Brendan Ryan (Labour)

Both as a Member of the Oireachtas and as a Kildare man, I would like to associate myself with the welcoming remarks. I have known Deputy Seán Power for many years. Our fathers were acquaintances, to put it mildly, in Fianna Fáil circles in County Kildare, so he is particularly welcome. With all the nuances of politics, I wish him well in his ministerial office. He is more than capable of doing a good job, and I hope that he is allowed to do so.

I move:

That Seanad Éireann, noting that the number of persons holding medical cards is more than 100,000 less than it was in 1997, and recalling the promise before the 2002 election to provide 200,000 extra medical cards, condemns the decision by the Government to abandon that election commitment and calls for:

(1) an immediate commitment to restore the number of medical cards to that extant in 1997,

(2) to provide the promised additional 200,000 and

(3) to outline a timetable for the introduction of a comprehensive system of primary health care which is free at point of use.

I was entertained by a little piece on the RTE web news today in which the Tánaiste appealed to Opposition parties not to play politics with problems regarding delayed heart surgery in Our Lady's Hospital in Crumlin. I can only say that when Ministers stop claiming credit for anything good that happens in the health services, those of us in Opposition will stop raising everything wrong with them.

The motion deals with the number of people who have ceased to have medical cards and the failure to implement a very explicit promise to extend the number of such cards. I intend to deal with the entire issue. I remember something that used to cause great hilarity in my house when my children were small. When they were having their fun and wanted to run around a little, Daddy used to cover his eyes with a blindfold and pretend to chase them around. Of course, being blindfolded, he could not see where he was going. Were it not for the human suffering involved, watching the Government's performance on medical cards would provide the rest of us with some similar entertainment. Once it had put its ideological blindfold on, it could never really manage to do anything properly regarding the health services, and that is what has happened; it has let ideology get in its way. The Tánaiste is now reaching the stage where she is defensive about the whole suggestion. She is not an ideologue but a pragmatist, and I may return to that theme later.

Let us deal with the indisputable facts. The percentage of the population that holds medical cards has dropped dramatically in the seven years that the Government has been in power, from perhaps 39% of the population to perhaps 27%. What is beyond doubt is that approximately 100,000 medical cards have effectively been withdrawn, since people have ceased to be eligible. It is worth putting on the record the income levels under which one is eligible for a medical card — it is a matter of opinion whether one is entitled. The threshold is €206.50 per week for a married couple and €26 for each additional child. The position for a single person is not even clear-cut, but it is approximately €142 per week.

The legislation under which medical cards were introduced makes it clear that such a card is meant to be available to someone where it would cause undue hardship for him or her to have to pay for GP services and drugs bills. The spin-off from the medical card system has been an enormous improvement in the dignity of those holding one over the previous dispensary doctor system in which people were stereotyped. It is perhaps the most effective and visible area where everyone has access to what is essentially the same service, subject to the one major caveat of money. Most people going into a doctor's surgery to see a GP have no way of knowing whether the person in front or behind in the queue is paying the doctor or has a medical card. That is a very progressive position.

However, the number of couples in this State who have an income below €206.50 has, thankfully, dropped. It is a very good thing that the proportion of our population on that sort of income has fallen. The proportion of the population with an individual income of less than €142 a week has also, thankfully, dropped. Let us all celebrate that happy situation as the achievement of sensible economic policies pursued by a succession of Governments going back to the late 1980s. However, as we have all become prosperous, doctors have sought to share in the prosperity, so that the price one pays for going to see a GP has gone up not at the rate of inflation but at the rate at which incomes have risen. It is probably a little unreasonable to suggest that GPs should have done other than increase their fees in line with the aspirations of society at large. Now a couple with two children, one of whom is working full time and another part time on the minimum wage, and with an income of €380 a week, are in our legislation and culture, and behind our ideological blindfold, presumed to be able to pay for medical care for themselves and their children without undue hardship.

This means that if they go to a GP they should be able to pay a sum between €35 and €50. Later on that week, if one of the children gets an infection along with a bad headache — the warnings about meningitis appear on television — the parents may bring the child back to the GP and pay perhaps another €40. The child then turns out to be suffering not from meningitis but from an ordinary infection which necessitates a prescription. Prescriptions are expensive and the parents may have to pay €50 or €60. In a one-week period, it is therefore not unreasonable to say that a couple earning less than €400 would have to fork out €50 for a doctor, perhaps twice in a bad week in the winter, when children get sick.

We all know how quickly children get sick and how one worries about them. The couple, one of whom might be earning the average industrial wage and the other working on a part-time basis, must pay €150 out of their week's income. Our dominant political culture, as exhibited by the Government which has been in power for seven years of unprecedented prosperity, has resulted in that being seen as acceptable.

One Member from the other side of the House said to me that I should be celebrating people's escape from dependence on the State because they no longer had medical cards. The ESRI report published yesterday made it clear what this escape from dependence meant, namely, that when people moved marginally above the income eligibility limit for a medical card, the average number of visits to a GP dropped from 6.6 per annum to 3.6 per annum. Neither figure is excessive. An average rate of six or seven visits per annum to a GP for someone on a medical card is not excessive. What we have is a deliberate decision to leave eligibility alone. That is why the amendment is so intellectually offensive. It gives the impression that something very positive happened accidentally, namely, that incomes went up.

The income levels for eligibility for medical cards are not written in stone. The Government could have doubled the income allowance for children and for couples, for whom it could have increased the allowance by 50%. There was no reason not to except that getting people off the medical cards saved money and created the illusion that more money was available for other elements of the health service. Ultimately, it was a matter not of resources, of which there is no shortage in this State, but of an ideologically driven view of how a health service should run, namely, that as many people as possible should be driven out of public health care into private health care, since it is for this that the Government stands.

Having the resources and the money, the Government could have afforded to do something about medical cards. It chose different priorities, leaving a significant gap and great hardship for young working families with young children for whom every hint of illness in the family is a threat of imminent hardship because of the scale of the costs involved and the absence of proper public support.