Ivana Bacik (Independent)

I welcome the opportunity to speak on this Bill, although I fundamentally oppose the changes it introduces. It represents a full-frontal attack on the principle of equality and on the principle of universal access to social services, in particular, health services. It is an immensely regressive measure.

Listening to some of the speeches from those on the Government side, I think they share that view. On listening to the speech of Senator Mary White, I found myself agreeing with her in particular. This is an ageist, regressive Bill that represents a backward step for us. Having taken the brave step of providing universal entitlement to health services for those over 70, I would have seen that as an important and positive starting point towards a more equitable health service generally. With the cut in the budget, as represented by this Bill, we have seen a major U-turn where older people and the principle of universality are concerned.

Others have mentioned the way in which the cut was introduced in the first place. It was handled very badly by the Government — the announcement of the subsequent U-turn, the ongoing confusion about means test limits, the unnecessary distress and concern caused to those over 70, their relatives and families, and the enormous protests we saw outside Leinster House. Any of us who went out to those protests could not help but be very impressed by the commitment of those who came on them and by the real anger and concern they felt at the Government's announcement of the cutback.

There is a fundamental and disturbing principle behind the cutback and the change in the budget represented by this Bill. The idea that medical cards should be available on an automatic basis to all over 70 could have been an important step towards the universal provision of health care in this country. Most unfortunately, in Ireland we have a two-tier health service but what the Government has done with this U-turn and with this Bill is to reinstate the two-tier system for those over 70 where we had seen at least the beginning of something more equitable based on universality.

There has been an enormous amount of self-justification by those on the Government side, albeit there has also been much criticism of the change. There have been many who have suggested that universal access meant that health care was free to millionaires. The idea that the automatic medical card for the over 70s meant that the health services were free to millionaires was a populist attack on the principle of universality. The reality about the principle is that social services should be provided under the European social model free at the point of access on the basis of need. In other words, people should be able to go to see their doctor for free without having to pay an upfront charge of €50 or €60 before they pay for any other treatments they need. The idea is that these services would be provided free at the point of access on the basis of need but they should be paid for in a equitable fashion through the taxation system on the basis of ability to pay. A much more equitable approach would have been to impose a higher levy on those with higher income rather than the flat levy initially proposed by the Government. I am glad to see that there is now a proposal to increase the levy on those earning more than €150,000, on which I am open to correction, but I would have liked to see a higher levy again on those earning more than €200,000 and more than €250,000. That would have been a much fairer way of seeking to make savings which, as we all are aware, are needed.

The attack on universality and the idea that it was somehow justified because millionaires were getting free health care was fundamentally a misrepresentation of the principle of universal access. Universal access is a more equitable way to provide social services. We all saw the enormous difficulties the means test for university grants posed in the 1980s and into the 1990s where PAYE workers were penalised because their children were not eligible for free fees while those who were self-assessed for income tax and were self-employed were able to present their earnings as lower and their children were eligible for free fees. The public concern about the inequity of the means test for university fees was one of the reasons university fees were abolished and was one of the reasons it became a popular move among the public.

There is another reason for universal access and to oppose the change proposed in this Bill. Universal access is not only fairer, but makes for a healthier society. The well-known health writer, Ms Maev-Ann Wren, emphasised this when she pointed out the enormous positive changes to the health of older people that have come about since the over 70s medical card was introduced. Chronic conditions have eased among older people, as the Minister of State with responsibility for older people, Deputy Hoctor, will be aware. Indeed, she pointed out in her speech that older people are healthier and are living longer. That is a hugely positive development for the health of our society and, inevitably, it is also positive in terms of economic benefit. Where a culture of preventative health care becomes established whereby people feel they can go free of charge to their general practitioner to take steps before a condition becomes chronic, one sees a healthier population and, ultimately, savings to the health service as a result. Older men, in particular, are reluctant to go to doctors generally. According to Ms Maev-Ann Wren's writing, it has become easier for people over 70 to go to their doctors and to gain the benefits of preventative health care because they feel they can go for free. The culture changed as a result of the medical card and that could have been developed further.

It is no surprise that the change in this legislation has come about. I see it as part of an overall attack on equality by the Government. It has already adopted the principle of co-location of private and public hospitals, which will copperfasten the existing two-tier structure of the health service. It has done a U-turn on a positive proposal to roll out a cervical cancer vaccination programme for young girls. Today, the chief executive of the Equality Authority, Niall Crowley, resigned. I pay tribute to the work Mr. Crowley and the authority have done in promoting equality for all in society by promoting best practices and anti-discrimination measures. The enormous cutback imposed on the authority's budget, coupled with the proposals in this Bill and the other measures I have described, represents a full frontal attack on the principle of equality and equity of access for all.

It is a pity that our infrastructure was not more solidly developed by the Government in the boom times. In a time of economic recession, when disadvantaged, older and vulnerable members of society most need our protection, it is a shame that the Government has seen fit to attack the benefits we provide for older people by means of a mean-spirited means test.