On entering office in 2011, the centrepiece of the Government's health policy was the introduction of universal health insurance. It has taken three years for the Government to publish a White Paper on the matter, which it did yesterday. Unfortunately, however, that White Paper has given rise to more questions than it has answers in respect of universal health insurance. It does not, for example, indicate what will be the cost of universal health insurance for individual families and the State or what health services will be covered. Neither does it outline the income threshold that will determine whether someone will pay his or her own health insurance or whether the State will pay it for him or her. It is becoming increasingly clear that universal health insurance is going to be another tax on middle Ireland. It will be a further tax on working families which have already been put to the pin of their collar to get by financially. In essence, it will be a tax on the people who already pay for everything in this country.

Reading between the lines of what is contained in the White Paper and parsing what the Minister for Health, Deputy Reilly, said yesterday, it seems quite clear that the current tax relief on health insurance policies from which people benefit is going to be cut and will probably be phased out altogether by the Government. When one considers that this will be in addition to the complete abolition of mortgage interest relief by 2017, it is clear middle income families are looking at a double whammy of tax hikes. The elimination of tax relief on health insurance policies and the abolition of mortgage interest relief will give rise to an increase of approximately €700 million in the amount of tax paid by middle income families during the next five years.

The Minister for Health has stated that no one will be obliged to pay anything extra under the new system of universal health insurance. There is no basis whatsoever for that assertion, which has been contradicted by the assessment carried out by the Department run by his colleague in government, the Minister for Public Expenditure and Reform, Deputy Howlin, in respect of universal health insurance. When will families be presented with a clear picture of what universal health insurance is going to cost them and when will we be made aware of what will be the exact role played by health insurers in the context of their control of the health service in the future?

I thank the Deputy for his questions, some of which I will be happy to try to answer. I will not be able to answer all of them because the overall position will not become clear until the consultation process has been completed.

Labour was the first political party in Ireland to propose universal health insurance - based on multiple insurers - as long ago as 2001. At that stage, the Deputy's party ridiculed the concept in its entirety. Our spur then - as now - was the inequity and inefficiency of Ireland's two-tier health system. The Labour and Fine Gael parties believe that a person's access to medical care should be determined by his or her medical needs, not the money in his or her pocket. Quite frankly, that is the difference between the Deputy's party and the current Government.

Not true.

Fianna Fáil was in government for a long period and it was vehemently opposed to the idea of universal health insurance.

We still oppose it.

Which means Fianna Fáil supports the two-tier system.

No, it does not.

Yes, it does. The unfair two-tier system that has determined the course - and many of the problems - of our health service for many years is simply not working. It does not work for people who cannot afford private health insurance or who find themselves at the back of the queue for consultants' appointments. It does not even work for those hard-pressed families which struggle to pay for private health insurance, only to find - as every Member of this House who pays into the group scheme knows - that their premiums are increasing each year while their benefits are going down.

When the Labour Party first proposed universal health insurance as a means of reforming both access to the health services, and how those services are funded, public health spending stood at €7.2 billion. Six years later, in 2007, it had grown by €6.5 billion. It is, therefore, the most expensive in our entire domestic budget. As the Deputy is aware, reform is never easy and it has been made harder by the fiscal crisis which we have all been obliged to endure and which continues. The boom demonstrated that one can keep investing money in a broken system but that if one does not fix the root of the problem, very little will change. This is the first Government to face up to fixing the root of the problem and to agree to develop a universal, single-tier health service. It is also the first Government committed to a system that will guarantee access to care based on need, not income. Furthermore, it is the first Government to commit to universal general practitioner care because that will incentivise the delivery of care early and, therefore, more efficiently. In the coming weeks the Minister of State at the Department of Health, Deputy White, will bring forward the legislation necessary to allow for GP care, without fees, for those under six years of age.

The publication of the comprehensive White Paper on universal health care is an essential step in this direction. There are many questions which, by definition, cannot be answered in an optimum way until we have completed the consultation process. As a result, it is not possible to provide answers to the questions the Deputy posed with regard to what might be the cost of universal health insurance to different categories of people three or four years from now. There must be clarity. The purpose of publishing the White Paper is to facilitate an informed consultation process. People in this House and throughout the country are concerned about the quality of care available, on the one hand, and the crisis affecting the health service, on the other.

I fully support the idea of a universal health care system-----

I am glad to hear that.

-----in which access is based on clinical need. What I do not support is handing over the future of the Irish health service to private, for-profit health insurers, which is precisely what lies at the heart of the policy in this regard. I would have thought this is the complete opposite to what the Labour Party stands for. The fundamental question which arises relates to circumstances where a person will - under the proposed system - require access to the Irish health service. Who will determine the nature of and terms relating to that access? Will it be a doctor or will it be a private health insurance company? All the indications point to the fact that those in the private health insurance industry will make the decisions to which I refer.

There is another way to proceed, namely, by establishing a public health system fully funded from taxation. That is the alternative.

Hear, hear.

The bottom line is that policy in this area is going in completely the opposite direction to what the Government states it is trying to achieve, that is, encouraging increasing numbers of people to take out private health insurance and to ensure ultimately, through the roll-out of universal health insurance, that everyone will be obliged to have this. The Government is driving people out of the market. Thousands of individuals are dropping their health insurance as a result of the Government's policy and the decisions it is making. I refer in this regard to the change relating to the tax relief on health insurance premiums which was announced in the most recent budget. The Government is pulling in opposite directions in the context of its policy. People woke this morning to headlines in the Irish Examiner to the effect that they will-----

We are on Leaders' Questions.

-----be obliged to pay €3,200 for health insurance cover for two adults and two children. That is the reality. Those who will be affected are people who currently cannot afford to pay for private health insurance. I am of the view that they deserve answers.

I think the Deputy will concede that the existing model is not working satisfactorily. While we may argue with regard to why this is the case and about the details involved, I do not believe anyone could say the current system, which is extremely expensive by international standards, is working properly. Whether it is because of his political ideology or his knowledge of the British national welfare system or the American system, he has immediately jumped in, without either reading the White Paper or clarifying the position-----

I have read the White Paper.

-----and made presumptions.

The Deputy has not clarified the situation for himself or established in fact that there is an option for a not-for-profit health insurance model. It was established by the coalition Government in 1954 and called the Voluntary Health Insurance Board. It is a not-for-profit health insurance system. Many of the systems in continental Europe which have a-----

It is a for-profit model.

Sorry, there is a time limit here, please.

I am trying to answer the question Deputy McGrath put to me and he is not accepting it. We have a not-for-profit model insurance company already. Fully 40% of people already have voluntary health insurance. It is not an option to eradicate an insurance model and go back to the British national health system as if we had a clear landscape. We are looking for a system whereby there will be multiple choice within a not-for-profit insurance system to enable us to get the right kind of care and not the kind of high-cost insurance model that exists in the United States.