Hell hath no fury like a Minister scorned

The introduction of universal health insurance is the centrepiece of the Government's plans for reforms in the health service, and Minister for Health James Reilly has indicated that the bringing in of such a scheme was one of the main drivers behind him going into politics.

In essence, the move is aimed at replacing the existing two-tier structure in Ireland, which is divided between a public healthcare system and a private market accessed by nearly two million people, with private health insurance.

Under the Government’s plans everyone would have to have insurance for a standard package of benefits ,with cover to be provided by competing insurers. Additional add-ons could be purchased.

Insurance payments would be related to ability to pay, with the State paying the premiums for people on low incomes and subsidising those for middle-income earners.

Over recent weeks the Department of Health has circulated a draft White Paper within the Government proposing how this new system would work in advance of the issue going to Cabinet.

Over recent days it emerged that the Department of Public Expenditure and the Department of Finance had some reservations. Last Wednesday, the Department of Public Expenditure sent a letter to the Department of Health effectively rejecting the White Paper proposals as unaffordable.

The letter said the White Paper did not present detailed and costed proposals, did not outline the services to be covered under universal health insurance and did not set out cost-effective pricing mechanisms and costed proposals for funding universal health insurance.

However, potentially most damaging politically, the letter contained an appendix which asserted to detail how the proposals would affect different population groups.

Medical cards
The letter maintained that people with GP-visit cards or those with no medical card or private health insurance could have to pay up to €1,672 – or €32 per week – for the standard package of benefits under universal health insurance.

It suggested medical card holders could have to pay up to €700 per year for drugs, while it also claimed that long-term illness card holders faced a bill of up to €2,000 per year in drug costs.

The letter also maintained that employers could have to meet €7 billion in costs for meeting employee contributions.

The reaction in the Department of Health was one of fury and it has rejected the claims out of hand.

Senior health sources argued the letter could not have been written without the imprimatur of Minister for Public Expenditure Brendan Howlin, and that it had the aim of killing off the universal health insurance project.

Informed health service sources condemned the Department of Public Expenditure for setting out “fantasy numbers” in its letter, misreading the White Paper proposals and criticising issues that were not included at all.

Health sources completely rejected that the proposals could force medical card recipients to pay €700 per year for drugs, and argued that drug costs of the lowest income groups would be met by the Government, and that it was not envisaged that people on medical cards would lose any entitlement.

Health sources also said it was untrue that business faced any additional costs.

It said business faced costs under universal health insurance in the Netherlands but this was not envisaged under the White Paper proposals.