John Crown (Independent) | Oireachtas source

It is obvious that circumstances have changed somewhat since this Bill first saw the light of day in a context when radical changes were taking place in the provision of medical cards. We had a new Bill which, taken on its own, could only be welcomed. Anything that seeks to expand the access and reach of the medical card scheme can only be seen as a positive thing. Taken on its own, it is not particularly progressive. It is expanding access to medical cards but, given the context of what was happening at the time, originally denied but now all but tacitly acknowledged - the attempt to row back on the interpretation of who would qualify for a medical card in other age groups on the grounds of need due to the alleged stringencies of probity - we now know there was a double-edged approach to the issue. The overall effect of this would have been to decrease the number of people who had medical cards, to reduce the expense of the system. While we were taking cards from people who, by virtue of illness and age, were more likely to incur an expense to the State through their medical cards, we were giving them to a demographic who in relative terms was less likely to cost money. One would have to say - I am sorry if I sound unduly cynical about this - that these two measures together, in the absence of a more fundamental approach to health reform, would appear to have been populist, vote-getting measures rather than substantive efforts at reform.

Who could oppose this Bill? I will not oppose it, but I cannot let the opportunity pass to make a few points that need to be made. Others have made them and I am sorry if I sound repetitive, but I work in one part of our health system and I am a close observer of the other parts. The hospital-based system is highly dysfunctional. It is unfair. It systematically incentivises inefficiency and inactivity. Its core business plan is to keep people on waiting lists as long as possible, because once they come off the waiting list they cost money. In this time of stringency, the only good that we are advocating in the health services is to come in under budget. We have an incredibly dysfunctional public hospital system which urgently needs reform.

We have quite a functional GP system. It works quite well.