Mary Upton (Dublin South Central, Labour)

I welcome the opportunity to speak on this Bill. I do so on behalf of very many of my constituents who have been in touch with me and continue to be on what is almost a daily basis. Their immediate concerns are about this measure but they are bothered also by the extraordinary level of confusion that seems to dominate their waking hours because they do not know exactly what the situation will be once this Bill is enacted.

I found breathtaking the arrogance of the Government on budget day in removing the medical card entitlement from those aged over 70. It was a gross approach to penny pinching. On budget day that was the single item that jumped out at me from all the other cuts declared. I found it incredible that the entitlement and small benefit that had been given to our senior citizens was to be removed from them in one fell swoop. It was extraordinarily disconcerting and lacked any consideration for their wellbeing because of the impact it would have on their financial status and on their psychological wellbeing.

Although it was breathtaking to hear what was said on budget day, it was equally breathtaking to see what happened in Molesworth Street and at the other meeting in the church in Westland Row where so many senior citizens turned out in force. They were more vocal than any of us would have expected them to be on that day. Despite what might have been taken for granted about them their spirit is alive and well. It was because of the events on those two occasions that the first of the partial U-turns was taken with regard to the budget. It is true that the decision caused panic and terror up and down the country, not only to those aged over 70, but also to their family members. They, too, have been in touch, sons and daughters of people affected who are concerned for their elderly parents. I still get such telephone calls on a regular basis. That is the reason I oppose this Bill, with the Labour Party.

The dilemma about automatic entitlement to the medical card for those aged over 70 started out as a political stroke designed to win an election in 2002. The measure was not agreed with doctors prior to the political announcement being made. As we now know, the consequence was that the doctors had the Government over the proverbial barrel with regard to payment and to striking a deal. In typical Fianna Fáil style, the Government once again proved profligate with taxpayers' money and ended up giving general practitioners a significantly greater payment for treating over 70s than they received for other medical card holders. There was no logic to this agreement except that the Government had played the vote catching game and subsequently had to play catch up with the general practitioners and pay them. I do not object that the over 70s were given the medical card at the time. I supported the measure then as I support it now. I make the political point that at the time its introduction was a political stroke and nothing more.

That did not seem to matter to the Government as long as the construction sector kept on building. From June 2007, the Agreed Programme for Government between Fianna Fáil, the Green Party and the Progressive Democrats promised to index link the income thresholds for medical cards to increases in the average industrial wage. Now that the building has stopped and the economy is in a tail spin, the Government, in a panic, seized upon the entitlements of the weakest in society, the elderly, and young people in education. It thought it would be able to pull another stroke while protecting the fat cats in the banks and the property moguls. How wrong it was. The sight of over 15,000 pensioners and their supporters lining the streets was a fantastic testament to democracy and to the determination of the elderly not to be sidelined or to have their rights removed.

On the other hand, I must emphasise the sense of fear, misunderstanding and genuine anger that is abundantly clear when one talks to those people. This happens every week at my advice clinics and through an unprecedented number of contacts, by e-mail, telephone and every other way that one can imagine. Everybody one meets on the street is still talking about it and still showing concern.

Although the Government harped on about a call to patriotism, this seemed to be a short-sighted money collecting exercise. What the Minister failed to realise was that automatic entitlement to the medical card makes a lot of sense from a treatment perspective. I am one of those who believes very strongly in preventive medicine and my view is that this is an area that could, and should, have been retained. In this country we are very limited in our approach to preventive medicine and we are constantly playing catch up. When something happens we try to remedy it. Why do we not try to put down blocks in the first place to prevent it happening? It should be done and it would have worked very well with the medical card for people aged over 70. The long view should have been taken here. Apart from saving money we could have looked at ways of preventing stress and ensuring a better quality of life for those people. People who can afford to go to the doctor at the first sign of illness remain healthier. That is well established and other speakers have mentioned it today. This afternoon I received a publication from UCD where some research has been done on this factor. This very point was made in that publication with regard to the health and quality of life for older people. It is also the case that people who can access their general practitioner do not spend as much time in accident and emergency departments and in acute hospitals. Space is thereby freed up in our desperately overcrowded hospitals.

In its panic and desperation at the sheer wave of hostility to the cuts, the Government flipflopped on the issue several times before finally agreeing to increase substantially the thresholds for eligibility. I already mentioned confusion. There truly was confusion and consternation among older people and I am afraid that it has not gone away, unfortunately. We have all spoken of and heard about those people who are just outside the income limits, the retired civil servant, garda, teacher and others. These people will be caught and will no longer have an entitlement. My concern is that there is nothing to stop the Minister or her successors lowering the income eligibility that has now been defined, or failing to index link it to inflation in the long term. This is simply not acceptable. The automatic right to a medical card, whatever their ulterior motives at the time, was one of the few positive steps taken by the Government to help the most marginalised in society.

There is another issue that has been brought to my attention, and I understand the Minister addressed this within the Bill. It relates to people who have medical cards that do not expire, for example, until 2013. Are they supposed to return their cards if they are over the income limits? I appreciate that this issue is dealt with in the Bill. When I spoke to a number of these people last Saturday they assured me that whatever the content of the Bill, they would be taking whatever legal advice is available to them and they will be making every effort to ensure that entitlement is retained. The way they see it is that they have a contract with the Minister and feel they are entitled to the value of that contract. They have assured me they will be taking whatever action they can.

For a number of people over 70, their chances of substantially maintaining their quality of life have been seriously damaged by the removal of the medical card. Our elderly deserve better, and I hope the Minister will review the situation and restore the medical card to those people.

See this speech in context