Sir – I read the recent Irish Times article on the second round of private health insurance increases this year with Marx’s famous saying in my head – history repeats itself first as tragedy, and then as farce (“VHI to hike prices with some families likely to be worse off by close to €300,” August 27th).The costs of private health insurance are now, for all intents and purposes, skyrocketing. Your article notes that older couples could experience cost rises of close to €300. Who has that kind of money?Only two months ago, on June 6th, The Irish Times identified that health insurers are cutting cover on some big procedures despite this increase in costs.None of this is surprising. Once healthcare is privatised, one of two things must happen. The cost either has to go up over time, or the service has to go down. The general advice to shop around given by most professionals, however well intentioned, is not really helpful any more. Many patients simply do not understand this system, the costs or the risks. For instance, what does it mean if a plan says that cover will be at 20 per cent, 35 per cent or 80 per cent for a procedure? It is impossible for a normal person to be able to assess what this means in terms of actual cost when they become sick.The lifetime community loading also contradicts other aspects of State policy. Officially, Ireland is meant to be moving towards universal healthcare. And yet it is financially punishing people for not purchasing private health insurance when they are young. This means that at the same time that it is pursuing universal healthcare, it is pushing people to take out ever more expensive private health insurance.The genuine tragedy in all this is that people are spending such vast sums of money on something that the State should be, and in fact has explicitly said that it would be, providing free at the point of need. – Yours, etc,DR MYLES BALFE,Senior lecturer in medical sociology,Department of Sociology,UCC.