Mick Wallace (Wexford, Independent) | Oireachtas source

The alteration to the criteria for medical card eligibility is one of several restrictions to eligibility for the over 70s since the beginning of the economic crisis. The over 70s used to be automatically entitled to a medical card before 2008 but since then entitlement has been increasingly restricted. The Government is planning to save €113 million through medical card probity and has set a target of €666 million in savings next year. The Government has justified its restriction of medical cards by pointing to the increased numbers of people now availing of the cards. The rate is now at the highest level ever, with over 44% of the population currently holding medical cards. However, health analysts, including as Sara Burke and the Irish Patients Association, have pointed out that this increase is down to more people needing medical cards. The IPA has stated, "This situation is more of a reflection of the current economic environment; falling incomes and other calls on disposable income" rather than an increase in the number of people on the live register.

While the Government's commitment to universal health care has been widely welcomed most commentators, including doctors, believe the current approach of introducing free general practitioner care for those under five years while restricting medical cards to others who might have a greater need for medical care is a contradictory and confused approach to the issue and flies in the face of the programme for Government's commitment to developing a universal, single-tier health service which guarantees access to medical care based on need, not income.

In response to measures announced in budget 2014, the chairman of the Irish Medical Organisation's GP committee, Dr. Ray Walley, said that the Government "is presiding over the widespread rationing of discretionary medical cards for people with long term illnesses and real medical needs and now it's engaging in a stunt by extending these cards to tens of thousands of children in relatively wealthy families who by any measure do not need them." Age Action Ireland has also said that it is concerned at changes to income limits for the over-70s medical card which this year will see the loss of another 35,000 cards and stated: "It is contradictory to be removing means-tested cards from a section of society which has high medical needs, in a budget which is rolling out free GP care for children and heralding it as the roll out of its universal primary care plans".

The Government’s approach to health is fundamentally confused and contradictory. It is not based on need but is driven primarily by financial concerns. Worryingly, part of this can be attributed to demands made by the troika. Although initially the troika seemed quite silent on health, it increasingly became vocal on conditions in health and stated the Government must "tackle the unsustainable growth in medical cards". The approach then is one based on fiscal concerns, particularly in the context of the EU-IMF programme, and not on the Government’s professed primary objective of need.

While there are fiscal constraints on the State in funding the health sector, an inconsistent and incoherent approach to health risks is undermining the health and lives of people. Where is the impact assessment of measures introduced in budget 2014? How were certain people’s health needs prioritised over others? It is obvious that such needs were not taken into consideration and that policy is being driven by budgetary concerns and the slashing of numbers, rather than on health care concerns. One could be forgiven for thinking that the Department of Public Expenditure and Reform is now running the Department of Health.

The huge risk being run at present is that there will be a permanent impairment to the health sector in Ireland and therefore to the well-being of citizens. In their TASC report, Eliminating Health Inequalities - A Matter of Life and Death,Sara Burke and Sinéad Pentony noted the dire consequences of slashing spending on health in 1980s:

... which were made in response to the then weakness in the public finances. It took a considerable time for health spending to recover from the cuts in the 1980s, and it can be argued that the provision of health services did not fully recover from those cuts.

In other words, the reason the health service is marked by the obvious problems with which all Members are familiar is precisely because the Government previously slashed funding on health and the service was never able to recover. It would be utter folly for the current Administration to repeat that same mistake, rather than learning from the past.

The Government’s commitment to universal health care is to be welcomed as it presents an opportunity to redress inequalities in Irish health care. Burke and Pentony noted:

... despite an overall improvement in the health of the Irish population [over the decades], very little has been done to address inequalities in health between high-income and low-income groups. [This means] if you work at an unskilled job and live in a deprived area, you are more likely to die earlier than a professional worker living in an affluent area.

Inequality in health is most starkly and sadly illustrated by the figures for Traveller people. Traveller men and women have four and three times, respectively, the mortality rate of the general population. Suicide rates among Traveller people are six times higher and account for approximately 11% of all Traveller deaths, while the infant mortality rate for Travellers is 3.5 times higher. These figures are frightening in a country that claims it cares. The Government must now act to redress such inequalities by introducing swiftly a system of universal health care that is equitable and that is truly based on need and not on income. Sadly, the Government’s strategy for so doing is undermining its best efforts as it is more concerned with achieving savings targets through restricting eligibility rather than taking a patient-centred and needs-based approach.

Too little is happening too slowly. Although Members have been promised a White Paper on universal health care since 2011, outlining the details of the proposed universal health care system, where is it? I acknowledge a preliminary paper was published this year, namely, The Path to Universal Healthcare, but Members still await the actual White Paper. Although groups have been established to research and oversee the implementation of a system of universal health care, there seems to be very little action from the Government and what it is doing is undermining directly its own professed goals. How much longer must Ireland be one of the few countries in Europe without universal health care? How much longer will Members accept that people are dying prematurely and are suffering disease and injury simply because the Government is incapable of tackling Ireland's two-tier system, in which those who can afford health care pay and those who cannot suffer the consequences?

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