Olivia Mitchell (Dublin South, Fine Gael)

As a Member of this House for more than 11 years, I can honestly say this is the most reprehensible and repulsive legislation that has come before us in that time. We are accustomed to spin from the Government but to find that the parliamentary draftsmen have been brought into the dishonest portrayal of these proposals is disappointing. The explanatory memorandum refers to the Bill as providing a new "scheme for entitlement to medical cards". The reality, however, is that it introduces a scheme for the removal of that entitlement. It is dishonest to pretend otherwise. I cannot recall any measure that has caused so much distress and upset.

Apart from the distress it has caused, it has also come as a shock to older people who, in planning their retirement, factored into their budgets the expectation of a medical card. These are people who were careful and who planned for the future. Now they find those plans, perhaps built over many years, are in tatters. Within the space of a few months, they have endured several attacks. Not only are their medical cards withdrawn, thus leaving them to find money for health bills they never expected to face, but they are also discovering that their pensions are not worth a fraction of what they expected and of what they contributed. Moreover, any savings will be affected by the fall in interest rates to almost nothing. Dividends on investments they may have made are reduced if not cancelled for the foreseeable future.

Whatever about frustrating the expectations of those who assumed they would receive a medical card next year and in the following years, nobody, on either side of the House or outside it, imagined the Government would take medical cards from those already in possession of them. This is being done not to millionaires but to 80 year olds, 90 year olds and 100 year olds. We heard all the claptrap about how millionaires do not deserve medical cards. There is no denying that and I fully agree that such persons should not be eligible for them. However, it is not they who are losing medical cards. For the most part, millionaires who were eligible never bothered to claim them. It is middle Ireland — compliant, tax-paying, hard-working former employees — who will lose out. Now, in old age, they are left to worry about how they will pay their medical bills. Teachers, nurses, gardaí, civil servants and their middle-income counterparts from the private sector will struggle without the medical cards they were promised by the Government.

We can be certain that from 1 January 2009, as has happened in the past, elderly people will avoid visiting their GPs and renewing prescriptions because they simply cannot afford to do so. Even if they can afford it, it may be their perception that they cannot. Older people are fearful of the future and careful with their money. If they believe they cannot afford to pay for medicines, they will stop taking them.

I spoke today to a former assistant principal who went on to work in the Dáil until recently. This person will lose her medical card next year. Single people are particularly penalised by the new system. It has always been the case that two people can live more cheaply than one. To set the single income threshold at half that for couples is particularly punitive for single individuals. In the case of two neighbouring households, for example, one occupied by a single person and the other by a couple, the overheads will be exactly the same. If nothing else is done, this at least should be reviewed.

The Minister seemed to assure us when this proposal was announced that the eligibility limits would be index linked. We now discover this is not the case. This is another example of the dishonesty shown to the public. Everybody understands that the money is gone, that the cushion we should have had against a global recession was spent foolishly and in a flathúlach fashion. However, there must surely be something left for our elderly. Surely at least those already granted a medical card should be allowed to retain it for the remaining years of their lives. Surely those who expected to receive a medical card this year or next could be granted at least two free GP visits per year or free medicines. Even a small flat charge for GP services would be better than nothing.

However, no effort has been made to provide any such concessions. Instead, the individuals concerned will have to pay the full cost of their primary medical care. Moreover, there is a double whammy in that tax relief on medical expenses will only be available at the standard rate. The elderly have been given one slap in the face after another, with no attempt made to negotiate with GPs. We were told the existing scheme was too expensive and that GPs were making considerable sums out of their participation in it. However, no attempt was made to renegotiate existing arrangements with GPs or to move to the provision of generic medicines. Instead, it was easy to use elderly people as leverage in seeking a new deal.

Eligibility is calculated with reference to gross income, including income from savings, dividends and so on. Never has such income been more volatile. A situation will arise where individuals will be eligible for a medical card one year but not the next and so on. Nobody, particularly elderly people, can plan their budgets on the basis of such uncertainty as to entitlements. They will live the remainder of their lives in fear and uncertainty, not knowing whether they need to pay health insurance in any given year and whether they can afford to put heating oil in the tank. This is unacceptable.

The entire thrust of the philosophy of the Minister and the Health Service Executive, as referred to again today by the Minister, is to move away from hospital care and towards care in the community. The aim is to keep people healthy and out of hospital by ensuring they have access to GP services so that illnesses are detected early and there is early intervention and treatment before the need for hospitalisation arises. That was the thinking behind the universal provision of medical cards for over 70s. In addition to early intervention, follow-up physiotherapy, dressings and so on were to be available to them free of charge. It is proven that this provision improved the quality of life of people over 70 years of age. In addition, there was a substantial saving for the State arising from the reduction in hospitalisation charges, which cost a minimum of €1,000 per day.

Older people are more frequently ill and need to consult their GP more regularly than younger people. The loss of a medical card to an elderly person is twice the burden it is for a younger individual. This greater financial burden on older people must be recognised. We must acknowledge that older people fear the future in a way that younger people do not. They will husband their resources and may decide, if they feel unwell, to wait one more day before seeking medical attention, then another day and so on until it may be too late. The promise of primary care investment is just that, another false promise. Nobody can have faith in a system or a Government that is built on ever shifting foundations, where principles expounded one day are cast out the next, a system where there is no consistency, logic or humanity. If somebody who loses their medical card faces huge medical bills, what are they expected to do? We are told by the Minister that the HSE will have discretion and will use it. Everybody knows what discretion for the HSE actually means. It is resource and time related. If somebody contracts cancer in January, they might receive a medical card, but if they contract cancer in July, it will be tough luck. That is the reality of the HSE's discretion. That was the case this year; God knows if it will even have that much discretion next year.

The killer blow to the elderly which will ensure they will have even less disposable income after they pay their medical bills is that they will also have to pay the Lenihan levy. A person whose income is at the threshold where they do not meet the eligibility criteria for the medical card will pay a minimum levy of €3,650 from that disposable income. If the person has been prudent and saved their money to provide for their future, they will pay even more because they will have to pay the levy on savings and investments.

As a final straw, it was reported in today's newspapers that there would be a concession by the Minister. In the legislation, as published, if widows and widowers had an income of slightly over €700 following the death of their spouse, the single person's eligibility level, they would lose their medical card. The big concession is that the Minister will wait until they are three years older before taking their medical card. It is breathtaking in its pettiness, total lack of compassion and meanness of spirit. It is unbelievable a Minister would suggest this. If I were the Minister of State, I would claim I had nothing to do with it. It is an absolute disgrace to even think of it.

I wish to deal with two further issues. The elderly must now attempt to take out private medical insurance again, that is, if they can get it and all their existing conditions will still be covered. They will also have to pay more because there is a levy. The Minister presides over the sale of this product. I have never previously seen a case where the introduction of competition in the sale of a product or service meant the price increased for everybody. That defies all understanding.

Where older people have lost their medical card, are unable to be kept in their homes and discover they must go into a nursing home, they will have to pay the full cost of that nursing home care under the new regime. The fair deal is fair to some, but those with savings and who are losing their medical card will not benefit from it.

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