Bobby Aylward (Carlow-Kilkenny, Fianna Fail)

The intensity of the public debate over the automatic entitlement to a medical card for the over 70s age group has been ferocious and the public response has been extremely hostile. I believe much of this commotion was founded on misinformation and deliberate distortion of the facts.

It is very important that the central thrust of this Government's intention should not be lost in all the emotion, all the political drama, and all the arguments which have been played out everywhere since the budget. We must all understand that we are now living in severely altered circumstances compared to those which prevailed up to very recently. The harsh reality is that our revenues are vastly depleted compared to those formerly at our disposal. We have a lot less money to share out and there are ever-increasing demands on the public purse. We have no choice but to make judicious decisions about where and how that money is spent. We have so many competing and deserving interests but the onus is on the Government to ensure that the taxpayers' money is spent carefully and invested prudently. The Government is compelled to make these strategic decisions based on the long-term view and the bigger national picture.

We have to bear in mind that this Government is motivated purely and simply by financial practicalities and financial constraints. The Government has at all times acted in the utmost good faith. Its clear intention is to economise and to allocate the available resources evenly and fairly while at the same time identifying areas of spending which can be reduced. This Government is driven by the clear need to cut its cloth to suit its measure and every decision is predicated on this. The budget was formulated in the context of a lot less money to go around and on the overriding imperative to direct those scarce resources towards those who need them most. There is absolutely nothing inherently wrong with that principle as it is basic common sense. It is not the intention of the Government to victimise any section of our society. It is not its intention to cause hardship or anxiety, rather this is a genuine attempt to tackle some of the more expensive aspects of the services which this State provides to its citizens on a daily basis.

The automatic entitlement to a medical card, irrespective of one's means, has long been considered to be an unduly costly facility. In my view, the original decision was not correct. It was particularly costly in terms of the capitation fee which was paid to administer the scheme. As of 1 October 2008, there were just over 139,000 medical card holders who did not have to satisfy a means test. Of the medical card holders aged 70 and over, the total number was increasing by between 2.5% and 3% per annum. However, medical cards issued on an automatic entitlement basis were increasing at over 7% per annum. The Minister has said repeatedly that it was not possible to sustain this scheme in the medium term because of the escalating costs and the fact that we will have diminishing revenues for the next couple of years. The truth is this scheme cost the Exchequer €245 million last year alone which was much more costly than originally anticipated.

The Government's purpose was to dismantle elements of the existing scheme in its current guise because it is difficult to justify its overall costs. The intention is to obtain real savings in the region of €100 million in the overall scheme and to bring it more into line with the costs attaching to the other medical card schemes.

The capitation fee associated with the over 70s medical card was astronomical relative to the cost of the regular medical card arrangement with the GPs and it simply did not stand to financial reason that it should be so expensive. The IMO played hardball with the Government in 2001 and extracted a high price from the State for its participation in the scheme.

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