Wednesday, 11 December 2013
Health (Alteration of Criteria for Eligibility) (No. 2) Bill 2013: Committee and Remaining Stages
We oppose the three sections because we are opposed to the Bill in its entirety and totality. I do not want to speak on any section for too long as the House has much business to get through today. We made our position on the Bill quite clear on Second Stage. It is important to put on the record as we debate Committee Stage the various concerns we have about the Bill. I believe in universal health care; that people should pay tax, which they do; and that we should decide what services people should receive as a right. The Minister of State made this point in a response on the issue of universality on Second Stage.
The reality is that we are moving away from that principle. While the Minister will argue that in time, we will see free GP care, the reality is that we are going to see a private health insurance-based model for this country, rather than universal health care, which should be provided by the State and funded from general taxation, which is the model that I would prefer. Whether the Minister agrees or not, there are people losing their medical cards left, right and centre in this State. I know that when politicians raise this, they can be dismissed as opposition politicians saying that their offices are full with people calling to them about different issues, but for the issue of medical cards, I have never dealt with so many queries from people with discretionary cards who have had them either reduced to GP-only cards or withdrawn altogether. I was dealing with one lady this week who needs an injection that costs €1,200 every two weeks, and her card was taken away from her. We are trying to sort that out, but that is one example of thousands we know are happening across the State.
It is not fair to say that we are moving towards universal health care and that more people are getting medical cards, when we see the reality that many people are losing their cards. In terms of figures, more people might be getting medical cards simply because more people are out of work. More people are qualifying because of the circumstances in which they find themselves. That is why there might be more people with cards, but there are people who need the cards on medical grounds but from whom they are being withdrawn, and that is not a good thing.
This Bill will change the criteria for those aged over 70. Why is that being done at a time when the Government claims it is moving towards universal health care and towards GP care for all? Why would the Government then remove the medical for those aged over 70? Is that not moving away from the principle of universality? I can see the Minister of State shake his head, but I do not understand why we would then take medical cards away from people-----
He can say it is a fact, but all pensioners are entitled to a medical card as of right because they paid their taxes. That is now being means tested, albeit in a measure brought in by Fianna Fáil before the current Government reduced the thresholds. That means medical cards are being taken away from people who have them. They had universal health care and full cover, and now many of them will not have cover. The argument being made is that these people can afford to pay for health care. In my view, that moves away from the principle of universality. The Minister of State made the point well that we pay taxes to make sure that people get education and yet we do not argue that education should be means tested. Why then should we apply the same principle to health care, if it is a fundamental right?
When this was first brought in by the previous Government, we argued that once a threshold was set at €900, it was always going to change and be revised downwards to €800, €700, €600 and €500. What is the acceptable level? Will it go down to €400? Will it be €300? That is the difficulty we have with all these measures. Once they are introduced, it becomes a slippery slope and more people start losing their cards. Senator Gilroy made the point on Second Stage that €500 is a significant amount of money for a pensioner who should be able to pay for medical expenses, but the same argument was made about €700, €800 and €900. So if we go to €300 next year, are we then saying that €300 is an acceptable amount of money to be means tested?
Age Action Ireland is concerned about this. The parliament which represents older people has expressed its opposition. I could remind the Minister of State of the protests that old age pensioners had in 2008 outside the Dáil, at which his party leader spoke and at which the Taoiseach spoke. They clearly said that what was happening was wrong and should not be happening, yet that is exactly what is happening in this Bill. The Government cannot walk away from that. It is exactly what Fianna Fáil were doing. I cannot understand why the Minister of State's head is shaking because there is no change-----
That is the only change. I think the people themselves can see through that. I have made my point. I am opposed to the change. What I will say is that I would prefer if we had parties in government, including both our parties, which support public services, universality, basic social protections for citizens, funded through general taxation, provided as of right, and not on the basis of how much money somebody has in their pocket. The way to make sure that wealthy people pay for all of these services is that they pay PAYE, proper progressive taxation and taxation on wealth. Then we can afford to pay for all of these services. That is what I want to see.
I would prefer a coalition partner to be a party of the left that believes in the core social values. I have a difficulty with the fact that the Labour Party is in government with a right wing party, rather than building a genuine alternative. That is a separate argument and I do not wish to get into that here and hold up the House. I have made my argument and I will listen to what the Minister of State has to say, but I will be voting against the Bill and I wanted to place my opposition to it on the record.
Now that the coalition negotiations are continuing, I want to say that we have not put forward amendments to the Bill because those we put forward in the Dáil were ruled out of order because they were a charge on the Exchequer. I do not wish to delay the House. We made the points on Second Stage about why we are opposing this Bill. We will oppose it section by section. We may have supported the amendment tabled by Senator Healy Eames, which was also ruled out of order. I think this is wrong.
I would like to remind the Senator who was in coalition negotiations that the previous Government did adjust this, but in a much more fair way.
One of the mistakes made was thankfully reversed and the thresholds were at €1,400 and €700. I quoted the "shame on you" declaration of the then Deputy Enda Kenny and the whine about the contribution made by the people who built the nation by the then Deputy James Reilly, as well as the rhetoric from the then Deputy Gilmore. They spoke about their difficulties at the time with what were much more generous criteria than we have here.
The Minister of State did not manage to see the Fianna Fáil pre-budget submission concerning the 3% proposal for those on over €100,000. It was part of his own party's proposal behind the scenes, but they did not manage to get it across the line.
I am glad you have ruled on that, because I was referring to the recent budget submissions, in respect of the 3% tax that the Labour Party did not manage to get across the line in its negotiations with Fine Gael on the budget. Those people are better heeled. In my view, they were expecting an additional hit and could shoulder that burden, yet we chose to ignore it. I very much regret that we did that, because I would gladly pay additional tax even at my salary - €65,000 - to ensure the relative security and health of the elderly and less well off. That is something we should have examined.
Whether or not they have a few shillings in the bank, people in their 70s, under this probity review, are being forced to fill out forms and consider a situation that should not apply to them at this stage in their life.
As I said on Second Stage, in view of the relatively positive signals and signs of additional taxation coming in to the Exchequer, we ought to look elsewhere to try to make the savings required. Everybody understands that savings are required and cutbacks have to be made. What divides us is how that is done. If the whip were removed, I do not think anybody would truly embrace this particular measure as one that is fairer than others that would affect people who are better heeled to shoulder that burden. I will not speak again until the end. Suffice to say we are utterly opposed to this level of adjustment for people in the relative autumn of their lives.
I welcome the Minister of State to the House. I wish to correct what has been said. This measure is not about removing medical cards from the over 70s. The impression has been given that we are removing medical cards for all over 70s. It is removing medical cards in respect of a particular category.
The category is that of people who live on their own and have an income of more than €26,000 per annum and married couples whose income exceeds €47,000. However, they will still get a GP card. It is important to note that where a person pays more than €144 per month for medication the cost is borne by the State.
Senator David Cullinane gave the impression that the Government is taking medical cards from everybody. Since we came to Government, an extra 254,000 medical cards or GP-only cards have been issued. As of June 2013, we had gone from more than 1,730,000 medical cards on 1 January 2011 to more than 2,100,000 medical cards or GP-only cards. If the Senator thinks the Government is being mean and divisive in the way it has managed the issue, I am not sure what we are getting wrong, given the number of additional cards that have been given out. We ensured the criteria were not substantially altered. However, in this case the criteria are being altered slightly. We are talking about a group of people who have a substantial income and for whom we are making this adjustment in order that we can cater for those who have far less income. Recently I spoke to a person in a rural area who has a non-contributory pension of €216 per week. He does not have a bus service or many other facilities. That is the type of person we need to look after and ensure they are provided with a level of care, whether through social welfare or medical care. That person has a total income of about €11,000 per year. It is difficult for him to survive on that income, given that he does not have access to public transport and other services.
I am sorry to raise this issue, but I have on my desk notification of a medical card review for a 91-year-old lady. I am astonished at what is being sought from her. She is a lady who has not sought anything from the State, including a pension. She and her made sure there was adequate provision for her older years. Her medical card has been withdrawn. The first she heard of the card being withdrawn was when we went to her pharmacy for a prescription and she was asked for €87. If I or the Minister of State were told the cost of a prescription was €87 that would be a shock, but to tell that to a 91-year-old lady is a little different. I have received a letter from the medical card unit seeking a whole series of documents from her, even though she submitted audited accounts, certified by an accountant, including the document from the Revenue Commissioners which assessed her income tax. It is seeking the rent books of properties from which she has rental income and copies of share certificates. She receives a small pension from the US. It also seeks a letter from the Social Security Administration in the US, even though she has already provided a letter from the US embassy setting out exactly what she is earning. To ask a 91-year-old lady for such documentation is going a bit too far. I am sorry for raising the issue but I am very cross about it. She has given all the information, yet more is being sought even though all the necessary documentation has been submitted, including documentation accepted by the Revenue Commissioners. That is wrong. It is one of the reasons so many people are complaining about this issue. I ask for a more diplomatic approach when assessing people over the age of 70.
I support the Bill because there is a need to look after people on lower income levels. That is what the Government has done on coming to office. While it would be better if we did not have to introduce the measure, we have to be careful about how we manage the finances to ensure those at the lower end are not left out of the loop. I think this is the best way of managing the health services and managing people's entitlement to medical cards.
Normally, when I stand up speak on any of the steps that have been taken, I support the Government because I want the economy put back on a sound footing. However, I have a problem with this measure. I mentioned last week - Senator Fidelma Healy Eames has tabled an amendment on this which has not been allowed - the medical card income limits of €500 for a person living on his or her own and €900, rather than €1,000, for a couple. As the amendment as not been allowed I cannot speak on it.
Yesterday I attended the launch of the Human Rights and Older People policy paper. I thought I was invited because I was such a good spokesman, but it turned out I am the eldest member of this and the other House. That, I am sure, is the reason I was invited to speak.
Those who are elderly seem to be a soft target - Senator Colm Burke spoke on this very well - as they are being targeted in so many different ways. I am sorry to see this happening and urge that consideration be given particularly to older people. I can understand if a person over 70 has a certain income and certain assets, but that lady of 91 years of age needs to be treated with sympathy and regard for her position. The present situation is such that it is not being done in that manner. It would be far wiser not to go ahead with this measure.
I thank the Minister of State for coming to the House. I understand my amendment has been ruled out of order because it could impose a charge on the Exchequer. Nevertheless, I would like a say a few words about it. I got quite a reaction to this issue. A couple, as defined in the Bill - I presume this means a married couple or a couple in a civil partnership - are discriminated against unfavourably compared with two single people living together in the same household. For example, if a brother and sister are living within the same household their income ceiling to qualify for a medical card is €500 each - that is, a total income of €1,000 - while if one has the misfortune to be married or in a civil partnership the income ceiling is €900.
What is that but discrimination against a couple? I read the research behind this. It is meant to relate to the cost of living. It is contended that it is cheaper for a couple to survive but that is
disputed in the case of a brother and sister, two sisters or any two others who live together in the same household. The Minister of State's argument falls there.
It falls on the basis that the limit for two people living under the same roof who are not defined as a couple is €500 each, while that for a couple is lower. I know of a couple over 70 whose income is €909. They are €9 over the limit. They live in an extreme corner of County Mayo. The lady must travel on a weekly basis to Galway University Hospital for cancer treatment. The couple made the point to me that this is not about the cost of living but about the cost of medical treatment. The couple cannot share medical treatment or drugs just because they are husband and wife. The costs are unique to the health issue of the individual.
As Senator Quinn said, this is an unfair singling out of older people. It worries them. Their income is finite and they feel rather powerless and disabled - if I may use that word - by this measure. I would like the Minister of State to address the anomaly I have pointed out. I refer in particular to where two people who are not a couple are living under one roof. They can avail of the €1,000 limit, or €500 each, whereas a married couple must avail of the €900 limit. What can the Minister of State propose by way of resolution?
I thank the Senators for their contributions. I will start with Senator David Cullinane's point on universality. He is correct that I have addressed this before in the course of the discussion on this Bill and other discussions. It is a discussion we have in both Chambers and across the board when talking about health services generally. The question of universality arises in respect of other public services also. I am a subscriber to the principle of universality in terms of access to medical care and treatment on the basis of medical need rather than ability to pay. There is a long tradition of support for that approach, not just in my party but also in other parties. It has been achieved to a greater or lesser extent at various times in our history, but there is certainly a tradition of support for universality across the board. This is worth bearing in mind when examining the future of health services. I am not 100% sure about the current position of Fianna Fáil on universal health insurance but I do not believe it is opposed to it in principle.
It depends on whom one speaks to. I believed the Senator was more concerted in his approach than that.
Universal access to primary care, the area with which I am most concerned in my remit, is a commitment in the programme for Government. It is essential. The objective is shared by both parties in government. I refer to the objective of having universal access to one's doctor, to primary care, without the barrier of fees. It is not just desirable but we must achieve it. As I said in this debate last week, unless we start to shift the focus of health services towards primary care and away, in so far as it is possible, from the acute services into the community, we will not be able to address the health needs of citizens in the future. It is essential not just to achieve the equity Senator David Cullinane advocates but also to fund health services in the first instance. To fund them, we must have a better system of primary care and access to primary care without the barrier of fees. That is what I am absolutely dedicated to achieving, as is the Government.
What are we doing? We set out our proposal in this regard in the programme for Government. There was a further elaboration on the particular route we intend to take on universal primary care earlier this year. In the budget, there was an announcement of an extension of universal access to primary care for children under six, that is, children aged five and under. That is part of a plan to extend universal access without fees to the entire population. That remains absolutely the commitment of the Government.
This brings me to Senator David Cullinane's objection. He stated, not for the first time, that the proposals in this Bill are inconsistent with the broad policy. For the umpteenth time, I contend they are not. If we were depriving anybody of free access to a GP under this Bill, the Senator would have a point. We are not, however. I do not make light of this. Senator MacSharry is correct that nobody, and certainly no Minister, embraces in this House the fact that we must change or adjust eligibility criteria for those over 70. I do not embrace that-----
There are many steps we would like not to have to take in respect of which we could talk to Senator MacSharry about why we have to take them. We would then have a much longer debate about a much broader set of problems about which he knows well. I refer to the record and recklessness of the previous Government, of which he was a supporter.
The Senator should stick to the issue at hand. The fact is we are not depriving anybody of access to a GP without fees in this legislation. It is simply not true to say the section is inconsistent with the policy of universal access to GP care. It does not fly in the face of it at all. Ensuring anybody who loses out on the full medical card will have the GP card is entirely consistent with our direction of travel with regard to access to GP services. I ask the House to accept that because it is factually the case. We can argue about many matters but that is a fact.
Senator David Cullinane made other points about people losing their medical cards for other reasons. An example pertains to the discretionary medical card and other issues. From a rhetorical perspective, I understand from where the Senator is coming although I disagree with him to some extent. One can get into that discussion all right, but let us not misrepresent anything in this legislation. It does not remove free access to GP care for any citizen in the State.
Ninety-three percent of all citizens over the age of 70 will still retain free access or access without fees to their GP. Approximately 85% will still have the full medical card if this Bill is passed. The 15% of those over 70 who will not have medical cards are relatively better off. Some 85% of the population over 70 will still have the medical card and 93% will still have free access to their GP. These are the facts and it is important to ensure we stick to them.
I will not rise to Senator MacSharry's bait. Perhaps we will have another opportunity to talk about what people would have done had they had the chance in government or were they still in government; suffice it to say that Senators Marc MacSharry and David Cullinane devoted much of their time on Second Stage to reminding people on this side of the House what they had said in 2008 and 2010. If that is the level at which we are to debate this, we will be here until teatime and beyond reminding Senator MacSharry what he and his party said during the term of the last Government and of what it said and did not say during the election campaign. One point Fianna Fáil did not make, which point was conspicuous in its absence from the party's manifesto and any other document, was on the notion of a higher rate of universal social charge or taxation for big earners. It was in the Labour Party's manifesto but it was not a matter on which we got agreement in government. It is a little hard to take Senator MacSharry's saying he is now in favour of what I described considering we know perfectly well he was not for it until it suited him to be so. He came in here so he could use the argument in a rhetorical way against us. Let us take this argument seriously. What is sauce for the goose is sauce for the gander.
No one embraces this proposal.
The Government has to make savings. Despite the required savings in the health sector in 2014, we know it will still be an extremely challenging year for the health service. Maintaining safe and quality health services will be as much a priority of the Government in 2014 as it has been in 2013, as will ensuring fairness in the measures that will have to be taken and that the burden is spread in a just fashion, not adversely affecting those who are most vulnerable in communities. The Government has done the best job possible in ensuring that will be the case.
The less well-off who account for four fifths of the over-70s population will not be affected by this legislation. The Government recognises that the living costs of an individual living alone are more than half the living costs of a couple living together. Expenditure does not necessarily diminish relative to the number of people in a household. In that context, the over-70s income limit for a single person has been reduced proportionately less than that for a couple. This is not new or unique to this legislation, as I indicated on Second Stage. For instance, the State pension is €230 per week for an individual and €436 for a couple. There is the provision of the living alone allowance, with an extra payment for those in receipt of social welfare pensions. Differential income limits also apply in the case of medical cards for persons aged under 70 years. In the assessment of supplementary welfare allowance, a differential rate applies whereby the rate for a dependent qualified adult is not half the personal rate of the applicant. Under the Insolvency Service of Ireland guidelines, there is not a significant extra sum allowed per month for a couple compared to a single person.
Senator Fidelma Healy Eames referred to medical costs. I accept that costs are a factor in assessing anyone’s means. However, this is a means test to determine eligibility. In these circumstances, it is reasonable to have regard to economies of scale as between a couple and a single person such that there would be differential limits.
I take Senators Colm Burke’s and Feargal Quinn’s point on the review process for medical cards. Senator Colm Burke referred to a case brought to his attention and what appeared, sometimes, to be repeated requests for information. It is a difficult issue. The HSE has a responsibility to ensure the resources we have available are spent properly and that those entitled to a medical card retain it, but those who are not so entitled ought not to retain it. This is not a reflection on the case raised by Senator Colm Burke. However, there needs to be a reasonably robust review system in place. Is it necessary for us to make repeated requests? The HSE and the PCRS, primary care reimbursement service, have taken a sensitive approach to this issue as best they can. It is a pity and does surprise me that people are still finding out from their pharmacist that their medical card has been withdrawn. I am advised that in the review process there is a three month letter of notice followed by a one month letter of notice. People receive notice well in advance. There is also a procedure under which a person’s doctor can extend the period by three months. Fail-safe mechanisms are in place. If the system is not working properly, I welcome Senators drawing to our attention ways by which it could be improved.
Senator Feargal Quinn stated we should not single out those over 70 years of age. We are not singling them out. We have a review process across the board. It is not targeted at those over 70 years of age, which would be unacceptable.
Anyone who loses out by this change in eligibility and is affected by the revised income limits will still be able to access his or her GP for free. Persons aged over 70 years whose gross income is above the revised limits may still apply for a medical card using the standard net income means test which is open to those in the general population who believe it applies to their situation.
I thank the Minister of State for his comprehensive response. Much of what he said I agree with, but we need to be clear about the arguments being made on all sides of the House. I have never said access to GP cover is being removed in this legislation from anyone. My arguments relate to the income limits which are changing. They were first introduced by Fianna Fáil and have been reduced several times since, including in budget 2014. While I do not misrepresent what is contained in the Bill, equally it is unfair for Senator Colm Burke to misrepresent what I said. At no point did I say all pensioners would lose their medical cards. I have said discretionary medical cards are becoming a problem. If Government Members are not receiving the same volume of complaints that I am receiving, there is something wrong with their constituency services and clinics.
I am sure all Senators are receiving the same volume of complaints. There is a difficulty with discretionary medical cards which is impacting on people. The Senator can smile, but there is much hurt and confusion among many families and individuals.
The Opposition has a responsibility to hold the Government to account. It may not be helpful for the Minister to go back to what was said during elections.
We have every right and entitlement to remind the Government parties of what they promised because we are here to hold them to account. I want to set out the facts. I have a responsibility to all those people who contacted me and to those organisations that have asked me to again highlight the inconsistencies in the Government's position having regard to what its members said then and what they say now. If we are not able to do that in here, where are we able to do?
I am addressing my comments not to the Minister of State but through the Chair - this seems to have been happening a good deal on Committee Stage debates recently for some reason, perhaps the Government is anxious to get legislation pushed through over Christmas. Prior to 2008 people over the age of 70 received a medical card without a means test. That is a fact. That was the position then. We then moved from a position of universal medical card cover to partial removal of the cover for some people because of the application of the means test. That is a fact.
We then had a U-turn by the previous Government on its decision to seek to remove all medical cards for those aged over 70. We cited the comments made by Opposition leaders during the protest at that time. We must remind ourselves of what the Minister for Health specifically said on this issue at that time and put it in the context of the Bill before us because it is important. He described the decision at that time as a vicious attack and a savage assault on the elderly, but it was not only with regard to the removal of the medical cards for everybody over the age of 70. When that decision was changed he said it was a desperate climbdown and that the then Government was simply tinkering with income limits, which he described as being nowhere near good enough. "Tinkering with income limits" and "nowhere near good enough" were his words, but then he came into office and did exactly that, he tinkered with income limits. If it was not good enough then, it should not be good enough now.
I do not want to be misrepresented on the point I was making about universality. I do not see universality in the provision of health care as being solely in the context of GP cover but in the context of all health care. It should be provided as a right in respect of primary and acute services, including medication, funded through general taxation. That is how I see it being done. We had this discussion on a different Bill yesterday with regard to people paying the universal social charge. They would ask themselves why are they paying the universal social charge, PRSI, more tax under the PAYE system and paying private health insurance and yet they still have to pay at the gate for health care. People pay three and four times in this State for health care. It might be more helpful if the Minister were to come into the House and have a discussion on universal health care and universal health insurance. I do not intend to speak again on this Bill as I have made my point. I just wanted to respond to what I consider to be as a misrepresentation of my argument. I fully accept that this will not have an impact on GP access for any older person but my understanding and view of universality of health care is broader than just GP access.
It is as if the Government parties got the Fianna Fáil manifesto, which it did not want and which was rejected by the people, and decided to follow that one instead of their own one.
The Government of today has options and choices. It is senior hurling now. The Minister of State cannot come in here and say that none of us embraced this. The Minister of State is in the position to do something about this. Poor Senator Colm Burke or Senator Gilroy, who are under the Whip, are not in a position to do something about it but as a Minister of State, Deputy White can do something about it. If he does not want to embrace it, he should not do so; he should go back and say to the Ministers, Deputies Howlin and Noonan, that what we want to do is to raise more funds from the people who are better heeled to shoulder the burden, and those people are there. In terms of universal health care, as a individual on a personal basis, I am absolutely against it. If one is particularly wealthy and is not elderly or young and has the funds to be to pay for this, then I agree one should pay, but that should not apply to the elderly, the infirm or the most vulnerable.
No, I am not in favour of that. I do not consider a person in receipt of an income of €500 a week a wealthy elderly person. I do not consider a couple in their 70s or 80s who have incomes of €900 a week to be a wealthy elderly couple. Senator Cullinane referred to this matter. The Minister of State accused me of doing a U-turn and adopting a position when it suited me but what about the Minister, Deputy Reilly, when it suits him? Lowering the qualifying income thresholds to €1,400 for a couple and €700 for an individual was a savage attack on the elderly. What is it other than that when there are choices. I was on the troika delegation for Fianna Fáil and there were choices all the way along. We have heard that the Government cannot do this or cannot do that-----
-----and about our economic sovereignty and we will have a state of the union address by the Taoiseach on this next Sunday when he will tell us how great it is to have our economic sovereignty back. I am drifting a little bit here.
Following Klaus Regling's comments in recent days, if there is going to be no retroactive deal on banking for Ireland, the Minister of State might ask the Taoiseach does that mean that, for having saved the euro effectively, the Irish people are faced with a situation where the Government has given up the ghost in terms of trying and get a better deal on it?
The facts are these. Has the Minister of State choices? Yes, he does. Can he take them? Yes, he can. I have even suggested how and where he can take them. His inability to get this over the line in terms of his internal discussions with Ministers is his business and his problem. Does this have to happen to raise €25 million? No, it does not.
We can talk about the past. Yes, Fianna Fáil made mistakes, it lost 53 Dáil seats and its manifesto was rejected. The collective Fine Gael-Labour Party one was accepted and those parties threw it out the window as quick as they could and said they would cut threshold of €1,400 down to €900 and discriminate against women or men who live together as a couple. I would say the Minister of State, in his other profession as a lawyer, would have good craic with that one down in the Four Courts in terms of the rights and costs of a couple living together versus those of an individual. I would say there would be a good few euro made on arguing that case in the Law Library, as the Minister of State would well know. The Fianna Fáil did this and did that rhetoric is fine and I have no difficulty with it; I know the mistakes that were made. The Minister of State will recall that when I was a finance spokesperson on the opposite side of the House I was severely critical of the Minister for Health on a wide variety of issues.
It is perfectly credible for me to stand here, arguably with a more current mandate than the Minster of State's following the Seanad referendum, and hold the Government to account, recall what is in manifestos or in programmes for Government and query the good points being made, argued by the Taoiseach, Deputy Kenny, the Tánaiste, Deputy Gilmore, and the Minister, Deputy Reilly when they were Opposition spokespeople fighting with one another to get up on the truck outside the gates of this House to preach to the elderly about all they would do when they got into office. When Fianna Fáil made the grave error of trying to do what it did for the over-70s at the time and then came back with much more generous qualifying income thresholds of €1,400 and €700, the elderly who were out protesting in Molesworth Street and in Clarendon Street church at that time did not have any idea what was coming down the track from the people who purported to be supporting them. I promise I will not speak again on this.
No, but I will, because I have had enough of it today, to tell the truth. The reality is that there are options. There were choices and the Minister of State has chosen not to take them. It is as simple as that. While the Minister of State might personally-----
-----not wish to embrace this particular issue, of all the people in the room at the moment he is the only one with a chance to do it because he is above the Whip. He is a Minister and he can sit down with his ministerial colleagues and say there are other ways. If he fails in doing that in consultation with the Minister for Finance, Deputy Noonan, and the Minister for Public Expenditure and Reform, Deputy Howlin, that is his problem and his failure. It is not a failure of this House to highlight the fact that there were choices and the Minister of State has just chosen not to take them.
I asked the Minister of State a question but he did not answer it. I will ask him again. He said he wished to ensure fairness. I agree that income limits had to be reduced. I have no difficulty with that, but I want to see them applied fairly to everyone. How does the Minister of State justify the anomaly that the ceiling for a couple who are married or in civil partnership is €900 whereas two single people living together within the same household, such as a brother and sister, have a ceiling of €500 each, which amounts to €1,000? I would like to hear an answer from the Minister of State.
It appears Senator Healy Eames has accepted that there are economies of scale in respect of persons living together. She accepts the principle but she takes issue with the differential application of the measure to persons who are a couple – married or in civil partnership – versus two sisters or siblings living together.
The logic of that is that we should extend the couple income limit to two siblings living together. No one has proposed that we do that. I have not heard the proposal that the Senator wants us to treat the two siblings in the same way as we propose to treat a couple.
It is not my intention to change the treatment of siblings in the case outlined by the Senator. We do not propose to change that. There is no proposal from anyone in the House that we should, and the Government does not intend doing so.
You will be pleased, a Leas-Chathaoirligh, that I will not go back down the road taken by Senator MacSharry, other than to say this-----
Indeed. It arises in relation to health issues. The only reason I responded to the question of what people said back then was that most of what Senator MacSharry has said - a good proportion of his speech on Second Stage and again today, as well as of the contribution of Senator Cullinane - was all about what people had said previously. This is a Parliament. Members are perfectly entitled to raise what people said in the past and to ask questions. No one objects to that. The point is that we come to expect something a little bit more than that in terms of an argument, but we hear less and less - particularly, I am sorry to say, from Senator MacSharry. If the only case against the Government is that what we are doing is not what we said would do, it ends up being quite thin. I am still waiting for a health policy.
At least we heard about universality from Senator Cullinane, although there is a huge debate about how it would be funded and the amount of persuasion that would be required for the public to pay at the absolute top level for all services in all circumstances. A significant debate is needed in that regard and perhaps we should have it in the Seanad. No health policy whatsoever is coming from the Fianna Fáil Party, other than simply to express annoyance, irritation and sometimes anger about what was said five years ago while the party claims the opposite is now being done. Senator MacSharry is entitled to make that point, but surely the Irish people are entitled to expect from the Fianna Fáil Party something additional to that, yet we do not hear anything whatsoever.
Reference was made to choices. We live up to our responsibility in government. We are two parties in government working together in the interests of the Irish people. Of course we must make choices and of course we do not always agree, at least initially, on precisely what choices we should make, but the fact it is that we do come to conclusions, very good and balanced ones. The two parties in government did not have a collective manifesto, as described by Senator MacSharry. We had two separate manifestos and approaches to the Irish people.
Neither manifesto was accepted in full. The Fine Gael Party came back to the other House with 76 or 77 seats and the Labour Party had 36 or 37 seats. We then came together in a coalition, which involves debate, discussion, agreement and making choices. We are taking responsibility. I ask Senator MacSharry to be serious and to pluck up something rather than to seek to embarrass the Labour Party. He knows that although we have a particular view on taxation, that did not form the full Government view. The Fianna Fáil Party then wants people to believe it has credibility in advancing such a proposal when it did not do so three years ago. That is the reason I put it to him that he cannot have any credibility in saying that we should do something now when we know it was not his view prior to the election. Let us wait and see whether Fianna Fáil’s next set of proposals-----
-----include taxing people at a higher level. Fianna Fáil will not do that. That is the reason I say that Fianna Fáil is devoid of credibility and that Senator MacSharry is bordering on dishonest when he suggests something that he knows in his heart of hearts that Fianna Fáil would never propose to the Irish electorate, namely, taxing high earners. It never has done so and it never will do so. Both parties are taking responsibility in government. It is true that we are making choices. It is also true that many of the choices and decisions we have to make are extremely difficult. However, the fact is that we must ensure the public finances are brought into balance. We are achieving that. We are making a start, which is hugely important for both parties in government, on the kinds of policy choice that have to do with universal access to primary care.
I accept Senator Cullinane's point that there is more to primary care and health than access to GP services. Other services are required as well, but let us get people focused on primary care and access to GPs. We must get people to visit their GPs on a regular basis and take responsibility for their own health. People must work with their GPs on preventative strategies in the community. The GP and ancillary services around the GP are central to that. For as long as there is a barrier of fees and people have to pay a fee to see the doctor we will have a huge obstacle to the advancement of our health care policy. I am passionate about universal access to GP services. I do not exclude the fact that there needs to be a debate about how we extend cover and pay for health insurance, all the acute services and the other community services, but in primary care, at which the GP is at the centre, let us remove the barrier of fees from that service. In so doing, we will greatly improve the health service as a whole.
- Ivana Bacik
- Terry Brennan
- Colm Burke
- Deirdre Clune
- Paul Coghlan
- Michael Comiskey
- Martin Conway
- Maurice Cummins
- Jim D'Arcy
- Michael D'Arcy
- John Gilroy
- Lorraine Higgins
- Caít Keane
- John Kelly
- Denis Landy
- Fiach MacConghail
- Mary Moran
- Tony Mulcahy
- Michael Mullins
- Hildegarde Naughton
- Catherine Noone
- Pat O'Neill
- Tom Shehan
- Jillian van Turnhout
- John Whelan
- Katherine Zappone
- Ivana Bacik
- Terry Brennan
- Colm Burke
- Deirdre Clune
- Paul Coghlan
- Michael Comiskey
- Martin Conway
- Maurice Cummins
- Jim D'Arcy
- Michael D'Arcy
- John Gilroy
- Lorraine Higgins
- Caít Keane
- John Kelly
- Denis Landy
- Fiach MacConghail
- Mary Moran
- Tony Mulcahy
- Michael Mullins
- Hildegarde Naughton
- Catherine Noone
- Pat O'Neill
- Tom Shehan
- Jillian van Turnhout
- John Whelan
- Katherine Zappone