Sunday 21 December 2014

Shuffling of medical cards nothing but a vote-catching conjuring trick

Published 17/10/2013 | 05:00

Unless action is taken, a quick appointment with the local family doctor may be a thing of the past.
Unless action is taken, a quick appointment with the local family doctor may be a thing of the past.

THERE IS a technical term for that centre-stage decision to give free GP visits to children aged five and under, even as medical cards are withheld from others, including children with long-term illnesses. It is 'wackdoodle'.

Wackdoodle because it is illogical. Wackdoodle because it is divisive. Wackdoodle because it fails the fairness test. That plan to introduce another universal benefit, even as others are pared back, is among the most troubling aspects to Budget 2014.

Its impact was accentuated on Radio 1 yesterday when a mother rang 'Today with Sean O'Rourke' to tell how her family is struggling because of the pressure on medical card eligibility.

The caller described the fallout from losing the cards for her two sons with cerebral palsy, one of them paraplegic – both completely dependent on their parents.

"There is a change," insisted Stella from Galway yesterday, as ministers Noonan and Howlin claimed the criteria for discretionary medical card allocation was untouched.

Her sons have been card-holders for the past 10 years but last month the benefit was taken away. This wasn't just Stella from Galway but Stella from the coalface.

"There will be mistakes," conceded Mr Howlin, as Mr Noonan seconded him vigorously. But mistakes have faces. They feel dismayed, exposed, the victims of an injustice. They can be called Stella, or go by other names. Dealing with illness is a daily challenge for them.

It brought home the reality of the medical card shuffle, where conflicting needs have not been weighed in the scales of justice, but in the scales of vote-catching.

The giveaway affects 24,000 families and they will be grateful, particularly the middle classes who vote. Offsetting it is the clawback of medical cards from other groups.

Stella, a part-time worker, said it cost €25,000 to supply just one of her son's needs. That meant she'd need to earn €50,000 without state help for him. She was trying to stay in the workforce but "this is a signal to come out".

Families looking after members with special needs spend the effort lovingly. But it is unacceptable that the physical and emotional toll on them should be magnified by a financial one.

Some of those turned down for medical cards are children and young people with long-term illnesses, such as cancer. Meanwhile, a universal benefit is extended to all five-year-olds and under – whether their parents need subsidising or not. Go figure.

Oh, I know the argument: it's the first step towards universal healthcare, early intervention generates long-term savings, and waiting times in A&E will come down.

But it is an empty gesture to hand out cards to the children of well-off people and remove them from those buckling under the weight of bills for their children's health needs. How does this cherish the children of the nation equally? How is this anything other than a conjuring trick?

Providing free GP visits for small children is a fine principle to aspire towards, but only when the State can afford it. Not at a time when Ireland still has a deficit. Not at a time when Health Minister James Reilly is slicing services to meet tight targets. Not at a time when those with long-term illnesses – from children to older people – are losing their medical cards.

The new package is something for the Government to point up as an achievement when its term of office draws to a close.

BUT it is a hollow goal because it does not meet the fairness measure by which we judge a Budget. Instead, it stokes apprehension and turns the future into a frightening place for some citizens. The troika has criticised Ireland's predilection for universal benefits – from the children's allowance to support packages for senior citizens – and our apparent inability to means-test so that money is directed towards those truly in need.

Perversely, the Government takes certain steps because the troika says it must, such as imposing property and water charges, yet is stubborn about other issues such as universal benefits. Indiscriminate handouts are untenable on economic grounds, if on no other.

Mr Howlin insisted repeatedly that 1.9 million people had medical cards – more than two in five of the population – costing €2bn annually. It is expensive, no doubt about it, and the State must live within its means. But the State must also allocate its resources in the most scrupulous way possible. Close on 200,000 discretionary cards have been reclaimed in the past year as discretion is interpreted in the strictest terms. Presumably, centralised decision-making is contributing to the scale of the loss.

Meanwhile, a total of €37m has been allocated to underwrite free GP visits for children. Details are sketchy regarding when the measure will be introduced in 2014, but it won't run for a full year. Still, it is easy to see where the economies to underwrite it are coming from.

The Government hopes to save €113m from a review of card qualification. Without question, there are overpayments to GPs where card-holders have emigrated or died. These should be identified and stopped.

But there was a cost-neutral way for the Coalition to leave alone genuine cases such as Stella from Galway and her boys. The banks could have been charged an annual tax of €250m or more, instead of the piddling €150m that was imposed on them.

That €150m is a facade of a figure. It is meaningless as a contribution from the banks to the national recovery, because the Government now sees fit to allow Irish banks to offset more of their losses against tax. The levy will end up costing the banks nothing, as stockbrokers Merrion Capital pointed out yesterday.

The same cannot be said of the price paid by citizens squeezed on medical card eligibility. Instead, the paring-back continues inexorably – it is hitting bone at this stage.

Irish Independent

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