Medical Cards: Motion (Resumed).

The following motion was moved by Deputy James Reilly on Tuesday, 21 October 2008:
That Dáil Éireann demands the immediate reversal of the Government decision to withdraw the automatic entitlement to a medical card from citizens aged over 70 years.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"—acknowledges the Government's expression of regret for the anxiety caused among older people in recent days and welcomes the new initiative to allay that anxiety;
supports the decision by the Government to introduce a revised scheme with a gross weekly income threshold of €700/€1,400 (single/couple) (€36,500/€73,000 p.a.) for eligibility for a medical card for persons aged 70 and over so that approximately 330,000 persons aged 70 and over will continue to have a medical card;
recognises that this initiative is within the context of the budgetary parameters set by the Government for the Health Service Executive;
supports the Government's move towards a single capitation payment to general practitioners in respect of medical card holders aged 70 and over and the process now to be undertaken to advance this;
looks forward to the work to be undertaken in association with the Irish Medical Organisation under the chairmanship of Dr. Michael Barry to achieve savings in drug usage, without compromising patient care; and
supports the Government's policies to build a fair and equitable health care system by focusing public resources on those in most need."
—(Minister for Health and Children).

It is beyond belief that the Government should seek to make savings on the backs of those aged over 70 years of age. The distress and anger caused by this proposal is palpable and resulted in many thousands of pensioners taking to the streets this afternoon to express their outrage at the Government. They came from all parts of the country to give a clear message, saying to the Government: "Hands off our health care. Hands off our medical cards."

Not since the tax marches of the 1980s has there been such a display of public anger. In recent days several Government representatives, including the Taoiseach, have tried to make out that their mistake was in not communicating their message properly. This is nonsense because their message was the problem. It was and remains the case that the Government chose to abolish the legal right of everybody over 70 years of age to free medical care. There is no way of dressing this up in order to make it look any different.

Not only did the Government do that but it then decided to cut in half the income limits that apply to the over 70s. It reduced the income limits for a couple from €596 to €298 per week. This savage cut was not mentioned on budget day. I really want to know who gave the instruction to the Health Service Executive to do that. Perhaps the Minister for Health and Children, Deputy Harney, who has just arrived in the Chamber, will clarify that for us. There was no mention of the halving of income limits on budget day. That only became apparent the following day.

Did the Minister approve that savage cut in income limits and give that instruction to the HSE? I cannot see that organisation doing that off its own bat. The real problem, the killer blow in many ways, was cutting the income limits in half. I would like the Minister to clarify for the House tonight whether she gave that instruction.

On two occasions yesterday the Taoiseach misled us by claiming that 70% of people would have qualified for medical cards under the budget changes. This is simply not true.

Under the budget changes the income limit was €298 for a couple. Two days later, after the Minister, Deputy Harney's rushed changes, this was increased to €480.60, which equates exactly to the top rate of the State pension. Therefore, a pensioner with even the smallest occupational pension would lose his or her medical card. In effect, the changes the Minister announced last Thursday made little or no difference to pensioners with regard to their entitlement to a medical card. We know the rule was in place which stated that if one's only income was from social welfare one would receive the card, irrespective of what income limit was stated. The Minister's increase, announced with a fanfare on Thursday, made absolutely no difference to the numbers of people who would qualify for a medical card.

Old age brings with it great uncertainty, not least with respect to people's fears for their health. The greatest fear of many older people is that if their health fails with advanced years, they may not be able to access adequate health care. The automatic entitlement to a medical card gave older people certainty and peace of mind. This budget decision shattered all of that.

It is hard to believe that a Government that once prided itself on having its finger on the pulse of the people should now be so clearly out of touch with what old people feel about their health. I could not help smiling last week when I heard Councillor Maurice Ahern say that his brother Bertie would never have done this. There are many things about Deputy Ahern I bitterly disagreed with but I will give him one thing. He understood people and he understood human nature. That trait has not been inherited by his successor.

The Deputy and her party could not get Deputy Ahern out quickly enough.

We kept him for a long time.

Fianna Fáil kept him for a long time.

After Friday's climbdown, the Taoiseach now claims that only 5% of pensioners will be excluded from having a medical card. There is no basis to that figure. Under these income limits a great many more than 5% will be excluded from the right to a medical card. One only had to look at the news this evening to see this. In the same vein I had calls to my office this afternoon. Teachers, gardaí and nurses who are retired will now find themselves above those limits and excluded from the free medical card. So, too, will many others, including those the Minister likes to refer to as the "high rollers". Very ordinary people will lose out under these limits and there is no basis for the claim of only 5%.

Apart from where income limits are set, far more important for many older people is the removal of the legal right. That issue brought people out on the streets today. Once that right has been removed, the Minister can reduce income limits at the stroke of a pen. If the Government could savagely slash income limits last week, is it not very likely it will do the same next year when the economic situation will probably be even worse?

From an economic perspective, retaining the automatic entitlement to a medical card is a no-brainer. The easier the access to primary care, the healthier people stay, and the less likely they are to need hospital care and expensive treatments. The past seven years have proved that. A medical card provides access to community care services which cannot even be bought in the private sector. Drugs costs are far more expensive under the drugs refund scheme than on the medical card.

It is increasingly difficult to stomach Government Ministers telling older people that it is they who must pay for the mess that the Government has created. The Minister for Finance, Deputy Lenihan, has a cheek to preach to older people about patriotism. He has a cheek to expect people in their retirement to pick up the tab for our economic difficulties while he allows the rich to get away scot free. Contrary to what the Minister claims, it does not have to be like this. The Government had choices to make about how it would balance the budget and rather than protecting the vulnerable, it chose to target them. That choice is morally indefensible, grossly unfair and economically stupid. I support the motion.

In bringing forward these draconian measures the Government has alienated the most vulnerable section of our society. Those who have reached the autumn years of their lives once had the cushion, the safety and the peace of mind of knowing they could go to a GP in an hour of need, but that luxury is no longer afforded to them. We had lectures last week from the Taoiseach about his republican and egalitarian ideals. What was done and visited upon these people last week was neither republican nor truly egalitarian. It ran counter to anything that is republican or egalitarian.

In the short time I have, I implore the Government to reverse this decision. If the thousands of people who came onto the streets of Dublin today are anything to go by in terms of delivering a short sharp message to the Government, today was the day it happened. The Government must listen to those people who have reached their autumn years and are now worried and full of angst about these measures. If we are truly to be a republic in the purest sense of that word, we must reverse this measure.

I propose to share time with the Minister of State at the Department of Health and Children, Deputy Mary Wallace, Deputy Mary White, the Minister for Communications, Energy and Natural Resources, Deputy Eamon Ryan, Deputy Timmy Dooley, Deputy M. J. Nolan and the Minister of State at the Department of Arts, Sport and Tourism, Deputy Martin Mansergh.

As Minister of State with responsibility for older people, I express my sorrow that people felt compelled today to take to the streets in numbers to speak out against the Government, despite the fact that more than nine out of ten people aged over 70 years will retain their medical cards following the decision taken by the Government yesterday. All of my colleagues fully recognise the deep sense of anger people felt on this issue. We have listened, however, and I am pleased that action has been taken to address the matter. The new income thresholds are designed to ensure that the vast majority of people aged 70 years and over will continue to have a medical card and only those on higher incomes will lose their entitlement to a card.

Elderly people are still angry.

The new income thresholds effective from 1 January 2009 will ensure that more than 90% of people aged over 70 years will retain the medical card.

The Government's figures do not add up.

Like the budget, they are full of holes.

Deputies referred to retired teachers, superintendents and gardaí. In the case of these groups, unless the spouses of those in question have similar income levels, they will not exceed the threshold and will not lose the medical card.

There are too many Marys in the Government.

(Interruptions).

Allow the Minister of State to continue without interruption, please.

Deputy Rabbitte should check the spelling of my name.

A single person aged 70 years and over and earning €36,500 or less per annum and couples earning €73,000 or less per annum can be certain that they will retain their medical card. Persons aged 70 years and over who earn above these amounts will, if they so wish, be considered by the Health Service Executive for a discretionary medical card based on their personal circumstances and medical needs.

Deputies will be aware that 1.3 million people currently have a medical card. The general medical service scheme has worked well since its introduction in 1972. The objective of the scheme is to ensure the medical card benefit is available to those who are unable, without undue hardship, to meet the costs of health services for themselves and their dependants. The number of people with medical cards continues to grow because of the increasingly difficult economic circumstances in which we find ourselves.

It is because their income is so low.

As a result, the cost of the GMS scheme continues to increase, which must be a cause of concern to everyone.

It should especially concern those who have lost their jobs.

The Deputy is correct as the rise in unemployment adds to the figure. I ask persons aged 70 years and over who have savings not to be concerned. Single persons in this age group may have savings of up to €36,000 without it having an impact on the medical card assessment process.

What if they are saving for a nursing home?

I will address that issue in due course. Couples may have twice that figure in savings and only the interest accruing on amounts above these figures will be assessed as income. The Government has taken effective measures to allay concerns by introducing the changes announced in recent days.

That does not explain the reason 15,000 people gathered on the streets today.

As the Minister of State with responsibility for older people, I will continue to work with many groups such as Age Action Ireland, the Irish Senior Citizens' Parliament and Active Retirement Ireland with which I have a good working relationship.

The Minister of State should do the honest thing and resign.

The Government has provided an unprecedented level of funding for older people, with an additional €500 million allocated for services for older people. In addition, more than 10,000 people are availing of home care packages. This figure will be maintained and additional funding of €454 million for the health budget in 2009 will ensure people can remain at home for as long as possible and receive good quality care. Where this approach has worked well, it will also be expanded.

There is not a Member of the House who does not regret how events have panned out in the past week.

The Minister of State should spare us the crocodile tears.

My office, like the offices of all Deputies, has been inundated with queries from older people, sick with anxiety and fear who genuinely believed they would lose their medical cards.

Under the original guidelines proposed in the budget last Tuesday, 215,000 people aged over 70 years would automatically retain their medical card. Unfortunately, this message was not properly conveyed.

The Minister of State is misleading the House.

One 90 year old lady living in a granny flat whose sole income was the old age pension and who had a small amount saved telephoned me last week. When I informed her that there would not be a problem with keeping her card because her only income was the old age pension, she said she understood that everyone aged over 70 years would lose their medical card.

In addition, complications arising from general medical card assessment guidelines added to the confusion. Clearly the Government's message that 70% of those aged 70 years and over would continue to qualify for a medical card did not get across.

People were convinced that their card could be withdrawn and thousands of older people experienced serious anxiety and worry. I am sorry this occurred as it was not the Government's intention.

The Government is responsible.

The improved income thresholds announced by the Taoiseach and Minister for Health and Children will mean 95% of those aged over 70 years will continue to have a medical card. For the small minority who will no longer be eligible, discretion will be used to take account of difficult personal circumstances. Already, 70,000 medical cards have been issued on these grounds.

There is no doubt given the serious state of the country's finances that the Government was required to make tough decisions which would have been unthinkable even one year ago. For this reason, it made the difficult decision not to give very wealthy people aged over 70 a medical card. The Fianna Fáil Party and Government have a strong record of supporting the elderly. A few years ago, hardly any older persons received nursing or therapy care at home because such care was confined to hospitals. Currently, 10,000 older people benefit from home care packages and 2,500 additional places have been provided in day and respite centres in the past three years. A sum of €55 million has also been provided for the fair deal scheme.

We can be proud that life expectancy in Ireland has increased by four years since 1996. This rate of progress is unmatched in any other European Union country. I share the concern about the anxiety which was needlessly caused to older people in the past week. There is no doubt that the Taoiseach and Minister for Health and Children worked hard over the weekend to find a solution to the problem.

We understand the difficulty of respecting the broad budgetary parameters while taking on board the depth of feeling expressed to us by elderly people and their families in the past week. The work on a new single capitation rate paid to general practitioners for people aged over 70 years who hold a medical card is important. It was difficult for older people to understand the reason a GP would receive €161 per annum for one person and €640 for another person in the same age group.

That was a Micheál Martin special.

Allow the Minister of State to continue without interruption, please. Time is limited.

Despite the economic difficulties Ireland is experiencing, it is important to have a sustainable scheme in future.

It is a James Reilly special.

I welcome the fact that Deputy Reilly is taking responsibility.

Where is the Minister, Deputy Martin?

It was very important that the Government found an alternative solution to deal with the reasonable concerns held by genuine people. Under the revised scheme, the vast majority of older people will continue to benefit from a medical card. It is up to the House to ensure that this message gets across and older people and their families are made aware of that to which they are entitled.

I propose to share time with the Minister for Communications, Energy and Natural Resources, Deputy Eamon Ryan.

I will not take lectures from any Deputies on the Opposition benches.

The Deputy was prepared to walk yesterday.

Please allow the Deputy to speak without interruption.

My party has responded to and apologised for the hurt caused by the medical card debacle. While we take our share of the blame, we worked hard to reverse the inequities of the scheme. Not so long ago, Fine Gael and the Labour Party opposed universal medical cards. Both parties have shown hypocrisy in preying on the fears of vulnerable people for selfish political gain. Shame on Deputy Kenny and his party.

I have some juicy information about Deputy Reilly. I propose to quote him.

Did the Deputy say the Green Party would pull out of Government? I will lead her across the lobby if she wishes.

Please allow the Deputy to be heard.

(Interruptions).

Come up those stairs and vote with me.

Please, allow the Deputy to speak.

It is very interesting to hear what Deputy Reilly had to say a few short months ago: "What I meant was, I did not want 70 year old millionaires——

The Deputy is doing Fianna Fáil's dirty work now. She got that outside in the corridor from Deputy Michael Kennedy.

——getting a medical card when Johnny is on two inhalers and his dad is on 15 grand a year and does not have it." Talk about political cant and hypocrisy.

The Deputy should talk about herself, out on the plinth.

The Deputy should say what she said on local radio in Wexford this morning. The Green Party is the junior partner in Government.

Let us turn to the Labour Party if we really want to be strong tonight. The last Labour Party Minister for Health said the same thing in 1984 and Deputy Liz McManus in 2004 described universal access as an obscenity.

(Interruptions).

Please allow the Deputy to address the House and be heard. I shall ask her to provide the source of her quotation for the records.

I thank the Leas-Cheann Comhairle. This scheme will support 95% of people with a medical card and that is good.

The Deputy should repeat what she said on local radio this morning.

(Interruptions).

Allow the Deputy to speak.

You could not allow her — it is hypocritical

I hate hypocrisy — hypocrisy kills me.

I ask the Deputy to give the source of her quotation.

I thank the Leas Cheann Comhairle. This scheme will support 95% of people with a medical card.

What about the Deputy's budget speech? I hate hypocrisy. I like straight talkers.

I said from the start that I would not stand over the savage cuts to people who needed medical cards for their medical needs. This new scheme——

She said she had not said it in the budget speech.

Hypocrisy kills me.

Allow the Deputy to be heard.

——will target finance to those who need it. I have one sentence to say and I should like to be heard.

(Interruptions).

Deputy McCormack should please allow Members to be heard in the House.

I want to be heard, too.

The Deputy will be called.

Looking at figures is not enough. Compassion has to be factored into accounting. Last week accounting took over. It must never happen again.

Government is about the allocation of scarce resources. We are at a time of increasing scarcity in our financial resources. I believe it is right for us to try to direct those scarce resources to those with the least means. I very much apologise for the fear and hurt that was caused last week.

That is appropriate.

I do. However, we need to get agreement and certainty on a fundamental issue. Was it right for us to have a scheme when we have scarce resources that have to be allocated, where someone gets a payment of some €660 while someone else, the same age, but in different circumstances is given €160?

Ask Deputy Micheál Martin.

Deputy Liz McManus, in Opposition at the time, in fairness said——

Where is the Minister, Deputy Micheál Martin? Call him in, we want Micheál. Deputy Ryan should let him answer.

——GPs were awarded three or four times as much to pay for one group of medical card holders and that this could create an incentive to attract GPs out of areas of deprivation. Deputy McManus said it was inequitable and——

She was right.

——she was right. It was appropriate for us in Government, when we have a decision to make around scarce resources, to address that fundamental unfairness.

(Interruptions).

Deputy Gogarty does not agree with the Minister.

The scheme we have ended up with will not satisfy everyone, and I have said I regret very much the insecurity and fear that has occurred. Nobody in politics ceases to be unpopular, but sometimes in Government unpopular decisions have to be taken.

Fair play, full marks for that.

The House has a choice tonight to make a real difference between what we all know, in all fairness, is right and what is popular.

A Deputy

A bunch of fakes, the Greens.

I believe that if we do what is right, fundamentally we will give people the confidence that we can manage our way through what will be a time of real scarcity where we have to manage our resources.

Correct and withdraw this amendment.

(Interruptions).

With permission, I shall pass over to my colleague after four minutes.

Certainly. The Deputy is down for five minutes, Deputy Nolan for five and Deputy Mansergh for five.

I believe it is two fours and a two.

That sounds like the size of a floor board.

(Interruptions).

I deeply regret the confusion——

(Interruptions).

——anxiety, uncertainty and fear suffered by so many people. For several days, on all sides of this House, we have found it very difficult. I am aware that on the other side, constituency offices were inundated with calls, as indeed were mine and those of my colleagues.

I sent them up to the Deputy.

I am sure Deputy Breen did, and rightly so. People wanted to communicate with those whom they had elected to represent them in this House. I want to thank all those who contacted me, whether by phone or e-mail. I have made best efforts to contact most of them and I shall continue over the coming days to reach those I have yet to contact. Many of those I have spoken to are more than happy with the new arrangements announced by the Government.

It is like the budget, it does not add up.

Those to whom I have spoken are clearly happy with the announcement that has been made. It is their view that they will come within the income limits. This, I believe, will help to instil a level of confidence again in the people, and indeed in the Government.

I welcome the efforts of the Taoiseach, the Minister for Finance and the Minister for Health and Children over the weekend to respond to the outcry we have seen over the past week and to find a solution to the problem. The process put in place, through consultation with the GPs and the increases in the income limits, while maintaining the budgetary framework, which is important from the Government's viewpoint, will help to instil confidence in those who were most worried and concerned. Unfortunately, the confusion that arose was of our making and we must take responsibility for that. However, there is a duty now on us to try to explain the message, the mechanism and the system that will be in place from here on, which as many speakers have indicated will more than adequately cover 95%.

That is untrue.

There were untruths on all sides. I heard Deputy Shortall say——

Deputies know it is not parliamentary to accuse Members of untruths.

The Deputy said that——

——a number of individuals, because they were on the income threshold, would not receive a medical card. There was no reference to medical costs which act as a disregard, and that clearly would have brought them below the threshold for a medical card.

(Interruptions).

Like others on this side of the House, I have played my part over recent days in passing on to the Minister the views and concerns of our constituents and we have come up with a disregard.

The Deputy said the same about Shannon.

Please, Deputy Kehoe.

I said at the outset that many people on all sides were concerned about this, but clearly a minority on the other side have sought to whip up fear and have had no regard for the elderly. They have exploited the fears of many people throughout the country.

Deputy Joe Behan, their own man, walked out.

The pensioners are clever. They have been around for a while and they will forgive a mistake. However, they will not forgive the hypocrisy of a number of people on the other side of the House.

(Interruptions).

Come with us tonight.

Deputy Dooley is eroding his colleagues' time. Deputy Ring, please desist from interrupting.

(Interruptions).

Deputies opposite have the opportunity to do the right thing and vote with us tonight.

I welcome the opportunity to speak on this motion and I want to put it on record that I will vote with the Government. This has been a difficult time, not just for politicians. It has been a particularly difficult time for the pensioners and their families. I am glad the Taoiseach and Government have admitted they made a mistake. They have apologised and we can move on from here.

It is important to remember that when this scheme was introduced in 2002-03, it was costing something in the region of €20 million to €25 million. Today it is costing €245 million. This scheme was approved at a time of plenty. Now that we are in far more difficult times, changes have to be made and are being made. I think of the families receiving home help. We were told this was one of the areas being considered by the Department and the Government for cutting. We must recognise that it is not going to be easy and that even more difficult times lie ahead. We will have to accept that harsh and difficult decisions will need to be taken.

I am glad that the Minister has asked for a report by Tuesday next and that the Government will make a decision on it at the Cabinet meeting on Wednesday. Moneys should be put into primary care where we are getting best value for it. I commend the Minister for accepting a mistake was made and the Government for rowing back from last week's position.

It is important to recognise that 30% of Government spending is in the area of health, that we have come from a low base and that we will have to continue to increase that spending. How much time do I have remaining?

A Deputy

Deputy M. J. Nolan is running out because he is shocked.

I am not one bit shocked. As I said at the outset, I have no problem supporting this. The Government recognises its mistake and has now come forward with new proposals.

The problems we are experiencing are not of our own making. There is an international global financial crisis for which we are not responsible. It is partly due to irresponsible lending by banks in the UK. We are in a recession and whether one likes it or not, we will have to make far more difficult decisions in the coming years.

We cannot isolate ourselves from what is going on globally. Let us get that straight. Those opposite are going to have to recognise that as much as we are.

Funding should be put into primary care where we are getting best value for it. If the Minister can negotiate, agree and approve the proposal next week whereby one fee will be charged for all medical cards, irrespective of the age of the holder, we will be going a long way towards ensuring we have a better health service.

I did not have to return to the constituency of Donegal South-West to appreciate the anger caused by last week's decision on medical cards for the over 70s. I first entered this House in 1981 and I have never experienced such anger, anxiety and fear among the over 70s and their families. Even among those who would have qualified under the initial decision, there was the fear of the unknown.

What about the unknown unknowns?

Perhaps we did not express this in detail. However, I, like many others in my party and on the backbenches, highlighted the issue in the parliamentary party and outside it. I felt it was necessary to do so to give comfort to the people I represent and that I should fight their cause. The Government, including the Taoiseach, the Minister for Health and Children and the Minister for Finance, took on board our concerns. Others in this House might claim they are responsible for the pragmatic change but it was the members of this party who were responsible for it.

Our concerns were taken on board and that culminated in last Monday's announcement raising the threshold to realistic levels which will ensure that in my constituency in excess of 95% of people will maintain their medical cards. This will ensure that those with State pensions and additional income from occupational pensions are covered. I am confident that the threshold will be linked to the consumer price index but that is a matter for Government.

It has not been for the past ten years.

The Minister for Health and Children, the Minister for Finance and the Taoiseach took on board the concerns of people on this side of the House, culminating in this announcement.

(Interruptions).

I will not be shouted down. I want to apologise to the people of my constituency. I know the threshold will accommodate practically all of those affected.

On 7 December 2000, it was said by none other than the Opposition health spokesperson, Deputy James Reilly: "It is not acceptable that the Government is handing out free medical cards to people who can afford golf club fees and at the same time neglecting those who cannot afford to attend to their children's health."

The Deputy should identify the quote for the record.

It was said by Deputy James Reilly, as chairman of the IMO general practitioners group, in an interview inThe Irish Times on 7 December 2000.

It is always regrettable when the Government must take away an entitlement, actual or anticipated. It is doubly regrettable when confusion about those who may be affected causes anxiety among older people who deserve to be treated well by us. Nevertheless, I am happy that arising from the controversy, a fair and well-judged balance has been arrived at between, on the one hand, the cold realities of what the wider community can sustainably afford by way of support for the extended scheme and the genuine needs of a steadily growing number of older people.

There are broadly three categories of people in the over 70 age group — those who have always been eligible for medical cards, others who would have been less well off but ineligible under what was originally proposed and who would struggle to meet heavy medical expenses out of their own pocket even with the support, in many cases, of otherwise strapped family members, and the comfortably well-to-do who are not necessarily wealthy but are, broadly speaking, able to look after themselves, who have health insurance and who, in most circumstances, neither need nor particularly want medical cards. The situation of the middle category especially needed to be addressed following the withdrawal in principle of universal entitlement and I am glad that has been done sooner rather than later and before any changes come into force.

Medical cards mean not merely free general practitioner services and prescriptions but are used as a reference guide for the provision of various free medical aids and home care. They do not affect eligibility for hospital care. This universal entitlement is of recent origin and only a few years standing. While a laudable step which I supported at the time, it has proved a bridge too far achieved only at an excessive cost which now must be revisited.

General practitioners in this country earn a high income compared to their counterparts abroad between, in many cases, large GMS practices and private patients. Perhaps Fine Gael's health spokesperson, Deputy James Reilly, would enlighten us as to what medical reason lies behind charging a capitation fee of €139 for an existing male medical card patient over 70 living within three miles of the doctor's clinic——

(Interruptions).

——and demanding a €640 capitation fee, or nearly for times as much, for a better off patient.

(Interruptions).

The Minister of State without interruption.

Was it simply done——

(Interruptions).

Allow Members to be heard.

It is hard to listen to that.

Was it simply done for income compensation? The vested interests, certainly in this instance well represented on the frontbench, trump value for money considerations in Fine Gael.

The Fine Gael spokesperson on health now claims he is working on a universal health policy scheme. The primary beneficiaries would be, in the first instance, the comfortably well off with medical insurance. Although I accept there are benefits to all in a universal system, it is not a panacea as the NHS experienced resource problems too.

In any case, for better or for worse, the medical profession saw that idea off between 1946 and 1951 when a doctor or doctors forced the resignation first of Dr. Con Ward, as Parliamentary Secretary in charge of health, and five years later, the Minister, Dr. Noel Browne. I hope the Fine Gael policy will have an answer to the key question as to how high a price the medical profession in the IMO and the IHCA will demand to participate, a topic into which Deputy Reilly may have a special insight.

Deputy Mansergh is obsessed with Deputy Reilly.

Next year when the Government deficit will be €12 billion, the cost of the unaltered GMS scheme will have arisen by 20% from €1.7 billion to around €2.05 billion in the context of a total health budget of €15 billion or a doubling of expenditure since 2003. This is not sustainable going into more difficult times. Changes to the capitation fee are essential. The implications for public expenditure of the striking deterioration in the public finances do not seem to have been fully taken on board.

Who was in Government all of this time?

This may be the first of several difficult years. My concern would be that if the savings in the budget are not made and if the situation deteriorates more than expected, our ability to maintain the broad level of public services, which are now taken for granted, may be undermined, possibly forcing even more difficult decisions and less discriminate ones.

I must call the next speaker.

It is essential for confidence and for people's longer-term welfare that the overall bottom line of the budget be adhered to. That will require some contribution and understanding by everyone in a position to give it, regardless of status, and a readiness by political partners in Government to take a stand on defensible ground with determination.

(Interruptions).

What people will remember about this budget is whether we rose to the challenge of helping the country safely through a very difficult time.

I wish to share my time with Deputies Catherine Byrne, Fergus O'Dowd, Kieran O'Donnell, Paul Kehoe, Terence Flanagan, Pat Breen, Andrew Doyle, Billy Timmins, Paul Connaughton, Joe Carey, Michael Ring and Tom Hayes and Deputy Liz McManus.

Is that agreed? Agreed.

I welcome the opportunity to contribute to this debate. I wish to direct my comments first of all at the backbenchers who claim to have saved the day with regard to the medical cards. Did they listen to opinions and feel the emotions opinions expressed outside the Dáil today or understand the views, reactions and concerns of the people who contributed most to the building of the State and to the standard of living we enjoy? The emotion most expressed was a feeling of betrayal as a result of the withdrawal of a service on which they depended.

How can we respond to people who believed that until they died they would have a medical card and the full services that come with it? How can we respond to those who trusted the Government on that and withdrew from paying private insurance, only to be left now in limbo? How does the Minister propose to deal with that?

There is a fear among the people that once one benefit is removed, another will follow. People have cried talking about this. It is unbelievable to think that the people who are so emotive and upset about what has been taken from them may need to be concerned about losing their other benefits, such as the free fuel allowance and free travel. Once one benefit goes because of cuts, what is to stop the Government removing other benefits?

We have not heard any mention of another group of people, namely, those who expected that at the age of 70, they would receive a medical card. These people, now in their 60s and approaching 70, expected they would get a medical card, but they too have been betrayed. Some Independent Members have said they want clarification. Clarification of how people feel was clearly given today in Kildare Street and Molesworth Street. That clarification must be responded to in the vote tonight.

I will not mention the Green Party, because its position depends on what radio station one listens to. If we listen to a local station, we understand the Green Party is responsible for the changes that have been made, but if we listen to a national station, we understand the party rowed in all the way with the Government.

We put the issue to the backbenchers who wanted change and who must face the people and to Independent Members. I urge them to be accountable now and to vote for our motion and give elderly people who have experience of the university of life their support. These people will not be waved aside any longer. We must listen to them, especially in this regard.

We in Fine Gael, like the rest of the country, are appalled at the measure to cut the medical card for the over 70s. The elderly population of the country is up in arms following last week's budget announcement that the Minister for Finance had cut the automatic entitlement to the medical card for the over 70s. The Taoiseach acknowledged there would be some unease at this decision. He certainly knows now the level of unease it has caused throughout the country.

Like other Deputies, I have been inundated with calls and e-mails from worried elderly people and their families. This cut to medical cards will have a devastating effect on their daily lives. Elderly people can be anxious at the best of times, but now they feel their lifeline has been removed. The worry and anxiety being felt throughout the country is being ignored by a Fianna Fáil Government that is hell bent on bringing the country to its knees.

In 2001, when the country was thriving, the Fianna Fáil Minister for Finance at the time, Charlie McCreevy, granted everyone over 70 a medical card, with no strings attached. The Government prided itself on taking care of the elderly and gave itself a tap on the back for this gesture. Seven years later, when the going gets tough, they ask for their money back. Why pick on the elderly? The elderly have shown us that they will not take this lying down. Their response has left us in no doubt that age is no barrier to challenging injustice. Their actions have been an inspiration to us all.

Deputies

Hear, hear.

Last weekend, on Thomas Street and in Ballyfermot, people queued to sign a petition calling for the reversal of this decision. I have never seen such outrage. Young and old were appalled by the Government's decision to cut back on the medical card. The elderly have paid their taxes, done their duty and contributed to the boom over the past 15 years. This is how Fianna Fáil, the Green Party and Independents repay them. The Government seems to be all over the place at the moment. The euphoria that first greeted the budget has now diminished, leaving the Government back-pedalling. One Independent Deputy declared he has now seen the light. What a pity he had to go to his constituency before he saw that light.

The Minister now wants to confuse everyone further. Thousands of pensioners will soon receive forms from the HSE to establish whether they are entitled to keep their medical cards. This is a useless red tape exercise that will place an unnecessary burden on the elderly, causing them even further stress and confusion. At yesterday's press conference, the Minister for Health and Children, Deputy Mary Harney, stated that she would rely on the honesty of the majority of our senior citizens to declare their entitlement. Are all senior citizens not to be trusted? I reject her choice of words.

Today, outside the gates of the Dáil, people's actions spoke louder than words. Young and old voiced their anger. The Government must surely realise it has made a huge mistake and must reinstate the medical card. Last night, I attended a meeting in Ballyfermot on the issue, but not one Fianna Fáil representative turned up. The message given to me by the people of Ballyfermot last night was that Ballyfermot will remember that those Deputies did not have the decency to show up; they will not forget it.

Deputies

Hear, hear.

All remaining speakers in this slot will have only two minutes to contribute. Deputies will squeeze others out if they go over time.

As someone who has campaigned for nursing home care and quality care, I believe I have some standing in this debate. The key difference between what the Government says and what we say is 20,000 people. The Government says that only 5% of those over 70 will not have medical cards, approximately 20,000 people. In effect, that is the number of nursing home beds in the country. It is as if the Government was taking the cards from everybody in those nursing homes only. That is the number it is talking about with regard to this serious issue.

Many of those who will lose their medical card will have held them for seven years or over. They are now 77, 87, 97 or 100 years old. Old people worry disproportionately about these issues. I charge the Minister and the Government with lack of concern and care for these people. We all know that cancer, heart disease and stroke have no respect for age or income. Whether one is a millionaire or a pauper, when cancer visits one's home, family, father or mother, we want care and comfort for that person. The care and comfort medical cards give is unbelievable and that is what brought people onto the streets today. The medical card is the comfort society must give to those most in need, both the very young and the sick and dying. The Government cannot and must not remove these 20,000 cards. That is unacceptable in a modern democracy.

I fully support the Fine Gael motion. On tonight's news the Minister for Finance, Deputy Brian Lenihan, was quoted as saying the Government had learnt from its mistakes and the matter was now resolved. It is far from resolved. The Government is completely out of touch. It has broken a sacred bond with the people. It has broken their trust. The people voted the Government in and it has broken the bond of trust with the elderly. When the then Minister for Health and Children, Deputy Martin, introduced the medical card scheme for the over 70s in May 2001 he said in this House:

It is important that we as a society show our commitment to the elderly and our appreciation for what the older generation has done to build this country. Elderly people have greater medical need than other age groups.

Shame on the Government, which is turning its back on the elderly. The same circumstances still apply. In pointing out that at the time only 30,000 people did not qualify for a medical card, the then Minister, Deputy Martin, said: "More than 1.15 million people in the country have a medical card so 30,000 is not an enormous figure". A figure of 20,000 is even smaller and is still not an enormous figure. The Minister, Deputy Harney, has said that only 5%, one person in 20, will not have a medical card. It is one in seven out of 140,000 who will lose a medical card. Like in the budget, the Government's figures do not add up.

This is a poor public health decision. If it costs €1,650 for a medical card, the cost of two nights in a hospital is far in excess of that figure and puts the Government's primary health care model to shame. The Minister, Deputy Harney, is quoted as saying the 2% health levy would not apply to anyone over 70 who previously had a medical card. Does that still apply because I saw nothing in yesterday's announcement to confirm that? I would like the Minister to put it on the record. Shame on the Government.

I very much appreciate having the opportunity to speak on this motion. It saddens me to need to come to the House to speak on such a motion which arises because the Government is so shameless. Thousands of people over 70 years of age were on the streets of Dublin today. I heard on the news this morning that some of them had got out of their beds at 3 a.m. I am sure the Minister, Deputy Harney, was not out of her bed or even awake in her bed at 3 a.m. thinking about people on pensions, some with diabetes, some in wheelchairs and others who have had strokes or heart attacks. They got out of their beds and travelled from throughout the country.

I heard Deputy Mary White speak on our local radio station this morning. She was asked why she gave the Minister for Finance a standing ovation after his Budget Statement. She said that she was so overwhelmed by the budget that she gave him a standing ovation. She said that at no stage in the Minister's speech did it mention taking the medical card form the over 70s. I am very disappointed that Deputy White has left the House.

All the Government backbenchers have left the House.

In his Budget Statement the Minister for Finance told the House: "The Government has decided to abolish the automatic entitlement to a medical card for those over 70 who are above the eligibility criteria". How plainly can the Minister put it for Deputy White to understand?

She was blinded by the lights.

Deputy White is like a junior infant partner in Government who claims that it was the bigger boys and girls in the Fianna Fáil Party who got it wrong. If there is collective Cabinet responsibility, what about the Ministers, Deputies Gormley and Ryan? What are they doing at the Cabinet table? Are they there just holding up the table for the Government? The Green Party is like global warming in Iceland — it cannot stick the heat.

I thank my colleagues, Deputies Kenny and Reilly, for tabling this motion. Like most Members across this House I am angered and enraged with the harsh realities of the budget. After almost ten years of unprecedented wealth in the economy being blown, the Government has let the people down. It has especially let down senior citizens, some of whom are here tonight. Their work helped sow the seeds of the Celtic tiger and some of them needed to pay up to 77 p in the pound to the Exchequer during their working lives. It is obvious in recent days that the Government decision to means test for the medical card for the over 70s has backfired very badly.

Having attended both the Age Action protest yesterday and the Irish senior citizens rally today, and having stood shoulder to shoulder with those senior citizens it is obvious the real power does not lie in here in Leinster House with the politicians but with our senior citizens. We owe them a debt of gratitude for all the work they have done for the country. We should certainly stand by them in their hour of need. Fianna Fáil should not take back their medical cards nor should it start tinkering with income limits.

The budget announcement created unnecessary fear, anxiety and unrest among the elderly. The decision to means test all over 70s for a medical card was cruel, wrong and a bad day's work by the Government. The change announced yesterday still imposes means testing on all new applicants. Although the Government has stated that almost 95% of the people will retain the medical card, I would not believe it. I do not trust the Government because it has not been upfront and has not published the figures. The Minister has not given a guarantee that the income thresholds will not be reduced again in future years. Fine Gael wants universal health care. We want everyone to be treated equally and we want all Members in the House to support the Fine Gael motion.

Today many of us witnessed scenes reminiscent of the French Revolution's storming of the Bastille. One could almost hear the tumbrels going down Kildare Street where people from all parts of the country were forced to take to the streets of Dublin. I congratulate them on taking part in today's march and I pay tribute to them for coming out in such great numbers. Many of them even travelled from my constituency of Clare.

The Minister and the Ministers of State present tonight should hang their heads in shame. Last week many of them could not wait to applaud their colleague. My God, one week makes an awful difference in politics. The former US President, Harry Truman, once said: "If you can't convince them, confuse them". For the past eight days the Government has been confusing the people.

It was Opposition Deputies who did that.

However, the Government cannot pull the wool over the eyes of the older people. No amount of tinkering with the scheme's income limits will mask how it got it so wrong. The only reason it was forced into a climb down was to save the blushes of the backbenchers.

They have an election coming.

When the tactic of confusion did not work, it sent out a south Tipperary Deputy on a national radio station looking for the head of the Minister for Health and Children in order to blame somebody else. Before the Taoiseach took the slow boat to China he said on RTE news on Friday night that he knew there would be a problem and defended the decision in the House. This was the Government's fifth attempt to explain the new income limits. It got it wrong and it is time for it to allay the fears of the pensioners it has punished. The former US President, Harry Truman, also said: "If you can't stick the heat, get out of the kitchen". I am urging everybody, including Government backbenchers, to join the revolution. Come with us in Fine Gael and vote with us tonight. The Government got it wrong and should admit it. It should rescind this disgraceful decision.

The first line of the Government amendment seeks for Dáil Éireann to acknowledge "the Government's expression of regret for the anxiety caused among older people in recent days and welcomes the new initiative to allay that anxiety". Anyone in Bray last night or outside here today will recognise that statement is not true and is not believed. Yesterday evening I heard on the radio a description of the coalition that had been put together last year as a rocket, assembled by the then Taoiseach, Deputy Bertie Ahern, with several booster jets to make it secure. One of the booster jets, Deputy Finian McGrath, fell off the day before yesterday. I wonder why we are here at all because on several occasions he enunciated that he had done a €250 million deal with the Government. I presume that is now null and void. Perhaps we should investigate that deal to ascertain if we can save any money from it.

I ask those on the Government side to stop putting out the figures that this scheme originally cost €15 million and is now costing €245 million. It was looking to save €100 million. An amount of €145 million was there all the time. The Government should not claim it started at €15 million and is now costing €245 million. It never was. A total of €145 million is still intact on the basis of people who qualify under the social welfare system, as outlined in the Budget Statement. The only thing wrong is not that the Government fails to recognise this is a mistake and it is stubborn and obstinate but that it will not give in completely. The people do not trust the Government to leave the universal care for people with medical cards intact. It is open to manoeuvre by reducing income limits or raising age limits. Somebody said the age limit would be raised to 90, which illustrates the level of distrust among the elderly. It is not a sin to make a mistake but it is a sin not to acknowledge and rectify it.

I have great pleasure in supporting the motion. The Government has spent a political generation flinging money at every problem. The only decision it had to make was how much. As a result, there is nothing in the coffers and the Government cannot tell right from wrong, good from bad, as evidenced by the budget it produced. Many Government Deputies and, in particular, the two Ministers of State at the Department of Health and Children referred to the need to assure people and to make sure there was no confusion while the Minister of State at the Department of Finance used the rather crass term "the comfortable well to do with private health insurance". Many people who are not comfortable nor well to do have private health insurance because they have no confidence in the system over which the Minister for Health and Children and her Government partners have presided during an unprecedented boom because it was not improved.

I recently had discussions with Age Action Ireland and a number of elderly people who drew my attention to their concerns about the VHI abandoning community rating. Has the Minister had meetings with VHI officials at which they proposed to abandon this policy? If she has information, perhaps she will brief the Minister of State, Deputy Moloney, who is replying on behalf of the Government. Has the VHI plans to abandon community rating, which is in place to ensure people can afford health insurance? Many people who were granted a medical card gave up their health insurance but they may have to rejoin the VHI in more difficult circumstances. It is imperative that the Minister brings clarity and reassures people about what she knows about this issue.

The Minister and the Government even now cannot get into their heads the importance the elderly people attach to the simple medical card because the power and the privilege have gone to their heads over the years being driven around on the best leather seats with their backsides on the back seat of the Mercedes. They are completely out of touch. It is unbelievable that in a country of 4 million people, 14 Ministers around a table could be so far removed from how the other half live. That is why there was so much anger outside the gates earlier. Given the Government's proposals regarding education services, there will be even more people outside next week.

The collective arrogance of the Government is breathtaking. Many people said today — I know this given my background — a medical card is a passport to health services that they otherwise would not be able to access. The Minister still does not recognise this. Do people with cancer aged under 70 have to go through a means assessment to obtain a medical card? I understand they must but a Government Deputy stated on Galway Bay FM earlier that they would have a card by right. Is that right or wrong?

Politics is about people and Fianna Fáil has forgotten this principle. Last week the Government parties began a holy war against the very people who elected them to represent them in this Parliament. If Fianna Fáil and the Green Party vote down the motion, they must understand they are doing away with the automatic entitlement to a medical card for the over 70s. In two years the Taoiseach has managed to blow the boom. We are faced with a deficit in the public finances of €15 billion because of his incompetence and, to add insult to injury, he has turned on the pensioners to make them pay for his mistakes.

In the past week, untold confusion, hurt and pain has reigned among the senior citizens of the State. My colleagues and I have been inundated with calls from people in distress crying on the telephone, which is terrible. The Government parties have brought this on them. Shame on them for that. Following five different announcements on the public airwaves and a great deal of confusion, the Government is still holding its ground and it will take the medical card off the over 70s. If the Government is allowed to proceed with this drastic measure, where will it stop? Will the free travel and free electricity schemes be abolished? Shame on the Government parties for establishing the principle of hitting the most vulnerable in this budget. Elderly people in their tens of thousands travelled to our capital city today, many of theme from my constituency in Clare. The very people who built this country have been let down with a bang by the Government. All eyes are on Leinster House and on the Government parties and Independent Deputies. I call on them to support Fine Gael and reverse this lunatic decision.

W. B. Yeats once wrote, "This is no country for old men". I would like to add that this is no country for old men and old women. Last week my blood pressure went up when I looked behind the Government front bench as the Fianna Fáil choir clapped and roared. The only thing they did not do was sing The Soldier's Song, Sinne Fianna Fáil, because they were clapping and roaring for this wonderful budget. What happened since last Tuesday? They all went home at the weekend and I told them the people would respond. I put it on the record of the House over the past few years that the people would soon be on the streets. I say well done to the women of Ireland and to the men of Ireland, the over 70s and the under 70s for coming on to the streets today because this is the second time this year they have put two fingers up to the Government. What is wrong with this Government is it is run by the Civil Service while Ministers sit in their Mercedes or in the front seats of Aer Lingus aeroplanes. Many Ministers spend more time in the air than any aeroplane of Aer Lingus. They have lost touch with the people, they have lost contact with the people and it is time to get them out of Government. The people should not forget them this time. They have codded the people for 50 years and it is time to get rid of them, get them out of power and put in a new Government.

I remind people in the Visitors Gallery that applause is not appropriate.

I thank Fine Gael for tabling this important motion and for giving me a few minutes to set the record straight. During my time in the House, I have become used to Fianna Fáil spinning the truth out of recognition but the deputy leader of the Green Party sank to new lows earlier.

I now understand that the Green Party is craven, dishonest and despicable in its politics.

Deputies

Hear, hear.

I have stood, as the Labour Party has stood, for universal values and for free access to primary care. The Minister could stand over that. I have been highly critical of the deal done with the doctors but my stand for many years has been for free access to primary care. I remind the Green Party that the Labour Party stands for universal values. We opened the doors of the universities——

——through Niamh Bhreathnach's decisions and contributions in Cabinet. We opened the doors to hospitals. We will ensure that the elderly have the security of free primary care, as will younger people who need that peace of mind. That is what we stand for.

We had to listen to the distortion voiced by the deputy leader of the Green Party, Deputy White.

I will tell the House what an obscenity is. An obscenity is to see a man with an oxygen tank outside the doors of his Parliament, pleading to get some protection in his old age. It is a woman on a zimmerframe, as we all saw today. That is what a real obscenity is and that is what Fianna Fáil, the Green Party and the Progressive Democrats are presiding over. I condemn them and urge anyone with a conscience to vote with this side of the House.

Deputies

Hear, hear.

I will now call on the Minister of State, Deputy Moloney. I need hardly remind Deputies that he should be afforded the same courtesy and be listened to in the same silence as he showed when listening to other contributors.

I thank the Ceann Comhairle. I take the opportunity to apologise for the concern and hurt——

The Minister of State's apology is no good.

Did I say something wrong?

The Government was caught.

I am sorry if Deputy Shortall is hurt by my apologising.

He is sorry for himself.

I do not have to be, thank God.

Why is the Minister of State sorry?

I will continue. I wished to reaffirm my apology. I also take this opportunity to reaffirm my full support for the Minister for Health and Children, Deputy Harney. I am delighted to work in the same Department as she does because of her integrity——

The Ministers for Finance and Defence blamed her.

——and, more importantly, because I believe she has the integrity to carry out her task of reforming the health service.

(Interruptions).

Allow the Minister of State to finish.

In recent days, much confusion has been set among the elderly.

The Minister of State used to be an undertaker. He is doing a great job.

Whatever I was, I am very proud of it. For the record, I am proud to be a sixth generation undertaker.

And so you should be.

The Minister of State will be getting more business.

I want to make a point without interruption, if possible. The confusion last week was aided and abetted by some members of the Opposition——

The Government did not need any help.

(Interruptions).

——who tried to sow the seeds of concern.

In all fairness, the Minister of State sat and listened in silence to other contributors. He deserves the same courtesy.

He knew we were right.

This is a democratic forum and people must be heard.

I am sure that I will get another minute from the Opposition.

He is provoking us.

The confusion, set in the main by the Opposition, created the impression among everyone over 70 years of age that they would lose their medical cards. It was never the case.

(Interruptions).

I was one of those who stood to support the budget and I still do. I do so because it was an attempt to separate those who could afford medical care from those who could not, so that we could provide funding for new services such as the cancer control programme, the fair deal and, in my area of responsibility, support for 125 therapists. I am proud of this.

I will also make the point, without interruption if possible, that I am proud of Fianna Fáil's involvement in government over the years, particularly our care of the elderly.

Was the Minister of State proud of the 15,000 people outside?

I am delighted that the Minister has, in the past three years, provided €500 million for care of the elderly.

There is still confusion.

I am happy to know that much needed funding for the care of the elderly, the fair deal for nursing home subventions and many other provisions will be supplied.

What about the fair deal? Where has the Minister of State been?

(Interruptions).

As a Government party, we took the initiative and provided free travel, which was much maligned by the then Opposition, and other support programmes. I am proud of the fact that, as a local Deputy in County Laois, I have provided 29 houses for the elderly, which I opened in my home town of Mountmellick three years ago. I got €3.4 million from the Department.

From where did the Minister of State get it?

From the Department responsible for housing.

Taxpayers paid for it.

I am pleased with that and I would challenge any member of the Opposition to state what he or she has done in this regard.

(Interruptions).

Allow the Minister of State to finish.

I wish to clarify an issue raised a few minutes ago regarding private health care, another ruse used in recent days. I thank a correspondent withThe Irish Times for information I gleaned from that newspaper. In 2001, 88,989 people over the age of 70 years had private health care. I have spent the day listening to comments about how people in that group have withdrawn from private health care, but the reality is that there are currently 121,776 people——

The population has changed.

(Interruptions).

I am sure that all of the immigrants have private health care. Is that what Deputies are suggesting?

Is that something of which we should be proud?

If I can, I wish to take a minute to——

(Interruptions).

The Minister of State's time has concluded.

The Minister of State's time is up.

I thank the IMO for entering into negotiations and——

(Interruptions).

——I congratulate Deputy Reilly on his excellent performance. While I agree with him on his negotiating skills, it is difficult to believe that he has the hypocrisy to table a motion before the House when, last December, he stated that he did not believe in cover for everyone over 70 years of age.

(Interruptions).

Fianna Fáil has been in government for the past seven years.

He is sorry that they were caught.

I would like to share time with Deputies Gregory, Reilly and Kenny.

Is that agreed? Agreed.

In the good times, the House got used to budgets being produced on the back of an envelope. When the Government introduced the early child care supplement, it had no idea that it would need to pay for children whose parents were in this country while the children were not resident here. It cost millions of euro more than expected.

When the Government announced decentralisation, it chose a pick and mix of towns around the country, no deal was negotiated with the public service unions, it cost a fortune and it was not delivered. The same applies to the over 70s medical card. On the news last Friday night, the Taoiseach stated that it was originally to have cost €15 million but by the end of the year it cost €51 million. Whose fault was that? It was not the fault of the man on my left. It was the fault of the Government opposite who did such a bad job of negotiating the deal.

Deputies

Hear, hear.

The then Minister, Deputy Martin.

Now that we are in recessionary times, our budgets are still being written on the back of an envelope. The Government is making it up as it goes along. The Minister of State, Deputy Moloney, believes that the confusion has mainly been caused by the Opposition. This decision was announced in last Tuesday's budget, it was explained later in the day by the Minister for Health and Children, it was supposedly clarified in the Dáil by the Taoiseach on Wednesday, it was confused in the Chamber by the Tánaiste on Thursday; we were told on Friday night that there would be a process and a fee structure, on Sunday we were told that there would be an announcement and, when the announcement was finally made on Tuesday, it inspired such confidence that 15,000 real patriots were out on the street today to tell the Government what they thought of the decision.

Deputies

Hear, hear.

All that the Government can tell us is that it regrets the confusion and fear. It is the Government's incompetence——

——that has whipped up this fear. The real fear is that the Government is still supposedly in charge. The Taoiseach further muddied the water in the House yesterday when he failed to give a clear answer to Deputy Kenny on the other free schemes. He told Deputy Kenny that anyone with a cursory knowledge of social welfare knows that it is the entitlement to pensions that provides the link. In the case of free travel, it is not the entitlement to a pension that provides the link. Rather, it is being over 66 years of age. It is a universal payment. People are right to wonder whether it will remain so.

The Government tells us that the scheme is not sustainable as structured. It is the Government's structure. I do not believe the figures of 5% because the Government is not capable of making the assessment. Some 15,000 people outside Leinster House today agreed.

Several people asked me today whether it was not only bad enough to lose a spouse without immediately losing one's medical card because one is suddenly over the limit and, consequently, fails the income test. The loss of someone's husband or wife will become a financial gain for the Government. The Minister of State did not clarify the issue when asked. This is the reality.

He did not clarify it last night either.

That is rubbish. The Deputy should get her facts right.

It is not rubbish.

The Minister of State's false regrets and speeches show that he does not listen and understand. When he walks up the steps tonight, he will show people that he does not care.

Deputies

Hear, hear.

I welcome the opportunity to put on record my support for the elderly and for their just demand to retain the entitlement to a medical card for the over 70s in the face of this Government's shameful attempt to renege on that entitlement. In recent days, the elderly have demonstrated to all vulnerable sections the real meaning of people power and how to respond to injustice. I sincerely hope other vulnerable sections will learn from the pensioners' example of how to mobilise and fight back.

We all know there is a financial crisis, but who created that crisis? It was certainly not the over 70s who built this country. It was the bankers, the developers and their political friends who caused the crisis. What does the Government do? It bails out the bankers and victimises the elderly and other vulnerable sections. Of course, there is always €70 million to be found for the horse and greyhound racing fund. The Government thought it had some easy, soft targets, but the elderly have put paid to that illusion. Pensioners have achieved in six days what the cosy partnership led by the ICTU constantly fails to achieve — a real defence of the disadvantaged in society.

Last week's Budget Statement was an exercise in hypocrisy, with its constant references to protecting the vulnerable when it did nothing of the sort. The elderly have changed all that by forcing this Government into a humiliating U-turn with a very clear message that the people do not want a two-tier health service. They want equality of treatment for all, based on medical need. That is the essence of automatic entitlement to the medical card for the elderly and that is why I support them.

Many people have questioned why I might have changed my stance on this issue. After seven years of universal provision of the medical card for over 70s, what was originally a political stroke has proven to be a serious social and public health gain for all the people in that age group. This has been one of the most important debates in this House in many years and I am honoured to be part of it. I also feel honoured to be able to stand up in this Chamber for my father's generation. This is the generation that paid 60% tax, that educated itself in the absence of free education, that emigrateden masse before returning to work to make this country what it is today.

The motion before the House is a simple one. It calls on the Government to reverse its decision to remove universal health care from the over 70s. It urges the Government to stop tinkering at the edges, with its confusion and minimalist concessions. We have had five changes to the income threshold in recent days. To cause even further confusion, the thresholds have moved from net income to gross income. We have been told that the people at whom this measure is aimed are millionaires. The reality, however, is that the gross threshold means that the garda married to the nurse will not be entitled to a medical card. The nurse married to the teacher may not qualify. These are not millionaires. They are the ordinary people of middle Ireland, the people who have worked hard, defended us, raised us and nourished us.

I said in this Chamber last night that the Government is out of touch with the people and out of sync with its backbenchers and that thousands would descend upon this House today if it did not reverse its decision. That is what happened. I was out there today and it was an extraordinary sight to see people on walking aids and in wheelchairs — 15,000 elderly people from the four corners of this country. And what was it all for? For the sake of €20 million, as the Minister for Health and Children, Deputy Harney, told us yesterday. This sum could have been found by putting an additional 10 cent on a packet of cigarettes. Some €20 million, and much more besides, could have been secured from the bankers who got off very lightly.

Deputies

Hear, hear.

An additional €100 million or €200 million from that source would not have gone astray. Instead, however, the Government went after the elderly whom it perceived as the soft option.

This was a lazy budget, but its laziness reveals the true face of the Government. It is a Government that talks about protecting the elderly, the vulnerable and the young but let us look at what it does. It performed a dawn raid on the elderly, taking their medical cards from them at a time when their pensions have evaporated in the turmoil of the international markets. This is the Government that failed to support the elderly with the long-term nursing home legislation which has been repeatedly promised and which has signalled its intention to impose an additional €200 a week on nursing home costs by reducing the relevant tax relief.

This is the Government whose meanness is personified by the removal of the disabled person's allowance from children aged 16 to 18 years and its replacement with the domiciliary care allowance, resulting in an annual loss of €6,000 to the families concerned.

Deputies

Hear, hear.

This is the Government whose meanness will result in the terminally ill, who were always entitled to a medical card heretofore, having to undergo a means test, with many of them likely to fail that test. Will we now have a situation where a 75 year old man lying on his deathbed must wrestle with his conscience as to whether he should give up his medical card or not, with the Minister for Health and Children's words ringing in his ears: "The Paymaster General knows your salary"?

Deputies

Hear, hear.

Fine Gael believes in universal health care for all. We will strive to achieve that through our policy commission. Our neighbours across the water were able to introduce it in 1948, despite having been brought to their knees by a world war that lasted six years.

The bottom line is that the trust is broken. Once the principle of universal provision is gone, the Minister can reduce thresholds with a stroke of her pen whenever she likes. We are at a crossroads. We can vote one way for liberty — the liberty of the elderly to live without the worry of medical expenses. We can vote one way for equality, so that all over 70s are treated the same. We can vote for fraternity, all of us standing together on this issue. Or we can vote for the way of the Minister for Health and Children, Fianna Fáil, the Green Party and their discredited Ireland which robs the elderly of their medical cards.

Deputies

Hear, hear.

The motion before the House is simple. It calls on the Government to reverse the decision that was taken to withdraw the universal principle of a right to a medical card for persons over 70 years of age. In my long experience in this House, I have never witnessed what I saw on the streets today. We saw the ignominy brought down on the elderly by this Government, forcing them to travel from the four corners of Ireland to stand up for what they believe in, in the country they built. The deep sense of guilt was not appreciated by the Government.

When the Minister for Finance, Deputy Brian Lenihan, came into the Chamber to deliver his radical budget, he quoted Franklin D. Roosevelt when he said, "We have nothing to fear but fear itself". Franklin Roosevelt also said that a radical was "a man with his feet firmly planted in the air". The Government is doomed by its own hand. The carry-on in recent weeks is evidence of the greatest incompetence of any Government of the last 40 years.

Deputies

Hear, hear.

The Government could have done it so differently. There have been three botched attempts to quell a backbench revolution. There have been three botched attempts to quell the fears of thousands of elderly people. The Government could have made the savings required by a switch from branded to generic drugs, via pay freezes, through redundancy savings in targeted schemes or by means of a far more aggressive quango reduction. It did not do so. Instead, it chose to use the elderly as a tool or weapon, reducing them to economic statistics.

As Deputy Connaughton remarked, cosseted as the Ministers are in their State cars, they forgot that people are the centre of politics. They sat around the table in Government Buildings and decided on the proposal by the Taoiseach and the Minister for Finance to end the universal right to a medical card for people over the age of 70. The Government forgot that people are central to politics. In the US, such complex matters are dealt with by way of KISS, keep it simple stupid.

Elderly people do not want to be pressurised about means tests and application forms or have to worry about their property, their savings, what they have in the bank, whether a man from Government will call to their home or if they will lose their right to the medical card. They do not want that. There are anxious about what might happen to themselves and their families. As has been pointed out, they know, understand and appreciate the value of that little card, which is a psychological comfort to them. They know it brings medical benefits when they need them. It is the one certainty of which they are sure in their twilight years. It might not be the best of service; it might not be world-class, as we would like, but the medical card is a passport to a service. It is this psychological relief that the Government has done down. It has completely misread the situation.

The Government has been surrounded by creature comforts and has forgotten that people are central to politics. People will not forget what the Government has done on this night, 22 October 2008. They will remember that members of the Fianna Fáil Party, the Green Party, the Progressive Democrats Party and, apparently, two Independents voted in Dáil Éireann to bring to an end the universal entitlement to a medical card for people on reaching 70 years of age.

The great Thomas Jefferson said: "Take not from the mouths of those who labour the bread that they have earned." Not alone did the elderly earn this medical card but the Government told them they earned it and they trusted and believed Government, a trust and belief now trampled upon and left broken by the actions of Government. I say to the Members opposite that courage and principle is what they need now. I invite them, when they walk up the steps, to think not of me or of Fine Gael but of the faces of the people who voted for them in the last election.

The Deputy is well over time.

They are the people who shook their hands and wished them well in their work for the country. They should think of their sense of disappointment at what they are now doing and of their own sense of guilt when they walk through the division gates to end a right given to the elderly seven years ago.

The Deputy is well over time.

I believe that when they walk through those gates they are making a statement to the effect that they believe that should end. I reject that. Let it be said that Fianna Fáil, the Green Party, the Progressive Democrats and some Independents will have inflicted a scar on the body politic of this country, the likes of which has not been seen for 50 years. Long after we all leave here, people will not forget what the Government has done.

Deputy Kenny, I must put the question.

That scar has been created by Fianna Fáil, the Green Party and the Progressive Democrats Party. It has been created by cynicism and a lack of respect, appreciation, competence and confidence. Surely, this Judas response to the elderly will be the Government's epitaph.

I commend the motion to the House.

Deputies

Hear, hear.

Amendment put.
The Dáil divided by electronic means.

For the aged and elderly of this country, I propose that under Standing Orders the vote be taken by other than electronic means. I ask the Government to walk through the lobbies. If the Greens wish to cycle through the lobbies, they are welcome to.

The vote will proceed.

Amendment again put.
The Dáil divided: Tá, 81; Níl, 74.

  • 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.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Mattie.
  • McGrath, Michael.
  • Mansergh, Martin.
  • Martin, Micheál.
  • 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.
  • Roche, Dick.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Bannon, James.
  • Barrett, Seán.
  • Behan, Joe.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGrath, Finian.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • 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.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P. J..
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
  • Wall, Jack.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided by electronic means.

As provided for under Standing Orders, we are giving the Government one more chance to support the Fine Gael motion, especially the backbenchers who have been so vocal over the past week, saying one thing in their constituencies and another in Dublin. I call a vote to be taken by other than electronic means.

That vote will now proceed.

Question again put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 81; Níl, 74.

  • 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.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Mattie.
  • McGrath, Michael.
  • Mansergh, Martin.
  • Martin, Micheál.
  • 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.
  • Roche, Dick.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Barrett, Seán.
  • Behan, Joe.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • 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.
  • Wall, Jack.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.
Question declared carried.