Reilly says everyone will be a winner under UHI but sceptics remain

Everyone will be a winner under the Government's ambitious system of universal health insurance, Minister for Health James Reilly claimed yesterday.

He promised there would be equal access to care for everyone regardless of means, costs would come down as greater efficiencies were introduced and private rooms would be the norm in all new public hospitals.

He said premiums would be affordable as a result of generous State subsidies, most doctors would not lose out financially and for those who currently pay for health cover, the carrot would be the provision of free GP services.

However, there is a long way to go from the launch of the Government’s White Paper on universal health insurance to having it actually in place in 2019.

In the meantime every vested interest, not least the general public, will try to work out how they would fare under the proposed new model.

For while the current two-tier system is widely criticised there are many people quite comfortable with the status quo.

Many hospital consultants hold salaried positions in the public health system and have an additional lucrative private practice outside it. There is a whole industry of private hospitals, while at the same time health insurance companies continue to make profits. And while more than 200,000 people have left the market, there are still 1.5 million people covered by private health insurance.

For many the motivation is the access it guarantees to treatment and doctor of choice within a reasonable timeframe. For others a private room in comfortable surroundings is important.

Shake-up
Dr Reilly rejected suggestions the middle classes would see their existing system of healthcare provision diminished under his reforms.

However, people who currently have health insurance cover are going to have to be convinced that they will not lose out in the shake-up.

Separately if the current dispute with GPs over free care for young children is anything to go by, hospital consultants will look carefully at the Minister’s assurance that their incomes would not be hit.

As the public consultation process gets under way on the UHI plans, it is likely that doctors, hospitals, insurance companies and patient interest groups will all seek to influence the shape of the new model.

Separately, the cost of the new initiative will also be crucial.

Dr Reilly argued that premium costs under the new scheme, if it was in place today, would probably end up being less than the current private insurance average of €920 per person.

He promised the Government would pay the premium for those with medical cards with a tiered system of subsidies introduced for those above that income threshold.

However, the exact cost of the annual premium for the standard basket of cover will not be known until it is finally determined what exact range of services it will contain.

The Department of Public Expenditure and Reform suggested during the internal Government rows about the Minister for Health's plan, that the standard scheme could cost €1,672 per person.

Level of subsidies
It does not take a genius to work out which figure critics of universal health insurance will highlight. Separately, the level of subsidies to apply will not be known until a later date. Nor will it be determined whether the estimated €400 million in tax breaks on health cover currently provided will be reallocated to underpin the universal health insurance model.

Dr Reilly and his advisers did well to win the argument in Government about the principle of universal health insurance. However, his opponents have not gone away.

Next year when the time comes for choosing a specific basket of services to be funded, it is likely that the same arguments will break out again.