Universal Health Insurance: James Reilly refused to take his medicine

Experts warned against it and the opposition predicted that universal health insurance (UHI) would never get off the ground.

An independent assessment of ‘Health System Funding in Ireland: Universal Health Insurance and the Options’, conducted by health economist Brian Turner on behalf of Fianna Fáil and published in the summer of 2013, concluded that there was “some evidence to suggest that such a move would lead to higher costs for the Irish public without significant improvements in health outcomes”.

Doctors derided the plan. A White Paper outlining the path to UHI presented at the Irish Medical Organisation’s AGM in April 2014 was described by some of our finest minds as “indecipherable gobbledygook”.

The Department of Public Expenditure and Reform (DPER) was similarly unimpressed — crucially, at a time of constrained finances, the White Paper failed to identify the projected cost of introducing UHI.

DPER went so far as to warn it could pose a risk to the economic stability of the State. As economist Ray Kinsella wrote in this newspaper two years ago, the Government had “no coherent strategy” for UHI, and “no Government consensus” and, “in the light of swingeing health cuts, any commitment seems disingenuous”.

None of this negativity or legitimate concern had any effect on then Minister for Health, James Reilly, who had effectively staked his reputation on pushing UHI through, even if the White Paper forced him to stretch the timeline for its introduction from 2016 to 2019.

To be fair, the ideological thinking driving it was genuine. Reilly’s plan was that, ultimately, everyone would have equal access to care regardless of means in a single-tier system where the State would pay insurance premia for people on low incomes and subsidise premia for people on middle incomes and everyone would have a choice between competing insurers.

But the panic set in as soon as anyone mentioned the costs.

There were leaks from reports suggesting the annual cost of UHI to cover a standard package of benefits for one adult could be between €2,000 and €3,000.

In fact, this was borne out by research published today — the UHI Premia Costing Report by consultants KPMG, which estimates that the average annual premium for a UHI package, before any subsidy, comprising GP care, hospital care, and mental health care, is €2,228 for adults and €773 for children.

While many of Reilly’s Cabinet colleagues ran for the hills at the mere mention of UHI, he ploughed on bullishly — until a Cabinet reshuffle stopped him in his tracks in July 2014.

One of the early actions of the new health minister, Leo Varadkar, was to order a major review of the cost of the controversial policy.

By that September, he was describing the 2019 UHI introduction target as “too ambitious”.

Those with a talent for deciphering this kind of rhetoric could see the writing was on the wall.

And so the reports published this week have finally borne out what many predicted in the past four years — that UHI, as proposed, was too expensive and would not be outweighed by benefits in terms of improved patient outcomes, lower healthcare prices or lower premiums.

As Dr Turner said in his 2013 report, “perhaps it would be better to maximise the benefits of the existing system, while making changes to the elements that are not functioning optimally, rather than embarking on a radical redesign of the entire system”.

And as Fianna Fáil health spokesman Billy Kelleher justifiably pointed out yesterday, if the Government had paid any heed to Dr Turner’s report, they might have arrived much sooner at the conclusion that the proposed model was simply too expensive to roll out.