Government’s life-time community rating is propping up the two-tier health system that they promised to dismantle
Column from Irish Independent on 13 March 2015
The central plank of this Government’s ‘democratic revolution’ for health was to develop a ‘universal, single-tiered health service, which guarantees access based on need, not income’. This was to be achieved by giving free GP care for all by early 2016 and rolling out universal health insurance in 2016.
There were 87 specific commitments in the health section of the Programme for Government. Being generous in assessing the original promises, just 17 of the 87 health policy choices named four years ago have been achieved. While neither of the central planks of a universal health system will be delivered on time, and perhaps, not at all. There may be free GP care for under sixes and over 70-year-olds by this time next year, but the plans for universal health insurance are no further along now than they were four years ago.
Central to not delivering their numerous health commitments was the absence of clarity of what they were trying to achieve, inherent differences between Fine Gael and Labour in the early stage of this Government, coinciding with cuts to the health budget despite a growing need and demand for services.
Leo Varadkar kicked to touch with James Reilly’s plans for compulsory health insurance when he became the health minister last July. Varadkar’s initial 10 priorities announced eight weeks after taking up office scarcely mentioned universal health insurance. There was a decisive shift in language from universal health insurance to universal health care once Varadkar took up post.
A more recent, detailed list of 85 priority areas for health, 2015 to 2017, published in January by Ministers Varadkar and Lynch has a specific section called ‘implement agreed step towards universal healthcare’. Included in this is 1) the ‘phased extension of free GP cover’; and 2) ‘scoping universal health care’.
The ‘scoping’ is a reassessment of the flawed model of universal health insurance proposed by James Reilly. This will be done once the ESRI produce their costing analysis of universal health insurance (UHI) which was commissioned after the publication of the White Paper on UHI last April. The ESRI is due to report to the minister next month. Then the minister will ‘revert to Government with a roadmap for next steps’.
The third part of the ‘steps towards universal healthcare’ states ‘promoting sustainable, cost effective private health insurance market, through authorising VHI and implementing a package of measures to increase the number of people with health insurance’.
It is a fundamental problem that the minister does not seem to realise that increasing the numbers of people with health insurance is directly contradictory to ‘steps towards universal healthcare’, unless one is planning for universal health insurance. And as far as we all know, there currently is no plan, no clarity, no timetable or vision for a universal health insurance system in Ireland.
Right now people who can afford to pay privately or have private health insurance can access essential diagnosis tests and hospital care quicker than those who are wholly dependent on the public health system. Implementing measures to increase the numbers of people with private health insurance further perpetuates the inequality in our system.
Minister Varadkar’s most recent measure of life-time community rating is even more incongruous. Life-time community rating is about scaring younger people into buying ‘voluntary’ private health insurance before they are 35, with the stick that it will be much more expensive if they delay signing up.
There is no logic to a 35-year-old cut off, what about those under 35? And if the plan is that everyone will have compulsory health insurance anyway, why would anyone sign up now as we are all meant be part of a system, eventually?
People generally do not have private health insurance because they cannot afford it. These people are even less likely to afford it later in life as their premiums will be higher under this scheme. Quite simply this measure exacerbates the two-tier system that this Government set out to dismantle.
Meanwhile, Fianna Fáil, which has always been a health policy- free zone, have begun to make some noises indicating that they too want to prop up the two-tier health system. Speaking to their national councillors’ conference at the end of February, their health spokesman Billy Kelleher said that Fianna Fáil will pursue a ‘taxation-funded health system as it is more progressive’ but they also ‘believe in a complementary private health care system as this gives people who can afford private health insurance a choice while subsidising the public health care system through tax’.
Fianna Fáil have yet to produce their long awaited and first ever health policy document, but Kelleher’s recent comments make clear their intent to maintain the status quo, which privileges those with money over those without.
And they don’t seem to realise that propping up the two-tier system through promoting private health insurance is inherently regressive.
In the run-up to the next general election, each of the parties will produce health policies. Will Fine Gael and Labour both still advocate universal health insurance? Or will they shift to the language of universal health care with no intent of dismantling the two-tier health system?
It will be really interesting to see what Sinn Féin comes up with as they have never put any flesh on what their version of an Irish National Health Service would look like.
Others in left parties, new parties and independents will also need to take a line.
Given the early indicators that Fine Gael and Fianna Fáil will be in unison on perpetuating the two-tier health system by promoting ‘voluntary’ private health insurance, there is real space for alternative voices advocating a universal health system.
The next six months should give us some idea of what type of health policies each party will pursue. Surely, election 2016 is the time for political choices that will deliver much needed health reform to give us a decent, equitable health system which is the norm in most other democratic republics.