Thousands of people are leaving the health insurance market on a monthly basis. Up to 6,000 people a month are cancelling their health insurance policies. By the end of 2013, we estimate 140,000 people will have cancelled health insurance. The bottom line is Government policy is driving people out of the health insurance market. Families and individuals can no longer afford policies. We only have to look back to the budget and the Minister for Finance's decision to reduce significantly tax relief on health insurance policies, which had a huge impact on many people. He pretended that the measure was for gold plated insurance policies but we now know that was an untruth as it affects up to 90% of policies. An additional bill of €30 million will flow from the decision to charge patients with health insurance for using public hospital beds and that will lead to another significant increase in the cost of health insurance. Earlier, the Minister for Health made an announcement, about which we learned through the media, that a 15% stamp duty increase would be levied on policies. Cumulatively, in the short space of two months, the Government has increased the cost of the average health insurance policy by €400. In many cases, the amount will be higher.

The Taoiseach and the Government knew when they took their budget decision on health insurance that this increase was coming down the road in the context of risk equalisation. They knew that when they decided to go heavy on reducing tax relief on insurance and the utilisation of public hospital beds. Was one increase not enough given all that is happening in the health insurance market? Why is the Taoiseach hammering hard pressed families who are of the view that they are paying for everything anyway without this additionality? Will he change policy and reverse the budget decision to reduce tax relief on health insurance policies and restore the relief to its pre-budget level?

It is never an easy position to have to draft budgets in an area like this given the circumstances in which we find ourselves. I detect from the Deputy's question that he has changed policy in this regard. It appears that he is advocating the abandoning of risk equalisation and community rating.

Freagair an cheist.

No, I did not say that. I referred to budget tax reliefs.

If that is what the Deputy is saying, he is denying reality in that 20,000 people a year become 65-----

Deputy Martin asked a straight question.

I said nothing about that.

The Deputy seems to be implying that there should be a change in Government policy, which would abandon older people to be manipulated by health insurance companies because they, naturally, might well have higher costs in terms of their medical requirements and the treatment they need. The clear objective of the Minister for Health is to reform the health service to deliver a single tier service in a way that allows for older people to be charged the same rate for the same policy as people who are much younger. That is community rating delivered through risk equalisation. If the Deputy is advocating a change in that, let him say so.

He did not. Be honest for a change.

It is clear we should not underestimate this issue. Every year, 20,000 people reach the age of 65, which equates to 3.3% annual growth compared with overall growth of 0.5%. In 2003, only 13% of those who had health insurance were aged over 60. That increased to 15.9% in 2009 and to 19% in 2012. It is a fact of life that our population is ageing and we will retain community rating and not have a situation where older people in our society are manipulated by health insurance companies that will seek to present health plans that effectively abandon the older population. We cannot and we will not do that.

Even in these straitened times, the Government still provides €400 million in support to policyholders through the tax system and €400 million in a subsidy to the public beds system because we do not charge for the full economic cost of beds in hospitals. While these things are never easy, we must and will maintain community rating and risk equalisation in order that the older people in our society are not abandoned.

Hear, hear.

The Taoiseach chose to ignore the question I asked. Will he change policy on the budget decision the Government took to reduce tax relief on health insurance and restore it to its pre-budget level?

No.

It costs money.

I never said anything should be abandoned in regard to community rating. The Taoiseach deliberately threw that out there to distract and to go down a cul-de-sac. That is a very dishonest presentation by him. That is fair enough; we are used to that.

The bottom line is if he is sincere about maintaining community rating, the haemorrhage cannot go on. Government policies are driving the haemorrhage from the system. A total of 64,000 people left the health insurance market in 2012. It is estimated 75,000 will leave by the end of 2013. Does the Taoiseach honestly think that increasing fees by reducing tax relief and charging for the utilisation of public beds by health insurance holders, even though they pay their taxes, will help community rating? Anybody who knows anything about the health insurance market is talking in terms of a death spiral, which means that when younger, healthier policyholders are taken out of the system, the burden on the older policyholders will increase to make it untenable. The centre will not hold if the haemorrhage of people from the health insurance market continues. In the meantime, the Government is making life unbearable for hard pressed families through this unfolding, incoherent, ad hoc policy.

The Minister for Health said he did not know that the Minister for Finance was going to do what he did on the taxation side of the budget and he was not consulted. That reveals the incoherence at the heart of Government policy on health and health insurance generally. Will the Taoiseach reverse the budget decision to reduce tax relief? By doing so, he would give much needed relief to people and give them some chance of holding on to their health insurance policies.

The answer to the Deputy's question is "No". That is the second time he has quoted Yeats in the House in the past fortnight, which I think is good. The newer insurers do not have older people. The Deputy cannot have it every way. Newer insurers cannot just expect to have younger people who, naturally, require less medical attention than older people.

That is what community rating is about.

I am glad he has reversed again. He started with an implication about the abandonment of risk equalisation and community rating.

I did not. Do not be dishonest.

Even in his own days as Minister for Health, the Deputy adhered to that. That is something we have to support.

The Taoiseach is having a Roscommon moment.

I will bring the Deputy to Roscommon. I am sick and tired of Opposition Members taking cheap shots.

We cannot have a situation where older people are abandoned and health insurers can present plans that are not suitable for older people.

Community rating and risk equalisation are a very important part of this for older people. Some 20,000 people reach 65 years of age every year.

The consultative forum set up by the Minister for Health to deal with this will report before Christmas and we will debate the report here. We will talk about retaining young people and young families, which are hard pressed in so many ways within the health system-----

The Government is driving people out of that market.

------and also how the health insurance companies can reduce their costs.

The Government is increasing the costs.

Why is it that in 2013 we are still paying the same charges for procedures which 20 years ago used to take quite a long time and required days in hospital but which can now be done in a relatively short time? Cataracts are now dealt with in 20 minutes. Why is it that the costs are still the same? What is going on here? Why is it that I hear so many stories every day from people who go through the health system? The charges seem to be very erratic, to put it mildly. There is a requirement on us all to debate the report of the consultative forum and the recommendations therein, which will be available in four to five weeks.

Deputy Martin will recognise, as a former Minister for Health, that there is clearly a need to reduce costs. There is no extra money coming into the Exchequer as a result of this. This money stays in the pool and extra credits are given to those who are over the age of 65. That is why it is very important to retain the community rating and the risk equalisation system.