I move:
That this committee demands the immediate reversal of the Government decision to withdraw the automatic entitlement to a medical card from citizens aged over 70 years.
Medical Cards: Motion.
I move amendment No. 1:
To delete all words after "That" and substitute the following:
The Oireachtas Joint Committee on Health and Children commends the Government for ensuring that everyone aged 70 or over will retain their medical card if their gross income is less than €700 a week for a single person and €1,400 a week for a couple.
The committee also supports the proposal to ensure that only the interest earned on savings is counted as income and not the savings themselves.
The committee endorses the Government's decision for providing that income from savings up to the first €36,000 for a single person and €72,000 for a couple is not counted.
And the committee also agrees with the Government's proposals to direct resources to ensure that they target those in greatest need.
All members agree that the people who most need resources in health care are the ones at whom they should be targeted. The Government's decision to increase the limit to €700 a week for a single person and €1,400 a week for a couple ensures those who need medical card will receive it. There is also the facility whereby someone with a medical condition can apply for a medical card under the discretionary medical card scheme.
I second the amendment. I am happy with its wording. It is fair to say that on the night of the budget there was panic among elderly people. It seemed everyone over 70 years would lose the medical card. This misunderstanding was helped by political comment which frightened the life out of people. This is something we want to avoid.
The issue has been finalised by the Government and meets what most would expect. If extra resources are available to the general medical service, they should be targeted at those in greatest need. I would love to live in Utopia where a medical card was universally available. In the Ireland in which I have lived all my life we have always had means-tests to avail of many services. A good job has been done. I agree with Deputy Conlon that the limits, €700 a week for a single person and €1,400 a week for a couple, are satisfactory. During the years there has been concern about the amount of savings people have. The Government must be commended on ensuring those with a gratuity on leaving work or who have saved money during their lifetime will not be penalised.
The decision to remove the medical card was not a great one, particularly considering the small amount of money to be saved. The Government has now rowed back somewhat on this decision. It should go the rest of the way.
I do not agree with the previous speakers. This issue has not gone away. Legislation will have to be introduced to deal with the matter. The people will then be back on the streets because they will realise what they will lose. It was claimed this cut would only affect millionaires. However, with the limit at €700 a week for a single person, it will affect nurses, gardaí, teachers and ordinary average people in middle Ireland who worked all their lives and gave some considerable service to the State.
Deputy Conlon referred to the discretionary medical card. I have to advise her that the Minister made it very clear that this fund will be capped and not available to everyone. This year, for the first time ever, terminally ill persons, who were always given a medical card on compassionate grounds as a token of their service to the State, will be means-tested and not receive it. Already terminally ill persons in Ballyfermot and Walkinstown have been told they will not receive it.
I put my hand up in the Dáil the other night and will do so again. When the scheme was introduced, I opposed it for the very reason the Government now claims — there are limited resources. They need to be focused on those in greatest need. It has been well shown by the longitudinal study at St. James's Hospital that there has been a considerable health and social gain in this age group because of the medical card scheme. I refer to independent research on the reduction of strokes and heart attacks.
We are great at framing things in such a manner that we can look at them in isolation. We cannot look at the health service in isolation and we cannot look at this issue in isolation. It costs €1,650 per year to provide a medical card to each person over 70. That is the average cost as given to us by the Minister. One day in hospital will consume that saving of €1,650. I have absolutely no doubt, on the basis of the information, that the withdrawal of this card will result in increased hospitalisation rates and possibly mortality among people in that age group, thus costing the taxpayer more than any saving that will be made.
I believe in universal health care. It is something we in Fine Gael are seeking to introduce. It is available in other countries, including the one right next door to us. It is available 40 miles up the road from here. It was introduced in the UK at a time when that country was on its knees after a six-year world war. However, they decided where their priorities were and they prioritised people's health over all other things. That is why it was introduced.
There is confusion about the figures. Without being overtly political, I will say this. The figures were wrong before and there is a grave danger they are wrong again. Why do I say that? Age Action Ireland issued a statement last week which said that from its inquiries to the CSO, it found there were 423,000 people over 70. If there are 355,000 people with over-70s medical cards, both old and new, that leaves nearly 70,000 people who have not availed of the opportunity to obtain a medical card. I am trying to get direct answers from the CSO and I will qualify my statement by saying that those figures came from Age Action Ireland. I want to get greater clarity on this from the CSO. However, it is very clear that the 355,000 people alluded to are not all the people over 70 in this country. They could not be, because we have already been told that Members of this House have not obtained medical cards and there are numerous other well-known personalities who have said they have not obtained one.
The withdrawal of the automatic entitlement to a medical card for the over-70s does not make sense. It is not morally or ethically right. Ultimately, if the intention was to go after the richest 5% of those over 70, if the figures from Age Action Ireland are correct, we have already got the top 14% who do not avail of it. Are we shooting ourselves in the foot again for a mere €16 million? We are making a bad decision. We have had our argument in the main Chamber but it is worth putting here again. The Government has gone a long way towards addressing the issue. For the sake of the few bob that is left, and in view of the harm that will be done — not might be done, but will be done — it should row back completely on this decision.
I support Deputy Reilly's original proposal, so I am speaking against the amendment. I welcome the fact that there has been a considerable improvement on what was announced in the budget and that this has been brought about by the power of public opinion. I commend all the senior citizens who made their way to Dublin the week before last and made their voices strongly heard.
I agree with Deputy Reilly, however, that those people still feel very strongly that the automatic entitlement to the medical card should be restored so that it is entirely free to those over 70. I say this because of the health gains, the security that having a medical card brings, and because of the kind of thing we heard in the presentation before this debate about the importance of having access to primary health care and everything that brings.
A number of people have said to me that one cannot buy a public health nurse. One cannot pay for that service even if one does not meet the criteria for the medical card. There are certain services one actually cannot get unless one has a medical card. Access to services such as a practice nurse, as we just heard about with regard to asthma, results in health gains and keeps people out of hospital. The information we have about improved health for those over 70 would indicate that there may well be a saving to the Exchequer in the long term if we have free medical cards for everybody over 70. The Labour Party, since 2001, has supported universal access to health care on a one-tier basis, but particularly free access to primary care through a health insurance system. The taste we had of it with the over-70s in the period during which it was free indicates that it does result in positive health gains.
I disagree with Deputy O'Hanlon, although I do not often do so, about where the confusion was caused. It was not caused by politicians but by what was written on the HSE website, on which the limits were changed about five times. While we did repeat what was mentioned on the website, that is what caused the confusion and there was a great deal of anger.
The other issue that has not been confronted is the cost of means testing. It is more or less voluntary. People are told they are supposed to tell the HSE if they are over a certain income limit and then, as I understand it, they are supposed to give their medical cards back. However, when we actually get to the point where we will do means tests, there will be costs. I suspect, despite the fact that we are told the limits will be reviewed every year with regard to the cost of living, that the scheme will not actually be index-linked. I suspect that in the future we will have problems, whereby the cost of means testing will render it unviable for such a small percentage of the population and the limit will come down. Thus, the average person with an occupational pension will end up being outside the limit and having to give up his or her medical card. For all these reasons, the Labour Party believes strongly that the automatic entitlement to a medical card should be retained for all those over 70 years of age. However, we do commend the Government on one aspect, that it has, we hope, renegotiated with the Irish Medical Organisation to have a level playing field for all those over 70 years in terms of what general practitioners are paid. That will right an imbalance that was having a bad effect: GPs were being paid four times as much for the person over 70 years who received the medical card automatically as for the person who received it after a means test. That is to be welcomed.
I lend my voice to those speaking against the amendment and in support of Deputy Reilly's motion. I do so for two very good reasons. I do not think the Government should receive any praise for what it has done on this occasion. There was an ulterior motive because the people who ensured this change was made were those who had defected from the Government side. It was that stark at the time. There were councillors meeting in Ballinasloe and so on. Let there be no doubt that a monumental mistake was made the first time. No matter how we dress it up, when we walked with the 15,000 or 20,000 old-age pensioners who came to Dublin, they left us in no doubt that they wanted nothing less than a universal entitlement to the medical card for all those over 70 years, after what they had done for Ireland during their lifetimes. They will come again, because they genuinely believe, as one of them said to me that day, that if they are entitled to free transport, irrespective of how well off they are, they should also be entitled to free medical cards, given that they already have them. There are cogent reasons to believe it saves money in the long term.
Irrespective of the veneer put on it in the Dáil or here, when the letters to determine eligibility issue, there are many who will most definitely keep their medical cards but who are very upset and anxious about the whole process. They genuinely believe the medical card is to be taken away from them. I do not think people over 70 years should be put in that situation. That is why I sincerely hope the amendment will be defeated.
I have a couple of points to make about the Government decision. First, it was clumsy and insensitive. It was a shame that a move had been made away from universal health care for this group of persons over 70 years, among whom there are many vulnerable individuals. There was no mandate for this in the election. It was one of the few areas in which there was universal health care.
Many doctors have said this provision was extremely helpful in keeping people in their home, developing community care and avoiding the use of accident and emergency departments and acute hospitals. The real cost of taking the medical card away from over-70s is yet to be seen. The costings have not been done properly. Any true costing must take accident and emergency costs into account. Elderly people who might now call a GP, be prescribed an antibiotic and not develop pneumonia, will now develop pneumonia. That is not scare-mongering, it will happen. Elderly people are concerned about the cost of calling a GP. The real cost will only be seen when people, who would otherwise have had preventive care in the community, go to accident and emergency departments.
The move away from universal care was made without a mandate. There was no mandate in the general election to move away from universal provision. When one looks at the amount of money wasted I have no doubt savings could be made elsewhere. Why were negotiations not held with GPs? Money could have been saved and the universal provision for the over-70s could have remained in place. The Minister for Health and Children, Deputy Harney, continually asked if someone like her should have a medical card. This reduces the matter to simplistic terms which does not take into account, as Deputy O'Sullivan has said, the cost of means testing.
There is evidence worldwide that the people who lose out in means-testing are often those who need it most. Many people feel very humiliated by means-testing, and even though they should receive the provision, they are so humiliated by taking a means test they do not do it.
I agree with Deputy Connaughton that there is significant anxiety about the process to be put in place. There are worries about people who have already been means-tested, and if they will be again. There are worries about people who are not yet 70 and who now have the medical card but may lose it when they reach 70. There are many unresolved issues about what has happened. It was a retrograde step to target this group in this way in the budget. I ask members to support the motion.
I agree with all that has been said. In light of the further expansion of means-testing, there is still a staff embargo in place. What is proposed to deal with this? I support the substantive motion and not the amendment.
I am substituting for Deputy Allen. I support the motion proposed by Deputy Reilly and reject the Government amendment. We need to find out where the Government stands on the principle of universality, and whether it is a principle or a penny-pinching exercise.
There is a lack of clarity on the schemes that are covered by it and those that are not. The Taoiseach was wrong when he said in the Dáil that the free travel scheme was linked to pensions. It is not linked to pensions, when one reaches the age of 66 there is an entitlement to free travel regardless of whether or not one is in receipt of any pension. I checked that with the Department of Social and Family Affairs.
If the Government stance on universality is taken to its ultimate conclusion, people were right and understandably have concerns about other universal payments. When one looks at what has happened to child benefit in the budget, it has also been attacked from a universal perspective. People have genuine queries and concerns.
The means test will be voluntary. It is a means test or it is not. I do not understand how it will work. All of us who hold constituency clinics understand what it is like when people receive a form or letter in the post regarding a payment to which they are or are not entitled. It frightens people. Having spoken with staff in the medical card section I do not know how they will cope with the extra work that will come with this scheme. People will not know if they qualify.
People with access to the medical card stay healthier for longer, as Deputy Reilly said, and they have access to GPs. It is not just about visits when they are sick; there are visits to keep them healthy, and they availed of blood tests and other procedures. That is under threat and people will make a decision on whether to go to the doctor, when, with a medical card they would go. Even people with a certain income will decide if they should spend money on doctor visits.
People stopped paying for health insurance because they could avail of the medical. This is an issue that has not yet been teased out.
I apologise for my late arrival. I was at the Order of Business and there were several votes. I am glad to support the amendment to the motion. Deputy Enright raised the issue of health insurance. I contacted the VHI three weeks ago. They told me there would be no difficulty for people who had left the VHI upon receiving a medical card. They will not be treated harshly if they have developed an illness since they left. They are still welcome to come back and the only stipulation was that they pay the premia the VHI lost out on over the years. That is business and that is how the VHI would do business with any of us, whether we are over or under 70.
The Government got it wrong when they brought in a tiered system. It recognised that and brought in a different, better system that covers 95% of those over 70. The Taoiseach apologised when he introduced the new scheme. From the people I have talked to, the general consensus is that people are happy now that the scheme was put right. They are sore that they were put through what we put them through. I am sorry we put them through that and wish we did not do it. What is on the table now is a very workable agreement.
Senator Fitzgerald spoke about people losing out because of the means test. Perhaps those that will not been means tested are the ones who need it most. I do not think people will lose out because of the means test. The 4%, 5% or 6% of people who are outside the new scheme may never have applied for a medical card. I know many people over 70 who have their own means and do not avail of the free medical card, so perhaps those people come under that category.
I congratulate and commend the IMO for coming in to discuss the costs. I see Deputy O'Reilly smiling, but I am not having a go. I am genuinely saying, "Well done" to those who took a cut and came down to a lower scale for the Government——
It has not been accepted yet.
I hope it will be accepted.
When I looked at this I was interested to read in the Mullingar accord, which was a programme for Government by the Labour Party and Fine Gael for the last general election, that they were not in favour of universality for the medical card scheme for the over-70s. I do not understand where all the concern is coming from. Deputy Reilly should read it in his document
No. The Senator is wrong. It is in the document, and it was for those under the age of five and 16 to start with.
He should read it in his document.
It was in the Mullingar accord. The Senator is wrong on that.
Could we keep the barracking for the Dáil Chamber? Deputy Conlon wants to conclude.
On a point of information, Deputy O'Sullivan is correct about the figures on the Health Service Executive website. I should have included it with the politicians who raised the ante as soon as the announcement was made.
We all regret what happened. It was not the intention of the Government to cause upset, distress and discomfort to anybody, particularly those over the age of 70. When this measure was introduced the economy was different. There was not broad support from Opposition parties to introduce universal entitlement to medical cards for people over the age of 70. If we wanted to be popular we would not have taken tough decisions such as those taken in the budget but, unfortunately, economic circumstances have changed and we had to take tough decisions. In principle, I have a difficulty with a 69 year old not being eligible for a medical card by virtue of a means test but who is entitled to a medical card on turning 70. We had to examine that aspect and take it into consideration.
The discretionary card is not gone; it is discretionary. It was not given to just anybody. Discretion is shown in terms of the people who are given it. A question was raised about means testing people who had been means tested previously. They will not be means tested again. If someone was means tested and then given a medical card, they will continue to have it.
The point was made also that defections were the reason this measure was changed. That is not the reason it was changed. We heard the message from older people. We listened to them and acted on that. We do not engage in gesture politics and for that reason I am pressing the amendment.
Given that Deputy Conlon had the right of reply, I would like the right of reply.
She is replying to the amendment she moved. The Deputy does not have the right to reply.
Can I correct a few inaccuracies?
No. I am putting the question.
I cannot correct an inaccuracy?
What is the inaccuracy?
Nobody said the discretionary card was gone. I said it is capped and, as a consequence, there are terminally ill people in Walkinstown and Ballyfermot who cannot get it. These are hardly the gated communities of millionaires.
Is the amendment agreed?
It is not agreed.
Amendment put.
The Joint Committee divided: Tá, 9; Níl, 8.
Tá
- Brady, Johnny.
- Calleary, Dara.
- Conlon, Margaret.
- Feeney, Geraldine.
- Flynn, Beverley.
- Ó Fearghaill, Seán.
- O’Connor, Charlie.
- O’Hanlon, Rory.
- White, Mary M.
Níl
- Connaughton, Paul.
- Enright, Olwyn.
- Fitzgerald, Frances.
- Lynch, Kathleen.
- O’Dowd, Fergus.
- O’Sullivan, Jan.
- Prendergast, Phil.
- Reilly, James.
Amendment declared carried.
Motion, as amended, agreed to.
I propose that the motion, as amended, be reported to the Houses of the Oireachtas and that Dáil Éireann take note of it. The motion will also be sent in written form to the Minister for Health and Children.
Are we permitted to vote on the substantive motion?
No.
There is a precedent.
We will not have any more votes. The committee stands adjourned until 3 p.m. on 18 November when we will meet representatives of the Simon Community.
The joint committee adjourned at 4.50 p.m. until 3 p.m. on Tuesday, 18 November 2008.