Alex White (Dublin South, Labour) | Oireachtas source

We will see if Fianna Fáil still opposes such a progressive measure when it is rolled out in the spring of next year.

I thank the Senators for their contributions. Senator Colm Burke rightly praised the Government's planned approach to reforms. As I have said and shall repeat, my vision of universal primary care is one of full universal access to GP care without fees. It should be the norm for the entire population. However, there will still be a proportion of the population who will need funding for their drugs, and in many cases full funding for their drugs. I think that there will still be a necessity to maintain the drugs payment scheme.

As Senator Colm Burke pointed out, there is a limit of €144 per month. I shall engage in the following debate without signalling a policy intention. There may be a case for an interim entitlement that ranges somewhere between €144 and having completely free drugs. There might be a better graduation in terms of what we can do for people. That is something that we would need to examine in the future and I look forward to debating the matter here.

Senator Quinn also raised the issue of universal access. I have addressed the matter but I am sure that I can return to it again. He raised the issue of differential treatment of a couple and a single person and I can explain the rationale for doing so. The living costs of an individual living alone are more than half the living costs of a couple living together. It is the Government's view, and appears to be the case, that expenditure does not necessarily diminish relative to the number of people in the household. There are economies of scale and I hope that I have used the term correctly. In that context, the over-70s income limit for a single person has been reduced proportionately less than the income limit for a couple.

The differential concept is not new or an isolated example but is evident in other areas of public policy. For example, the State pension is €230 per week for an individual and €436 per week for a couple; the provision of the living alone increase - an extra payment for people on social welfare pensions who live alone; differential income limits apply for medical cards for persons under 70 years between individuals and couples; and in the assessment for supplementary welfare allowance, a differential applies whereby the rate for a dependent qualified adult is not half the personal rate of the applicant. Finally, the Insolvency Service of Ireland guidelines used various scenarios but a significant extra sum was not allowed per month, after tax and PRSI, for a couple compared with a single person. This differential treatment of a couple and a single person is not unique.

Senator Gilroy made some interesting points and observations.

I would certainly accept the point that there is no cut in an area like health, or virtually none of which I can think, where one could say there was no problem associated with it or there was not some adverse impact or pain, which was the word used. The objective of a progressive and a caring Government is to ensure we minimise that adverse impact and do what we need to do in as fair a manner as is at all possible.

I think Senator Cullinane made the point that we are introducing the under six measure but are changing the eligibility in regard to over 70s. If the Seanad agrees to this measure, no one will lose GP access because anyone who loses their full medical card as a consequence of this measure will have a GP card - without quibble. There is no question of a new application regime or otherwise, so it is not inconsistent with universal access to GP care. If we were taking anybody out of free GP access, a case could be made that it was inconsistent. Giving it to some and taking it from others would be inconsistent and we would stand to be criticised on that but that is not what we are doing. We are not taking free GP access from a single citizen as a consequence of the measure we propose to the Seanad.