Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The Minister of State might be looking forward to hearing our views but we cannot express any confidence in this Bill.

First and foremost, on the aspect of the Bill being published last week, Deputies have been unable to get a copy of it and we are now in the Dáil Chamber discussing Second Stage. Quite clearly, this an unpopular measure the Government is bringing forward. Let us be under no illusions. Nobody in the broader public is embracing this measure. Nobody in this Chamber is supportive of it, but the Government has an overwhelming majority and will ram it through. There has been no discussion on this legislation. It was published last week. There has been no time for stakeholders, advocacy groups and others who represent those in the community who will be directly affected by this legislation. It is inherently a nasty piece of legislation.

The Minister of State, Deputy Alex White, in his opening remarks, stated that the legislation was about protecting the vulnerable, that the Government had to make difficult decisions. The Government had to wrestle with its conscience. It had to look deep into its heart. The problem here is that the Government did not wrestle with its conscience. In particular, the Labour Party did not wrestle with its conscience in the context of the formulation of the last budget. There was an easy way to avoid all of this, in terms of targeted cuts. The cuts to date have been targeted at the most vulnerable. They have been targeted at the over 70s, in this legislation, at home help and at special needs assistants. They have been targeted at all of the areas where people are most vulnerable. The mobility allowance is another such area where they were targeted. Quite clearly, those who have been targeted most by this Government have been the elderly, those with disability and those who require State supports. Any perusal of the budgetary strategy would indicate that. If the Government really wanted to be fair and equitable and ask those who have most to carry most, it would have had a completely different budget arithmetic brought to this House last year. For example, the universal social charge would have been increased for those earning more than €100,000. That would have realised a major increase in tax receipts and the Government would not have had to bring about some of the insidious and nasty cuts that have been announced.

I do not want to go back over the history of eligibility for those over 70s, but it is interesting. The first one to put a cap on eligibility was the previous Government made up of Fianna Fáil, the Progressive Democrats and the Greens. Previously, it was a Fianna Fáil-led Government that brought in automatic entitlement for those over 70. When, in January 2009, we brought in a more liberal regime in terms of assessing eligibility for medical cards for those over 70, the parties opposite were apoplectic with rage. The Government parties, then in opposition, were beside themselves with anger, indignation and sheer determination that they would campaign to the end to take away the inherent unjust proposal that was being brought forward. The Minister, Deputy Reilly, was furious in opposition at the time when we were bringing in an eligibility income threshold, but a more generous one than that being proposed in this legislation. He stated that those were the people who made this country what it is today, that they raised us, nursed us when we were sick, protected us from violence, grew our food and ran a proud Civil Service.

I find it hard to believe that the Government is bringing this in as it stands. First, there has been no consultation whatsoever. It was announced as a budgetary matter, but one would have thought that the legislation would be published and that there would have been time for Deputies to collect it and read it before it was rammed through the Dáil so that there would be no dissent from Government backbenchers. One would have thought also that there would have been an opportunity for engagement with the broader community and society because this will impact on people's lives.

What I cannot understand is that while the Government speaks about universal health insurance and getting rid of the two-tier system, every policy it has adopted since has provided the opposite and created more difficulty for people. The policy of charging private insurance companies the full cost for patients in public beds will increase the price of private health insurance dramatically to subscribers who are put to the pin of their collar to retain private health insurance. Previously, subscribers have responded to the Government's suggestion that they take out private health insurance to lighten the burden on the public health system and to enable them to access care. Here we have a Government, that is promising to bring in health insurance for everybody while at the same time loading private health insurance against those who are trying their best to lighten the burden on the State in terms of the provision of health care. A total of 67,000 people gave up their private health insurance last year. Any assessment or actuarial analysis of the figures shows that this is quite alarming because it is the younger subscribers, those who are healthiest, who are leaving private health insurance and the burden will fall further on those who retain private health insurance, and there will be a price spiral.

One need not be an economist or actuary to assess the impact of this. One need only listen to Mr. Donal Clancy. He represents a private health insurance company, but he, along with many others such as VHI, GloHealth and Aviva, was quite adamant in his evidence to the Joint Committee on Health and Children. All of the insurers state that this will have a devastating impact on the ability of the private health insurance market to grow, prosper and develop. At the same time, week in and week out, I get a lecture from the Minister for Health that he has a mandate to bring in universal health insurance. He has a mandate, but he certainly did not seek a mandate to inflate private health insurance and drive families, who are put to the pin of their collar making decisions on whether they will fill the oil tank or whether they will buy essential services and supplies for their house, to decide not to pay their private health insurance. That is what people are doing. The Minister of State should go out to Dunshaughlin or Stamullen. If he goes anywhere in County Meath, he will hear this on the doorsteps. Residents are saying they simply have not got it. Now they are getting a letter through the letterbox. That is a separate issue, but it shows that people simply do not have disposable income. Are we now viewing private health insurance as a luxury? Is this now considered a luxury that one can do without? It is fine. If they do without it, they will fall into the public health system.

My point is the Minister is making decisions that go against everything of which he speaks when he refers to universality. On universal GP care, the problem is this legislation makes it more expensive for people to access their GP and medicines. That simply is the case and there is no way around it. Listening to the opening statement from the Minister of State, who has responsibility for primary care, it is quite evident that a U-turn of massive proportions is being done in terms of the legislation the Minister has presented to the Dáil. At the same time, the Government is promising free GP care for everybody. If we cannot afford to look after those who, as the Minister stated, made this country what it is today, how does he expect us to believe that the Government could afford to provide free GP care to everybody? It simply does not add up.

It is time that the Government stopped this delusional approach and had a rational debate on how we fund the health services. I am the first to accept there are budgetary constraints on the Government. We all realise the difficulties the country faces, but the critical issue is how we apportion funding and taxpayers' money, who we decide are vulnerable and who we decide we should care for. As a member of the Labour Party, I am amazed the Minister of State, Deputy White, is coming forward with this legislation. He should have fought tooth and nail with the Minister in the corridors of Hawkins House not to present this legislation in terms of the budget arithmetic because it is inherently unfair, if we are talking about universality.

All the statistics on the number of GP visits show clearly that older persons will visit their GP more, will access medications more, will have higher incidence of chronic diseases and need chronic illness management. This legislation will impact disproportionately on older persons. It will have a profound impact on those who built this country, and I quote none other than the Minister for Health.

When one goes through the legislation, there is another little nasty nugget in it.

We talk about democratic accountability in this Chamber, but I do not believe anybody believes that anymore. The Bill will allow a Minister without ever having to come into the House again to decide to change the eligibility criteria for those on medical cards. Up until now a Minister had to come into here - brazen and with a brass neck possibly - and explain to the House why he or she was changing the eligibility criteria and reducing people's entitlements and rights. However, with one fell swoop this legislation takes that democratic accountability away. If we pass the Bill, we will allow the Minister, whoever it might be, to decide without any further approval to change criteria and reduce medical card eligibility. Most people inside and outside this Chamber could not accept that. It simply gives a Minister too much power to decide without having to explain the rationale behind it to a democratic assembly.

The Bill is contrary to stated Government policy as outlined in the programme for Government and is a U-turn of massive proportions. Just as importantly, it denies public representatives the opportunity to speak on changes to eligibility to medical cards and GP-only cards. We will be opposing the Bill and urging everybody else to oppose it. As the Minister of State well knows, its provisions can and will be abused. There is more mention of the Minister for Public Expenditure and Reform than anything else with phrases such as "with the consent of the Minister for Public Expenditure and Reform". Where are we going? We are giving a carte blanchefor responsibility for budgetary matters. Removing accountability of any form must be genuinely reconsidered. We will be opposing the Bill on Second Stage. The Government may make its case for changing eligibility. However, the democratic deficit will be forever enshrined in the legislation if passed and is a shameful exercise in itself regardless of the attack on the older people. Equally, there is an attack on the ability of democratically elected public representatives to at least have an opportunity to speak and defend those who are vulnerable and for the Minister of the day to come into the House and explain his or rationale for changing eligibility criteria. The Minister of State knows in his heart and soul that is wrong for many reasons.

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