Madam, - The Supreme Court's decision, striking down risk equalisation, gives us a chance to reorganise the health insurance system from scratch.
Given that the current system was designed for a market with a single monopoly supplier (VHI) and has been in place for 50-odd years, this must be seen as long overdue.
Accepting the Minister's argument that community rating without risk equalisation is unstable, we can conclude that community rating now needs to be reformed.
I suggest that what we need is a more comprehensive form of community rating, whereby premiums are proportional to income, with a cut-off, of course.
This form of community rating is employed in many mainland European countries and is, because many older people earn more than younger people, inherently more stable than our narrow, restricted regime.
Many older people thus don't just cost more, they would contribute more also.
The other necessary half of the reform is to make health insurance compulsory, thus achieving the objective of a single-tier system. If we're all insured, then we're all treated as private patients. A community rating system whereby premiums are based on income makes such an aspiration possible. - Yours, etc,
NORMAN STEWART,
Seapark,
Malahide,
Co Dublin.