Alex White (Dublin South, Labour) | Oireachtas source

I thank Senators for their contributions. Very interesting points were raised in the course of the debate.

I will start by referring to two points made by Senator Deirdre Clune. On the extent to which the Government has acted in a proportionate way in its actions in respect of eligibility for people over 70 years, the Senator brought a measure of balance to the debate by pointing out, as I have many times, that 93% of all persons over the age of 70 years will continue to have access to their GPs without fees. A somewhat lower figure, 85%, have access to a full medical card. If Senators pass this measure and it is enacted, 85% of all citizens over 70 years of age will still have a full medical card, while a further 8% will have a GP card. That gives a total of 93% who will have access without fees to their GPs.

The second point made by the Senator was on the importance of access to a GP without the barrier of fees. The bedrock of a universal primary care system is that we remove the barrier of fees for attending one's doctor. Senator David Cullinane queried how serious the Government and I were in this respect. We are very serious. It is not just a gimmick, as Senator Marc MacSharry suggested; it is not just something that is desirable in its own right, as it is, it is also a necessity. No country in the world and no taxation or health insurance system will be able to fund and sustain a modern health system unless it adjusts towards primary care provision. That is a fact. Let us consider the experiences of any country in the provision of health care and the challenge presented in dealing with chronic illnesses. We live in a completely different world from the world of 20 or 30 years ago in terms of what we must do in the health service. There are massive challenges presented by diabetes, cardiovascular illnesses and so forth which demand that we refocus our attention on preventive strategies. They can only be carried out in primary care settings.

We must gradually shift resources out of the acute services in order to ensure that we address the challenges of the present and the future in a proper way.

The primary care strategy of 2001 that Senator MacSharry's colleague, Deputy Micheál Martin, introduced, was a very good document. It set out a lot of the challenges that the then Government saw. The challenges still exist. We have made progress towards addressing them but not anything like enough progress. We have experienced times of serious financial constraint and this means that we have been limited in what we can do about them. I do not accept Senator Cullinane's suggestion that we take with one hand and give with the other. This is a time when we must make savings and balance the books. However, we must also have a vision for the future and put aside some money to invest in the future for the health of all our citizens. We can only do so by adjusting towards primary care. In my respectful view, the system will literally not sustain itself unless we do so. It is a necessity. I do not stand here as a politician just expressing a whim when I say that we must remove the barrier of fees charged when one attends a GP. There is a lot of evidence that proves that even relatively well off people will not go to their doctor because fees ranging between €50, €60 or whatever act as a disincentive. We must remove the commercial relationship between the citizen or patient and his or her doctor. It is a progressive move that we must achieve.

First, a good place to start would be extending free GP cover to those under 6 years of age. Senator Cullinane will recall that the programme for Government outlined a route that would commence with long-term illness people and then move to high tech drugs. Last May the Taoiseach made a very clear statement that we were looking at a better and faster way to achieve that goal.

We have dealt with the matter in the Chamber before. One could have regulations instead of having complex legislation that would set out the base upon which one would give a GP card to people who have various illnesses or conditions, and all of the attendant complications and cumbersome legislation and regulations that would apply. One could have regulations that stipulated that the diagnostic basis of asthma and the different forms of cancer that qualify for a medical card. On examination these matters are far more complicated than initially thought. It is fair to admit that they are far more complicated than they looked to the people who, with the best will in the world, compiled the programme for Government. We have examined a different route. The under-6s provision is an interim measure that has been criticised by Senator MacSharry and others as a gimmick. It is not a gimmick because it cannot be one. It must be part of the implementation of full access for the entire population to GP services without the barrier of fees. I ask colleagues to reconsider. There is no other area of public policy where it is more urgent that we work together than on the future configuration of the health services and their funding. Universal primary care is an absolutely essential in order for us to achieve that goal.

Senator MacSharry criticised the measure but he did not attack it. He raised the issue about the wisdom of universality and gave himself as an example as someone who has young children and is perhaps better off. People on relatively low incomes cannot qualify for a medical card. Oddly enough, there are people on low to middle incomes who would not pass the incomes limits set for a medical card and Senators will know that from their work as politicians. Therefore, it is far from a case of us satisfying millionaires or people who are well off by providing a medical card for children aged under 6. The measure will help families on low and middle incomes but some people who are millionaires or very wealthy will also benefit.

That leads me back to the tried and tested debate on universality. I ask Senator MacSharry and others present to consider the following. We never argue about all children having access to primary education. We do not means test access to primary education because we regard it as an absolute bedrock entitlement of every child, irrespective of the income of parents. Immunisation is another example. There is a range of fundamental rights and entitlements for all children in the State and health care ought to be one of them. What else would be on the list if health care and primary health care were not?

In terms of equity and ensuring equity, there are many other instruments that we can address in that regard. The taxation system is an obvious one. Senator MacSharry asked whether very wealthy people are subjected to enough tax but I did notice such a proposal in Fianna Fáil's manifesto for the last election.