Jan O'Sullivan (Limerick East, Labour)

As I said earlier, the withdrawal of the universal entitlement of people over the age of 70 to the medical card will reverse some proven health gains. This regressive and inhumane measure will reduce the peace of mind of such people. We are all aware that the decision to remove this entitlement led to a significant expression of outrage on the streets of Dublin some weeks ago. We owe it to those who travelled from the four corners of Ireland to the Age Action Ireland meeting in a church on Westland Row, and to the Irish Senior Citizens Parliament demonstration outside Leinster House, to fight their cause in this democratic Chamber. The people of the generation in question paid taxes at a rate that the young earners of today would find unbelievable. They saved their money for a rainy day. They did not allow themselves the luxuries people take for granted nowadays, such as holidays and regular changes of home decor. They are the kind of people who made their own sandwiches and got their water from a tap or a well. They would have been horrified by the notion of buying bottled water or sandwiches for lunch. They scrimped and saved their money. They richly deserve something back from the State because they had to watch as this country's riches were squandered on things like PPARS and electronic voting, with little long-term benefit. In the health sector, almost €1 billion in taxpayers' money, in the form of tax breaks, is being given to rich people who are being allowed to develop co-located hospitals on public hospital grounds.

I give the Fianna Fáil-Progressive Democrats coalition Government credit for granting an automatic medical card to everyone over the age of 70. This decision, which was made in advance of the 2002 general election, was one of the few things done to help elderly people. It seems that the medical card was granted only for as long as it suited the Government. When times got tough, the entitlement was removed as part of the first batch of cuts. Similarly, children in classes of more than 30 pupils and 12 year girls, who had been promised a life-saving vaccine, were among the first to be targeted. This was done in a budget that we had been led to believe would be framed in a way that would protect the vulnerable. On the contrary, the vulnerable are taking the brunt of the pain of these cutbacks. As someone who attended the meetings I have mentioned, I am aware that representatives of the Government were taken aback by the size and vehemence of the protests against this measure. Having been in government for over 11 years, it is clear that Ministers, in particular, do not realise what is going on in the real world. They are out of touch. I would have expected the Green Party members of the Government to have recent memories of what it is like for people with small amounts of money who are about to lose their medical cards. Instead, the Green Party Ministers were happy to avail of the shelter of the Cabinet. I accept that a Fianna Fáil backbencher showed the courage to shake the Government out of its complacency and bring about a partial climbdown.

The extent to which the Government is out of touch was made clear when it set punitive income thresholds in the immediate aftermath of the budget. It subsequently had to provide for four changes to those thresholds in the space of a week. Yesterday's announcement that recently widowed people will retain their medical cards for three years is a further climbdown. It will bring relief to a small number of people. Can the Minister confirm that it is legally possible to apply a different rule to different categories of widows and widowers, depending on how long they have been widowed? While I accept that she referred to the matter in her speech this morning, I question the legality of the measure that is being introduced. Perhaps the Minister will respond to that point. This proposal will introduce a further inequality where single people are concerned. I have received a number of telephone calls from people who point out that single people have to meet many of the same household expenses as couples — heat, light and mortgage etc. — but no allowance is made for that. The upper income threshold that applies to them is exactly half of that which applies to couples. As far as I can tell, this is the only means tested measure where gross income, as opposed to net income, is the applicable criterion. This is quite unfair.

I question whether there will be any appreciable saving as a result of this legislation, when the cost of the administration of the means test for the medical card is taken into account. I am aware that the Minister has disputed the €16 million figure that was mentioned earlier in this debate. It is certainly not much more than that. The cost of the administration of the means test needs to be taken into account. What does the Government intend to do in this context in the future? The yearly review will not guarantee that the card will not be removed from more and more people in the years to come. I listened with interest to the Minister's suggestion that there will be an additional 535,000 people over the age of 70 by 2021.

The Labour Party believes that the principle of universal access should be retained. Since 2002, we have advocated a system of universal health care, including free access to primary care for all citizens. The improvement since 2001 in certain statistics relating to older people offers us a snapshot of what such a system could do for the health of the nation. A study published in the Irish Medical Journal in 2004 showed that access to the medical card resulted in older people visiting their GPs more often, an increased uptake of the influenza vaccine and a reduction in the percentage of people over the age of 70 who had a disability. It is not unreasonable to conclude that such improvements have resulted from older people enjoying better access to primary care and improved management of existing health conditions. There is strong evidence to suggest that men enjoy better health outcomes when they have medical cards. Many men tend not to visit their GPs for regular check-ups and monitoring of conditions if they do not have medical cards. In general, they will not visit the doctor unless they have an acute health problem. It is feasible to suggest that there would be a saving in the overall health budget in the medium term if all people over the age of 70 were to be allowed to keep their medical cards.

At the beginning of my contribution, I mentioned that having a medical card is not just a question of having free access to medication and one's GP. One can also avail of services like physiotherapy, supplies like incontinence pads and bandages and access to public health nurses. More than 700 people in acute hospital beds could be looked after in the community if there were places for them. If people are going to lose their medical cards, it will cause more people to end up in acute beds. Not having a medical card will mean they will not have access to the support that would allow them to stay in the community. I know the Minister's policy is that more people should be able to be treated in the community, with which we fully agree. However, this may just be lip service unless funding is given to community care services. Taking medical cards from senior citizens will make it more difficult for them to go back into the community because they will not be entitled to the various other supports, which are very important to people in staying in their own homes.

The Labour Party supports renegotiating the fee for GPs to get the same fee for all medical card patients over 70 irrespective of whether they got it as a result of a means test or a general entitlement. However, that could have been done any time in the past seven years since the introduction of the free medical card for the over 70s. It was not necessary to remove the entitlement in order to renegotiate with the GPs. However, the medical card income thresholds for other people in the community have not been raised for some time. I urge the Minister to include more people in the medical card scheme right across the age spectrum.

I refer to some individual cases of which I have become aware. I have received many phone calls about the loss of the medical card. There is great anger among senior citizens. They are not satisfied with the Minister raising the thresholds under pressure. They want a return of the right they were given. They are extremely angry that this one benefit they got from the Celtic tiger after paying high taxes all their lives has been taken from them. One person sold their house in order to raise funds to go into a nursing home. That person has money in a financial institution as a result of selling the house that has been gradually used in paying for the nursing home over time. That money would bring the person over the threshold in terms of savings. Where does that person stand in terms of retaining the medical card?

A number of people who are living alone have contacted me. Those individuals need to pay all the kinds of bills a couple must pay. Some of them are barely over the limit and will lose their medical cards. I support Deputy Reilly regarding terminally ill people. While I accept they may be able to get a discretionary medical card, there are genuine cases of people with a terminal illness, which can be very costly, who do not qualify for a medical card. That is truly inhuman and cruel. I ask the Minister to address in particular the issue of people who are terminally ill.

I support what Deputy Noonan said about the letter which I also got from the retired secondary teachers in the constituency we both share. The Government initially gave the message that this would only affect approximately 5% of the population who were very rich and could well afford to do without a medical card. However, we are talking about retired teachers, gardaí and nurses as well as people retired from working in the private sector with a limited income. We are not just talking about people in the very high-income bracket. We are talking about people who will genuinely struggle and for whom the peace of mind of having the medical card was a great bonus and the loss of which they will feel greatly.

I question taking medical cards from people who already have them. I question the legal issues of taking a medical card that somebody has as of right. In many cases those cards will not expire for another two, three or four years. Yet those people are expected to hand in their medical cards at the beginning of March. While I know that is being left to themselves, generally speaking people in that age bracket are very honourable and honest. Many of them have said to me that they would feel guilty if they held on to their medical cards. They are being put into a position of having to choose between returning the medical card voluntarily or to live with the guilt that many of them would feel. Why is the Minister taking medical cards back from people who already have them? Is the Minister legally entitled to do so?

I urge the Minister to reconsider this measure. It will not save the Government much money. It probably would have done if the Government had gone ahead with the original proposal to set the income thresholds at a very low level. On 16 October, I raised the matter on the Adjournment. The response was given by the Minister of State, Deputy Barry Andrews, who stated that at that stage the weekly income limit for a medical card would be €240.30 for a single person and €480.60 for a couple. That was the original intention. If it had not been for the outcry on the streets showing the tremendous sense of anger and outrage among our senior citizens and the courageous action of at least one Fianna Fáil backbencher who was willing to stand on his principles, that is how it would have remained. The thresholds only became more realistic in terms of including more people because of the outcry. It would not take considerably more money to restore the full automatic entitlement of a medical card to all over 70s and therefore to restore the sense of the security of knowing they can afford their medication. I believe the change will not save that much for the taxpayer, certainly not in the medium term because there will be more people in acute hospitals.

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