LAST week's whopping rise in VHI premiums has major implications for many Irish families, including my own. It hits families with children aged over 18 especially hard.
But if the rises are shocking, the absence yet again of a government minister to defend the news came as no surprise. Mary Harney was on holidays, and her government colleagues were "unavailable".
A family of two adults with two dependant children aged over 21 already faces an annual bill for VHI Plan B Option health insurance of at least €3,943.44. And that is after group scheme deductions and tax allowances. With the 45 per cent increase now being imposed, that bill will rise by €1,774.55 to at least €5,717.99.
From water shortages through bankrupt banks to a chaotic health care system, we are witnessing a failure of government. We are on our own.
Last week, the Health Insurance Authority sounded like the former Financial Regulator: lame. Its "shop-around" advice, laced with qualifications, was unconvincing. Citizens have come to learn that such "choice", from banking to mobile phones to insurance, comes with hidden catches and confusion.
Harney's ideological trumpeting of "consumer choice" is no substitute for coherent national health care. Who wants a privatised health-care system like that of the US, where the middle-class is squeezed ever harder and the poor are neglected?
And the VHI rises are even worse for families than last week's figures suggest, because they come on top of recent reductions in taxation allowances for medical expenses. Those reductions increased the real cost of medical care by up to one-quarter. They were, in effect, a sneaky new taxation on the middle-classes. Prescription subsidies were also reduced.
And health cover itself is riddled with ever more limitations for those who try to avail of it. I found myself unexpectedly in hospital for tests just before Christmas. I failed to get precise information from VHI on what it would eventually reimburse me for the tests done. It seemed impossible to get a clear answer.
Now the VHI is jacking up the cost of people's Plan B Option by 45 per cent. That is 45 per cent of each existing gross premium of €1,432.32 (or an increase of €644.54 per person per year). Not only are VHI benefits being squeezed, but VHI charges are being raised far faster than the rate of inflation. And this at a time of pay cuts and higher taxes.
VHI boasts of having a special scheme for families. However, that scheme is intended to cover younger kids. So families with dependant children over 18 now face a real challenge. This is so especially where those children are either not students or are students aged over 21.
And there are also families where adult children are earning, but due to the recession or changes in working conditions have a very stretched income. The young adults cannot afford an annual premium of a couple of thousand euro. Their families are under moral pressure to continue paying for such sons and daughters, or see them go with either reduced or no medical cover.
Citizens may now change to cheaper insurance, either with VHI or elsewhere. But how do we know, when shopping around, what illness will strike us? A young person may decide that they do not need heart cover but it is precisely when a young person unexpectedly gets heart trouble that they most need the benefits of health cover.
It is reckless to base national health insurance on some statistical averages, like a game of roulette. It is a bit like saying that you need car insurance only once every 10 years because your chances of being in a car accident in any particular year are less than one in 10.
Are families to abandon themselves or their children to the public health system, which already cannot cope and does not provide adequate or timely care?
And even when people do manage to pay for VHI, it covers less and less. There are rising excesses that must be paid by patients themselves. There are also annual ceilings on the amount paid out for specific necessary treatments -- some of them relatively basic. A person who becomes ill is left to worry that their cover may run out at any time.
This is where a government might be useful. We should be able to rely on our costly health insurance system to cover us fully when we fall ill. The system now is not fit for purpose.