Thursday, 11 December 2008
Dáil Eireann Debate
This is an important item of legislation because it is a significant statement by the State about the provision of free health care and access to it. The context of this legislation is the certainty that political decisions on access to health care are always going to be emotive and intense. The lessons the Government must learn from the way in which the decisions guiding this Bill were made are that it must be clearer and more sensitive, with greater consideration.
Deputy Mary Alexandra White: A balance has been struck in this legislation but mistakes were made along the way. It is worthwhile expressing an apology to the countless number of senior citizens who were confused and upset by the initial announcements. Accounting must never take over completely in our legislation. Compassion must be factored into our business in the Dáil. The balance in this legislation regarding the reform of access to medical cards for those 70 and over is found in the safeguards contained in the legislation.
Deputy Mary Alexandra White: The threshold over which people will not have automatic entitlement is sufficiently high. Members must understand that 90% of people over 70 will be entitled to a medical card. That is a reasonable figure.
Deputy Mary Alexandra White: Our party has not rowed back on anything. We never supported the full entitlement. For those who could pay, we agreed that those over 70 should pay it. That was our party position in 2001.
Deputy Mary Alexandra White: The provisions for those 70 or over, but whose spouses are under 70, are also sensible and fair, as are the provisions for those who are over the threshold because of low net income or surgical or medical expenses. That is factored into the legislation. I would not be standing here if this was not a reasonable item of legislation. These provisions are equitable and important.
The amendment of the Health Contributions Act, so that the health levy will not be payable by our senior citizens, is also an important component of this legislation. Within the context of this legislation, the Government’s action in trying to find potential savings in drugs costs must be acknowledged. Dr. Michael Barry’s report on potential saving for public funds on drugs while ensuring responsible prescribing is an important contribution to this legislation. I hope the Department gives this report urgent and focused attention. The impact of prescriptive drugs inflation on the State can be addressed in a meaningful way in this review. These are important provisions. It is very easy to knock but if one reads the legislation, one will see good things in it.
I was pleased to read in the IMO’s submission on the issue of a single capitation fee for GPs in respect of medical card holders that savings of €80 million can be found in drugs costs. This legislation leaves medical care for our senior citizens almost the same as in 2001 when universal entitlement of a sector of society did not exist. Perhaps Deputy Bannon knows that the Fine Gael health spokesperson was not in favour of granting universal health care at the time.
Deputy Mary Alexandra White: Deputy Bannon should examine the record. This legislation is guided by the principle of targeting resources at those most in need, against a backdrop of an increasing number of people——
Deputy Mary Alexandra White: The Deputy in question, Deputy Reilly, did not rebut this during a Private Members’ Bill. Members should check the record. This debate on access to health care is so vital and the various options that are possible, such as universal health insurance, must be continually considered. I believe in compassion, a word not often bandied about in politics, but I want to use it now. In tough times we need more of it. Budgets must be balanced but a caring society is one built on social justice and equity. Compassion must be factored into all of our legislation. People make our country what it is. People matter and so too does fair and equitable legislation.
Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael P. Kitt): I am glad to contribute to this debate. I support what Deputy White has said about the importance of this legislation. The point stressed by her and other Members is that the medical card is being made available to those who are unable, without undue hardship, to meet the cost of health services for them and their dependents. This is important. When dealing with the automatic entitlement of people over 70 to the medical card, we refer to very vulnerable people but we are also talking about a situation that was difficult when it was introduced. Deputy Behan referred to that. GPs were getting four times the rate for people over 70 compared to those under 70. As our elderly population grows, we are in a difficult situation. I am glad to hear the Minister say that 95% of people will qualify because their income will be below the limits of €700 per week for a single person or €1,400 for a couple. The House will agree these are high limits. The phrase she used, in referring to payments made to those over 70 in the GMS service, was perverse incentive. This is a good point because there is no justification for that. I welcome the recommendation of Mr. Eddie Sullivan, who proposed a single fee capitation level of €290, which will be implemented next year.
We all agree that people over 70 used the medical card. People were more inclined to go the doctor, particularly the male population, who are notoriously poor at attending GPs. I welcome that. The Minister stated that we have the youngest population in Europe and the number of people over 70 is expected to grow substantially in the coming years. The figures will be 363,000 in 2011, 433,000 by 2016 and 535,000 by 2021.
Regarding criticism of Fianna Fáil and this Government, for many years there was great recognition of the elderly by this Government and various Fianna Fáil Ministers. A Fianna Fáil Minister brought in many of the packages for people over 66 years of age. We now refer to this package as household benefits and it includes free travel, free electricity, free telephone rental and the national fuel schemes. The late Frank Cluskey increased social welfare payments during his time in that Department. He did much better than Proinsias De Rossa, who succeeded him but who was not a great success in the Department. When Ray MacSharry was Minister for Finance in difficult times many years ago, he made provision for the medical card to be granted to everyone aged over 66. That lasted for a short while but he was succeeded by Barry Desmond in a coalition government, who did not retain this measure. Opposition Members should note this when they state Fianna Fáil is not being kind to the elderly. There was little protest about this reversal at the time.
However, nowadays there are significantly more elderly people and, in difficult economic times, we must examine what we are doing. Mr. Eddie Sullivan made a fair recommendation of a single capitation fee of €290 per patient. Dr. Michael Barry is examining the potential saving on drug costs. He is chairing a group to make recommendations on good practice, which will secure safe and effective prescribing for patients and maximise the potential for economy in the use of public funds, and its report has been submitted to the Department. That is another welcome development because the overall funding of the health budget must be examined and not only the medical card provision. This has always been central to Fianna Fáil policy and its Ministers in the Departments of Health and Social Welfare over the years.
I refer to the Age Action Ireland publication, The True Cost of Living Alone. The organisation has been lobbying for a long time to examine ways to help pensioners living alone. Its budget submission concentrated very much on the living alone and fuel allowances and the security of having a medical card. The Minister is confident the vast majority of people aged 70 and over will retain their medical card. The scheme is often used as a criterion for other schemes such as the school transport scheme, which is difficult to understand. If one has a medical card, one can qualify for free school transport. It is strange that because one has a medical card, one is entitled to other benefits. However, it is clear from the Age Action Ireland publication that the medical card provides security for elderly people.
I agree with Members that mistakes were made and there were communications issues in letting people know what would happen. We made changes but, as many Members said, perhaps the elderly were caught in the crossfire between the Government and the medical profession who were trying to resolve the fee per patient issue, which was €640 per pensioner at the time. I am sorry about that and, like other Deputies, I very much regret the way this was communicated. However, 350,000 people aged 70 and over are in receipt of the medical card and the number will increase in years to come, for which we must provide. I am glad the legislation provides for a gross income threshold of €36,500 a year for a single person and €73,000 for a couple.
It is important that we make it easier for people to access medical cards. The Minister explained the current position regarding elderly couples who seek a review of their income where one partner is aged 70 or over but the other is not. It is to her credit that she has increased income limits during her tenure by 29% and allowances are also provided for PRSI, child care, mortgage or rent and travel to work expenses. For example, over the past two years, 125,000 additional medical cards were granted and, currently, 1.27 million people have medical cards, which is the highest number since 1996 while 75,000 have GP visit cards. A total of 200,000 more people can visit their GP free of charge, which is the highest number since 1994.
Home care packages are also important because it is not enough to provide only a medical card as the elderly face issues relating to physiotherapy, chiropody and speech and language therapy services, although they are much improved. The Nursing Home Support Scheme Bill 2008, known as the Fair Deal, was another important contribution by the Minister and the Government.
I hope the House will agree we have greatly improved the way we deal with issues relating to the elderly. I am proud of Fianna Fáil’s record going back to Ministers who provided social welfare and health packages over the years. I am delighted more people are in receipt of the medical card, particularly those in the over 70 category. I also hope the issue of providing easier access to the medical card scheme will be examined further. A great deal of paperwork is involved in some professions. There should not be as much paperwork involved in applications for the medical card. When the health boards were in place, I proposed that paperwork should be kept to a minimum and a print out was subsequently provided, which kept information to the minimum. I hope that will be the way forward and I will call on the Minister to make applications and interaction with community welfare officers easier. They are busy dealing with paperwork for various other schemes.
The legislation provides for a Government decision to end the automatic entitlement to a medical card and I hope the new arrangements will ensure the vast majority people aged 70 and over will continue to have medical cards under the new income threshold, which is realistic. I also hope the Bill is speedily passed through the House.
Deputy Jack Wall: I fully support the position of the Labour spokesperson, Deputy Jan O’Sullivan, on this legislation. I find it sad to be in the House listening to speaker after speaker from Fianna Fáil and the Green Party trying to support this legislation. Deputies state the Fianna Fáil Party has done many things for senior citizens over the lifetimes of various Governments. No one in this House can deny that. However, to try to ring-fence a mistake by indicating the positive actions taken by the party over the years is wrong.
During the week, I read an article by Charlie McCreevy, now a European Commissioner and the former Minister for Finance who introduced free medical cards for those aged over 70. This article was about the Lisbon treaty and Mr. McCreevy stated the Government must respect what the people stated. If Mr. McCreevy was still Minister for Finance and this thinking was applied with regard to the medical cards he would have rejected this proposal.
To a man and a woman, the senior citizens in the major assembly who came to the Dáil to object to this stated the new proposals put together at short notice were unacceptable. They wanted universal provision of medical cards. They did not want this because they had suddenly qualified for it. This did not interest them one iota. They believed the decision made in 2002 was proper and recognised the value of senior citizens to this country over many years and that the provision of medical cards should be applied across the board.
I hear arguments on whether a judge or a Garda superintendent should have a medical card. This is camouflage by Fianna Fáil members who know in their hearts and souls that this was a major error of judgment. One could put it down to the inexperience of the Government although there was a great deal of experience around the table. However, it seemed those with experience were not listened to and this decision was forced through. Was it forced through because the Minister for Health and Children would have resigned otherwise? Something of this nature had to be in place or stated at the time for the Fianna Fáil Ministers to agree to this. It meant that 5% of senior citizens were disowned by the Government and this was never on because of the value they have given to the country.
A judge would never apply for a medical card in his or her lifetime. However, we tell judges that because of the money they earn, they are not entitled to a medical card. This does not tally with the statements from Deputies on the other side of the House that they look after senior citizens. Universality should apply and medical cards should be provided not to one senior citizen or 10% of them but to 100% of senior citizens.
I listened to Deputy White try to distance the Green Party from this decision, stating that the party must agree with the Government, that it is a saving and that we must look after senior citizens and it is wonderful to do so. This is a fob. The Government knows it made a mistake and Members are trying to hang their hats on various aspects of it but this does not wear. To a person, senior citizens believe this should have been given to all of them.
We have all heard representations from the Retired Teachers Association of Ireland, RTAI, which is gravely concerned about this. Recently, a good friend of mine who is a wonderful community worker walked up to me and told me she would lose her medical card. I know about her health condition. She attends hospital and consultants on a regular basis. I could see the concern in her face about the fact that she knew she would lose her medical card. These are the people who ensured education was the bedrock of the Celtic tiger. Fianna Fáil and the Green Party now state that those in the RTAI made such a contribution but in these times they cannot be provided with medical cards. The trust they had in the Government at the time the decision was made by Charlie McCreevy in 2002 has been lost forever, to all intents and purposes.
The RTAI has an expectancy, as does Age Action and the Irish Senior Citizens Parliament that medical cards should be provided and this provision should be underpinned. For the measly amount of money being saved, the dignity of the Minister and to ensure the Government did not back away from the measure, Fianna Fáil and the Green Party supported it. This is a major error of judgment. I hope people in these parties will state they made a mistake on the day, as Deputy Joe Behan stated. He put his political future on the line and has not made up his mind whether he will run for this House again. He believes the Fianna Fáil Party, of which he was a member for so long, was wrong to support the Minister on this. This has been reflected on an individual basis by many people throughout the country. I support our spokesperson in her opposition to this Bill.
Deputy Joe Costello: I support fully what has been stated by my colleague, Deputy Jack Wall, and our spokesperson on health and children, Deputy Jan O’Sullivan. This is a new low for the Government. I would not have expected anything different from the Progressive Democrats but I would have expected that Fianna Fáil would have had more compassion for senior citizens who have supported them through the years. I would have thought that the Green Party, with all of its rhetoric, would have been able to put forward a better case in this issue.
One of the most powerful sights in 2008 was the sight of 15,000 senior citizens protesting outside the Dáil in October following publication of the budget which proposed to do away with medical cards for those with an income of €201 per week. The universal right to a medical card from the age of 70 was being abolished. It was an appalling decision. I compliment the Irish Senior Citizens Parliament for the efficient and effective manner in which it mobilised so many senior citizens throughout the country.
Under massive public protest the Government has done a partial U-turn and today we have the Health Bill to introduce the new scheme to abolish the automatic right to the medical card and to establish new income limits for those aged over 70. This is the Government’s Christmas present to tens of thousands of senior citizens. Scrooge would be delighted. The comfort and security of universal health protection for all those aged over 70 has been abolished in one fell swoop.
On 1 January 2009 those senior citizens who reach their 70th birthday will worry not that they may earn too little in the future but that they may earn too much. This is the appalling vista which faces them. The cut-off point is €700 per week or approximately €36,000 per annum and this is subject to annual review by the Minister for Health and Children to reflect increases in the consumer price index. It seems that once over the limit always over the limit.
The Government’s justification for introducing means testing was that it did not want billionaires or multi-millionaires such as Tony O’Reilly and Michael Smurfit getting a medical card for free. This was outrageous as none of them was likely to apply for it as they would have private insurance. This was a useless argument which had no bearing on the matter whatsoever.
Teachers, nurses, gardaí, middle grade civil servants and various professionals will fall into the Minister’s net. Effectively, middle Ireland, which has paid its taxes all along, will again bear the brunt of the Government’s cutbacks. Having never received a tax break during their working lives, middle income earners will be denied any crumb of security during the vulnerable years of their old age. For example, the pension of a retired teacher, which will reflect promotions, degree qualifications, supervision duties, long-term increments and other special duties, will likely exceed the threshold of €36,000. Income from saving funds or retirement gratuities, where the principal exceeds €36,000, will also be included in the pot of money on which a person’s eligibility is assessed. Retired teachers have no social welfare pension and, therefore, no entitlement to excess in regard to dental, optical or aural cover.
To compound the situation, VHI charges are becoming increasingly expensive and out of reach for many people. We are not talking about the super rich. Those who will be most affected by these changes are the solid, industrious people who maintained this country through thick and thin, reared their children and put them through college prior to the introduction by the Labour Party of universal free third level education in 1996. These people, representing the backbone of the State, always gave and never received anything for free throughout their working lives. Nor will they receive anything now, when they are most in need of assistance. Instead, their expectation of a medical card to comfort and reassure them in their old age is dashed.
The Scrooge Minister who has overseen the ruination of the health service for the last four years is now determined to ensure that the golden years of as many people as possible are made miserable. The decision to base the means testing of medical cards on net rather then gross income, as was previously the case, is the thin end of the wedge which will scoop many more people into the threshold net. The Minister has stated that 95% of the age cohort, or approximately 20,000 people, will be excluded. I do not accept that for a minute. The devious way the legislation is formulated means the number will greatly exceed that estimation and may well be a multiple of it.
I ask the Minister to exempt senior citizens over the age of 80 from the provisions of the Bill. Many such persons are paying their own way in private nursing homes but are, fortunately, in receipt of a medical card. When this legislation goes through, they will find themselves without a medical card and with additional bills to pay on top of the nursing home charges. This anomaly will cause serious problems for many people.
The issue of access to services has not been sufficiently highlighted. For example, nurses and physiotherapists can be difficult to source in the private sector. Private sector providers have concentrated on certain areas where they can expect a good return. This will cause people great difficulty in accessing such services. This is a sad day for the State. It is certainly a sad day for the Government. The Labour Party will oppose this Bill at every opportunity.
Deputy Ciarán Lynch: The first question that comes to mind in regard to this legislation is whether there is a deliberate strategy on the part of the Government to remove the medical card provision for every citizen in the State over 70 years of age. Some weeks ago, Members sat in this Chamber with certain expectations when the budget was announced. We expected it to be a tough budget, that action would be taken to address the shortfall in public finances and that initiatives would be introduced in regard to job creation. Ultimately, we expected a strategy to bring us out of the difficult economic times in which we find ourselves.
None of those expectations was met in the budget. There was no job creation strategy and no strategy for public finance control. For the public, the budget inspired no confidence in a Government which seemed merely to be falling from one crisis to the next. What we received was crisis-driven government, and nothing has reflected that approach more than the decisions taken on the provision of medical cards to over 70s since the initial proposal was announced in the House on budget day.
When the financial position of an entire country is invested in the pyramid scheme that was the property bubble, these types of consequences are bound to ensue. The achievements of economic and social growth, where the economy works hand in hand with society so that ordinary people living in their communities begin to see the benefit of that economic growth, have been flushed down the drain because of the speculative behaviour of the Government in encouraging the property bubble. Like a junkie, high on the tax receipts from property speculation, the Government ignored every other aspect of the body politic and the harm being done to it. The Government was like a person fixing the roof of a house on a long, warm summer’s day, reassuring the owner that all would be well. When the autumn rain came, however, we found out the truth, which is that the Government now sees fit to attack the old, the young and the disabled. Nothing typified this attack more than the withdrawal of the medical card from people aged over 70.
The introduction some years ago of the universal entitlement to a medical card for all persons aged over 70 years was welcomed by some and condemned by others. In life, we sometimes devise good ideas strategically and deliberate while, on other occasions, we stumble upon them accidentally. Whatever the Government’s motivation for the provision of medical cards to the over 70s, the reality is that it was an effective measure. All the available research shows that an automatic entitlement to a medical card has led to a significant improvement in the overall health of this age group. In addition, it has resulted in Exchequer savings because of the reduction in the demand for hospital care and nursing home beds. In other words, the scheme is both beneficial to the health of the group concerned and cost effective for the State. Moreover, it may cost the State an additional €6 million to reintroduce a fee-paying structure. Therefore, the existing provision represents a more cost efficient system than what is currently proposed.
Why is the Government so adamant in its opposition to the universal provision of medical cards for over 70s given that it makes both medical and economic sense? Medical cards allow elderly people to monitor their health because there is no financial impediment to accessing primary care when it is needed. What is the philosophical basis for the Government’s stance? The only answer I can arrive at is that the Government is hell bent on preventing or doing away with any type of universal provision. It has set out its stall in regard to third level fees. It is not a question of finances but of political philosophy. There are economic choices available to the Government. Therefore, this Bill represents a political statement rather an economic imperative.
Like other Members, I received telephone calls after the budget announcement from confused elderly people who were unsure whether their medical card would be revoked the next morning or on 1 January. Prior to the budget announcement, the system that was in place was simple. All persons who reached the age of 70 were entitled to a medical card for the remainder of their lives. There was consistency in that all members of the community were entitled to it on the same basis. This Bill will merely create confusion. Even those who remain eligible for a medical card are anxious and concerned that they will not receive it.
I understand from where Fianna Fáil is coming on this issue. Having been in bed with the Progressive Democrats for 15 years, it has developed some pillow habits with them. However, what about the Green Party? It appears to have only one agenda. It is like a religious cult. For as long as it is saving the planet, worldly things such as houses, medical cards and education are distractions from the greater good and the party should not get caught up with them. The party might roll out a backbencher to apologise to the rest of us but, ultimately, we are distracting it from its core issues.
Deputy Joe McHugh: I welcome the opportunity to speak on the Bill in the short time available. I have two questions for the Minister, one simple and one quite fundamental. The Minister hopes the ending of the automatic entitlement to the medical card will yield a further €20 million. I believe it will not save money. Given that the new system will lead to further HSE bureaucracy and labyrinthine form filling, how much money will be spent paying civil servants to implement this new, unsophisticated system which is ill thought out and a panic reaction to plummeting ratings in the opinion polls? That is the first, simple question which must be answered.
My second question is fundamental and relates to issues surrounding health insurance. Insurers will not insure illnesses that have arisen in the past ten years for new policy holders over the age of 60. Let us take the example of a 71 year old woman who let her long-standing VHI or Quinn Direct-Bupa policy lapse 12 months ago as a result of qualifying automatically for a medical card. She cannot get medical insurance for conditions or illnesses that have arisen in the last ten years, nor can she re-establish her old health insurance policy because a VHI policy lapses within 13 weeks. She will also face massive medical costs that she might be unable to meet. What does the Government propose to do in this case? Has the Minister, Deputy Harney, thought about this problem? Will she ask the medical insurance companies to re-establish lapsed policies on condition the policy holders pay for the lapsed time? That would be unfair. She can only resolve this issue by financing the lapsed time payments from the public coffers, which ultimately would cost more than the intended savings of €20 million.
This scheme is ill thought out, unworkable and unsophisticated. We must examine how we can engage more with people over 70 years of age. No lessons appear to have been learned from the demonstrations in Dublin. They were not about a single issue but a plethora of issues. If one were to describe exactly what was happening it was about a category of people who feel disregarded, worthless, without a role in society and taken for granted. That group of people has more to give.
We should start by accepting the principle of universality with regard to health. It worked for people because they undertook, on their own initiative, to undergo regular check-ups. That will no longer happen with the new threshold. That is a problem.
We must also confront the challenge of stereotyping people whom we have put into a dependent category. They are not a dependent group on society and should not be perceived as such. These people are active and have a role to play in society. Some of them might wish to continue working full-time or part-time. Some might wish to get involved in the voluntary sector. I note the presence of the Minister of State, Deputy Barry Andrews. If we are to confront the challenges for youth, engage with young people and get them more involved in society, we should look to our senior citizens. Ask them for their help because there will not be enough money to pay for youth and community workers.
Deputy Michael Ring: I have spoken on this issue previously. The decision by the Government is mean. We teach children when they are young that if they give something to somebody, they should not take it back. Before the 2002 election there was no clamour for a medical card for the over 70s. The Government made a political decision to give it to them. Now, it is taking it back. That is mean. The Government’s treatment of the old people in this country is wrong. These are the people who brought the State to where it was before this Government destroyed it over the last number of years.
I ask the Minister and the Department to do something about the thresholds for the medical card. Middle income people are caught badly. I wish to put the thresholds on record for the benefit of the media, who might not understand. If a person under 65 years of age is earning more than €184 per week, they will not qualify for a medical card. A single person on jobseeker’s allowance gets €197 per week and almost will not qualify for the medical card. The medical card situation is daft. In the case of a married couple with three children under 16 years of age, the medical card threshold is €383.50. If that couple is on jobseeker’s allowance, in other words, the dole, they would get €401.10 and would not qualify for the medical card. The thresholds must be increased. They have not increased for the last number of years. The way we are treating young families is wrong. People who are finding life difficult and people who are working are being squeezed.
What the Minister and the Government did to the over 70s was an attack on the elderly. It was wrong. They must honour the commitment they gave the people of this country. The elderly are waiting for the next election. In the last election they voted for the Government because it gave them the medical card. In the next election they will vote against the Government for withdrawing it. It is wrong to give with one hand and take back with the other. The Minister has made a bad mistake on this issue. I hope the Independents and Deputy Joe Behan will vote with us today to save the medical card for the over 70s.
Deputy Paul Connaughton: With due deference to the Ministers of State, Deputy John Moloney and Deputy Barry Andrews, who are present and for whom I have the height of respect, I can guarantee that this Bill was certainly not considered on the day of the Budget Statement. The Ministers did not have the slightest intention of having anything to do with a Bill such as this. I recall the Minister for Finance stating that his budget would be fair and balanced. It was unfair and unbalanced in about ten different areas, which I do not have time to discuss. It was only when the Minister for Finance and the Taoiseach saw the 40,000 pensioners coming to Kildare Street that they began to understand. The Minister of State will recall the event in the church.
A Fianna Fáil Government of ten, 20 or 30 years ago would not do this. I will hand it to Fianna Fáil that it was good at these matters over the years. However, all sense has left the party. The men and women over 70 spent their lives gallantly working for Ireland but the only response Fianna Fáil had to a recession was to take the medical card from them. There is no logic, good, bad or indifferent, in that.
The budget is the cause of all the Government’s troubles. Those troubles started on budget day. The budget was a false start. The Government has apologised for what it did to one group or another every day since the budget was introduced. As a long-serving Member of this House, I know people are waiting in the long grass to get a rattle at the Government. They will do so next June because the Government lost touch with its roots and hit the most vulnerable. Shame on the Cabinet.
Deputy Dinny McGinley: I thank my colleagues for sharing time. While I may only speak on the Bill for two and half minutes, I could speak for two and a half hours. Deputy Connaughton indicated that the issue of medical cards for the elderly has been mishandled since the budget. It has been mishandled since this type of medical card was first introduced in 2001. At that time, it was estimated that the scheme would cost approximately €30 million per annum to finance. In its first and second years of operation, however, it cost €70 million and €115 million, respectively, to fund the scheme. Preparation, planning and consultation were absent.
This scheme reminds me of the decentralisation programme because it, too, fell to pieces. It was announced in the recent budget that the measure to curtail the availability of medical cards to those aged over 70 years would deliver savings of €100 million. The Minister has indicated, however, that it will save €16 million. Why were 350,000 elderly people put through such anxiety and exposed to such travails to save €16 million per annum?
I echo my colleagues’ call on the Minister to restore the principle of universality and provide medical cards to everyone aged 70 years and over. Those affected by the measure have worked hard, built up the Celtic tiger and financed services through taxes and other contributions. A cohort of retired public servants, including teachers, gardaí and nurses, as well as widows who receive a social welfare payment or widow’s pension, will find that their incomes are above the threshold and lose medical cards they have had for three, four or five years.
I am pleased the Minister has entered the Chamber. Many elderly lifelong VHI subscribers terminated their policies when they received a medical card. Will they be able to rejoin the VHI and, if so, how long will they have to wait? For the sake of saving €16 million, the Bill does not merit support. I appeal to Government Deputies and the Minister to restore the principle of universality and, in so doing, remove the anxiety people are experiencing.
Deputy Tom Hayes: I thank my colleagues for sharing time in this important debate. Having spoken on many Bills, I do not believe this legislation should have come before the House. We are all aware of the worry caused to pensioners by the budget measure on medical cards for those aged over 70 years. We saw the protest on Kildare Street and heard people from across the political divide state the measure was wrong. We are not all wrong and I appeal to the Minister to take this final opportunity to reverse her decision.
I ask the Minister to exclude from the measure all those living in nursing homes. Nursing home care is extremely expensive and many families have no option but to place a mother, father or elderly relative in a nursing home. Some nursing home residents have good incomes which are above the threshold. All those living in a nursing home should be given a medical card. It is difficult enough to move from one’s home to a nursing home. In the dying hours of this debate, I ask the Minister to grasp the opportunity to look after those living in nursing homes. Having visited many such homes, she will be aware of the worry and anxiety nursing home residents are experiencing.
Minister for Health and Children (Deputy Mary Harney): I thank Deputies who contributed to the debate. In response to the two Deputies who spoke immediately before me, one year ago next Sunday the Fine Gael spokesperson on health, Deputy James Reilly, told the respected journalist, Ms Aileen O’Meara, that medical cards for those aged over 70 years should be means tested. It is hard to believe he made this comment less than a year ago.
Deputy Mary Harney: In response to Deputy McGinley’s comments on the Voluntary Health Insurance, the granting of a medical card did not affect private health insurance policies except in respect of the VHI’s plan P. Approximately 25,000 people have the plan which covers the inpatient hospital charge. The VHI has informed me that while there is no evidence that people exited the plan, anyone who did so may rejoin without penalty.
Deputy Mary Harney: Deputy Tom Hayes raised the affordability of nursing home care, which is an important issue. As Deputies are aware, if somebody is in a publicly funded or publicly provided bed, 95% of the cost is paid by taxpayers. If, however, he or she is in a private bed, some 60% of the cost is paid by the person being cared for. This is a major burden on families and individuals and a cause of considerable worry and trauma. It was for this reason that the fair deal legislation currently before the House was introduced. I look forward to moving this Bill into committee early in the new year.
On the number of people affected by the measure, 355,000 people aged 70 years and over have a medical card. While some of these persons are aged under 70 years, the card is granted on a family basis, which means that if one partner, either the husband or wife, was aged over 70 years, his or her spouse was also given the medical card. This accounts for some of the figure. The Government’s decision did not affect 215,000 of these people because they received a card based on their means. Some of them received a card while aged in their 60s and retained it when they reached 70 years. The only people who were ever affected by the budget announcement were those who received the medical card by virtue of their age. Many of this group were not affected by the initial Government announcement.
The change means gross income will be used. I am sure we will debate this issue more thoroughly on Committee Stage. We are constantly told how poor everybody is, yet on this issue it appears Deputies are suggesting that virtually everybody will lose the medical card. They cannot have it both ways. Data are available on the earnings of older people over the age of 70 years. We are satisfied——
Deputy Mary Harney: I am not suggesting that. However, persons aged 66 and 67 years may earn a maximum income of €298 — as a couple — to qualify for a medical card. What we are doing for those aged over 70 years is substantially ahead of that.
Expenditure on medical cards in general is increasing by approximately 3% per annum, whereas the increase for the medical card for those aged over 70 years is approximately 7% per annum. I repeat the statement I made yesterday that the current arrangements are not financially sustainable. If they were to continue, it would be at the expense of much poorer people and other much needed services. I am sure we will debate all these issues on Committee Stage.
Many references were made to the manner in which income will be calculated. We are not taking into account any income from property, land or farms. Only actual income will be calculated. It is often the case, as it is now, that nursing home subventions and many other social welfare schemes impute income at a particular rate. It will not happen here. It will refer to actual income, which is a significant improvement and has been greatly welcomed.
Regarding the issue of same-sex couples, which was raised by Deputy Noonan, this legislation applies to cohabiting couples and husbands and wives. It does not include same-sex couples. We could not include them for legal reasons until we have the civil union Bill. There is an existing medical card scheme, much of which is done on an administrative basis. Legal advice showed it was not possible to provide for a different set of circumstances here that do not apply to social welfare and many other entitlements.
In drafting that legislation, which I am advised we will have early in the new year, different Government Departments have made their views on entitlements known. I support the principle of equality and we have provided for it in a fair deal. The difference between the fair deal legislation and this Bill is that it is an entirely new scheme. We are amending an Act of 2001 which provided for the automatic entitlement to a medical card on reaching the age of 70.
The basis upon which people receive the card on grounds of age and the issue of legitimate expectation was raised and is based on legislation. If the Government could not introduce this kind of legislation one could never make anything prospective. The entitlement is based on the legislation not a piece of paper. On capitation fees, the higher fee was paid on foot of legislation. In order to change that fee we require legislation. That is the reality.
Few people, apart from Deputy Reilly who argued recently on “The Marian Finucane Show” that the fee was not excessive, regarded a fee of €640 for better-off over 70s and €160 for the less well-off as fair.
Deputy Mary Harney: I will not go into who agreed to it. Each side did their job. I am not going to get involved in that. We cannot change it, other than through changing this legislation because the fee was based on an Act of the Oireachtas passed in 2001.
Everyone agrees it was not fair or appropriate to have perverse incentives for general practitioners operating in better-off areas against those operating in disadvantaged areas. There is no doubt that with the changed fee structure, as recommended by Mr. Eddie Sullivan and accepted by the Government, and applicable from 1 January next, the fee is fair. We accept €290 is a fair fee and will be paid regardless of where the general practitioner operates.
It is appropriate that a higher fee be paid for those over 70 because they attend general practitioners more frequently than the typical person who has a medical card. The last household survey had data for 2007 which showed that over 70s visit their GP 5.2 times per year. Deputies mentioned different instances yesterday. It is true that if someone does not have to pay a charge they are more inclined to visit their general practitioner.
There is no data, from any source, available to the Department that suggests there have been better health outcomes. Deputy Reilly referred to longitudinal studies. The longitudinal study is only beginning. We do not have longitudinal studies. One is underway on children and we hope to have one underway on older people.
Deputy Mary Harney: We have not done a longitudinal study in Ireland. Discussions are currently under way between Dr. Kenny, a leading geriatrician at St. James’s Hospital, my Department, the HSE and others on this area. To have a longitudinal study one must take a long period of time to get the data. There must be base data and outcome data.
Deputy Mary Harney: It is a fact that life expectancy in Ireland has greatly increased over the last decade, which we all welcome. It is acknowledged by many experts that 50% to 60% of the increase in life expectancy in Ireland is a result of better health interventions. The remainder is a result of the growth in our prosperity. The result is that a child born in Ireland today will live longer than a child born in the UK, Germany, Belgium, Denmark and many other countries. We must welcome that. Almost 60% of the reason for that is better health intervention, particularly cardiovascular health.
Many issues raised here concerned appliances, such as wheelchairs, which are of great assistance, particularly to elderly people. I am assured by the HSE that these services will be available on the basis of medical need, as is the current situation, to people under 70. They are not exclusively available to those over 70 by virtue of their medical card. Many people who receive home care packages and home help hours do not have medical cards.
The transformation programme is underway in the north east. From the start of next year there will be an additional 800 or 900 home care packages in the region which will go to people on the basis of medical need. People who require home, clinical and other supports to allow them to live at home and have a higher quality of life will receive them.
Almost one third of those in long-term care in Ireland today do not need to be there if a decision was made on appropriate home supports at the time they went into care. That is why the transformation of the health service is——
Deputy Mary Harney: I suggest Deputy Stagg brief himself on the facts because he has been saying the same thing in this House for 11 years. There are 53,000 families in receipt of home help services, which is the highest number ever. There are 11,000 home care packages. When we continue with the roll out of our primary care supports——
Deputy Mary Harney: Given the circumstances in which we find ourselves, with the economic challenges we face and the support we need to provide for social services in health, education and social welfare, this Bill is appropriate. On 16 December, Deputy Reilly advocated to respected journalists that the medical card for over 70s should be means tested. I have not seen that corrected.
|Ahern, Bertie.||Ahern, Dermot.|
|Ahern, Michael.||Ahern, Noel.|
|Andrews, Barry.||Andrews, Chris.|
|Ardagh, Seán.||Aylward, Bobby.|
|Blaney, Niall.||Brady, Áine.|
|Brady, Cyprian.||Brady, Johnny.|
|Browne, John.||Byrne, Thomas.|
|Calleary, Dara.||Carey, Pat.|
|Collins, Niall.||Conlon, Margaret.|
|Connick, Seán.||Coughlan, Mary.|
|Cregan, John.||Cullen, Martin.|
|Dempsey, Noel.||Devins, Jimmy.|
|Dooley, Timmy.||Fahey, Frank.|
|Finneran, Michael.||Fitzpatrick, Michael.|
|Flynn, Beverley.||Gogarty, Paul.|
|Grealish, Noel.||Hanafin, Mary.|
|Harney, Mary.||Haughey, Seán.|
|Hoctor, Máire.||Kelleher, Billy.|
|Kelly, Peter.||Kenneally, Brendan.|
|Kennedy, Michael.||Kirk, Séamus.|
|Kitt, Michael P.||Kitt, Tom.|
|Lenihan, Brian.||Lenihan, Conor.|
|Lowry, Michael.||McEllistrim, Thomas.|
|McGrath, Mattie.||McGrath, Michael.|
|McGuinness, John.||Mansergh, Martin.|
|Moloney, John.||Moynihan, Michael.|
|Mulcahy, Michael.||Nolan, M.J.|
|Ó Cuív, Éamon.||Ó Fearghaíl, Seán.|
|O’Brien, Darragh.||O’Connor, Charlie.|
|O’Dea, Willie.||O’Flynn, Noel.|
|O’Hanlon, Rory.||O’Keeffe, Edward.|
|O’Rourke, Mary.||O’Sullivan, Christy.|
|Power, Peter.||Power, Seán.|
|Ryan, Eamon.||Sargent, Trevor.|
|Scanlon, Eamon.||Treacy, Noel.|
|Wallace, Mary.||White, Mary Alexandra.|
|Allen, Bernard.||Bannon, James.|
|Barrett, Seán.||Behan, Joe.|
|Breen, Pat.||Bruton, Richard.|
|Burke, Ulick.||Burton, Joan.|
|Carey, Joe.||Clune, Deirdre.|
|Connaughton, Paul.||Coonan, Noel J.|
|Costello, Joe.||Coveney, Simon.|
|Crawford, Seymour.||Creed, Michael.|
|Creighton, Lucinda.||Deasy, John.|
|Deenihan, Jimmy.||Doyle, Andrew.|
|English, Damien.||Feighan, Frank.|
|Ferris, Martin.||Flanagan, Charles.|
|Flanagan, Terence.||Gilmore, Eamon.|
|Hayes, Brian.||Hayes, Tom.|
|Higgins, Michael D.||Hogan, Phil.|
|Howlin, Brendan.||Kehoe, Paul.|
|Lynch, Ciarán.||Lynch, Kathleen.|
|McCormack, Pádraic.||McEntee, Shane.|
|McGinley, Dinny.||McGrath, Finian.|
|McHugh, Joe.||McManus, Liz.|
|Mitchell, Olivia.||Morgan, Arthur.|
|Naughten, Denis.||Neville, Dan.|
|Ó Caoláin, Caoimhghín.||Ó Snodaigh, Aengus.|
|O’Donnell, Kieran.||O’Dowd, Fergus.|
|O’Mahony, John.||O’Shea, Brian.|
|O’Sullivan, Jan.||Penrose, Willie.|
|Perry, John.||Quinn, Ruairí.|
|Rabbitte, Pat.||Reilly, James.|
|Ring, Michael.||Shatter, Alan.|
|Sheahan, Tom.||Sheehan, P.J.|
|Sherlock, Seán.||Shortall, Róisín.|
|Stagg, Emmet.||Stanton, David.|
|Timmins, Billy.||Tuffy, Joanna.|
|Upton, Mary.||Varadkar, Leo.|
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