Dáil debates
Tuesday, 21 October 2008
Medical Cards: Motion
7:00 pm
James Reilly (Dublin North, Fine Gael)
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I move:
That Dáil Éireann demands the immediate reversal of the Government decision to withdraw the automatic entitlement to a medical card from citizens aged over 70 years.
I wish to share time with Deputies Shatter, McCormack, Naughten, Breen, Feighan, O'Mahony, Sheehan, Bannon, Sheahan, Deenihan and Coveney.
James Reilly (Dublin North, Fine Gael)
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This motion is as simple as it is clear. It demands neither more nor less than a reversal of the decision to withdraw the over 70s entitlement to a medical card. The Government has lost touch with the people and misled its own backbenchers. It thought it could carry out this attack on the elderly under the guise of patriotism, when it was more like an act of terrorism.
The principle is simple; universal health care for everyone over the age of 70. For seven years those pensioners had universal health care. Those are the people who made this country what it is today, notwithstanding the Government's best efforts to undermine them. They raised us, nursed us when we were sick, protected us from violence, grew our food and ran a proud Civil Service. Are we to repay them by taking away something which was freely given by the then Minister for Health, Deputy Martin, and his Government in 2001? What is that Minister's view of the matter? I have not heard a single word from him since news of the Government's decision broke.
This decision is morally wrong and the people of the country know it. That is why the Church of St. Andrew on Westland Row was full to bursting this morning with anxious, worried and, now, angry pensioners and their families. That is why thousands will descend on this House tomorrow. The decision is penny wise but pound foolish. The Minister for Health and Children, Deputy Harney, told us that the annual cost of a medical card is €1,650. With the loss of their medical cards, many of those affected will attend their doctors less frequently than they should and may not take their medicines regularly. If they end up in hospital as a result, one day's care will negate any saving made to the Exchequer.
Professor Des O'Neill has mentioned the health gains made by the elderly since the introduction of the scheme in 2001. He does not insist that the health benefits are directly related but points out that the gains in the area of strokes and heart attacks have been substantial between 2004 and 2006. This begs the question of whether anyone in the Department of Health and Children has conducted a cost-benefit analysis on money saved by removing universal entitlement versus the cost to the Exchequer arising from ill health, attendance at hospitals and medications. Invariably, medications supplied in hospitals turn out much more expensive than those prescribed in general practice.
For the sake of €20 million, we are sacrificing the principle of universality in health care for the over 70s. What is next?
Michael Kennedy (Dublin North, Fianna Fail)
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Does the Deputy remember what he said in December 2007 to The Sunday Business Post?
James Reilly (Dublin North, Fine Gael)
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I ask Deputy Kennedy whether the bus pass will be next to go.
Michael Kennedy (Dublin North, Fianna Fail)
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Deputy Reilly did not want millionaires getting the medical card.
James Reilly (Dublin North, Fine Gael)
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Does Deputy Kennedy want to take the bus pass from the people of Swords?
Brendan Howlin (Wexford, Labour)
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Allow Deputy Reilly to speak without interruption.
Michael Kennedy (Dublin North, Fianna Fail)
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He should read the article dated 16 December 2007.
James Reilly (Dublin North, Fine Gael)
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Does Deputy Kennedy want the reintroduction of primary and secondary school fees? Does he want charges to be imposed for the vaccination programmes? Would he have the children's allowance means tested? Those are coming down the track.
This saving could have been made in many ways. More than €100 million could have been saved in the health service by introducing generic prescribing. A further €105 million could have been saved had an additional 50 cent been put on the price of a pack of cigarettes. At least €100 million could have been taken from banks through the bank levy. Many people believe the banks got off extremely lightly.
James Reilly (Dublin North, Fine Gael)
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The public impression is that the Government bails out the banks while bailing out on the elderly.
Fine Gael supports the policy of universal health care for all. I reject the assertion by the Minister for Health and Children and the Taoiseach that universal health care is unaffordable.
Michael Kennedy (Dublin North, Fianna Fail)
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The Deputy changed his mind since he spoke to The Sunday Business Post.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Deputy Kennedy stood up and applauded the budget last week.
James Reilly (Dublin North, Fine Gael)
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It is Fine Gael policy to introduce universal health care and we have established a policy commission to examine how best to achieve that aim. It makes no sense to remove the medical card from the over 70s. It is important to point out that the removal of the card is in direct contradiction to the stated aim of the Minister and Professor Drumm of supporting people at home and in the community, thereby avoiding hospitalisation. How does Professor Drumm feel about this matter?
The Taoiseach was asked today whether he would give an undertaking that he would not interfere with the other universal schemes for the elderly but he waffled and refused to answer. He wonders why some of us who thought this was an inappropriate measure at the time of its introduction have changed our minds. It is because we now understand that, after seven years, people have become dependent on medical cards and have a legitimate expectation of them because of the health gains I outlined earlier. We are also aware of the savings made to hospital budgets and the need to support people at home. Furthermore, it is no time to kick the elderly when international turmoil on the markets has reduced pensions to flitters.
Due to the Government's incompetence, it has repeatedly failed to introduce the promised fair deal legislation for long-term nursing care. The €110 million earmarked for this measure last year has been capped at €55 million for next year, which is a clear indication that many people who would otherwise avail of it will be unable to do so. To add insult to injury, the Government plans to reduce the tax relief on nursing home expenses from the top rate to the standard rate from 1 January 2010, thereby increasing the cost to families of nursing home care by a minimum of €200 per week. Having asked us why we might have changed our minds, the Taoiseach, the Minister and Government backbenchers fail to answer why——
Michael Kennedy (Dublin North, Fianna Fail)
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Deputy Reilly should read the article in The Sunday Business Post dated 16 December 2007.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Deputy Kennedy gave the budget a standing ovation last week. He should be ashamed of himself.
James Reilly (Dublin North, Fine Gael)
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——they believed it was a good deal and was the right thing to do in 2001, when they went around the country describing what great fellows they were for rewarding those who paid tax at 60% in the tough times. Why is it now such a bad idea? Where has the morality gone? My personal belief is that once Irish citizens have adequate food, clothes on their backs and roofs over their heads, they should be entitled to proper access to health and education regardless of their status, creed, race or religion.
The Minister intends to remove the saver clause, which states that in the interest of equity and fairness the medical card can be reissued for a three-year period on a once-off basis. Will that be removed for the over 70s or for everybody? Where was the early warning system in the Fianna Fáil Party? Was it asleep at the wheel or has it lost its social conscience?
What about the Green Party, with two senior Ministers, Deputies Gormley and Ryan, who were fully briefed on the issue, and one Minister of State, Deputy Sargent, all of whom voted for the budget presented by the Minister for Finance, Deputy Brian Lenihan? Has that party also lost its social conscience? Will the Tánaiste go ahead with her tutorials for backbenchers in her parliamentary party or have the Fianna Fáil voters in Donegal given her a tutorial?
Brendan Howlin (Wexford, Labour)
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Deputy Reilly is squeezing out Deputy Coveney.
James Reilly (Dublin North, Fine Gael)
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I am proud to defend the elderly and as long as I am a public representative, I will do so.
Paul Kehoe
Alan Shatter (Dublin South, Fine Gael)
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I rise in support of this motion. This was a callous and cold-hearted decision made by a totally incompetent Government. It was a decision applauded by every Member on the Government side of the House. They applauded the mugging of pensioners and the targeting of the elderly by the Government under the guise of saving funds.
Ulick Burke (Galway East, Fine Gael)
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Exhibit A is on the Government benches.
Alan Shatter (Dublin South, Fine Gael)
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They applauded a decision that created panic and stress in many people throughout the country who were under the belief that they had a right to universal health care, protected by the Government.
Michael Kennedy (Dublin North, Fianna Fail)
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The Deputies will be embarrassed.
Alan Shatter (Dublin South, Fine Gael)
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They understood and believed that when Fianna Fáil decided to provide universal health care to the over 70s it was based on some principle. What they did not realise is that the only principle to which Fianna Fáil and the Progressive Democrats espoused in 2001 was how to get elected as rapidly as possible and how to fool as many people as possible. There was no principled commitment to universal health care, they were simply using and manipulating the elderly for political gain.
Just as easily, last week, they decided to throw the elderly aside. I do not believe that is an appropriate way to treat people. If one extends the right to universal health care in circumstances in which they rely on it for their lives, one cannot simply withdraw it arbitrarily. The chaos the Government has created has resulted in three versions of the scheme being announced over the past week. As Fianna Fáil Deputies gathered in panic, realising the impact of what they had done and moaned on the national airwaves, the Government sought to re-examine the decision.
The decision of today is just as flawed as those earlier decisions. To suggest that an individual with €36,500 gross is among the super rich is such a warped view of income as to defy understanding. The proposals announced today are flawed and will give rise to a need for further clarification and will create further difficulties. For example, what is the position for a couple in their 70s with an income of €1,200 per week when one of them dies? The widow or widower may be left with a small additional leftover occupational pension from the deceased spouse as well as his or her own pension. Will such a person, with perhaps €800 gross per week, find that the State deprives him or her of the medical card as a consequence of the death of the spouse?
What about the other benefits that accrue to those with the medical card? Deputy Reilly referred to the Government policy of allowing elderly people to remain in their homes and experience independent living. That requires the support of visits from community nurses. Will we deprive individuals of that right when we take the medical card away?
What is the situation of those who have been given cards with no expiration date? Are they supposed to hand back their cards? Is there to be a new police service operating out of the Department of Health and Children or the HSE, visiting the elderly and demanding the return of cards given to them for the entirety of their lives, as perviously issued based on the Government's policy? It is extraordinary that the Government has sought to deal with the elderly in this way.
Deputy McDaid told us that this is an issue the Government pursued to renegotiate the deal done with the doctors. The Government could have attempted to consult the doctors any time over the past seven years without frightening the elderly and using them as weapons in an industrial relations bargaining process. It is a disgraceful and disgusting way to treat people.
Tomorrow evening there will be an opportunity for Members opposite, who have been vocal in their protests about this policy and who sought to reassure their constituents, to vote in favour of the Fine Gael motion. Will they have the courage to vote the way they are talking? Will we see members of Fianna Fáil huddled together like horrified hobbits holding hands going up the stairwell and turning to the left to vote against this Fine Gael motion, or will they have the courage to vote with their feet?
Will we see the Green Party and hear more hot air from it, contributing to the increase in climate change?
P J Sheehan (Cork South West, Fine Gael)
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They are more interested in bicycles.
Alan Shatter (Dublin South, Fine Gael)
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Will we have real politics from the Green Party? Will it vote with Fine Gael to defeat this measure or will it continue to betray its commitment, so clearly announced in the last election, to universal health care by voting to deprive the over 70s of a provision already in force at the time when the Green Party entered Government?
Pádraic McCormack (Galway West, Fine Gael)
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The part I remember most about this failed budget is the standing ovation given by Government Deputies at the end of the Minister's speech. That included Deputy Joe Behan, who has left the party since, and ten or 12 other Deputies who denounced the budget on the airwaves in the following days. They were like the Gunner McGee, leading the regiment from behind. When they saw how public opinion was going they changed their minds, after their enthusiasm on budget day when they clapped for everyone.
We had the spectacle of two Ministers, Deputies Brian Lenihan and Willie O'Dea, on "Today with Pat Kenny" trying to lay the blame on the Minister for Health and Children, Deputy Harney. Deputy Mary White, of the white party, the Green Party or rather the yellow party, was on the airwaves stating that the Green Party did not agree with this budget.
Kathleen Lynch (Cork North Central, Labour)
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Waving the white flag.
Pádraic McCormack (Galway West, Fine Gael)
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She did not realise that the two Green Party Ministers were at the Cabinet when this budget was accepted. So much for Cabinet responsibility in this matter.
This morning we had the fifth climb-down and change in the qualification limits since the budget was announced. This had more to do with bringing dissenters back in line to support the Government amendment tomorrow than supporting the Fine Gael motion, as most had said they would on the airwaves.
If the Government had any concern for the elderly, it would have abandoned this budget. I was at St. Andrew's Church with 500 or 600 people. Despite what was reported on the "News At One", that Age Action Ireland had welcomed the Minister's climbdown, not one of the speakers in an hour and a half welcomed it. Every speaker castigated the Government. They said that they will wait and, unlike on previous occasions, they will remember this when going into the voting booth at a general election, which cannot be too far away by the way the Government has performed in the past few days.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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The introduction of the means test is a Trojan horse, one that can be used to water down the entitlements of the elderly over the coming months. Based on the Government announcements, the proposed income thresholds are dependent on Mr. O'Sullivan getting a deal from the GPs. At present, over 70s on the standard rate of tax have been branded as the super rich. The reality is that far more than the 14% of those with a medical card will lose this entitlement, contrary to the announcement today. What is stopping the Government from cutting income limits again once the Dáil removes the automatic right to a medical card for over 70s? If this right is removed, what is to stop the Government removing free travel, free electricity and free telephone entitlements? What will be the income threshold for a couple where one person is under the age of 70 and one is over that age? Will the promised thresholds be based on income tax returns for 2007, or on incomes for 2008 that have seen significant reductions on dividends and interest rates? Will the Government try to make up the savings by reducing the benefits of having a medical card? We have already seen that those on medical cards have had their entitlements to chiropody and optician services reduced. Will access to medicines be taken from the medical card, with the result that even those who have the card must actually pay for their prescriptions?
There is no doubt that this budget targets elderly people for a financial hit that should have Government Deputies hiding in shame. Instead, as we saw in this Chamber last week, they gave a standing ovation to the announcements of the Minister for Finance and to his cutbacks in respect of the elderly, including the removal of entitlement to the medical card.
Michael Creed (Cork North West, Fine Gael)
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They are hiding tonight.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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There will be significant cutbacks next year in funding for repairs to houses for the elderly and disabled. Any elderly person who must raise a loan as a result of not being able to get funding under those grants will get no recognition by way of means assessment in order to make repayments to banks or building societies. The calculations are now based on their gross rather than on their net income. On this occasion, therefore, those people will be doubly penalised because the Government is taking away the housing grants.
For €20 million, one third of the cost of electronic voting machines, this issue could be resolved once and for all. The Government could have changed the regulations to enable pharmacies to dispense generic drugs instead of branded ones, saving €150 million, €50 million above the savings it proposes in this measure. If only the Government had charged the banks slightly more than €500 million it would not have had to proceed with this callous proposal. This Government's policy has been to save the banks and screw the pensioners.
P J Sheehan (Cork South West, Fine Gael)
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Where are the soldiers of destiny tonight?
Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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I welcomed the automatic entitlement of people aged over 70 for the medical card. At the time I felt that it acknowledged the people who worked so hard, lived frugally and gave enormous sacrifice to bring our country to where it was. Unfortunately, Fianna Fáil did not see it that way but rather saw it as a pitch for the grey vote in advance of the 2002 general election. It carried out no prior calculations to determine the costs and the number of people involved and seriously underestimated this situation.
If I may put forward a word to describe this action by the Government last week, it is "lousy". One man who wrote to me said it was the lousiest thing any Government had ever done to the old and vulnerable in this society. He said the Government gave the banks the kid glove attitude but when it came to the old and vulnerable they put the boot in. Shame on this Government and the way it has treated the elderly people of our country.
Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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This must be reversed. We must ensure that the elderly and those who fought for this country and built it up, placing it where it is now, are treated with respect and dignity. They should not have to come to Dublin to march on the streets or hold big protests in the capital. This Government should listen to them because they as politicians have let down the old and vulnerable in our society.
John O'Mahony (Mayo, Fine Gael)
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I congratulate Deputy Reilly and Fine Gael on bringing this motion before the House. I have only a couple of minutes but I want to convey to the Minister for Health and Children, Deputy Harney, and to the Government the real depth of feeling that all of us have encountered in our offices and clinics and on our telephones over recent days. The Government's action has caused unnecessary fear and hurt and confusion, because of the changes that were made or announced daily. Some calculations, like that of today, are based on gross income. Last week's were based on net income and that change caused further confusion. People felt fear, because they felt they would lose their independence and that their families would have to pay for them in their old age. They were hurt, because these are the people who never complained all their lives but worked hard, only to have this taken away from them when they might have enjoyed some little comforts in their old age.
These are the people who grew up in difficult economic times of the 1930s, 1940s and 1950s, when they got little or no assistance from the State to raise their families. The breadwinner usually had to emigrate and send money home to feed the children. These are the people who paid the high taxes of 60% in the 1970s and 1980s when Fianna Fáil-led Governments told us all we had to tighten our belts. The only comfort they got was when they reached 70 years of age and got their medical card, seeing it as thanks for the sacrifices they made during the hard times. These are the people for whom the world darkened last Tuesday as a result of this savage budget. The changes announced almost daily since then have just added to the confusion, fear and hurt. Medical cards allowed people to be cared for at home and in their communities. The card, with all its ancillary services and benefits, plays an essential part in supporting older people to live independently within their communities for as long as possible. Independence is very important for old people. It was taken away last Tuesday and I ask everybody to support this motion to restore that independence to the old people of this country.
P J Sheehan (Cork South West, Fine Gael)
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I rise to defend all those people who are retired and who built our nation into what it is today. At times they paid an effective tax rate of up to 60% during their working careers, or caring for our children.
As somebody who has worked all my life in politics to help the weaker members of the community, this is the meanest decision I have ever seen. We will very soon see if those opposite who gave the budget speech a standing ovation — though I do not know where those soldiers of destiny have gone tonight——
Michael Kennedy (Dublin North, Fianna Fail)
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They will be here tomorrow.
P J Sheehan (Cork South West, Fine Gael)
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——have the guts to admit they got it wrong, and to vote to reverse this decision which tried to take the full medical card from nine out of ten elderly people entitled to this scheme.
My real concern is that many of these people whose sense of security has been taken from them will be unable to go to their doctor or afford the prescribed drugs and will end up in hospital at a greater cost to the taxpayer. Was this decision taken during the summer? Was the budget brought forward by two months in order to allow the overburdened bureaucrats in the Health Service Executive time to process the means test? The Government should instead have been consulting the Irish Medical Organisation.
Now that we have a self-assessed medical card, would the Government not like another two months in order to re-draft the budget in respect of the medical card, the Lenihan levies, the savage cuts in teaching posts, the welfare payments to the disabled, the charging of nurses for parking while on night shift? Will the Government charge the Bray firemen for their parking last Friday night?
The historical facts of this matter offer a classic example of Fianna Fáil stroke politics. In the year 2000, during a campaign from this side of the House, it was pointed out that only 29% of the population were being awarded medical cards while the general medical scheme agreement with the Irish Medical Association allowed up to 40% of the population to be covered by this scheme. Under pressure to do the right thing and raise the income limits, the then Minister for Health, Deputy Micheál Martin, chose to do all the wrong things. He proposed at the stroke of a pen that the medical card should be extended, without reference to income, to everyone aged over 70 on 1 May 2001 in order to entice the grey vote to vote for Fianna Fáil.
Deputy Martin's mismanagement does not end there, however. He underestimated by more than half the number of people aged over 70. He had no comprehension of the medical card scheme and so had to renegotiate a whole new scheme at short notice while fighting the South Tipperary by-election, in which he had no room to wriggle.
P J Sheehan (Cork South West, Fine Gael)
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No wonder the IMO was able to negotiate such a good deal for its members when it was dealing with such an incompetent Minister.
P J Sheehan (Cork South West, Fine Gael)
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Someone else used a phrase at the time to describe another bad Government deal, saying that it was like turning up at an ATM machine to withdraw cash. That mess is bad enough but the same Minister was also responsible for the PPARS and the nursing home rebates. If it was not for the multiple faults of this Minister at the taxpayer's expense we would now have a much healthier book of Estimates.
A Government that could take this decision has lost all touch with reality——
Brendan Howlin (Wexford, Labour)
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The Deputy is eating into the time of other Deputies.
P J Sheehan (Cork South West, Fine Gael)
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——all touch with its electorate, and has broken the trust of the people who elected it. The Government has been in office for so long that it is being forced to correct its mistakes. I hope that for the next budget, which will probably be introduced sooner than the Minister believes, those on the benches opposite will hold their hands in their pockets rather than jumping to their feet to give a standing ovation to their Minister. They must remember they are here to represent their constituents, rather than to engage in the stroke politics we have seen on this issue. I commend the motion, unamended by the back slappers, to the House.
James Bannon (Longford-Westmeath, Fine Gael)
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This morning's announcement by the Taoiseach on the issue of medical cards for those aged more than 70 years is undoubtedly a climbdown by a shamed Government which sought to save €100 million at the expense of those aged 70 years and upwards, including those aged more than 100. It does not matter how vulnerable one is or whether one is elderly, infirm or disabled, the Fianna Fáil-led Government would, if it could get away with it, take from them over and over again to make good its mistakes. The voice of the people roared in disgust and, in a move designed more to save the Government than to benefit pensioners, the Taoiseach backed away from certain political suicide. The problem, however, is that the Government did not climb down far enough. In a face-saving measure the Taoiseach amended the plan outlined by his colleague, the Minister for Finance, Deputy Brian Lenihan, rather than scrapping it outright. In taking over the reins the Taoiseach relegated his Minister to the status of a boy.
As for the Minister for Health and Children, the less said the better. Speaking on radio earlier today, Deputy Finian McGrath indicated that the Minister's inflexible stance on universal payments, of which she is not a fan, is the stumbling block to the complete removal of this appalling and disgraceful measure.
To have proposed to take €100 million from those aged over 70 years was criminal when one considers the sum would have barely covered the amount the Government squandered on dud e-voting machines for which it continues to pay and which it should have scrapped long ago.
James Bannon (Longford-Westmeath, Fine Gael)
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As always, however, things are not as straightforward as they appear. In typical two-faced Government speak, Fianna Fáil Deputies have been overheard telling constituents to cover their tracks — that is putting it mildly — when declaring their income levels once the assessment is introduced on 1 January. It seems the answer to the question, "When is a lie not a lie?" is when it is a Government lie.
Shame on the Fianna Fáil-led Government for first using and abusing the elderly people of this country before attempting to get them on side. Shame on the Taoiseach, the Minister for Finance and the Minister for Health and Children for causing such anguish over the saving of a mere €100 million which, as we all know, the Government could squander at the stroke of a pen at any time, as it has done several times over the past ten years. Never again will the Government enjoy the trust of the electorate. The people have spoken and the made a vow of wrath against this democratically elected Government, which will never recover from the damage it has done.
Tom Sheahan (Kerry South, Fine Gael)
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As Robert Emmett said, "Let no man write my epitaph for no man knows my motives." These words are pertinent in the case of the Minister for Health and Children. When I was elected to the House, many members of the public sympathised with and pitied the Minister on the job she was trying to do. I am afraid the position has changed and we have turned full circle. Some of the words I have heard used to describe the measure on medical cards include "lousy", "cold", "hard", "unwarranted", "unfair" and "wrong".
The Minister is brow beaten and should be ashamed of what she tried to do to those aged over 70 years. Her biggest slip was to introduce a measure which affects entire families. As she will discover when the ballot boxes are next opened, no one wants his or her grandmother, grandfather, mother and father to be picked on. She cannot blame this cock up on the Health Service Executive, which has served as a good scapegoat on which to blame all her mistakes. The Minister's political epitaph consists of two lines. Now that her party and colleagues have disappeared, it is time for her to follow them.
Jimmy Deenihan (Kerry North, Fine Gael)
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As a result of this collective Government decision, the concept of universal health care is dead. Those aged over 70 years considered the medical card to be a sacred cow which provided them with reassurance, comfort and security. It was one of the most effective instruments of primary care ever introduced. A medical card for a person aged more than 70 years cost €1,650 per annum to the State. The availability of the card meant a large number of people did not have to go to hospital where a stay of one night costs as much as the annual cost of the medical card. For this reason, the budget measures on medical cards do not make sense.
In County Kerry 13,500 people aged more than 70 years have medical cards. If even 5% — the figure cited today — of this group are deprived of their medical cards, 670 elderly people will be affected. This is bound to put pressure on services in Kerry General Hospital and elsewhere. Even at this stage, I appeal to the Minister and sensible members of the Government, of whom I am sure there are still a few, to withdraw the measure, even on financial and economic grounds.
Tomorrow, thousands of people will gather on the street outside the House. In my 21 years as a Deputy I have never seen old people being forced to come to the House to publicly demand and fight for their rights. Surely this sends a message to the Government. I doubt the Minister is completely deaf and hope she is listening and watching.
Simon Coveney (Cork South Central, Fine Gael)
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The Minister has made a mistake on the issue of medical cards. Last week, people had been conditioned to expect tough measures and were prepared to accept a difficult budget if it targeted problem areas which need to be reformed to return the country to a path of recovery. Elderly people who are not part of the problem were targeted last week. Despite the political stunt we saw this morning as the Government sought to defuse political tension, those aged over 70 years remain nervous, unhappy and distressed. Under the new so-called means test, an automatic entitlement to a medical card will apply to those with an annual gross income of less than €36,500, which is below the average industrial wage. Those excluded will not be wealthy former bank managers, senior civil servants or politicians but pensioners who previously enjoyed middle incomes. They expected protection from the State and had planned their future on that basis. The measure should be reversed and the House should support the motion.
Ulick Burke (Galway East, Fine Gael)
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I will put two or three questions to the Minister. Is the budget the result of the collective wisdom of all Government Ministers? If so, the uncertainty about the content of the budget pertaining to medical cards displayed by all Ministers immediately after its delivery in the House is adequate evidence of the Government's careless and callous approach to the elderly.
Did the Government consider targets other than the elderly? Why did it not tax the many tax exiles who, from afar, appear to have more influence on Government policy than Ministers? The Minister must emphatically state that she will withdraw this measure which is a disaster for the Government and elderly people. Why did they not tax the many tax exiles we have, who seem to have more power from afar in the delivery of Government policy than the Ministers? It is important that the Minister for Health and Children should emphatically state tonight that she is withdrawing this disaster for this Government and for the country's elderly.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I intend to share time with Deputy Barry Andrews, if that is in order.
I move amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"acknowledges:
the Government's expression of regret for the anxiety caused among older people in recent days and welcomes the new initiative to allay that anxiety;
supports:
the decision by the Government to introduce a revised scheme with a gross weekly income threshold of €700/€1,400 (single/couple) (€36,500/€73,000 p.a.) for eligibility for a medical card for persons aged 70 and over so that approximately 330,000 persons aged 70 and over will continue to have a medical card;
recognises:
that this initiative is within the context of the budgetary parameters set by the Government for the Health Service Executive;
supports:
the Government's move towards a single capitation payment to general practitioners in respect of medical card holders aged 70 and over and the process now to be undertaken to advance this;
looks forward:
to the work to be undertaken in association with the Irish Medical Organisation under the chairmanship of Dr. Michael Barry to achieve savings in drug usage, without compromising patient care; and
supports:
the Government's policies to build a fair and equitable healthcare system by focusing public resources on those in most need."
It is important to put in context the one idea we are talking about tonight, namely, the Fine Gael motion which seeks to reverse the decision to end automatic entitlement to a medical card for those reaching the age of 70. When the Government discussed this, it was not in a theoretical sense or as a matter of principle or policy. We did not have a seminar in relation to the issue. We discussed it in the context of the most difficult economic circumstances this country has faced in two decades.
P J Sheehan (Cork South West, Fine Gael)
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Why were the pensioners singled out?
Mary Harney (Dublin Mid West, Progressive Democrats)
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I want to tell Deputy Sheehan that I was in the House 20 years ago when I heard Ministers for Health being called awful names, perhaps even worse than were used tonight. I was here for those years. I was here when the health budget was reduced by 3.5%. Next year, even with the challenges, it is increased by 3.5%. The Department of Health and Children, in the context of this year's budget, had to reduce its expenditure by €700 million on what had been planned. There is no low-hanging fruit in health. It is not easy to find sums of money of that order — that is a fact. I can say with confidence, and give many quotations, that the GMS scheme, as constructed, is rising at such a rate that no matter who was in this job, he or she would have to tackle it. It has risen by €1 billion alone since 2003.
Pádraic McCormack (Galway West, Fine Gael)
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The Minister is backing out now.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Since this card was introduced, the fees to doctors have gone from €203.8 million to €431 million and the fees for drugs have increased from €434 million to over €1 billion. Next year, even with this decision, medical card costs will rise by 14%.
Mary Harney (Dublin Mid West, Progressive Democrats)
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With respect, I allowed other people to speak. Even with the decision that has been made, our medical card costs will rise by 14% next year. There are more treatments, more expensive drugs and more people are losing their jobs who will have to access a medical card for themselves and their families. In that context, when resources are limited, clearly any Minister for Health and Children and any Government must look at who needs them most.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I listened to all on the Opposition side, with respect. We need some honesty here. The last Fine Gael Minister for Health was asked whether he would automatically extend——
Charles Flanagan (Laois-Offaly, Fine Gael)
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Deal with the issue.
Mary Harney (Dublin Mid West, Progressive Democrats)
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——a medical card to everybody aged over 80, and he said, "I do not think it is justifiable to give an automatic entitlement to a medical card to all citizens, aged 80 and over, without reference to their means."
Mary Harney (Dublin Mid West, Progressive Democrats)
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I shall deal with that in a moment.
Brendan Howlin (Wexford, Labour)
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The Minister, without interruption, please.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The last Labour Minister for Health, who happens to be the present Leas-Cheann Comhairle, said exactly the same thing in 1994.
Charles Flanagan (Laois-Offaly, Fine Gael)
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The Minister will not get away with history lessons now.
Mary Harney (Dublin Mid West, Progressive Democrats)
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In November 2004 in this House, Deputy Liz McManus as Labour Party health spokesperson, described it as an obscenity.
Jan O'Sullivan (Limerick East, Labour)
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That was because of the difference——-
P J Sheehan (Cork South West, Fine Gael)
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The Minister should speak for herself.
Mary Harney (Dublin Mid West, Progressive Democrats)
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She described it as an obscenity, so let us have some——-
Brendan Howlin (Wexford, Labour)
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Allow the Minister to make her contribution without interruption. There is a time limit on the debate.
Mary Harney (Dublin Mid West, Progressive Democrats)
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By virtue of this measure, the Government identified that savings of €100 million could be made. Deputy Sheehan might regard the fee to doctors as "an ATM", as he said——-
Charles Flanagan (Laois-Offaly, Fine Gael)
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The Government negotiated it.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Reilly, on behalf of Fine Gael, said at the weekend that it was an appropriate fee. The fact is that this scheme is highly expensive. It was envisaged at the time of its introduction that it would cost £15 million a year, and last year it cost €245 million.
James Bannon (Longford-Westmeath, Fine Gael)
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The Government negotiated it.
Brendan Howlin (Wexford, Labour)
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The Minister, without interruption.
Pat Rabbitte (Dublin South West, Labour)
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By the way, where is the Minister for Foreign Affairs, Deputy Micheál Martin?
Kathleen Lynch (Cork North Central, Labour)
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Messing up the world.
Mary Harney (Dublin Mid West, Progressive Democrats)
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To be fair to my ministerial colleague, Deputy Martin, he negotiated that in good faith. The Government made the decision in the context of financial circumstances very different from those we face today. In the context of the budget it was a priority for the Government to introduce the fair deal to help older people in long-term care. We know we have a highly inequitable situation where someone in publicly funded residential care or in a contract bed gets 90% of the costs paid. However, somebody in a private nursing who has not got a contract bed has to pay 60% of the cost. That is unfair. It is placing an enormous burden on older people and their families and that is why the new legislation is important. Provision is made to introduce that next year.
We know that cancer outcomes in Ireland are not what they should be and we are transitioning services into eight designated centres. All the breast cancer services will be transitioned by March next year. During 2009 we shall transition prostate and lung cancer services and that requires additional resources. The main beneficiaries will be older people as well as other citizens who get cancer.
Simon Coveney (Cork South Central, Fine Gael)
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We have not opposed that.
Brendan Howlin (Wexford, Labour)
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Please allow the Minister to reply.
Mary Harney (Dublin Mid West, Progressive Democrats)
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For children with special needs, we want to employ 100 or 120 new therapists next year, in speech and physiotherapy. These are the choices. We want to be able to maintain as many old people as possible at home. Currently some 10,000 older people are receiving home care packages. We did not have any home care packages a couple of years ago. In addition——
Mary Harney (Dublin Mid West, Progressive Democrats)
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——we have 53,000 families receiving home help. All these were factors in the discussions and the choices made. There is the issue of the budget and the confidentiality associated with it, issues to do with competition law, as we have heard, contractual issues with doctors and industrial relations questions. These are the practicalities that must be taken on board in relation to this decision.
Brendan Howlin (Wexford, Labour)
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The Minister, without interruption, please.
Pat Rabbitte (Dublin South West, Labour)
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How much is the Government saving?
Mary Harney (Dublin Mid West, Progressive Democrats)
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We are saving €100 million from this proposal.
Pat Rabbitte (Dublin South West, Labour)
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It is about €16 million.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Rabbitte is wrong. I will go through the figures.
Brendan Howlin (Wexford, Labour)
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The Minister should not respond to interruptions.
Mary Harney (Dublin Mid West, Progressive Democrats)
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If the Deputies opposite would allow me to speak, I might not have to respond to interruptions
Brendan Howlin (Wexford, Labour)
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If the Minister would just proceed.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The proposal that the Government announced this morning will save €100 million in 2009. As the House knows, we have established a process and are not allowed to negotiate with the IMO under Irish competition law. A process is to be established, to be chaired by Mr. Eddie Sullivan. He will receive submissions from the Irish Medical Organisation this week, from individual practitioners and others who have an interest in this area. Next Tuesday he will report to me and we will discuss this matter at Cabinet on Wednesday. The intention is to have a single fee for all patients over 70. I do not believe it is right that those over 70 who got a medical card based on means — 215,000 people — were worth approximately €160 a year to their doctor while those who qualified automatically, based on age, were worth €640. I do not believe that is fair.
Mary Harney (Dublin Mid West, Progressive Democrats)
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That it is not sustainable, particularly in the context of doctors seeking to work in areas of disadvantage — and neither is it fair to the patients. The hope is that we will have a single capitation fee for all patients over 70, the same fee regardless whether they had a means-tested card before they reached that age. I believe that is appropriate.
Dr. Michael Barry, the leading expert in Ireland, who heads the pharmaco-economic school in Trinity College Dublin and is attached to St. James's Hospital, as well as being a member of the board of HIQA, is going to oversee a process regarding prescribing practices and so on. A combination of the capitation, the prescribing practices and the 20,000 who will not qualify for medical cards, will deliver savings of €100 million during 2009. The incomes about which we are talking here are incomes earned by people who leave employment——
John Perry (Sligo-North Leitrim, Fine Gael)
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On a point of information——
Brendan Howlin (Wexford, Labour)
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Is the Deputy making a point of order?
John Perry (Sligo-North Leitrim, Fine Gael)
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On a point of information——
Brendan Howlin (Wexford, Labour)
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There is no such thing as a point of information. Does the Deputy have a point of order to make?
John Perry (Sligo-North Leitrim, Fine Gael)
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Is it not the case that the Comptroller and Auditor General carried out a report into this?
Brendan Howlin (Wexford, Labour)
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That is not a point of order.
Tom Hayes (Tipperary South, Fine Gael)
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It is a point of order.
Brendan Howlin (Wexford, Labour)
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If one is making a point of order, one must make it through the Chair.
John Perry (Sligo-North Leitrim, Fine Gael)
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The Comptroller and Auditor General carried out a detailed report into this.
Brendan Howlin (Wexford, Labour)
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That is not a point of order. The Deputy knows that. The Minister has limited enough time.
John Perry (Sligo-North Leitrim, Fine Gael)
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I was Chairman of the Committee of Public Accounts and in 2002——
Brendan Howlin (Wexford, Labour)
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That is not a point of order.
John Perry (Sligo-North Leitrim, Fine Gael)
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——the Comptroller and Auditor General carried out a detailed report into this and clearly established the risk but the Government did nothing about it then. How come it waited five years?
Brendan Howlin (Wexford, Labour)
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Deputy Perry should resume his seat. The Fine Gael party had 40 minutes and 12 speakers spoke without interruption.
John Perry (Sligo-North Leitrim, Fine Gael)
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It is a relevant point.
Brendan Howlin (Wexford, Labour)
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Allow the Minister to speak. The Fine Gael Party will have further time to respond to anything it likes.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I would say to Deputy Perry that we must bring legislation to the House to do what he suggests. It is a fair that to each doctor a patient who reaches the age of 70 should be worth the same. Everybody would subscribe to that. It is particularly important for doctors working in disadvantaged areas.
In regard to the wider issues, of course we deeply regret the upset and hurt caused to many older people and their families.
James Bannon (Longford-Westmeath, Fine Gael)
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The Government has been paralysed by it.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I would say to Deputy Bannon that we all have older family members and we know how older people are feeling. The vast majority of older people were not affected by the decision made by the Government. Some 65% of people over 75 years have their medical cards based on means. They were never affected by this decision.
The income thresholds, which the Government announced today, are €700 for a single person and €1,400 for a married couple. Deputy Gilmore asked earlier how we can verify that data. We have given that data to the Labour Party. Higher pension incomes are earned by only 5% of our population.
P J Sheehan (Cork South West, Fine Gael)
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Is that gross or net income?
Mary Harney (Dublin Mid West, Progressive Democrats)
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Unfortunately, the average income of people over 70 years is approximately €260 per week, believe it or not. Only 57,000 people over the age of 65 years ever reach a taxable income. We are confident that no more than 20,000 people, or 5% of those persons aged over 70 years, will not be entitled to a medical card as a result of this decision.
Pádraic McCormack (Galway West, Fine Gael)
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Why did the Government not do that at the beginning?
Simon Coveney (Cork South Central, Fine Gael)
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Does that take account of savings?
Mary Harney (Dublin Mid West, Progressive Democrats)
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There are competition, contractual and many other issues.
P J Sheehan (Cork South West, Fine Gael)
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The Government wanted to win the 2002 election. That is the reason they did not do it at the beginning.
Mary Harney (Dublin Mid West, Progressive Democrats)
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In regard to the challenges facing this country, the health service consumes approximately 30% of the money we spend running this country. In recent years, health spending has been increasing by just under 9%. It is the second highest growth in health spending in all the OECD group of countries. We spend 9% of our national income on health, yet we know we have huge challenges. When the country is faced with serious economic challenges and——
James Bannon (Longford-Westmeath, Fine Gael)
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It is all statistics. The Government does not care.
Mary Harney (Dublin Mid West, Progressive Democrats)
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——when we raise €10 million less per day than we spend, we know the consequences. Notwithstanding that, Deputy Bannon's party has suggested we should cut health by a further €700 million. I invite Deputy Reilly to spell out to me where he would get this additional €700 million on top of the decisions which have already been made.
P J Sheehan (Cork South West, Fine Gael)
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The Minister could get it from the banks which the Government bailed out.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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The Minister could start with the HSE.
Mary Harney (Dublin Mid West, Progressive Democrats)
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There is universal entitlement to hospital care, except for a small charge. Some people earning €300 per week cannot get a medical card. Some 30% of our population have a medical card and we know, notwithstanding that, there are many people in difficult situations. We do not have unlimited budgets.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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When the Government had an unlimited budget, it could have made the decisions.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I know of no other health ministry in the world that has an unlimited budget, no matter how it is funded, whether by private insurance, social insurance or taxation. There are limitations on what we can spend. When there are limitations, we must make choices. In particular, we must seek to target resources at those who need them most. That was the essence of the decision-making process in which the Government engaged. It did not make this decision lightly. We would have preferred not have made this decision but, quite honestly, we do not have alternatives with the kind of——
Pádraic McCormack (Galway West, Fine Gael)
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What about the HSE bonus scheme?
Mary Harney (Dublin Mid West, Progressive Democrats)
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One would not even save a €1 million there. Let us put things into perspective. Even with the money available, we will face immense challenges trying to provide services at hospital, community and primary care levels and home supports. There will be major challenges next year and it is in that context that this decision was made. I commend the Government amendment and I hope it will be carried.
Brendan Howlin (Wexford, Labour)
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I call the Minister of State, Deputy Barry Andrews. There are 14 minutes left in the slot.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Where is the standing ovation now?
Brendan Howlin (Wexford, Labour)
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Members should allow the Minister of State to speak.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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This has been a very difficult week for everybody in politics.
Tom Hayes (Tipperary South, Fine Gael)
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The Government made it difficult.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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Anybody opposite who delighted in the difficulty over the past week should be ashamed. It was a difficult week for everybody in politics. Anybody opposite who would say otherwise should be ashamed because it was not pleasant for anybody to hear some of the concerns and emotions expressed by older people in our community. They telephoned the offices of every Deputy and Senator.
James Bannon (Longford-Westmeath, Fine Gael)
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They had every right to do so.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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The Deputy should let me speak.
Brendan Howlin (Wexford, Labour)
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Please Deputy Bannon, you have already had——
Barry Andrews (Dún Laoghaire, Fianna Fail)
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If Deputy Bannon had a little control and restraint, there might be a small bit of illumination on this issue because people want to know what went on over the past six days or so and the way we approached this issue. They do not want to see Deputy Bannon jump up and speak his usual incomprehensible garbage.
James Bannon (Longford-Westmeath, Fine Gael)
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Why did Deputy Behan resign from Fianna Fáil?
Barry Andrews (Dún Laoghaire, Fianna Fail)
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What happened over the past few days was——
James Bannon (Longford-Westmeath, Fine Gael)
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Deputy Behan resigned because Fianna Fáil let old age pensioners down.
Brendan Howlin (Wexford, Labour)
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This is a House of Parliament. Please show some respect.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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I thank the Leas-Cheann Comhairle. The Cabinet had a number of difficult choices to make. We are in a very difficult position. Many of the older people who telephoned me lacked information on the specific detail of the scheme.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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Again, we take responsibility and we are sorry for that. We apologise to right thinking people with common sense who know the score, who know we had extremely difficult choices to make and who know we will have more extremely difficult choices to make. It will be a measure of this Government and its supporters that we will get through this. Older people know that we have come through other recessions and have survived them. They know the score. One tightens one's belt and one gets on with it. To a large extent, people are prepared to accept that.
P J Sheehan (Cork South West, Fine Gael)
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What about the e-voting machines and the millions spent storing them?
8:00 pm
Barry Andrews (Dún Laoghaire, Fianna Fail)
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We have to take responsibility for the fear sown in some people's minds and we must move on from that.
Some 95% of over 70s will now have a full medical card. That is the most important message that will come out of this debate tonight. We listened to what the people, our councillors and our backbenchers said as well as to what anybody else who cared to share their opinions with us had to say. We have made a decision and we have the humility to accept that a mistake was made and that the deliberative process fell short of what it should have been. People know that is the position and we have tried to communicate that to as many people as possible.
I wish to touch on a few of the issues that have arisen in the past few days, in particular the issue of universality. This matter came up in the Seanad today in a debate on child care provision. Senator Bacik stated that primary care is a universal social service, which is a fair point. We must consider what universality really means and whether it will apply to all social services and provisions within the economy or whether we can from time to time, in certain circumstances and in the straitened circumstances we have now, look at the question of universality in certain areas and pull back from that.
Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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What is the next area to be considered? Will it be children's allowance?
Barry Andrews (Dún Laoghaire, Fianna Fail)
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We have a situation where medical cards are being given to people who, by their own admission, do not need them. Large numbers of people over 70 years of age have not applied for them because they are genuinely patriotic people who know they do not have the need for that provision. They know the spreading of resources around our economy is more appropriately served by issuing cards to those who need them rather than to those who can provide out of their own means.
Alan Shatter (Dublin South, Fine Gael)
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Is the Deputy suggesting that those who apply for medical cards are not patriotic?
Barry Andrews (Dún Laoghaire, Fianna Fail)
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People have bandied the word patriotism around this House, but what it means to people is that their patriotism can assist us in a practical way to get through this difficult period. I do not say this in an effort to achieve some short-term political dividend or to get us out of the hole in which we find ourselves. I say it because all of us must contribute to some extent. I know that patriotism is not a clear concept to some people and that it is being used in a glib and trite way.
The discussion we have had within Fianna Fáil has been very useful. I was a backbencher until recently and was not afraid to throw the rattle out of the pram once in a while. It is a perfectly valid part of the armoury of a backbencher to do that from time to time.
Pat Rabbitte (Dublin South West, Labour)
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They would rather throw out the baby with the bathwater.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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The well chosen throw of the rattle out of the pram is acceptable. However, when all the backbenchers throw it out at the same time, we know we have stepped into dangerous territory. Our backbenchers spoke clearly and eloquently and I would make no criticism of them. Fianna Fáil has never shied away from honest and robust debate within the parliamentary party.
A number of people have chosen to evoke the names of de Valera and Lemass. It is worth reflecting on this.
Alan Shatter (Dublin South, Fine Gael)
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It is extraordinary arrogance to refer to one's colleagues as throwing rattles out of their prams.
Brendan Howlin (Wexford, Labour)
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The Minister of State, without interruption.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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I was referring to myself. Deputy Shatter should have paid attention throughout my speech. The names Lemass and de Valera are used in the context of not using high office for personal enrichment. Older people have rung me and asked about the values of Lemass and de Valera. We have come a long way from that time.
P J Sheehan (Cork South West, Fine Gael)
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They would turn in their graves if they knew what was going on.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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At the beginning of the State our statesmen had no interest in self enrichment through public office. At the end of his life de Valera was worried about his own pension, which demonstrates the kind of people they were. It is wrong for people to assume that by bandying these names about, they can imply they are the inheritors of their legacy. That is a wrong assumption.
James Bannon (Longford-Westmeath, Fine Gael)
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Did the Irish Press shares not pay him dividends?
Barry Andrews (Dún Laoghaire, Fianna Fail)
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I wish to refer to a reference made as far back as 1977 that will give some context to our situation now in 2008. We have had this debate before, have been in this position and will get out of it. People must accept this. In 1977, the NESC published research carried out by Eithne Fitzgerald, later a Member of this House, that concluded by stating:
The problem of coping with limited finance overshadows the provision of social services. Despite the fact that social services have been absorbing an increasing share of Government spending and of GNP, the level of provision in relation to total need remains low in a number of areas. Very many services, therefore, are selective in intent, in a bid to concentrate resources where they are felt to be most needed.
This is what we are trying to achieve in budget 2009. There is an uncanny similarity between where we are now and that time.
Olivia Mitchell (Dublin South, Fine Gael)
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That period was not preceded by 12 years' growth.
Barry Andrews (Dún Laoghaire, Fianna Fail)
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We have had an extraordinary downturn in our economy and in the global economy and must accept we are in a difficult position. It is not a case of people running for cover or of people avoiding responsibility. We must show we have the confidence to govern and that we will make the tough decisions. That will serve not our short-term interest, but the best interest of people in Ireland.
P J Sheehan (Cork South West, Fine Gael)
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The Government is like a ship without a rudder.
Jan O'Sullivan (Limerick East, Labour)
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I wish to share time with Deputies Caoimhghín Ó Caoláin, Róisín Shortall, Kathleen Lynch and Seán Sherlock.
Jan O'Sullivan (Limerick East, Labour)
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The Government still does not appear to understand what has happened among the general public. It has lost the trust of the people. We have just heard further lectures about getting through this and about patriotism, but it was the Minister for Finance who introduced the idea of patriotism in his budget speech. The concept of universalism was a concept endorsed and put forward by many of the illustrious predecessors of the Minister of State, Deputy Barry Andrews, in the Fianna Fáil Party.
The Government no longer has the trust of the people. Despite the fact it has rowed back considerably today, if any of the Government side had been in St. Andrew's Church in Westland Row today and listened to the more than 2,000 people who were there, they would know the people are not at all satisfied with what has been announced. They no longer trust the Government. They know that despite the fact the limits have been upped, once universal entitlement has been removed any Minister can, with one stroke of a pen, reduce the limits and exclude more people.
The people know too that the figures do not add up. The Minister said the measure will only affect 5% of the elderly, but the figures on savings do not add up. The most the Government could save, by my calculation, is approximately €20 million. I do not know where the Minister will get €100 million from. She will not get it, judging by the figures available to us. We will have 330,000 over 70s entitled to full medical cards and 20,000 excluded. That will not bring about the savings mentioned. Therefore, people are concerned the Government will decide later that having talked to the doctors and not having got the agreement it wanted, it will say it is sorry but must now include more people. There is no confidence that the scheme will work.
The plan may work, save the backbenchers from revolting, keep the Fianna Fáil Party together and may hold the Green Party in Government, but I was on a radio programme yesterday with Deputy Gogarty and he said the scheme would have to be scrapped or the Green Party would not be happy. However, the scheme has not been scrapped and the concept of universalism is being removed. The Government may have managed to hold the Green Party and the Fianna Fáil backbenchers, despite what they said on the public airwaves, but it has not got the confidence and trust of the people. The Government will see this tomorrow when the protest is held outside the Dáil. I am certain it will be a huge protest and that people will not accept the Government scheme.
We have a Government that knows the price of everything and the value of nothing. This is demonstrated in what happened to the health services in the budget. The Minister has said there is a 2.3% increase in the health budget, but that will not keep up with medical inflation, with already agreed pay rises or with our growing population. There is no doubt that health services will be cut and hit hard.
I wish to respond to the Minister with regard to what happened when universal entitlement was introduced by the former Minister for Health and Children, Deputy Michéal Martin. The objection of the Labour Party at the time was to the fact that doctors would be paid four times more for certain patients over 70s than for others and that this would provide an inequality of reward to doctors and would affect the way in which the population would be served.
Brendan Howlin (Wexford, Labour)
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If the Deputy is taking ten minutes, she has one minute left.
Jan O'Sullivan (Limerick East, Labour)
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That was the problem the Labour Party had with this at the time. The Labour Party proposed an amendment to the Competition Act which could have been accepted by the Government and would have allowed it to talk to the doctors. I do not understand why it is only now, seven years later, seeking a new deal with the doctors. That could have been done at any time in the past seven years.
Brendan Howlin (Wexford, Labour)
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I apologise to the Deputy. I miscalled that. My clock states there are 20 minutes left in this slot but there are obviously more.
Pat Rabbitte (Dublin South West, Labour)
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Even Homer nods, a Leas-Cheann Comhairle.
Brendan Howlin (Wexford, Labour)
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There are 20 minutes before the debate adjourns, which is what was on my clock.
Jan O'Sullivan (Limerick East, Labour)
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May I continue until 8.20 p.m.?
Brendan Howlin (Wexford, Labour)
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Yes. I will call Deputy Ó Caoláin at 8.20 p.m.
Jan O'Sullivan (Limerick East, Labour)
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Over the period the over 70s have had free access to medical cards there is scientific evidence in studies that their health has improved. In that context the Government knows the price of everything and the value of nothing. During the period of universal entitlement, because the elderly were able to go to their GPs, have flu vaccines and have their blood pressure checked, the outcomes were that fewer people over 70 were described as disabled than in the period before free access. There is real scientific evidence in a study published in the Irish Medical Journal that there was an improvement in the health of over 70s during that period.
In taking away the entitlement the Government is taking a retrograde step. In accordance with the policies the Minister has enunciated to have more people cared for in the community, to keep people out of hospitals and to have people attend primary care, in taking away the entitlement to a free medical card for the over 70s she is taking away the kinds of services that were keeping elderly people out of hospital. The other aspect is that if they do not have a medical card, not only do they not have access to a GP and their medicines, they also do not have access to public health nurses, physiotherapists and the other supports that are vital in keeping elderly people in their homes. Although the Minister says she wants to keep people in their own homes and in the community, one of the direct results of taking medical cards from the over 70s is that more of them will need to go into hospital and other more costly services which are not good for the community, not good for the elderly person and not good for the Government's budget. We should learn from what has happened in those seven years.
The other aspect of taking something from people who have had it is that it takes away the certainty they have come to rely on over the years. When we first heard there would be a U-turn today we thought the Government might allow the over 70s who already have the medical card to retain it. However, that is not the case. There is a particular dishonesty in suggesting and implying, as I heard one Fianna Fáil backbencher do on radio today, that a blind eye would be turned towards people who held on to the card even if their income was over the limit. Whatever else about elderly people, they are honest. People were horrified at the idea that they might try to hold on to the card if they did not qualify. An element of uncertainty has been introduced which is a serious problem for elderly people.
Brendan Howlin (Wexford, Labour)
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I apologise for interrupting the Deputy again. She has now used up ten minutes. There are another 20 minutes left in the slot if the Deputy wanted to share with other Labour speakers.
Jan O'Sullivan (Limerick East, Labour)
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Does that mean that the rest of the time is tomorrow night?
Brendan Howlin (Wexford, Labour)
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As the Government side ended early, five minutes of the slot that would normally fall due tomorrow night will be available to the Deputy and those with whom she is sharing tonight.
Jan O'Sullivan (Limerick East, Labour)
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In that case I will conclude. Fianna Fáil once stated that health cuts hurt the old, the sick and the disabled. That is exactly what the Government has done to the old, sick and disabled in this budget. From listening to people, I know they will not forget that.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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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.
Kathleen Lynch (Cork North Central, Labour)
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I congratulate Deputy Reilly and Fine Gael on tabling the motion. As he said, it is clear and simple, unlike the Government's proposal to abolish the medical card for the over 70s. I usually agree with much of what the Minister of State at the Department of Health and Children, Deputy Barry Andrews, says and I strongly agree with his comment that there was a great deal of confusion among the public. The over 70s are the same as the rest of us. They hear headlines about the removal of the medical card and that is chilling for people whose sole concern is security. That covers everything from being safe in their homes, to food and heat security to accessing the health service when they fall ill and not having to worry about how much it will cost. That is a fundamental issue, which worries everyone.
I saw a film recently which was about total confusion. Towards the end of it, a character asked what people had learned from it. He replied that he hoped we had learned never to do it again. This was followed by the punchline: "If only we knew what we had done." The Government parties still do not understand what they did. They instilled fear in a group of people who felt in their latter years they would be secure and they would not have worries. We hope to feel the same way when we retire. However, in one swoop, the Government removed that security. The issue was their sense of security, not the medical card. A prominent member of the Progressive Democrats once said if one could bottle security, one would be made for life. The Minister for Health and Children should have learned from that person.
Mary Harney (Dublin Mid West, Progressive Democrats)
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Was that political security?
Kathleen Lynch (Cork North Central, Labour)
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If she had learned that, she should never have made this mistake. It defies logic that 15 Ministers sat around a table, made this decision and no one said, "Stop, this will not work. You should not do it." They also sat around the table and decided to increase the number of children in classrooms and no one said "Stop". They then decided to apply a levy to the wages of people earning less than the national minimum wage and no one said "Stop". My only explanation for this is that this is the first time the Government parties have had to make hard decisions. It makes sense that if a Minister has spent 11 years being driven around, he or she will not know the price of petrol.
Pat Rabbitte (Dublin South West, Labour)
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The Green Party Members come in on their bikes.
Kathleen Lynch (Cork North Central, Labour)
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I forgot that but their tyres will be paid for. If one spends 11 years eating out, one will not know the cost of a restaurant meal. If one spends 11 years out of contact with the average person, one will not realise what it is like to feel the sense of insecurity experienced by the over 70s last week. Deputy O'Sullivan stated this group of people, who usually vote conservatively, has lost trust in the Government but they have lost more than that because they have lost their sense of security, which is paramount to them.
The Minister needs to reverse this decision and forget the waffle about the 5% because it is not the worth the hassle. People need this in black and white. They should be told the measure will not happen and they will be allowed to keep their medical cards. Let us move on to the cutbacks in education and disability services. The budget should be thrown on a bonfire and the Government should start again. It is a disaster and it will remain with the Government parties unless they decide to introduce a supplementary budget in order not to run with this one. People in their latter years who for once felt secure about access to the health service with their medical cards no longer feel that sense of security. The Minister should forget about the 5% and how much could be saved and allow them to retain their medical cards.
She should strive to provide medical cards for every person aged under 16 but she will baulk at that. The Government should have learned from the budget that it is a disaster on many fronts and it will not work. The Government parties need to get rid of it and introduce an alternative. The Government has probably run its course and we would all welcome a general election, particularly those in the Visitors Gallery, the over 70s, those involved in the disability sector and the teachers' unions.