Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

It is frightening to think that a group of men and women sat around a Cabinet table in Government Buildings and approved the decision to re-impose means testing for medical cards for the over 70s. Did they not consider the huge anxiety and anguish this would cause to hundreds of thousands of senior citizens? Did they not consider the injustice of slashing this universal entitlement which they had introduced for the over 70s with such fanfare seven years ago and on which older people had come to rely?

Even looking at it from the crude point of view of political management this has been a disaster. What trust can the people have in these troubled economic times in a Government that could perpetrate such a massive political blunder? More worrying is that fundamental policy decisions on health and taxation, affecting the lives of millions of people, could be taken in such a sloppy, irresponsible and ill-considered manner.

The climb-down we have seen today came about because the first crack has now appeared in Fianna Fáil Parliamentary Party discipline. The departure of Deputy Joe Behan from Fianna Fáil ensured that others were forced to speak out also. I can only describe as pathetic the role of the Green Party Members who played their part to the full in the framing of this budget, including the medical card fiasco.

The medical card climb-down by the Government today does not go far enough. Universal medical card entitlement for the over 70s should be fully restored. This decision comes from a Government clearly reeling after the wave of anger which hit it in the wake of the budget. After creating all this anxiety it is now unclear whether the Government will make any savings from the scheme at all. The original decision should still be reversed and universal provision for over 70s restored. I commend senior citizens on making their voices heard so loudly and clearly over the past week. They have rocked the political system and it is clear that massive public pressure led to this climb down.

We in Sinn Féin approach this issue from a point of principle. We say that access to health services should be based on medical need and medical need alone. We want to see the State moving towards a universal public health system where all citizens would be entitled to health care services free at the point of delivery. We want to see such a system funded from fair and progressive taxation because we believe that when people are working they pay their taxes in order that decent public services can be provided for them and for their families. They pay taxes to ensure they are provided for in old age and that all children, and all those who are unable to work or are out of work, are properly looked after.

We want to see a public health system which would employ general practitioners directly on set salaries. Instead we have the current system where, under competition law, the Government cannot even negotiate directly with the IMO on GP fees for medical cards. We have the ludicrous pretence that set GP fees do not exist. We have the nonsense theory under competition law that people are going to "shop around" between GPs to find the cheapest one. We all know that is not the real world in which we live.

We are constantly challenged when we call for better health services and wider entitlement. The question posed is always "Who will pay for this?" The question should be "Who paid for this?" and the answer is "the pensioners of Ireland". They paid for a decent health service in taxes during their working lives.

If the Government is looking for savings then instead of taking away medical cards let it take away tax breaks from developers of private hospitals. That tax break cost €10.6 million in 2006, the last year for which figures are available, and that saving alone would have funded 6,000 extra full medical cards. Making all discretionary tax relief schemes available only at the standard rate would raise €1 billion. Those are just two examples. The Minister for Finance said his budget was a "call to patriotic action". The Minister and the Taoiseach should recall the patriotism of our senior citizens who worked all their lives and paid taxes at much higher rates than people paid during the Celtic tiger years and who made sacrifices in order that their children and grandchildren could enjoy a better Ireland.

The other health cuts should not be forgotten and they will also hit older people hard. Government backbenchers who have rightly protested about this medical card measure should be equally exercised about the entire range of other health cuts. These include higher charges for medicines with the drugs payment scheme threshold increasing to €100 per month; higher charges for hospital accident and emergency department visits; the miserly 2.1% increase in overall funding for health, which is way below inflation, resulting in major cuts right across the health services in 2009; and reductions in funding for disability services. Even before the budget, there were cuts in home help hours, hospital services were closed for weeks to stay within so-called HSE budgets and queues were lengthening in accident and emergency departments.

I support the motion and I urge all Deputies to support it and vote accordingly. The Government decision, even in modified form, is an attack on the principle of universal entitlement. The Government parties have their sights on child benefit and who knows what other entitlements will follow. People power and political pressure forced a climbdown today on two issues. That power and pressure should be maintained and people should unite in defence of decent public services for all and the third serious measure in the budget, the attack on our education system and the pupil-teacher ratio.

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