Madam - The Minister for Health's ruling that "risk equalisation" should be introduced would appear to the average Martian as utter madness.
The Minister's decision completes a process of reductio ad absurdum, finally revealing to us the problems inherent in community rating.
In the old days, when the VHI was the only health insurer in the country, the system of community rating was iniquitous and immoral, but at least it was stable.
Now, with multiple health insurers active, it leads ineluctably to a system which is iniquitous, immoral and unstable.
What principle of morality or social justice dictates that young couples, struggling to pay off huge mortgages, should subsidise the health premiums of the wealthy, just because the latter happen to be older?
Why should non-smokers subsidise the healthcare of smokers, or non-drinkers that of drinkers? It was bad enough that we had to suffer these injustices in the days of the VHI monopoly, but now the whole rotten scheme is threatening to bring down the entire health insurance structure.
It's time to call a halt, to recognise the flaw underlying the entire problem and to act accordingly.
I would propose the following principles to restabilise our health insurance industry.
1. Health insurance subsidies must be based on ability to pay, not on arbitrary factors like age.
2. Payment of subsidies among insurers is destabilising and cannot be permitted. Subsidies must come from central government and be financed out of general taxation.
While we're at it, we can go a major step further and use subsidies to make health insurance available to all. Most of us agree that health insurance is inherently a good thing; the problem is that not everyone has it.
I would propose making health insurance compulsory; those who can't afford it get it at a special rate subvented from general taxation.
The Minister's decision has helped by precipitating the need for radical change. Now is the time to get on with it. - Yours, etc,
Dr NORMAN STEWART,
Seapark,
Malahide,
Co Dublin.