On many occasions in this House I have raised the issue of private health insurance and its costs, not just after the most recent budget with the reduction in tax relief on policies that the Minister for Finance, Deputy Noonan, called "gold plated". Last week his Department confirmed these changes will affect 1.1 million policies not the 500,000 originally estimated. That was a major hit for those prudently paying for private health insurance. Nearly 200,000 people have given up their policies in the last three years because they cannot afford it.

Yesterday the Minister for Health, Deputy James Reilly, announced an increase in the stamp duty on private health insurance cases by way of risk equalisation. That means an increase in policy premiums of approximately 15%. Most renewals are coming up between now and January and the Leader and everybody else here will have had people in contact about the increases in their health insurance policy costs. Laya Healthcare managing director Mr. Dónal Clancy said, "Rather than protect the most vulnerable patients as outlined by the Minister, the levy hike will only increase the burden on an already struggling public health system.” GloHealth chief executive Mr. Jim Dowdall said, “It is farcical, bizarre and absurd that the Minister continually calls on health insurers to drive down costs when Government policies have been the overwhelming driver of rising premiums in recent years.” Mr. Dermot Goode of Cornmarket Healthcare Division said, “Consumers are going to get clobbered," and that is a fact. Mr. Goode said the changes announced by the Minister would have an inflationary effect, even though the stamp duty was not levied on consumers, because insurers are likely to pass on the cost increases.

I raise this issue in the context of the much heralded universal health care the Minister and Government keep talking about. We have no White Paper or roadmap; we do not know where it is at. All the public and I see is discretionary medical cards and over 70s medical cards being removed and private health insurance premiums going through the roof forcing thousands of people to leave the system, which will put a further burden on the public health system. This is without the Minister, Deputy James Reilly, publishing the HSE service plan, due next week. The situation is going from bad to worse and is at crisis point. I wonder if the Government has any knowledge or feeling for what is happening. We will have further tens of thousands of people giving up private health insurance policies. They will come into the public health system, which is already creaking. The chief executives of the main hospitals in this city have already said they are at breaking point. Where are we going? The Minister for Health must make a statement on where he is going with universal health care. Are all these things he is doing part of the jigsaw to get us to the Dutch model? The Dutch are unpicking their system and moving back from it. I do not understand where the health plan is going.

Has the Leader a date from the Government on when it will introduce free GP care for those aged five years and under? The Minister announced this as a cloak. He said he would bring it in but there was no date and no consultation with the Irish Medical Organisation or the GPs. Incredibly, the week before last, he said he would introduce free GP care for all by 2016. What planet does he live on? He will have free GP care for all because nobody will have private health insurance. I am proposing an amendment to the Order of Business that the Minister come to the House for one hour to make a statement on universal health care and the situation with regard to private health insurance cover. It is far too serious for us to be raising the issue every morning and getting no statement from the Minister.

I have been seeking a debate on universal health insurance with the Minister, Deputy James Reilly. The Leader has said he will ask the Minister to come here. It is unreasonable to expect him to come here today, but it would be good to have the debate in order we can hear from the Minister about the steps that have been made towards universal health care such as the introduction of free primary care for those aged under six years. It would be good to hear from the Minister in detail about that in the near future.

Following the contributions many of us made on yesterday's Order of Business I welcome the news from the meeting of EU leaders that there is a very serious pledge to tackle youth unemployment. A funding stream of €6 billion in the EU fund specifically to implement the youth guarantee will be made available from 1 January 2014. As I said yesterday, the Minister for Social Protection, Deputy Joan Burton, has indicated she will come into this House to discuss with us in detail her plan for the implementation of the youth guarantee in Ireland. It is very important to see the Taoiseach committing to the four-month guarantee, that is that no young person would be on jobseeker's allowance for more than four months without having access to a work placement, traineeship or a place in further education and upskilling. It is very important that we have that debate.

I commend Ms Kitty Holland for her excellent but very harrowing piece in The Irish Times about the plight of the tracheotomy babies, children up to three years of age who are in Crumlin hospital for seemingly unnecessary periods awaiting a home care package from the HSE. It is hard to know what is the reason for this, but it would be good to have a debate with the Minister for Health on this issue or to hear from him why the HSE cannot make available the funding to enable these young children and babies to be brought home. There is no economic reason for this. It is far better economically, as well as emotionally for them and for their families, to have them cared for at home. In each of the seven cases Ms Holland described the parents have been trained to offer the 24 hour care needed and all that is required is for the home care package to be made available. It is a very serious matter if these children are being kept in a hospital longer than they need to be and it would be good to hear from the Minister as to why that is.

I second what Senator Darragh O'Brien has said about health insurance. We have known for a very long time that VHI has hidden behind its alleged-----

Is the Senator seconding the amendment?

Yes.

We have known for a long time that VHI has hidden behind its older profile of patients in order to impose levies on its competitors. This is another bailout today. I have raised several times in the House the Milliman report, which states:

While it is undoubtedly true that VHI has an older and (arguably) sicker population than its competitors, we believe limited focus has been given to utilisation management and investing in ways to manage claims that can yield savings regardless of the risk profile of its population. ... In all our discussions with VHI, there was minimal emphasis on issues around managing the quality of care given to patients and hence reducing claims cost by limiting inappropriate treatment with no proven medical benefit. Our experience in other markets and our data analysis leads us to believe this is likely to be a source of considerable potential savings.

We have relieved VHI of these efficiencies by continually asking the other companies to bail it out. While this report is heavily redacted, we see on page 31 that it states VHI’s admission rates are too high and there is an average length of stay of 10.6 days when the report estimates it would be 3.7 days in a well managed system. When we raised these points, the Government side said the McLoughlin report would answer some of this. However, it appears the Minister has acted before the McLoughlin report. We need to debate that urgently in the House. McLoughlin, who had previously implemented interesting reforms in local government, was to address these issues. The Leader has agreed that the use of the phrase "gold-plated" in the budget was inappropriate as over 90% of people will pay more because of the wish to clamp down on gold-plating. The gold-plating is in the VHI organisation. The consumer is not protected by the Health Insurance Authority which has been captured by the VHI company. If we have universal health care in that system, VHI will have the ability to tax everybody in the country. Now, it just imposes taxes on the rest of us who are not members of VHI. It is an entirely inappropriate way to run the health insurance market. We have been condemned in the Irish courts and the European courts. We need to find ways other than continuously supporting VHI with money transferred from its competitors. There must be better ways to run the health insurance system. We were hoping Mr. McLoughlin would have a chance to report on these issues and we need to debate what he has to say. However, it seems to me that the permanent government in the Department of Health will always defend VHI when it badly needs some competition.