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People will not be fooled by yellow pack medical cards

2 March, 2005


Sinn Féin Health spokesperson Caoimhghín Ó Caoláin has said the Government cannot fool people with its introduction of the "yellow-pack" medical card legislation just before the by-elections. Speaking on the Bill to introduce the cards he said figures showed the numbers of people with medical cards had fallen dramatically since 2002, despite the Government's claim that the new GP-only cards fulfilled its General Election promise to extend medical cards to a further 200,000 people.

Deputy Ó Caoláin told the Dáil:

"What has become known as the yellow-pack medical card appeared out of the blue last year. Perhaps it was inspired by the blue sky over Inchydoney. There was no indication previously that the Government was going to take this route. During the 2002 General Election the Fianna Fáil party promised to provide a further 200,000 people with medical cards. It is often forgotten that the PDs made a similar promise when their manifesto said in 2002 that they would "ensure eligibility criteria would at least keep pace with movements in incomes".

"Not only have the promises of both Coalition parties not been fulfilled but the situation has gone into reverse. There are now 64,478 fewer people with medical cards than there were when those promises were made in 2002. There are 109,767 fewer people with medical cards than there were in 1997 when the Fianna Fáil/PD Coalition came into Government.

"But it gets worse. In January of this year 6,296 people lost their qualification for medical cards. The figure for the month before was 2,068. So, since Deputy Mary Harney took over as Minister for Health and Children well over 8,000 people have lost their medical cards.

"The Government may be rushing this Bill in time for the by-elections but the people will not be so easily fooled."

Full text of contribution of Caoimhghin Ó Caoláin to Health (Amdt.) Bill 2005 debate

This is a dual-purpose Bill. Firstly it gives effect to those parts of the Health (Amendment) (No. 2) Bill that were found to be constitutional by the Supreme Court. Secondly it introduces the GP-only medical card announced by the Government last November. These are two very distinct and separate matters and I question their inclusion in one Bill.

I also question the rush to enact the first part of this legislation in the absence of any clarity on how those people wrongly charged by the State for long-term residential care are to be reimbursed. The government is moving very swiftly to ensure that those in-patients receiving long-stay care who can be charged following the Supreme Court judgement will be charged and as soon as possible. There is no similar rush to repay those unlawfully charged over a period of many years. In the memo with the Bill, the estimated cost of the loss of income to the State since 9 December 2004 when charging was stopped is given as €2 million per week. Where is the estimate for what those mostly elderly and infirm people are owed by the State?

We are told that a Cabinet sub-committee has been formed to decide on the scheme of reimbursement. But I detect a distinct lack of urgency on the part of the Government. It is certainly in contrast to the swift production of this Bill. It is all the more unacceptable given what we now know about the extent of knowledge within the Department of Health and within successive governments about the illegal charging of long-stay patients over many years. The system knew people were being wrongly charged but did nothing to stop it.

Since this issue came to light there has been widespread concern and confusion among the families of people in long-stay residential care. Following the Supreme Court judgement they are still none the wiser about the next steps that will be taken and the implications for their personal circumstances. We learned this week that the Health Services Executive had allocated only six staff members to the dedicated help-lines. An additional four staff has not made an appreciable difference as long delays in answering calls is still being experienced. My fellow Sinn Fein deputies and I have had many inquiries to our offices on this matter and I presume other deputies have also been contacted by many people seeking information. The State's response has been disgraceful. The Government must start making decisions and must get information out to the general public. Above all it must repay all those entitled to repayment.

I now turn to the second part of the Bill - the doctor-only medical card. What has become known as the yellow-pack medical card appeared out of the blue last year. Perhaps it was inspired by the blue sky over Inchydoney. There was no indication previously that the Government was going to take this route. During the 2002 General Election the Fianna Fáil party promised to provide a further 200,000 people with medical cards. It is often forgotten that the PDs made a similar promise when their manifesto said in 2002 that they would "ensure eligibility criteria would at least keep pace with movements in incomes".

Not only have the promises of both Coalition parties not been fulfilled but the situation has gone into reverse. There are now 64,478 fewer people with medical cards than there were when those promises were made in 2002. There are 109,767 fewer people with medical cards than there were in 1997 when the Fianna Fáil/PD Coalition came into Government.

But it gets worse. In January of this year 6,296 people lost their qualification for medical cards. The figure for the month before was 2,068. So, since Deputy Mary Harney took over as Minister for Health and Children well over 8,000 people have lost their medical cards.

Where does this leave the Minister‚s estimate that in the region of 200,000 people should qualify for the doctor-only medical card? It is a very convenient figure for the Government which has been haunted since 2002 by its own extravagant promises. But does the figure have any meaning?

The reality is that very many of these cards will go to people who were previously entitled to the full medical card but who lost it because their incomes rose above the disgracefully low level of the income guidelines.

On Budget Day I tabled a Dáil Question to the Minister for Health and Children asking the approximate cost of the GP-only card compared to the full medical card. She stated that the GP-only card will cost approximately €250 per year while the annual cost of the full medical card is €1000. So, both in terms of the numbers qualifying and in terms of the value of the new card it is clear that the Government‚s claimed generosity is by no means all that it would like the public to believe.

We also have to take into consideration the government's hiking of hospital charges and medicine costs to see that it is giving with one hand and taking away with the other. While the extension of free GP services is welcome as far as it goes - and how far remains to be seen - the Government cannot fool people into thinking they are getting the full value of the medical card. They will still bear the heavy cost of medicines which together with hospital charges represent three quarters of the value of the real medical card.

This Government has been responsible for a succession of steep rises in the costs of medicines. Those who fare worst are people whose income is just above the medical card income guidelines and who must take regular medication. A year ago they had to pay up to €70 per month before they were entitled to a refund under the Drugs Payment Scheme. After two rises in the threshold over the past 12 months, they must now pay €85 per month. For people on low incomes, and especially for those who are dependent on ongoing medication for their very lives, this is a disgraceful rise.

This Bill maintains the myth that entitlement to the medical card is based on "undue hardship". The reality is that the entitlement is based on the income guidelines drawn up by the Minister and her Department within the constraints set by the Minister for Finance in the annual estimates. Only in the most exceptional of circumstances will people above those income guidelines be considered for a medical card ˆ no matter how much "undue hardship" they and their dependents experience. All deputies here will have experience of representing people in such circumstances who have been denied a medical card. This Bill introduces a further euphemism. It states that the GP-only card will go to people for whom payment of GP fees would be "unduly burdensome". Again the reality is dictated by the income guidelines and not by the individual circumstances of each person applying - no matter how heavy the burden they carry.

In conclusion this Bill - in both its parts - adds another rickety extension to our ramshackle, ill-planned, inequitable and inefficient health service. It comes at a time when Minister Harney is accelerating the development of private medicine and giving favoured treatment to the private health business. The A and E crisis continues. Local hospitals are being denuded of services. The development of primary care - supposedly the cornerstone of the government's Health Strategy - has been put on the long finger.

The Government may be rushing this Bill in time for the by-elections but the people will not be so easily fooled.

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