Shane Ross (Independent)

I welcome the Minister of State back to the House. I am delighted she is here to listen to what Opposition Members have to say in this important debate, which is not necessarily about cuts. Members on both sides of the House understand the need for cuts across the board in public expenditure. There is no problem about that. What amazes me about this particular measure, however, is the extraordinary insensitivity of the Government towards the feelings and psychology of older people. It is essential that we should have cuts in public expenditure, which in monetary terms dig far deeper than this particular measure does. It is strange, however, that the Government has decided to victimise a reasonably small section of the population who are almost by definition not only vulnerable but also scared. People over 70 worry enormously about their future, whether they will have enough to live on and what the Government is offering them in terms of subsidies and health care. This Bill is a direct attack on that psychological condition. It is so insensitive that it makes one wonder whether the Government, including Fianna Fáil, which is traditionally in touch with older people, has to some extent lost the political knack it had for so long for avoiding political minefields.

The Bill is also deeply unfair because it takes a swipe at people who are not especially well off or rich. The thresholds in the legislation are not very high. They will make a considerable difference to people who would not consider themselves or be considered by any standards to be rich. It is not just a matter of telling them that they must pay for particular medicines over a certain price threshold to reduce the number of medical cards.

I referred to the psychology of the elderly people because they will be deterred from going to doctors and district nurses or their substitutes. Consequently, the medical conditions of some will worsen. I do not claim to be an expert in the minds of the elderly, but they are defensive about their health and are particularly concerned about whether they will have enough to live on for the rest of their lives. Irrespective of whether they can afford it, they will curtail their visits to doctors, district nurses, their substitutes or private care because they are too expensive. The frequency of their medical treatment will lessen and their medical conditions will worsen. That is inexorably true.

I cannot understand why, for so little money, the Government has decided to do so much damage to the elderly. Were the Government serious about making cuts in health, it would be difficult to look further than the HSE. Rather than being a political cliché, it is well known, even according to people inside the HSE, that the wastage therein would make FÁS look to be in the ha'penny place were the former examined properly. The political protection given to the HSE is unjustifiable. As every insider will assert, its budget is wasted in certain areas, although not altogether. The attitude in the HSE is that public money used for health is sacrosanct. While it should be sacrosanct as public money, much of it is being used for administration, bureaucracy, duplication and other inefficiencies that should have been addressed.

I do not understand why the Government does not approach State agencies and tell them that their budgets are to be cut, not by dramatic amounts, but by a few hundred million euro in each case. The Government should tell them to get on with it and then watch so that front-line services are not affected. Let the agencies make cuts in waste. I welcome the establishment of the second bord snip, but it will report years too late. I hope that its recommendations will be dramatic and painful for those who are making gains from the health service, not the patients. That is possible. The service should be patient-led, not bureaucracy-led, and that problem must be faced.

Will the Bill prompt the elderly to spend less money on their health insurance? The number of cuts that people on €35,000 per year can make is limited. Many of them have obligations to children, grandchildren and others. Almost by definition, they tend to be selfless in making cuts in their personal budgets. This matter relates to the question of why the amounts charged by the VHI, which is run by the Government, are so high. If people are to be charged for health in one area, which should not be the case, why should VHI's charges continue to increase? It is part of the health system because it offers a health service.