Enda Kenny (Mayo, Fine Gael)
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If the Taoiseach had been in St. Andrew's church, Westland Row, today with Members of the Government he would have appreciated to a far greater extent the hurt and anger felt by the elderly population arising from the Government's shameful decision. At least 2,000 people heard stories from the elderly of the circumstances in which they now find themselves and what faces them as a consequence of the Government's decision to take back that which they never asked for and to end the principle of universality in regard to medical cards for people on reaching the age of 70 years. That card was given to them on the basis of what they did for this country when times were not good, how they sustained it during bad times in paying exorbitant rates of tax, for paying in full for their children's education and in accepting in good faith and in trust that this State would look after their medical needs when they passed the age of 70 years having been given a medical card.

The Taoiseach and the Government created fear and concern among the elderly who are bruised and offended by what was done. Since Friday, the Taoiseach has made three attempts to rectify this problem, namely, on "Six One" news, on Sunday and again today. I am not sure where the Minister for Finance, Deputy Brian Lenihan, who introduced this measure, was. One would have thought that he who introduced it should have been at the conference today.

Each intervention by the Taoiseach was not on the basis of dealing with the elderly but of quelling the revolt in the backbenches of Fianna Fáil who know this decision was wrong; that this principle should not be breached. The decision of Government is now recognised by every Fianna Fáil member to have been grievously wrong. The Taoiseach has expressed regret that this decision was taken and for the incompetent and shameful manner in which this matter was handled. The Taoiseach will shortly leave for China on important business and I respect that. The saving as a result of this decision was calculated to be €30 million, half the amount spent on electronic voting machines.

Will the Taoiseach, before he leaves, prevent the ignominy of thousands of elderly citizens arriving in this city tomorrow to campaign to retain their right to a medical card, a right given to them in good faith by this Government, a trust now breached?

Deputies:

Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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Will he accept the Government was wrong and put his hands up and say that he is sorry?

Bernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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Will he, as suggested by Fine Gael, try to find another means of raising this €30 million and ensure these people retain the right to their medical cards? Will he leave the right of universality unbreached and go to China knowing his backbenchers will not be forced to climb the steps tomorrow and vote against the motion as dictated by him?

Brian Cowen (Laois-Offaly, Fianna Fail)
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The announcement made this morning was for the purpose of allaying the concerns of the people involved in this situation. As I stated, approximately 95% of people who had cards in the past will retain them under the new arrangements. The core decision and the requirement for a core budget arithmetic to be respected is incorporated in the revised scheme brought forward in the interests of providing a sustainable way forward. The principle the Deputy enunciates today was not advocated by his party when this measure was introduced. One can quote from various Deputies in the House on the other side who did not agree with universal entitlement for their own reasons.

At a time of depleting resources, there is a need to target resources in a whole range of areas in the health sector for people most in need, and this principle comes into very sharp focus in the exceptional economic times in which we live. Therefore, we have sought in this case to allay public concern. In political terms, there may be some disappointment if it starts to be allayed as a result of the decision this morning but it is important in the public interest that the concern is allayed.

I have expressed profound regret to any family or individual who, because of the way in which the matter was being portrayed or as a result of our failure to communicate properly, felt they were not going to continue with an entitlement because more than 70% of the people concerned were going to retain their medical entitlement.

Róisín Shortall (Dublin North West, Labour)
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That is not true.

Jan O'Sullivan (Limerick East, Labour)
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They were not.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Instead of the graduated response for the others, as per the original proposal, we are now extending medical card eligibility, as I have stated, right up to those who have income of €700 per week for a single person or €1,400 for a couple. For those reasons, this is a comprehensive response by Government in the face of such concern to allay it, dispel it and deal with it.

With regard to the budget arithmetic, as I have stated during an earlier session of Leaders' Questions, the Fine Gael Party has a budgetary position that does not stand up to any scrutiny at all.

Bernard Durkan (Kildare North, Fine Gael)
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The Taoiseach's does.

Billy Timmins (Wicklow, Fine Gael)
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The Fianna Fáil figures are shaky too.

John O'Donoghue (Kerry South, Ceann Comhairle)
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We must allow the Taoiseach to finish.

Alan Shatter (Dublin South, Fine Gael)
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This is the Taoiseach's fifth year presiding over a disastrous budget. He had four as Minister for Finance.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is the stated position of the Fine Gael Party that with no tax rises, a deficit of 5.5% would require further cuts of €4 billion.

Simon Coveney (Cork South Central, Fine Gael)
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The Taoiseach has some cheek to focus on our figures.

Brian Cowen (Laois-Offaly, Fianna Fail)
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That is a fact.

Olwyn Enright (Laois-Offaly, Fine Gael)
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It is not.

Alan Shatter (Dublin South, Fine Gael)
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The country is now committed to the Taoiseach's level.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Sticking to the point that is of particular concern to people today, that is the background I wish to mention. The fact is we are dealing with that situation comprehensively, providing for savings to be obtained by reason of the fact there will be people who will not be entitled to the card as they are over those eligibility limits on 1 January. That will provide a saving.

From next week there will be an agreed common single capitation rate for those over 70s on the medical card scheme, which will provide savings. Of course, the committee, chaired by the person we have obtained, for the purpose of dealing with drug usage will provide the significant and substantial savings which we believe, on the basis of consultation with GP representative bodies, are available given that total drug spend at the moment is approximately €1.95 billion. That has almost doubled since 2003.

Enda Kenny (Mayo, Fine Gael)
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This does not deal with the fundamental fact. We are talking about a decision of the Fianna Fáil Government, backed up by the remaining Progressive Democrat and the Green Party, the deputy leader of which stated on KCLR this morning that but for the fact that the Green Party threatened to pull out of Government, this morning's action would not have happened. We are back to square one.

Timmy Dooley (Clare, Fianna Fail)
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Never.

Enda Kenny (Mayo, Fine Gael)
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I will make the point to the Taoiseach again. Irrespective of the discussion going on around this, the Taoiseach and his Ministers sat down at the Cabinet table and decided to do this and break the principle of universality to give people, by right, a card after 70 years. This was given to them in good faith by the Government seven years ago as a reward for what they did in sustaining this country and building it up so they could, in their twilight years, look forward to the State looking after their health benefits.

I understand in some cases even people with a terminal illness are being means tested in respect of their medical cards. Will the Taoiseach confirm that?

John Cregan (Limerick West, Fianna Fail)
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No. The Deputy should get his facts right.

Enda Kenny (Mayo, Fine Gael)
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Those over 70 do not accept the decision of Government this morning.

Shane McEntee (Meath East, Fine Gael)
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No.

Enda Kenny (Mayo, Fine Gael)
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They were given this card by the Government in good faith.

Bernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Shane McEntee (Meath East, Fine Gael)
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Leave them alone.

Dan Neville (Limerick West, Fine Gael)
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Leave them alone as right.

Enda Kenny (Mayo, Fine Gael)
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That faith and trust has been breached. The Taoiseach can give a categorical assurance on the following concern if he wishes. The people are concerned that this will be driven through by the Taoiseach and the people behind him — they will have a very different view when they go down to the constituencies where they speak like Opposition Deputies on every radio station. They will be forced tomorrow evening to go up those stairs and turn right or left.

Where would the Deputy's party get its €4 billion in cuts?

Enda Kenny (Mayo, Fine Gael)
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Before the Taoiseach leaves for China, I ask him to give the House a categorical assurance that when he rams this shameful, disgraceful and callous decision through, he will not follow it with similar decisions on electricity, telephone and travel allowances, which he can do without any legislation. I ask him for that assurance today.

The Taoiseach can prevent the ignominy of whatever number of elderly people from all over the country turn up tomorrow. They will travel to the capital city to protest——

Paul Kehoe (Wexford, Fine Gael)
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It is unreal.

Enda Kenny (Mayo, Fine Gael)
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——and defend the right that the Taoiseach's party gave them to have a medical card on reaching 70 years. He can prevent the ignominy of the cowardice of his Government's members when going up those stairs tomorrow evening to vote for a decision they know in their hearts is wrong. Principle and courage are required and this could have been done in an entirely different way. The elderly sector should not be segmented into those who have cards and those who do not.

Before leaving for China, will the Taoiseach stand up and say his Government got this wrong, that he is sorry, that he is withdrawing it, will leave the elderly with their cards and the universal principle will apply under Fianna Fáil? They have said over the years they will look after the sick, the old, the vulnerable, the lonely and the isolated.

Noel Dempsey (Meath West, Fianna Fail)
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We will do so.

Enda Kenny (Mayo, Fine Gael)
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Shame on all of them for putting this through.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Peddling untruths and scaremongering is not an example of principle or courage.

Paul Kehoe (Wexford, Fine Gael)
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We are not scaremongering.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It does not reflect very well.

Billy Timmins (Wicklow, Fine Gael)
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Read the budget.

Alan Shatter (Dublin South, Fine Gael)
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The Taoiseach scared the backbenchers as well as the elderly.

Brian Cowen (Laois-Offaly, Fianna Fail)
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If the purpose is to find a response that allays concern, what the Deputy has said——

John O'Donoghue (Kerry South, Ceann Comhairle)
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Let the Taoiseach finish.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——is a patent untruth since there is no question of other free schemes being in any way involved or dependent on the medical card.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Answer the question.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Anybody with a cursory knowledge of the social welfare code knows that to be the case. It is entitlement to pension that provides that link.

Enda Kenny (Mayo, Fine Gael)
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I asked for a categorical assurance——

Noel Dempsey (Meath West, Fianna Fail)
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The Deputy is seeking to scare people

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy knows that and should not make statements publicly for the benefit of television. It does not become him.

Enda Kenny (Mayo, Fine Gael)
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——which the Taoiseach does not want to give.

Brian Cowen (Laois-Offaly, Fianna Fail)
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If the Deputy's concern and outrage is genuine, there is no need to peddle that sort of untruth. He does not need to.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The second point relates to the question of principle that the Deputy has indicated is involved.

Paul Kehoe (Wexford, Fine Gael)
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The Taoiseach has no principles.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I will respond to the point. Shouting at me does not get the Deputy anywhere either, by the way. There are many Deputies on the other side of the House, who at the time of this scheme's introduction and since, are on the record as saying they were not in favour of that universality being provided.

Enda Kenny (Mayo, Fine Gael)
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Yes, but it was brought in.

Brian Cowen (Laois-Offaly, Fianna Fail)
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So therefore it clearly was not a principle then. Perhaps it is a principle now because the Deputy sees a political opportunity.

Bernard Durkan (Kildare North, Fine Gael)
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It was introduced.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Be that as it may, it is the Deputy's version of leadership.

Enda Kenny (Mayo, Fine Gael)
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I will not take that nonsense from the Taoiseach

Brian Cowen (Laois-Offaly, Fianna Fail)
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I will not take barracking from the Deputy either.

Enda Kenny (Mayo, Fine Gael)
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The Taoiseach has done down the elderly and the economy and is not true to his own word. I have listened——

Brian Cowen (Laois-Offaly, Fianna Fail)
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I listened——

John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Kenny, allow the Taoiseach to finish.

Dan Neville (Limerick West, Fine Gael)
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It was done to appease those behind the Taoiseach.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I listened in silence to the Deputy's comments.

Enda Kenny (Mayo, Fine Gael)
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I will not be lectured.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am entitled to respond. When I do so and the Deputy does not like it he speaks of people lecturing. I am not lecturing the Deputy but I am stating the facts. The facts are that my version of leadership was to go on television on Friday to say I would find another solution to this problem that would be within the parameters of budgetary discipline.

Enda Kenny (Mayo, Fine Gael)
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To appease those behind the Taoiseach.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is the duty of the Government, not the Opposition, to stand over that. It has the luxury of being able to come forward with a phony budget strategy and not be answerable to anyone.

Enda Kenny (Mayo, Fine Gael)
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I will not take that from the Taoiseach.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputies are pretty good at giving it now.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Let him finish.

Enda Kenny (Mayo, Fine Gael)
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I am not going to take that from him.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The Deputy will have to take the facts. The facts are Fine Gael has a budgetary strategy and the Deputy has that luxury as Leader of the Opposition.

Paul Kehoe (Wexford, Fine Gael)
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Does the Taoiseach want to be Leader of the Opposition?

Brian Cowen (Laois-Offaly, Fianna Fail)
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The sort of leadership he provides——

Paul Kehoe (Wexford, Fine Gael)
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He can be Leader of the Opposition.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——is that in respect of every individual economy, cut or saving we bring forward, he opposes it.

Enda Kenny (Mayo, Fine Gael)
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There is a €15 billion deficit

Brian Cowen (Laois-Offaly, Fianna Fail)
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Their overall budget strategy requires cuts of €4 billion more than what we have brought forward, if the figures were to stand up.

Paul Kehoe (Wexford, Fine Gael)
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If the Taoiseach wants to be Leader of the Opposition, he should come over here.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The figures do not have to stand up because the party is in Opposition. That is precisely why it is there.

Paul Kehoe (Wexford, Fine Gael)
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Fianna Fáil can come over here to be the Opposition.

Brian Cowen (Laois-Offaly, Fianna Fail)
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What we must do in this matter is ensure the decisions brought forward——

Enda Kenny (Mayo, Fine Gael)
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Where is the Minister for Finance, Deputy Brian Lenihan?

Brian Cowen (Laois-Offaly, Fianna Fail)
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——and the different solution——

Enda Kenny (Mayo, Fine Gael)
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There is a €15 billion deficit.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——we have brought forward today still respects the budgetary parameters as I have outlined and in the ways I suggested. That has been indicated to us in consultation with those medical practitioners who are at the very front line of service delivery——

John Cregan (Limerick West, Fianna Fail)
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Where are Deputy Kenny's figures?

Brian Cowen (Laois-Offaly, Fianna Fail)
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——not only with this scheme but with primary care practice generally in this country. Therefore, as I stated, it is in co-operation with those practitioners and working in good faith with them, and I thank them for their co-operation——

Enda Kenny (Mayo, Fine Gael)
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It was not good faith last week.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I thank them for the role they have played in assisting the Government to come forward with a proposal that is far more comprehensive, should meet with far wider public acceptance and still meets the budgetary disciplines that must be met.

Ulick Burke (Galway East, Fine Gael)
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More assistance.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Deputy Kenny can come in here, call me callous——

Dan Neville (Limerick West, Fine Gael)
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Which the Taoiseach is.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——or all the names he likes——

Enda Kenny (Mayo, Fine Gael)
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This is shameful.

Brian Cowen (Laois-Offaly, Fianna Fail)
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——but, as far as I am concerned, I will continue to provide leadership in the solution of problems, not the Deputy's exaggeration or misrepresentation of them or his attempt to scaremonger people because he is disappointed.

Enda Kenny (Mayo, Fine Gael)
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The Government is shameful. Shame on them all.

Paul Kehoe (Wexford, Fine Gael)
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It is the Taoiseach who is disappointed.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is a sad thing to have to say but the Deputy is disappointed that concerns may be allayed in respect of this matter and his political advantage cannot continue.

Paul Kehoe (Wexford, Fine Gael)
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The Taoiseach is disappointed his backbenchers made him climb down.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Iarraim anois——

James Reilly (Dublin North, Fine Gael)
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If it was right to give it, why is it right to take it away?

John Cregan (Limerick West, Fianna Fail)
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Deputy Reilly has made his money.

James Reilly (Dublin North, Fine Gael)
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The Government has taken the card from the over-70s.

Alan Shatter (Dublin South, Fine Gael)
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The Taoiseach has never got any of his figures right in any budget he brought before this House.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Iarraim anois ar cheannaire Pháirtí an Lucht Oibre, an Teachta Gilmore, without interruption.

Deputies:

Brian the butcher.

Eamon Gilmore (Dún Laoghaire, Labour)
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The Taoiseach has stated that the formula he announced this morning means that 95% of those who are over 70 now will qualify for a full medical card. If that is the case, why does he not just do the decent thing and leave them with an automatic entitlement to a medical card?

Bernard Durkan (Kildare North, Fine Gael)
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Exactly.

Deputies:

Hear, hear.

Eamon Gilmore (Dún Laoghaire, Labour)
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This should be done instead of having them worried, as they are, that their income will creep up above the limits of €700 and €1,400, respectively, for those who are single or married. They are worried about what will happen if one partner dies and what income will be left to the other partner. They are worried whether, at some future stage, the Minister will reduce the level of the means test. If they are not worried about themselves, they are worried about their neighbours who may be in such a position. Moreover, if the Taoiseach begins to withdraw universal entitlements to medical cards today, they are worried about where he will stop. Will it be the bus pass next year and something else the following year?

The Taoiseach should clarify a couple of points in respect of his announcement this morning. He stated that 5% of the single and married over-70s earn in excess of €700 and €1,400, respectively. What is the basis for this figure? I do not know whether income distribution figures are available for those who are over 70. I have never seen or had access to them. What is the basis for the Taoiseach's assertion in respect of this figure of 5%? Is it simply off the back of the envelope?

The Taoiseach has stated that from 1 January, there will be no automatic entitlement to a medical card for those who are over 70. Can the Taoiseach confirm to the House that after 1 January, the income limits may be changed by ministerial order and will not require approval from this House? What assurance can the Taoiseach give to pensioners that they will not be further reduced if economic conditions continue to be bad? Will the €700 and €1,400 limits, to which the Taoiseach referred this morning, be index-linked?

What is the position in respect of someone who has a medical card which states it is valid until 2012? Will such people keep those medical cards until 2012 or will they be required to make a declaration that their income has gone over the limit? What happens if someone does not make a declaration that his or her income has exceeded the limit and this is discovered subsequently? Will they be committing an offence under the Health Act 1970, which I understand to be the position at present? Will the HSE be entitled to go after such people for the health costs they incurred while holding medical cards in circumstances in which they did not make the declaration?

Members have heard the figures for the income limit for holding a full medical card. Are new income limits available for doctor-only cards or for qualification for the €400 subsidy that was announced on budget day? Have the doctor-only card for the over-70s and the €400 subsidy that was announced on budget day now been taken off the table?

Brian Cowen (Laois-Offaly, Fianna Fail)
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To take the final point first, we have brought forward a different proposal in respect of widening the eligibility criteria in order that more people are entitled to the medical card. Therefore, the requirement for the GP-only card or the fee payment does not arise. These were graduated responses in the past when, while preparing the budget, the Government was dealing with a scheme as constituted then and as remains until it hears from Mr. Sullivan, which has a differentiated fee payment system in respect of those who now are over 70 and who have means tested medical cards because they entered the medical card system before turning 70 and those who acquired it simply because of their age, regardless of their means. As the Deputy is aware, a differentiated system was in place.

As for the question of the calculations of the Department of Health and Children regarding the numbers who would be eligible in respect of income etc., information is available and the Minister for Health and Children can provide it to the Deputy.

As for the question regarding the position after 1 January 2009, the Government's statement indicated that there will be a repeal of the Health Act 2001 such that the legal basis for the eligibility for a card is in line with the decision to which the Government has come and which was announced this morning. I also make the point that new entrants onto the scheme after 1 January will be required to apply for their medical cards under these new arrangements. Everyone will be notified by way of letter as to what are the new arrangements. Those who have an income above the limits set out in the letter will be asked to notify the Health Service Executive that they now are over the limit under the new arrangements. The repeal of the Act, which changes the legal basis upon which the entitlement of the card is provided to everyone, obviously is the legal basis upon which it should be held beyond 1 January, when the new scheme becomes operable.

On the question of how such a notification process would work, as I said, the Government believes it should be voluntary in the main. Obviously, administrative data exist which would be available to the Government through its agencies over time to ascertain the manner in which those who are over the limit can be identified. However, I believe that most people will comply and will notify the Health Service Executive of their situation in the future.

Eamon Gilmore (Dún Laoghaire, Labour)
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I thank the Taoiseach for offering to make the income information available. The income distribution on which this decision is based should be published today.

The formula announced today by the Taoiseach has been designed more to solve his political problem than to settle the worries of pensioners who are concerned about losing their medical cards. While it may satisfy the more gullible of his backbenchers, I do not believe it will satisfy those pensioners who are rightly concerned about this measure and see what was done last week as an assault on them. It was a kick in the teeth to those who have given a lifetime of work to this country and who ask for nothing more than to have the peace of mind, through the possession of a medical card, to visit their doctors when feeling unwell in the morning without being obliged to worry about the cost.

The Taoiseach is departing on a trade mission to China and, like Deputy Kenny, I wish him well in this regard. However, he is leaving behind him the biggest budget shambles of any Government in recent times. When the economy began to experience difficulties, the Taoiseach's big idea for addressing it was to bring forward the date of the budget. He now is in a position whereby he cannot get the budget that was announced in this Chamber last Tuesday through the House. One after another, the measures he announced in the budget are falling like nine-pins. The medical card issue has had to be changed. The Taoiseach informed the House earlier today that he will be obliged to make changes to the income levy and I believe that, in time, he will be forced to make changes to other measures that were announced in the budget, including the issues of class sizes, cuts in education and some cuts in the social welfare area that Members have not yet addressed. The Taoiseach's budget is a mess. What is the standing of the Government and what is its authority as the Taoiseach leaves for China in circumstances where he clearly does not have a mandate for what he is doing? This is not what he or, indeed, anybody presented to the Irish people last June. He has no mandate to do what he did in last week's budget, whether in regard to the medical cards or other issues. It is now manifest these measures cannot be put through the House.

Paul Kehoe (Wexford, Fine Gael)
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The wheels are off.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I do not accept for a moment the contention by Deputy Gilmore. I have already explained the context in which two adjustments have been made in specific elements of the budgetary arrangements passed last week. The adjustment in respect of medical cards for the over 70s and the willingness to provide an exemption from the income levy for people on low wages retain the essential principles of the decisions as announced, and are being implemented on the basis that the broad budgetary framework applicable in both cases will be maintained.

It is right that the Government should consider problems which are identified. In the case of medical cards, confusion and anxiety were caused to large numbers of older people who would not in any event have been affected by the proposals.

James Bannon (Longford-Westmeath, Fine Gael)
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Who created them?

Brian Cowen (Laois-Offaly, Fianna Fail)
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It proved possible to identify an alternative strategy which retained the essential elements of the decision regarding the granting of medical cards irrespective of income but in a way which confined its impact to the manifestly much better off. In the case of the income levy, the essential elements and financial impact are being maintained. It is right, in the context of our relationship with the social partners and the importance to the country of the stability afforded by a new pay agreement, that we should take seriously the concerns expressed by Congress, and that is what we have done.

Difficult and challenging measures will have to be implemented in line with the budget announcements. It is inevitable in regard to such difficult decisions, which come after a long period of sustained economic growth and substantial increments to benefits for taxpayers in budgets over many years, that the adjustment to the new economic and fiscal environment is difficult. That is all the more reason for the Government to be sensitive and reflect on issues raised when it is possible to do so within the framework of the budget strategy and arithmetic. As for other matters, these will be implemented, and the serious situation outlined by the Minister for Finance will be faced with determination in the exceptional times in which we live.