Leaders' Questions

We read today that those who have health insurance are facing a further 15% hike in premiums from 1 July. This means that the average premium for two adults and two children will have doubled in the past three years, to €2,500. The hike about to come in is the result of legislation that is coming in July. The Government wants to raise €60 million and wants to charge the full cost for private patients using the public health system. In essence, it is putting an unsustainable burden on individual families. Subscribers pay their taxes and under the 1970 Health Act, they are entitled to treatment in acute hospitals. They pay a second contribution through health insurance.

The problem is fundamentally that the continual price hikes are threatening the sustainability of the health insurance market. The Health Insurance Authority estimates that 90,000 will leave in 2014 and 68,000 left in 2012. Approximately 6,000 per month are leaving the health insurance market. Given that there is a community rating system which depends on younger subscribers cross-subsidising older users of the system, it is clear that it is the younger members who are not taking up the premiums or are leaving and that this is placing significant strains on the sustainability of the health insurance market. This is in the context of the universal health insurance model or the Dutch model that was proposed by the Minister for Health, Deputy Reilly, and the Taoiseach before the last election. We are nowhere near the realisation of that. No White Paper has been published.

Does the Tánaiste accept that the position is not sustainable and we are in the beginning of a cycle that could spell the death-knell for the private health insurance market? I am not saying that, analysts are saying it. The Health Insurance Authority is putting out warnings in that regard. Something must happen in terms of the overall plan to intervene to stop what is, in essence, a debt spiral in the health insurance market.

What is being proposed is that the cost of a public bed in a public hospital should be chargeable to the insurance company where there is insurance involved. As we all will be aware, the private health insurers charge for everything - the consultant, the anaesthetist and, if it is a private bed, the bed - but at present the hospital cannot charge for the use of the public bed, and that is what is being proposed.

As Deputy Martin stated, the amount of money it is proposed that will raise is €60 million this year. Against a total pay-out by the insurance industry of €2.2 billion, €60 million does not amount to a 15% increase in premiums, even if it were passed on. There are greatly exaggerated statements being made about that.

The Government is undertaking a major reform of the health services to reduce the cost of delivering them. The Minister for Health will shortly bring forward his proposals on hospital groups which will streamline services for patients and the Minister of State, Deputy Alex White, is overseeing a chronic illnesses programme which will see patients treated more cost-effectively in primary care settings rather than expensive hospital settings. We are doing this also, of course, while having to reduce the budget for the health services due to the state in which the Government of which Deputy Martin was a Minister left the country.

Private inpatients in public hospitals are subject to maintenance charges, that generally range from €586 to €1,046 per day, when they are accommodated on a private or semi-private basis and this charge is separate to the private consultant fees which a patient also pays. Approximately 20% of beds in public hospitals are designated as private beds. The other beds are designated as public beds, with the exception of a small number of beds which are not designated. If a private designated bed is not available and a private inpatient is accommodated in a public bed, the maintenance charge is not levied. As a result of this practice, hospital maintenance charges are not payable by private inpatients occupying public designated beds or non-designated beds. The change, which is being proposed and which is in the draft legislation which is coming forward, is to provide for the charging of the public beds. That makes sense. If the hospital can charge for the private bed, it ought to be able to charge for the public bed rather than having the entire cost of that fall on the taxpayer.

The public hospitals have always charged health insurance companies. What is proposed now is that it will be the full cost. The problem is that it is being done in a vacuum and without any overall solution coming forward in terms of the issues that face the funding of the overall health service.

People pay their taxes. The average health insurance subscribers are taxpayers. They are not super-wealthy persons. They are average families that have taken out health insurance. That has been a tradition. It has been part of the system for a long time.

Many will be surprised at the Tánaiste's description of the price hikes as being exaggerated. This is the third hike that will happen this year. Subscribers are feeling it. They will be amazed at the idea that somebody thinks that the price hikes in health insurance are somehow exaggerated.

That is not what I said.

Some 6,000 subscribers are leaving a month. Some 90,000 will leave between now and 2014 and 68,000 left in 2012.

Do we not know why?

The Tánaiste will reply. Deputy Martin should make his point.

With respect to the Minister, Deputy Rabbitte, it is Leaders' Questions. He was leader once, he is not now. I would appreciate that I would be allowed to ask the Tánaiste the question.

I thank Deputy Martin and ask him to proceed.

The people were promised that there would be a universal health model introduced. They were promised the Dutch model. There has not even been a White Paper in that regard.

People were promised the sun, the moon and the stars and that this would be a painless approach to accessing health services and funding health services. The Dutch model was held out as the great solution to all our ills. We still do not know whether people who have health insurance now would pay less under the Dutch model or whether people on medical cards would be paying more. Where do the 20% stand who have neither health insurance nor the medical card?

The Deputy walked away from the Department of Health and Children.

In the meantime the point I am making is the centre cannot hold. I am not alone in saying this. The Health Insurance Authority has warned that the sustainability of the market is at risk.

Did the Deputy read that one?

Other analysts are saying that the market is heading into a death spiral because of adverse selection risks. Essentially, younger people are leaving in their droves and are not there to cross-subsidise older members of the health insurance market and we are heading into a significant downward cycle that needs to be addressed. All we have been told is that it will be 2016 or 2017 before we can even contemplate universal health insurance. There is a genuine issue that demands a meaningful substantive response as opposed to just the politicking that goes on.

The Deputy's reading has improved since he went into opposition.

He probably printed it.

I did not say that the increases in health insurance premiums are exaggerated. The increases in health insurance premiums for families are staggering and there is a major issue in that regard. I said that the charging for public beds in public hospitals as proposed will yield €60 million this year on a total payout of €2.2 billion by the insurance companies. No matter how the sums are done that does not amount to a 15% increase in premiums. Those who suggest that are exaggerating the impact of charging the insurance companies for the use of public beds. That is what I said and the Deputy chose to twist it-----

The Tánaiste is good at that himself.

-----to make a political point.

Let us be clear about what I am saying. There are issues the insurance companies need to address. There are issues relating to their cost base and there are issues relating to the very high level of other charges that are charged to the insurance companies, including hospital charges, charges by professionals, etc., which need to be addressed. Anybody who has got a bill from a health insurance company knows that well.

I disagree with my colleague, the Minister, Deputy Rabbitte, that Deputy Martin's reading has improved - it has not. On 15 February, the Minister, Deputy Reilly, published a paper, The Path to Universal Healthcare: A Preliminary Paper on Universal Health Insurance. Contrary to the claim the Deputy just made-----

That is not the White Paper.

-----it provides a comprehensive update on the progress achieved to date and sets out the main actions.

That is not the White Paper.

It does not matter what it is called.

The Minister, Deputy Reilly, said a White Paper - he has been promising it for two years.

It sets out the progress made to date and the main actions to be done.

The Tánaiste's defence of the Minister, Deputy Reilly, is as consistent as ever.

A policy paper, Money Follows the Patient: A Policy Paper on Hospital Financing, was recently published. The Government is making progress on the policy of implementing universal health insurance. It was never claimed that it was something that could be introduced overnight. The transition to universal health insurance is-----

-----a programme that will take time to achieve as the Deputy well knows.

It will never happen.

If the updated stability programme the Government published during the week showed anything, it is that austerity is not working. Yet again it has been forced to revise down growth forecasts and revise upwards unemployment projections. Throughout Europe, people are waking up to the reality that austerity is not working. I note today President Higgins is the nation's voice.

No. We do not go there. The Deputy should not go there with regard to the President. We do not discuss the President in Dáil Éireann.

Citizens in the real world have been pushed to breaking point and now the Government has advised them that two more years of austerity are on the way. The stealth taxes, the family home tax, cuts to child benefit and taxing maternity benefit all have a real impact on low and middle-income families. People need a break. If the State is due to meet the deficit targets with €1 billion or more to spare, this money needs to be used to give people a break and ease the burden on citizens.

The Deputy is contradicting herself.

I wish to highlight one section of people who are suffering, the carers. Perhaps the most mean-spirited cut in the last budget was the €300 or 19% cut in the respite care grant. At the time of the budget the Government could not defend on any level that nasty cut and to this day nobody with a bone of decency in them could stand over it. The cut, which will save the State only €26 million in total, has caused real hardship for the 70,000 families in receipt of it. Why does the Government not use the breathing space it has advised us we have to reverse the cut to the respite care grant? It is only €26 million and the Government claims we will have €1 billion in advance of targets. Can the Government give the carers some comfort and respite by reversing that cut?

There would be no breathing space if the Government had followed the prescription advocated by Sinn Féin.


Hear, hear.

When the Government was formed, the Sinn Féin leader proclaimed that the IMF should go home and take its money with it.


Sorry, please-----

If that had happened there would have been five months' money left to pay for all public services in circumstances where at the stage when we came into government the country was not able to borrow on the private markets.

The deal was done before the Government came in to office.

I do not know what it would have recommended that we would do for money.

We now have some breathing space because of the way the Government has managed the country's finances and the economy. We are making a recovery, which was very adequately demonstrated this week with the numbers of new job announcements. The creation of jobs is at the root of economic recovery. Another 100 jobs were announced in Waterford today and 100 announced yesterday in Dublin. Some 1,600 jobs were announced for the Glanbia development. There will be approximately 1,000 jobs on the development of the M7 and N11 which have also been announced. That is how we will get economic recovery.

There is a debate throughout Europe about the economic strategy to be pursued. Austerity, as the Deputy calls it, is not some kind of choice. The Government needs to ensure we have a solvent country that can pay its way. It is unfortunate that as a country we are still borrowing approximately €1 billion a month to pay our way. Nobody is in any doubt that we need to get the deficit down unless they live some kind of fairytale existence as Sinn Féin members seem to do. The recovery that needs to come about is not a recovery based solely on budget adjustment. That is obviously part of it because we need to get the deficit down. It is also based on creating the circumstances for investment in the country with jobs created and we grow our way out of it. That is the Government's strategy.

That is the strategy the Government has been advocating at a European level and I am glad to see that more are taking heed of that and that European policy overall is adjusting more to the strategy we have been advocating for some time.

The Government's problem is that it has again had to adjust downwards the growth projections. That gives the lie to the claim that its strategy is working.

The Government has also had to revise upwards the unemployment projections, so the Tánaiste should not come in with his own fairytale that all is well, because it is not. By the way, nobody ever contested the fact the budget deficit had to be tackled. We produced proposals to do precisely this, but in a different way.

Darby O'Gill economics.

Whatever about the Tánaiste's fairytale-----

It was some fairytale on "Prime Time" the other night.

-----it is no fairytale for carers because home help hours have been cut by more than 1 million hours in the system in 2012 and prescription charges have increased, but the salt in the wound was the mean cut to the respite grant of €300, or almost 20%, which would yield a saving of €26 million.

The Tánaiste boasted about the breathing space, so he should use it, and when he stands up again I ask him please to address the issue of carers and the respite grant. It might interest him to know carers have launched a campaign, Give Carers a Break, which sets out in very stark terms the effect this cut to the respite grant has had.

We cannot go through it today.

The campaign video features Carolyn, who cares for her mother, and Antoinette and Sam, who care for their daughter and sister respectively.

Thank you, Deputy.

They set out in very clear and real terms - there are no fairytales - the effect this particular cut to the respite grant has had on their lives.

They have cut back on heating and food. This is real material damage to the lives of carers and those for whom they care.

I ask the Tánaiste very simply to reverse this particular cut. It is only one of the cuts which has hurt carers.

Thank you. I call the Tánaiste.

For €26 million I ask the Tánaiste to reverse this cut, which I do not believe he could ever stand over, even in the budget.

I ask Deputies to respect the Chair and the time restraints I must impose.

I do not need any lecture from Deputy McDonald-----

It was a question.

-----on the important work carers do.

That is why you have cut them, is it?

I have some personal experience of it, so please do not give us this type of pompous lecture.

Then stop the cuts.

The work carers do is hugely important and valued, which is why the Government, unlike its predecessor, has published a carer's strategy. This is why Ministers in the Government work to support carers and will continue to do so.

I am glad to hear Deputy McDonald state, and it is the first time I have heard it from Sinn Féin, that she now accepts the target of reducing the deficit to 3% by 2015-----

Then your listening skills are poor.

Where have you been for the past three years?

-----because Sinn Féin has not been saying this.

We have. We do it every budget cycle.

It will be interesting to see what proposals come from Sinn Féin in the run-in to the 2014 budget. I look forward to seeing them.

What about the respite grant?

I have answered the Deputy on the respite grant.

No, you have not. So your answer is that you will not reverse it-----

I have answered.

-----and you understand the work of carers.

Would Deputy McDonald mind addressing her remarks through the Chair? It is the normal courtesy, in case she does not know it, which exists in the House.

A Cheann Comhairle-----

Resume your seat.

Can I raise an issue?

No, you cannot. Resume your seat.

I presume when we ask a question-----

Resume your seat, I said.

-----that we can expect an answer.

I am not responsible for the replies.

I asked specifically about the respite care grant and the Tánaiste specifically did not answer.

I will not ask the Deputy a second time to resume her seat.

Will the Ceann Comhairle ask the Tánaiste to answer the question?

Deputy McDonald is expected to respect the Chair, like everybody else.

The Tánaiste did not answer the question on the carers.

Yesterday, the heads of the protection of life during pregnancy Bill were discussed in the House. It was condemned by some as a positive compromise and condemned by others as not going far enough. I suggest both approaches are seriously flawed. The very content of the Bill in its current form undermines the very rights it sets out to protect.

Who wrote that for you?

Did Deputy Clare Daly help with it?

I waited with the greatest respect and I hope to get respect. I want to speak on behalf of people who have a different view.

Please, allow the Deputy to put his question.

On a point of order, this goes on all the time and it is wrong.

I will deal with it. I ask Deputies to stay quiet.

You are not all-----

Stay quiet, Deputy Lawlor, please, and I will not ask you a second time.

It never happened when Deputy Martin was in government.

What is going on is wrong. Deputies should be allowed have two minutes to ask a question. The Deputies opposite are shouting down democracy.

I ask Deputy Martin to please allow me do my job-----

I will indeed, but with respect, it is not what is happening.

-----and he can do his.

They are interrupting all the time.

I had to write to the Ceann Comhairle last week. He does his best always, but we are not being allowed to speak and it is not fair on us over here.

I am looking after it.

Go raibh maith agat. The Bill does this by framing proposed legislation which completely ignores the weight of medical evidence which demonstrates beyond reasonable doubt that abortion as a treatment for suicide is harmful to women and favours an ideological position not supported by facts. It is also proposed that certain hospitals will be designated to perform these so-called terminations. What will be the position if the hospital refuses to perform these terminations? What if it conflicts with the established ethos of these hospitals as set down in many cases by contractual agreements between the HSE and the hospitals? The Bill contains a conscientious objection clause for individuals, but will the same apply to institutions which cannot in conscience perform these procedures? I suspect this is one more demonstration that the Bill is profoundly unworkable and risks an enormous level of Government intrusion into the practice and integrity of our health system. The entire situation speaks to the lack of equality between the life of the mother and the child as laid out in Article 40.3.3° of the Constitution. The Bill also requires that the abortion can only be granted in the reasonable opinion of two psychiatrists that the risk can only be averted by this procedure. It is asking psychiatrists for a reasonable opinion despite the fact the majority of them have stated this is unreasonable.

As the Deputy and the House know, the Government has approved the heads of a Bill which is intended to protect the lives of women during pregnancy. Every year, thousands of women in Ireland give birth. It is a happy occasion and a cause of great joy. However, there are occasions when things go wrong, and in these cases women are entitled to know they will get the treatment which will save their lives, and the doctors who treat them also need to know their position is clear when they take action to save a woman's life during pregnancy. The heads of the Bill will be referred to the Oireachtas Joint Committee on Health and Children. I invite Deputy McGrath to put the case he has made and the issues he has raised to the committee and take the opportunity when the Bill is before the House to make the case he has made. There will be a full debate on the Bill in the House. There will be a full discussion on the heads of the Bill at the Oireachtas committee and there will be plenty of opportunities for Deputy McGrath to make the points he has made and have them responded to by the Minister.

I am a member of the health committee and I was at the meeting this morning. I will make these points at the committee also. I hope the committee will not just be a stalking horse for the legislation and that we, and those who come before us, will be listened to. What persuaded the Tánaiste to include a provision for psychiatrists to arrive at a position which they have stated is not supported by evidence? In practice, will this not seriously limit the pool of mental health professionals who will participate in such a process and thus leave the door open to the tiny minority who believe abortion will serve the interests of women?

The evidence from every other jurisdiction in the world has demonstrated time and again that despite the best intentions of legislators, and regardless of the alleged restrictiveness of legislation, no government has succeeded in preventing an abortion on demand situation from occurring once the principle of targeting innocent human life is accepted. I say this honestly. An appeals mechanism on behalf of suicidal women refused an abortion is contained in the heads of the Bill. Since the unborn child has equal right to life will there be room for an appeal on behalf of the unborn child in the event two psychiatrists in the teeth of the relevant evidence sign the child's life away? Will the Tánaiste give a commitment to this in the interests of equality?

When the Committee on Health and Children held its hearings on this issue earlier this year, it did so in a very dignified and reasoned way. I expect that, in considering the content of the heads of the Bill, the committee will address it in the same reasoned way. As I said yesterday, it is important that this debate be conducted in a reasonable manner. Deputy Mattie McGrath has a point of view on the Bill and he will have plenty of opportunity to air his views at the Committee on Health and Children, of which he is a member, and in the debate here in the House. Those are the appropriate places for the issues he has raised this morning to be teased out in detail.

The Bill has been worked on for some time and is balanced and reasonable. It is within the confines of the constitutional provision, the judgment in the X case, and the judgment given by the European Court of Human Rights. There are obviously details that have to be, and will be, discussed here on the floor of the House and at the committee, including the issues that Deputy McGrath has raised this morning. In fairness, that is probably the best place to have that matter discussed. That is what the Oireachtas is for - to debate and discuss the detail of legislative proposals. I expect there will be plenty of opportunity to have the issues which Deputy McGrath raised - which related to detailed provisions in the Bill - fully teased out. There will be plenty of opportunity for that to be done.