Coalition rift over universal health insurance

Minister for Health James Reilly is locked in a bitter battle to save his plans for universal health insurance, which have been described by the Department of Public Expenditure and Reform as posing a risk to the State's financial stability.

In one of the most significant disagreements in the lifetime of the Coalition, Dr Reilly has in effect accused Minister for Public Expenditure Brendan Howlin of trying to "frustrate" his goal of introducing universal health insurance.

In a letter sent through a senior official last night, the Minister in essence accused the Department of Public Expenditure and Reform of making “exaggerated and unsustainable claims about the Government’s universal health insurance policy”.

The letter said that while Dr Reilly accepted robust analysis and was willing to clarify certain matters, exaggerated or unsustainable claims “should not be allowed to either frustrate or delay its introduction".

The move came following a letter sent by the Department of Public Expenditure and Reform to the Department of Health on Wednesday which criticised the proposals.

Criticism rejected
Senior health service sources have rejected the criticism out of hand. They have contended that the letter, written by a senior official, could not have been sent without being sanctioned by Mr Howlin. Health sources maintained the letter was unfair and inaccurate.

The Department of Public Expenditure and Reform maintained that Dr Reilly’s proposals “had the real risk of creating a potentially open-ended financial liability for the exchequer and taxpayers”.

It maintained that if experience of universal health insurance in the Netherlands – which it said was the model closest to the Reilly proposals – were replicated here it would add €5 billion to healthcare costs.

The Department of Public Expenditure and Reform suggested that under the proposals in Dr Reilly’s draft White Paper, there would be “large numbers of losers when compared to the current level of services yet these are not highlighted”.

It claimed that medical card holders would have to pay drug costs of about €700 a year.

Perhaps most controversially, it argued that if costs under the proposals were to escalate to the levels in the Netherlands, “implementation of universal health insurance could entail a doubling of the individual cost of [insurance] premia”.

It suggested the standard package of universal health insurance could cost up to €1,672 which the State would pay in full or subsidise for some.

In the letter sent last night, the Department of Health said it would never present proposals that posed a threat to fiscal stability and that its proposals contained stringent cost controls.