Why suddenly all is changed, changed utterly, on the contentious issue of medical cards
Enda Kenny promised to fix the "medical card mess", while Minister James Reilly floated the idea of a third tier to medical card access. Yesterday's announcement by Junior Minister Alex White means they might both deliver on these significant promises.
Following a cabinet subcommittee on health, White told the Dail of the Government's five-point plan to deal with the medical card debacle.
First, and most importantly to the 49,596 people who currently have discretionary medical cards, HSE director general Tony O'Brien has suspended any further reviews of discretionary medical cards. These people will hang on to their cards until a new system is in place.
Second, O'Brien has been enabled to do this due to a significant change in government policy, that is, to introduce eligibility to free care based on medical need and not means as is currently the case.
Third, the Department of Health is going to explore the best legislative option to make this happen. Previously, the department and various ministers said it was not possible to extend free GP care on the basis of illness or medical need.
Following yesterday's cabinet sub-committee meeting, they have decided the opposite is the case – that it is possible to amend the 1970 Health Act to include medical need as well as 'undue hardship'.
And if it is not possible to amend the 1970 Act, they will publish new legislation. Fourth, in order to decide which conditions are included and which are not – and what is the best 'care package' for them – they are establishing an expert panel to determine this.
It will also identify the best place to start, presumably starting with those in most medical need. Obviously, this will be a tricky process but it is as good a way to start as any other.
All of this change has to happen quickly, because the Department of Health and the minister want to know how much this will cost by the time the hard negotiating happens on the health budget for 2015.
There will be a financial price to pay and it will not solve everybody's dilemma. For example, people who have already lost their card or who are over 70 and above the income limits, will find that this initiative is of no benefit to them. But the move does take the heat out of removing discretionary medical cards from those who are most sick.
All this will go to the Cabinet in a memo on Tuesday and the Department of Health is to map out how to extend free GP care to the entire population, presumably moving on to the illnesses/lifelong limiting conditions after the under-sixes.
This is really significant because it is the first tangible step of delivering on free universal healthcare on the basis of medical need – not ability to pay – which was long promised in the Programme for Government.
Not only does it get the Government out of a deep hole on the medical card front, but it maps out a way to actually delivering on its ambitious promise of universal access, which many – including this author – had long written off as a mere aspiration.
Critical to achieving this enormous shift in health policy is delivering on it. And it will not be cheap. Giving medical cards, or access to the appropriate type of care free at the point of delivery, based on medical need, will inevitably cost hundreds of millions of euros.
But Public Expenditure Minister Brendan Howlin sits on the health cabinet subcommittee and the fact that he has signed up to this plan is very important.
It was Howlin's department that came up with the fantasy figure of €113m for 'medical card probity', a measure that if implemented could have brought down the Government as hundreds of thousands of people would have lost their cards.
They backed down on that after huge haggling from the health minister and the HSE. Now it seems, the Department of Public Expenditure and Reform is signing up to a very different strategy of extending access, which it well knows will cost a lot of money.
It took the political crisis of Labour's wipeout and Fine Gael suffering losses in the local and European elections for the political powers-that-be to face up to the medical card crisis.
This political predicament opened a window of opportunity for Dr Reilly to push through a really tangible step on his programme of reform.
If this is delivered – if access to free healthcare is determined by medical need for those who are the most sick or with lifelong limiting conditions – then yesterday's announcement is a really significant step on the path to universal care.
If funding is provided and it actually happens, this five-point plan has the possibility of salvaging Dr Reilly's – and the Coalition's – credibility on health matters.