Bobby Aylward (Carlow-Kilkenny, Fianna Fail)

It has acknowledged its commitment to afford special care to the elderly. It has recognised, without any ambiguity, the singular contribution made by this age group to the national economy and to society. I am delighted that the Government decided to revise the income threshold up to €700 gross weekly or €36,500 annually for a single person and €1,400 gross per week or €73,000 annually for a couple. Now 95% of people who are over 70 will retain the medical card. This amounts to approximately 20,000 people and some of these people may be entitled to apply for a discretionary medical card if they are experiencing particular hardships, health problems or high medical expenses. Some of these may also be covered by the drugs repayment scheme, which also provides a good cushion.

There is another element to this debate which is relevant and worth noting so that everyone is clear about their entitlements. I am glad to see that the element of means testing has been retained for this medical card, as is the case with all other medical cards. It is generally accepted that people who can afford to pay should pay for the services they receive. Virtually no one disagrees with that principle. No one expects the taxpayer and the State to carry the entire cost for those who have sufficient means to pay their own way. In an ideal world with infinite resources, it would be desirable to retain the concept of universal or automatic entitlement but the pressing reality now is that we just cannot afford to extend that luxury to everyone. While there may be some resistance to the introduction of a means test, it is a fair basis on which to disburse limited resources and ensure that available moneys are delivered to those who need the support of the State to meet their daily needs.

A total of 5% of the over 70s population can afford to pay for professional medical services, therapies and pharmaceutical drugs. I do not believe that anyone of that age cohort, who has more than adequate means, would refuse to pay or would realistically expect the taxpayer to bear his or her costs. It is only fair and equitable that those above the new weekly threshold of €700 gross income per week should in fact defray their own medical expenses. I know they will regard this as a very reasonable proposition. Furthermore, virtually all of that 5% of the over 70s population have private health insurance and may also be availing of the State's long-term illness scheme.

The revision of this medical card income threshold will come as an enormous relief to all those who felt they were being affected. The increase in the threshold is substantial and it will ensure that the majority of the over 70s population will now be catered for. The onus now rests on the Government to find the savings of at least €64 million elsewhere in the Department of Health and Children.

I am pleased that it has signalled its willingness to review the drugs scheme and to investigate the possibility of dispensing generic drugs where this is appropriate. I have long been an advocate of effecting economies within the dispensing system and I believe that pharmacists generally are supportive of this initiative. Medications are expensive in this country and it would be infinitely sensible to explore prescribing generic medicines where a suitable alternative to the branded drug exists and provided it is safe and effective for the patient. There is scope for significant savings in this drug initiative and all the parties concerned can work together to achieve greater cost efficiencies when it comes to prescribing and dispensing medicines. For these reasons I commend this Bill to the House.

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