbenchers he is like the Niall Horan of Fine Gael. They speak of all the reform he has introduced in the past two years. I remember being here in 2008 when the then Minister for Health and Children, Ms Harney, introduced the reforms that have revolutionised cancer treatment and revolutionised the outcomes for those who are unfortunately suffering from cancer. I remember the Minister, Deputy Reilly, leading the charge against those reforms because it suited him and it suited Fine Gael in Sligo, Mayo, Galway, Cavan and Monaghan to lead the charge against those reforms - reforms which he has now championed. We now have to listen particularly to the Fine Gael Deputies praising him for that; the Labour Deputies are slightly more circumspect of the Minister, Deputy Reilly, which, given their experience with him, is to be understood.

These are reforms he bitterly opposed and from the back of every truck during 2011 he told every community he would deliver and subsequently he has gone away. I will not take a lecture on the lack of reform during our time in government from Deputies so devoted to a Minister who opposed every one of those reforms and got votes on the back of opposing those reforms. Now we are all supposed to bow down and face towards north County Dublin - or is it Tipperary, I get confused - and pray towards him and give thanks to God for this maestro who is Minister for Health. The 140,000 people who have given up on the Minister's health insurance policies do not even begin to add up to the number of people who have given up in other areas of health. Nobody should expect us to accept him as a champion of reform.

I am pleased to have the opportunity to speak on the motion ably proposed last night by Deputy Kelleher. Not alone did he propose the motion, but he also proposed a number of solutions to the problem which should be taken on board on the far side of the House. As this is my first opportunity to do so, I wish the Minister of State, Deputy White, every success in his position. As Deputy Kelleher has said, I am sure he will stand up to the Minister, Deputy Reilly, and plough his own furrow in the Department.

We have a serious problem with the health insurance industry where the ever-increasing cost means 200 people every day are giving up on their health insurance. The programme for Government committed to acting speedily to reduce costs in the delivery of public and private health care, but obviously that has not happened. The Government is now beginning its third year in office and nothing substantial has happened in this area. On Monday the Oireachtas Members from Wexford were briefed by senior representatives of the HSE south. One of the points made to us was that the number of people giving up private health insurance was having a serious effect on people attending hospitals in the south east, resulting in a large increases in the operations and people attending such hospitals. They made the point that we will have ever-increasing problems in dealing with the numbers of people leaving the VHI and the other private health insurers.

There is an ongoing and persistent increase in the cost of private health insurance with a crisis developing in affordability for individuals and families. The increase in private health insurance premiums is significantly higher than not only inflation generally but even health-sector inflation. An average of 6,000 consumers leave the private health insurance market every month. Obviously that is a major problem in the public health area. What plans do the VHI and other private health insurers have to deal with this? Obviously a company in the commercial sector losing that number of customers would be trying to deal with it effectively. Clearly the VHI's running costs are far too high. Even though it has lost a significant number of members, it still has the same number of staff. Surely this is not acceptable. The company should take a serious look at how it is operating and the high costs of its operations, and make changes.

As other Deputies have said when the Minister, Deputy Reilly, was on this side of the House he had all the solutions to the problems of the private health sector. He castigated the then Minister for Health and Children, Ms Harney, and the then Government for not dealing with the issue. However, now he just shrugs his shoulders, saying this is the way it is and this is the way it will continue. However, it cannot just continue because if huge numbers continue to leave the private health sector we will have serious problems in the public sector. This is an issue in which the Minister of State should involve himself directly because obviously the Minister, Deputy Reilly, has no interest in dealing with it.

I thank Deputy Kelleher for tabling the motion. He has outlined some of the solutions that can be implemented to bring about a reduction in costs and allow people to remain in the sector. We cannot afford for them to be leaving it thereby putting pressure on other areas of the health services.

Few things strike more fear in the heart of a family than the fear of illness and concerns over the inability to pay for the care of a family member. Over the years that aspect of Irish culture has driven a relatively high participation in private health insurance notwithstanding the universality of the service that is provided. That fear is real to the family and out of that concern people have participated fully. While that fear still exists, approximately 200 people are dropping out of private health insurance on a daily basis. That is a staggering number. I recognise we are in a recessionary period and I am sure the Minister of State and his colleagues, as is their wont, will apportion blame for why we are in this position.

The Deputy might occasionally acknowledge that.

Sadly that will not solve the problem of the other 200 families about to make the decision tomorrow not to participate. That will allow that fear to be a daily fear - not just the fear of illness, but the fear of being unable to pay if a family member falls ill. It is not good enough for Deputy Buttimer or any other Member to come in here and give us a history lesson as they regularly do. That is fine when we are having general banter and just tossing political jibes across the House. However, tonight is about addressing a crisis in the private health insurance sector. It is not just a crisis in the health insurance sector, it is a crisis among so many families across the State and is being exacerbated every day. It ill behoves any of us to start throwing politics around the House.

We have an opportunity to resolve it. Unless we can come up with a solution that can stop this vicious circle of people being unable to pay, thereby falling out of the system, putting a greater burden on those in the system and increasing the charges for those fortunate enough to be able to scrape together the money to participate. Next month as the charges increase more people will find themselves outside the net and unable to pay. That is an ever-decreasing circle that will lead to a major problem. The problem exists already but the increase in charges will make it worse and we have to tackle it. The Government will need to propose incentives and solutions to help the people who want to pay - and paid when they could - but are no longer in a position to do so.

We know the pressures they are under. I do not propose to engage in the usual commentary about other taxes. I accept that the tax base needs to broaden. Private health insurance, which is a fundamental component of the livelihoods of many people, is being tossed aside. I am disappointed at the approach the Minister is taking given he came to office with so many promises of resolving the perceived inability to control spending in the health area. We heard much about money following the patient. What happened to that proposal? What has happened to the proposed universal health insurance system under which the State would pick up the tab for those who could not afford to pay and those who could pay would pay an affordable rate? It appears to have gone out the window.

Deputy Buttimer stated that the delivery of the entire health system has changed in the past two years and that we now have some of the most advanced technologies and facilities. It is as if all of this mushroomed in the past two years. What Deputy Buttimer and others on the Government side - I do not include the Minister of State, Deputy Alex White, who has always been balanced in terms of his commentary - have failed to recognise is that many of these advances were made under former Minister for Health, Mary Harney, whose only fault was the manner in which she communicated them. I believe she would admit that herself.

In my view, the advances in reconfiguration of the delivery of health services has led to a much better service delivery, which Deputy Buttimer and his colleagues refused to accept and worked against on a daily basis. They frightened the people of this country, telling them they would die if the reconfiguration of services went ahead, which was outrageous. Thankfully, Members on this side of the House are not engaging in that type of banter tonight but are instead putting forward solutions that are acceptable, meaningful and have the capacity to assist the Minister in the discharge of his duties.

I do not propose to continue the battles of the past in the House tonight. I am not interested in doing so. While many Members say in their contributions that they want only to speak about the future and that Members on the opposite side want only to speak about the past, one finds that five minutes into their speeches they are speaking about the past, which is ludicrous. We cannot make any progress if that continues. However, I can banter another day about that. This is far too important an issue to do so now.

I thank Deputy Kelleher and his colleagues for raising this important matter and giving the Government the opportunity to restate its commitment - which has not been abandoned, far from it - to the introduction of a system of universal health insurance which will bring an end to the current two-tier health system which for so many years, it cannot be denied, has discriminated against patients on the grounds of income.

As stated last night by the Minister, Deputy Reilly, this Government is the first in the history of the State committed to developing a universal single tier health service which guarantees access to medical care based on need and not income. We will leave the failed policies of the past behind and introduce UHI with equal access to care for all. This has been a useful debate. I welcome some of the contributions made on all sides of the House. I do not underestimate the size of the task ahead. I have previously made clear that it would take two terms in government to achieve our aims in relation to the introduction of universal health insurance. Much has been achieved already. It is only fair that Deputies opposite would acknowledge this. For example, through the efforts of the special delivery unit, SDU in my Department, working with hospitals and clinicians, we are successfully tackling problems associated with delays in accessing care. These are real achievements and substantial improvements that should be acknowledged.

As Minister of State with responsibility for primary care, I want to see progress continue to be made in building capacity in primary care and in chronic disease management, particularly for the management of diabetes. Only today the Health Service Executive announced the appointment of 17 clinical nurse specialists who, as part of their role, will support health care professionals providing care for diabetes patients in primary and secondary care settings. Currently 1.8 million individuals in the State hold medical cards, the highest number in our history. The Bill to allow for the extension of free GP care to persons with prescribed illness will be published this year. It is not unreasonable for Deputy Kelleher to raise the issue of the pace of change. We all want to see change happen quickly. I have been Minister of State for almost six months now. I too am often frustrated at how long it takes for particular changes to imbed in the system. However, change is occurring. As acknowledged last night by Deputy McConalogue change takes time, particularly change in the health services.

I would like to address the issue of risk equalisation, which is the meat of this debate. As Deputies will be aware the Health Insurance (Amendment) Act 2012 has provided for the introduction, for the first time in this country, of a permanent risk equalisation scheme, RES, with effect from 1 January 2013. I recall that legislation was strongly supported on all sides of this House, although some Members opposite appear now to be criticising it. The new scheme will play an essential role in maintaining stability in the private health insurance market. As outlined last night by the Minister, with effect from end March 2013, support levels under risk equalisation will increase substantially over 2012 levels for higher risk groups, particularly men aged 70 and above. This will further reduce the incentives which insurers have to select younger and healthier customers at the expense of older and less healthy customers. It will help to ensure to a significant extent that private health insurance remains affordable for older and less healthy people. I regard risk equalisation as an indispensable element of the necessary reforms of our system.

Deputy Kelleher raised the issue of the pace of change. The recurring theme of the speeches made by Members opposite has been the number of young policy holders leaving the system. I acknowledge this is a problem. I do not seek to suggest that is not an issue. Members opposite have described the problem. The challenge is to come up with solutions. Seeking to undermine the risk equalisation scheme will not form part of any realistic solution. For example, a deferral, as advocated for in the Fianna Fáil motion, of the increase in the health levy, which is scheduled for end March 2013, would manifestly undermine the risk equalisation scheme and would take from it. It would add to the problems rather than reduce them. It may be attractive on the face of it to suggest children should be removed from liability to the levy. Three to five of the proposals in Fianna Fáil's motion would, I respectively suggest, rather than help the situation undermine the risk equalisation scheme and levy system crucial to it. I can do just as well as Deputy Kelleher in describing the problem. There can be no doubt in anybody's mind - Deputy Dooley will have to acknowledge this - that the reduction in the number of people who hold or have reduced their insurance cover is manifestly linked to the reduction in people's living standards owing to the economic and financial collapse here and the increase in the number of people unemployed and the affect this has had on families. In terms of everybody being honest with each other, it appears strange to me that the Opposition would not acknowledge this is a factor.

Deputies opposite say we need a solution and to look to the future and address this issue in the long term. I agree with them. I call on everybody in this House, particularly those who have taken an interest in this issue, to contribute to the debate on what universal health insurance should look like. I do not regard as a settled issue precisely how it will manifest itself or be implemented. I ask Members opposite to contribute to the debate on the way forward. Wisdom does not reside on one particular side of the House or with Government alone. I would welcome a good, strong and healthy debate on these issues.

I thank all Members who contributed to the debate and for their viewpoints on this issue. Fianna Fáil tabled this motion because we believe the cost of private health insurance is a problem. There is no doubt but that families are finding it difficult to maintain health cover or are cancelling their policies. We can argue about the current state of the economy and how we got there but health insurance inflation is not the direct result of the difficulties in our economy. There are other reasons for the major increases in health insurance premiums, one of which is Government policy. Regardless of the difficulties in our economy, Government has, through its policies, interfered in the health insurance market by way of legislation and-----

Fianna Fáil supported that legislation.

-----other proposals with regard to full cost charge for patients being treated in public beds. Let us park the argument about the shortage of money, the inability of the Minister for Health to balance last year's books and his having to obtain a loan from the health insurance companies to tide him over and sort out overdrafts for hospitals.

The real reason the Government is proposing to charge full cost for private patients in public beds is nothing more or less than a finance raising mechanism. This is not about taking away subsidies from health insurance companies; it is about charging customers of health insurance companies. Their universal entitlement to be treated in a hospital is something which those on the other side of the House espouse. Under the Government's proposal one will be treated in a hospital, but if one stays in a public bed one will be charged the full cost. The Minister pretends the insurance companies will pay for it but this is not correct. The premium holders will do so because the insurance companies will be obligated to pass it back to them because they cannot run deficits. They are obligated to keep a reserve and legislation is in place to ensure this is the case. Yes they will make profits, but this is not about removing a subsidy; it is about double taxation and attacking a fundamental right to free health care at the point of need in a public hospital. That is what this is about.

If some consultants are sending people through the system and charging them even though they are being treated in a public bed the Government should deal with this and there are other ways to do so. This blanket decision to penalise on the double for going to a public hospital every person who has worked hard, paid their taxes and decided to take out private health insurance to protect them and provide for their health care is unacceptable in my view and should be unacceptable in the view of the Minister of State. If he espouses universal health insurance, this attempt the Government is making at the start of the process suggests it will be very unfair for much of middle Ireland who pay their taxes and try to provide for themselves and their families. At one fell swoop the Government is telling them they must pay twice to be treated. Being asked to do this is the most mean-spirited attack I have seen in recent years on people who make an effort and work hard to provide for themselves.

We supported the Health Insurance (Amendment) Act. We were proponents of risk equalisation and we saw the necessity for it. We were led to believe there would be two types of plans, non-advanced and advanced. During the discussions in the Chamber we were led to believe the Health Insurance Authority would deem 47 plans as non-advanced and they would avoid the higher levy. The legislation has been passed and now it transpires there are no non-advanced plans and all of the health insurers will now have to design them. The important point to be made is with regard to people who are already under huge financial pressure in trying to retain health insurance, who have been reducing their cover and barely hanging on. This will force health insurance companies to drop benefits and certain cover for the lower plans to ensure they are non-advanced. The same people who will have to avail of these non-advanced plans will then have to pay for some of the services that will be provided if they go into a private hospital. With another fell swoop the Government is asking people who can barely afford health insurance to subsidise those who can afford higher premiums and higher insurance cover, or the Rolls-Royce five-star private health insurance. It is a direct transfer of wealth from the poorest in terms of private health insurance to those who can afford it most. The Minister of State knows this is completely wrong. He knows it is unfair and anathema to everything for which most people in the Chamber stand. I suggest it is something with which the Minister of State certainly does not agree.

In fairness to the Minister for Health, he is often wrong but never doubts himself. How could he have come in here on Second Stage and stated there would be 47 non-advanced plans which would avoid the high levy because he was so concerned about those on the lower reaches of private health insurance who were barely hanging on to it? The legislation has been passed and what do we get? There are no non-advanced plans. This must be revisited because what will happen is that MRI scans and many other benefits which were in the lower plans will now be removed to qualify for the lower levy, which will mean those who can barely afford it will have to pay more out of their pockets for treatments in private hospitals.

There is a view that those with private health insurance are queue jumpers who buy themselves a place ahead of those in the public hospital system. The vast majority of elective surgeries are carried out in private hospitals. If one has private health cover one is not taking a bed from somebody in a public hospital because most elective surgery is done in private hospitals which have no contact with the Exchequer or public patients. If people really wanted to support and help the public hospital system because of the difficulties in which it finds itself, as many people as possible should be encouraged to take out private health insurance so they would lighten the burden on the public hospital system. This is what the Minister for Health proposes in his universal health insurance policy. I have stated before, and will do so again, that the Minister, Deputy Reilly, and his party sat in opposition for 14 years and came up with grand plans and great schemes. I would have assumed that on taking office, although his party did so with wild outlandish promises as did the Labour Party, he would have had some blueprint in his mind for universal health insurance based on a particular model. We have had the Dutch model and every other model-----

We have had the Wexford model also.

-----but we still do not know what the Minister proposes. Fine Gael and the Labour Party had a great debate about whether it would be a social insurance model and now we find it will be a private universal health care model. This is what seems to be emanating. Officials have gone to Germany and the United States and done the rounds.

What does Deputy Kelleher think?

We will publish a policy document, which will be fair and equitable and will not be an amalgam of two parties with varying views and pre-election promises cobbled together in a programme for Government. We will publish something fair and equitable and based on people being able to access health care at the point of need without hindrance. In the meantime, what the Government is doing in its push towards a universal health care model will make it more difficult for people to access health care in this country.

The Government has had two years in office and is going into its third year.

It is our second year.

The Government is going into its third year and in six months time it will be halfway through its mandate.

Make that man Minister for Finance.

Perhaps I would do as well as the Minister for Public Expenditure and Reform. The Government will not have published universal health insurance proposals until halfway through the mandated term.

They were published.

Can we see them?

They were published several weeks ago.

I am speaking about the actual details.

Did Deputy Kelleher even know that?

He has not read it anyway.

Did the Deputy know about this being published?

Yes I did, but I am speaking about the actual details-----

Did the Deputy read it?

-----of the document in terms of what exactly the proposal will be. The document does not contain this and the Minister of State and the Minister know this. It contains only the broad parameters.

The Minister spoke about 4% of the overall number, but this 4% comprises families who can no longer afford private health insurance and 200 people a day are dropping out. The Minister for Finance has stated the household tax is only €2 a week. Ministers are now saying the property tax will be only €40 a month.

To families who are on their knees trying to keep the show on the road, €40 a month is an awful lot of money.

Who put them there?

It is an awful lot of money.

We are trying to keep the show on the road after your lot.

Can we have some order please? Deputy Kelleher has the floor.

It is hard to take.

I hope the Deputy was listening as opposed to watching.

There is now a cohort of people in this country who are finding it very difficult to live on a daily basis, pay bills, fund themselves, put their children through school and all that goes with it.

Have you only discovered that now?

They are primarily people on the lower pay scale. The budget that was passed last year, for example, was a direct attack on people on lower rates of pay. No effort was made by this Government to help them. This was confirmed by the ESRI which said that the last two budgets were regressive. In other words, those who had least paid most.

The Minister knows that Labour should have insisted on an increase of taxes for those earning over €100,000. There should have been an increase on universal social charges and all Deputies know that.

Why did Fianna Fáil not bring it in?

They were too busy wrecking the country.

I am afraid the time has expired.

The Labour Party threatened to walk out of Government because the universal social charge was not increased, yet they walked back in and it still has not been increased, so what has changed?

I commend this motion to the House. I ask the Government to consider our proposals in full and, more important, to understand the pressure that families are under on a daily basis in trying to retain private health insurance.

As we are now past the time, I must put the question on amendment No. 1 in the name of the Minister for Health.

Amendment put:
The Dáil divided: Tá, 82; Níl, 49.

  • Bannon, James.
  • Breen, Pat.
  • Burton, Joan.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Coonan, Noel.
  • Corcoran Kennedy, Marcella.
  • Creed, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Deering, Pat.
  • Doherty, Regina.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Brian.
  • Hayes, Tom.
  • Heydon, Martin.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kelly, Alan.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lyons, John.
  • McCarthy, Michael.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • Maloney, Eamonn.
  • Mathews, Peter.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Ó Ríordáin, Aodhán.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Phelan, Ann.
  • Phelan, John Paul.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Sherlock, Sean.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Wall, Jack.
  • Walsh, Brian.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Joan.
  • Colreavy, Michael.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Donnelly, Stephen S.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Flanagan, Luke 'Ming'.
  • Fleming, Tom.
  • Grealish, Noel.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Higgins, Joe.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Lowry, Michael.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • McLellan, Sandra.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Naughten, Denis.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Dea, Willie.
  • Pringle, Thomas.
  • Ross, Shane.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Billy Kelleher and Timmy Dooley.
Amendment declared carried.
Question, "That the motion, as amended, be agreed to", put and declared carried.
The Dáil adjourned at 9.17 p.m. until 10.30 a.m. on Thursday, 7 March 2013.