Mary Harney (Dublin Mid West, Progressive Democrats)

With regard to the debate about universality, and it has merit, tax rates of at least 60% would be required to fund the proposals suggested by the Opposition. Senator Twomey referred to the United Kingdom but pharmacists in the UK, for example, earn at least €100,000 less than their Irish counterparts and the same applies to general practitioners. In the British health care system, one cannot get Herceptin for breast cancer, for example. We must compare like with like.

Recently I met the German deputy Minister for Health, who was here as part of a delegation. She pointed out that a high dependency bed in a nursing home in Ireland costs as much per week as it does per month in Germany. If we are to have a debate and compare ourselves with other countries, we must refer to the cost of health care professionals and to patient-staff ratios, including the ratio of nurses to patients, which is double in Ireland what it is in France.

We are living through a very serious economic crisis, as Senator Quinn pointed out. A number of people have yet to come to terms with how bad things are. Senator Quinn made the point that the money for 10% of all public sector salaries must be borrowed and that 100% of the pay for any new public sector employee recruited will have to be borrowed.

I did not, and do not, have the option of making people in the health service redundant. However, we should have a redundancy plan but we must be sure about who we want to make redundant. We had a redundancy plan in this country in the past and the wrong people left the public sector, although many of them subsequently returned. We do not want a redundancy plan which involves us running around like headless chickens cutting 1,000 jobs here and 500 there. It must be properly thought out and funded up front because it will be expensive. We must also ensure that we maintain appropriate patient-staff ratios. Any redundancy plan must apply across the health service, not just in what is broadly called the bureaucracy. One person's bureaucrat is another's support staff. None the less, there are many areas in which there is scope for redundancies.

The bill for public sector pay next year will be €19 billion. A 10% saving on that would yield €1.9 billion. If we could make choices like that, some of those other choices might not have been necessary. I make that point because we will have to make those kinds of choices.

Decisions being made in the health service are not taken lightly. The cost of medical cards will rise by 14% next year. The numbers accessing the over 70's medical card scheme is growing by 7% annually while the number receiving medical cards in the general population, that is, among the poorest people, is only growing at 2%. Up to now, a couple aged 69 earning more than €300 per week would not get a medical card but once they reached 70, they qualified for a card, regardless of their means.

I wish to clarify a point in connection with something Senator Quinn said. When a person reaches 70, he or she does not automatically receive a medical card but must apply for one. I have met a number of people who have applied for the card but have never used it. However, regardless of whether one uses it, the nominated doctor is paid the fee of €640. Furthermore, it was not open to us to renegotiate that fee unless we annulled the legislation. The contract with doctors in relation to that fee has legislative backing. The contract is based on the Health (Miscellaneous Provisions) Act 2001 and the fee can only be changed by altering that Act. The ending of automatic entitlement is essential to change the fee structure and the contractual arrangements which were entered into. The contract states that under the 2001 Act, the contract has been agreed with the IMO and can only be changed with its agreement. I am not blaming anyone for the contract. It was entered into in good faith and at a time of plenty. The view was taken that the scheme would be good for older people in our society.