Sean Barrett (Independent) | Oireachtas source

I, too, extend a warm welcome to the Minister of State. It is important to reflect on how one gets into a problem. The Brennan commission, of which I was a member, examined this issue. When we embarked on the process of issuing medical cards to everyone aged 70 years and over, it was estimated that 39,000 people would be eligible for the new card at a projected cost of ¤19 million. It subsequently transpired, however, that 77,000 people were eligible for the cards. Clearly, the Department needs a health economist.

The medical cards for the elderly scheme was doomed from the beginning. It was not only that it amounted to a political promise to secure the votes of the elderly but that the Department did not know how many people of a certain age were living in the State. I found this failure impossible to believe at the time because the Central Statistics Office can provide information on the number of people in the various age categories. Professor Niamh Brennan's report was critical of the Department's mistake, which demonstrates the need for the Department to engage in proper appraisals and analysis.

I agree with Senator Colm Burke on the need to secure a much better deal on drugs. Susan Mitchell of The Sunday Business Post, the journalist to whom the Senator referred, has been flying this flag. She cites Mr. Paul Bell of SIPTU who noted not only that we pay too much for medicines but that pharmacists receive secret discounts of up to 90%. The key benchmark used by the "Today with Pat Kenny" programme and in other forums is usually how much cheaper drugs are in Spain than Ireland. When the drugs industry argues that prices here are reasonable because Ireland is in a particular zone, I must ask what zone Spain is in and where does free trade in the European Union enter the equation? Why can the drug companies supply medicines at much lower prices in other countries?
The Sunday Business Post and an International Monetary Fund report have found that our hospital bed night costs are twice the OECD average and twice those of Germany and Canada, two countries that enjoy the triple A credit rating that the Government is working hard to get back. In addition, the Milliman report on health insurance notes that treatments that would take 3.7 days on the basis of worldwide best practice take on average 11.6 days in Ireland. Closing this gap could give rise to savings of a couple of thousand euro per bed night.

We have to ensure that the people from whom medical cards are being taken, those who remain in the medical card system, the taxpayer and the Department get good value for the money being spent.

The Minister of State only mentioned it in passing but we must take cognisance of the fact that we passed legislation here to open up the GMS market to new graduates and perhaps we will be given an update on how that is progressing. I am concerned about a section in this Bill that appears to be sliding back from that. It was an IMF requirement under the bailout agreement because that organisation has expressed concern about the high cost of the Irish health service compared with the cost in some of the countries which are bailing us out. What savings could be made from opening up the GMS market? I came across some figures published in the Irish Examineron 29 September 2011. The article refers to GPs earning over ¤750,000 from the medical card scheme. I will not mention any names here but there was one doctor in Dublin who earned ¤767,000, another in Donegal who earned ¤754,000 and another in south Dublin who earned ¤718,000. A GP in Cork earned ¤679,000 while one in Kerry earned ¤569,000 and the list goes on. The summary was that 58 GP clinics earned over ¤500,000; 156 earned between ¤400,000 and ¤500,000; 379 earned between ¤300,000 and ¤400,000; and 615 earned between ¤200,000 and ¤300,000. Lots of new medical graduates had to emigrate last year but I am sure it was at least a possibility that some of those jobs could have been done for less than ¤300,000. I hope that the Department is shopping around for new graduates and not allowing local monopolists to push up the costs to the Department and to patients.

I broadly support this specific measure, albeit with the caveats I have just mentioned. The Minister of State has said that the income limit will be ¤700 per week for a couple. That compares with the ¤298 income limit for those aged between 65 and 69 and ¤266.50 for a couple under 65. In that sense, it has been tilted towards older people but we have a problem with universalism itself. This project was always bedevilled by the fact that we undertook it on the basis of incorrect data. To say that millionaires of a certain age are entitled to a benefit that is not available to many working people and to which those who are surviving solely on a State pension are barely entitled, was a mistake. It was a mistaken form of universalism in the first instance.

I have tabled two amendments to the Bill which we will be discussing tomorrow but broadly speaking, as the Minister of State has said, this change has to be made. However, it does not address many of the huge problems regarding the way resources are allocated within the Irish health services, such as the drugs and hospitals bills and the lack of competition in health insurance. It does not address the question of whether local monopolists earning ¤600,000 or ¤700,000 per year from the GMS are inhibiting new doctors from providing such services instead of emigrating. Such doctors could provide a better service for patients and reduce the bill to the Exchequer.

Broadly speaking, I welcome the Bill. I know the Minister of State is new in the Department of Health and I wish him success in his role. However, there are a lot of legacy issues to be addressed in the context of this particular legislation and in the wider health service, in terms of its relatively high cost. Our health service costs between 11% and 12% of gross national income. In the Scandinavian countries, which we admire so much, health service costs are between 9% and 10% of gross national income. There is an excess cost here, as documented in an article by Oliver O'Connor in the Sunday Business Post last Sunday, based on IMF data. The challenge is to get the best value for the patient and the taxpayer and to tackle many of the restrictive practices in the system. I agree with other Senators that drugs prices would be a very good place to start in that regard.