Martin Mansergh (Tipperary South, Fianna Fail)

It is always regrettable when the Government must take away an entitlement, actual or anticipated. It is doubly regrettable when confusion about those who may be affected causes anxiety among older people who deserve to be treated well by us. Nevertheless, I am happy that arising from the controversy, a fair and well-judged balance has been arrived at between, on the one hand, the cold realities of what the wider community can sustainably afford by way of support for the extended scheme and the genuine needs of a steadily growing number of older people.

There are broadly three categories of people in the over 70 age group — those who have always been eligible for medical cards, others who would have been less well off but ineligible under what was originally proposed and who would struggle to meet heavy medical expenses out of their own pocket even with the support, in many cases, of otherwise strapped family members, and the comfortably well-to-do who are not necessarily wealthy but are, broadly speaking, able to look after themselves, who have health insurance and who, in most circumstances, neither need nor particularly want medical cards. The situation of the middle category especially needed to be addressed following the withdrawal in principle of universal entitlement and I am glad that has been done sooner rather than later and before any changes come into force.

Medical cards mean not merely free general practitioner services and prescriptions but are used as a reference guide for the provision of various free medical aids and home care. They do not affect eligibility for hospital care. This universal entitlement is of recent origin and only a few years standing. While a laudable step which I supported at the time, it has proved a bridge too far achieved only at an excessive cost which now must be revisited.

General practitioners in this country earn a high income compared to their counterparts abroad between, in many cases, large GMS practices and private patients. Perhaps Fine Gael's health spokesperson, Deputy James Reilly, would enlighten us as to what medical reason lies behind charging a capitation fee of €139 for an existing male medical card patient over 70 living within three miles of the doctor's clinic——

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