Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Wednesday, 11 Dec 1974

Vol. 276 No. 9

Private Members' Business. - Health Contributions (Amendment) Bill, 1974: Second Stage (Resumed).

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

This Bill aims to raise £3½ million extra, a tiny fraction of the cost of the health services. The Minister said it is a mere 10 per cent of the cost of providing limited eligibility classes and their dependants with hospital and specialist services, maternity and infant care services as well as drug subsidy. This £3½ million represents less than 3 per cent of the total hospital and specialist services cost. The sum for which the Minister is asking is so tiny that I cannot understand why he is asking for it. I cannot understand why he should think fit to burden the working classes with this weekly imposition. It is an unfair burden in these days of rising prices. It is unfair for many reasons. What is not obvious is the fact that the upper income group are actually having their hospital costs subsidised by the State, subsidised by those who will have to bear this burden of a health contribution. To me, this is deplorable.

Is the Minister aware that the cost of a hospital bed to a person in the upper income group bears no relation whatever to the actual cost to the State of such a bed? I will give a concrete example: the weekly cost to the State of a bed for a patient in Our Lady's Hospital in Crumlin was £109 last year. This year it must be very much more. A private patient in the upper income group pays a mere £35 to £45 a week for the same bed. The upper income group patient is subsidised to the tune of nearly £70 per week. That is something we do not seem to realise. I go so far as to say that the middle income group patient is subsidising the upper income group patient under our present system of health services. This is quite wrong socially.

Who is subsidising whom? We are talking about subsidising the middle and lower income groups, but actually the reverse is happening. The Minister and his Department obviously approve of this inverted socialism.

Hear, hear.

These are some of the finer nuances. I describe the Minister's imposition as a discriminatory tax on a particular section of our community. There should be fair play and this is not fair play. The middle and lower income groups are experiencing a very rough time at the moment with spiralling prices. Many people are suffering serious privation. There is a ground swell of protest which is growing in volume every day. We should heed the fact that there is a crushing burden already on a certain section of our community. We all know it is the last straw which breaks the camel's back and this parlous situation is being reached. This very minor sum should be found from the Exchequer by way of taxation. It should not be an imposition on a section of the community least able to bear it.

How much is the sum imposed?

Deputy O'Connell must be allowed to develop his speech without interruption.

I am not a dramatist. I am a realist. Two bob a week— ten new pence.

Deputy Coughlan must cease interrupting.

The price of a bottle of lemonade.

Would the Deputy know what that cost?

I know a little more about it than the Deputy does and, if the Deputy wants to bring me into the ring, I am his man here and now.

Order. The Chair will insist on this being an orderly debate. There must be no further interruptions. If the Deputy cannot listen to another speaker he has his remedy. There is a way out for him.

As I said, this imposition will be a heavy burden. I disagreed with it in 1971 and made clear the reason why I disagreed. At the moment there is a serious inadequacy in our hospital services. I tried to get a patient with a serious eye condition an appointment to have her eyes examined and I was told that the earliest an appointment could be made was next February. If people are asked to pay to cover limited eligibility then we must make sure they get that to which they are entitled. If we are going to take in an extra £3½ million then let us put it to some use, such as improving out-patient services and bed services. These services are not being provided and people are not getting what they are entitled to; there is a serious problem with regard to these services. I can say that quite honestly.

It can all be solved on a concessional basis. That is how we have solved it in our health board.

The Minister said in his introductory speech:

It is evident that the provision of limited eligibility services at 15 pence a week and £7 a year has been exceptionally good value and compares very favourably with private health insurance schemes.

This limited eligibility was provided before. We had it under the 1953 Health Act. We cannot talk in terms of this providing value. We can talk about the £700,000 which was the cost of the beds. The patients paid 10s. a day. We had these services for years. This 15p a week is not good value.

I notice that the Minister has not taken sides on the question of whether the flat rate contributions are regressive because they do not take into account the person's income. The Minister has not given us his views on this. My views on it are very clear. It is wrong to apply a flat rate contribution when people have different incomes. It is wrong that it should be applied uniformly across the board. The Minister's predecessor assured this House that the Revenue Commissioners had set up a highlevel working party to plan the change-over to a graduated scheme in the health contributions. We were told that in June, 1971. That is three years ago. Will the Minister tell the House what has happened in regard to this working party? Have the plans been formulated? Are they about to be implemented and, if so, when will they come into effect? Why were they not incorporated into this Bill?

I am pleased to note a statement by the Minister that he proposes to begin shortly a review of the present system of financing our health services. This is a very good idea. It is long overdue. I commend this move by the Minister. I would ask him to consider now setting up an all-party committee of the Dáil to review and examine the various aspects of the health services and to see what can be done. The Minister could take that initiative now. This would do what Deputy Coughlan has suggested, that is, take health out of the area of politics. We have too few Dáil committees. If the Minister did this it would be an excellent initiative. It would be a major step.

Surely the Deputy does not think Fianna Fáil would take politics out of anything?

The Deputy is an ornament to any party, any city, any constituency.

I have been representing my constituency for many a long day. I am an alderman in Limerick. There is no Fianna Fáil alderman in Limerick.

Deputy Coughlan, please resume your seat.

"Ornament" is the word I used.

Go back to the people of Limerick and they will tell you.

If the Deputies do not desist, I will order both of them out of the House. I am referring to Deputy Coughlan and Deputy G. Fitzgerald.

I am on the defensive.

Please resume your seat.

I hope the Minister will give serious consideration to that suggestion. If such a committee were set up we might see some positive work done. An all-party Dáil committee was set up some years ago by the then Minister for Health, Mr. MacEntee. It examined the various aspects of the health services to see how they could be improved. If we set up a committee now, we might come up with some very good proposals for altering the structure of our health services, and decide how they should be financed in the interests of the entire country without party interest being involved.

I have been critical. I hope constructively. I am aware of the warning in the Minister's speech that there will be little real growth over the next two years and that this will have serious implications particularly in relation to the growth in tax revenues. This is a serious warning and we should pay heed to it. This Bill to raise £3½ million should be looked at again. It should be a temporary measure only. If what I read is true, there is a serious breakdown in the operation of the scheme in relation to the £7 a year being paid by the farming community. I should like to know what percentage of the eligible farmers are paying it. I notice that in the Western Health Board area the percentage is very low. Is it worth pursuing if the level of co-operation is so low? We should be told these things. I should like the Minister to spell out in greater detail the review he has in mind and I should like him seriously to consider my proposal. Because of our stringent economic situation at the moment, we have to accept this Bill. I do not think it is the answer. I have expressed my views and I hope the Minister will accept them in the spirit I have offered them.

This is a small amending Bill covering a very small section of the Health Act. I would urge the Minister to deal with the defects in the health services which, as I see it, mainly concern the dental and ophthalmic services. The people in the lower and middle income groups have their difficulties and I regret that they cannot get some subsidy for their teeth under this Bill. The other aspect to which I would like to refer is the £60 valuation. It is correct to say that this £60 valuation was introduced when the financial level was £1,200 but the latter figure has since gone to £1,800 and to £2,250 for a particular section while for the farmers it remains at £60. There is something unjust and unfair in this.

It has been pointed out to the House that this amendment is based on Fianna Fáil legislation but that legislation was aimed at providing for the most needy. It is difficult to see how the Minister, who stated that our finances are limited and that there will be difficulties, cannot continue to extend the hospital services to the upper income group.

Debate adjourned.