Continued slashing of health budget may yet bring down this Government
FIFTY-SEVEN per cent of voters cited the removal of discretionary medical cards as the main reason for their fury with the Government last Friday. Anger about medical cards came ahead of water charges and property tax in the RTE exit poll.
The Taoiseach, Tanaiste and a line-up of senior ministers were out on the public airwaves talking about the need for a "renewal" or a "refurbishment" of the Programme for Government. Specifically, they promised to address the medical card issue, all of them saying that it was unacceptable to ask people with life-long illnesses to prove that they still had them.
Speaking on Saturday night, Eamon Gilmore said: "We have to address the huge mess that was made of the medical card issue, and we have to renew the work that we are doing in Government."
What each of these political leaders is missing is that it is their policies and choices that are the reason for the "huge mess".
Senior health service personnel are seething at the crass political dishonesty of Eamon Gilmore, Brendan Howlin and their ilk. As well as hammering the HSE for reviewing the circumstances of sick and disabled children with medical cards, the politicians are also accusing the HSE of harassing the over-70s.
Sick and disabled people's medical cards are being reviewed because that's the law. Medical cards are granted on the basis of 'means', ie when financial hardship is caused by illness or disability. Medical cards are issued for a set period of time and are automatically reviewed before being re-issued.
The reason for greater stringency on medical card reviews is the serial cuts to the health budget overseen by this Government. As the HSE is under increasing pressure to continue to provide the same amount of services to a growing, ageing population with less money and fewer staff, it has no choice but to cut wherever it can.
Government ministers had choices to make and they chose to disproportionately cut the health budget, in effect hanging the Health Minister and the HSE out to dry.
Ultimately, health budget decisions are made by the Economic Monetary Council – made up of the Taoiseach, Tanaiste and Ministers Noonan and Howlin. The reason for the repeated reviews of the over-70s is the Government's own repeated changes to the income thresholds for this age group, made in consecutive Budgets. Each reduction necessitates a process of systematic review. The reviews target over- 70s because government policy targets over-70s.
Mr Howlin and his department are persistently harassing the HSE to make sure these reviews are carried out.
If the HSE implements the 2014 income limits for over-70s, up to 50,000 older people will lose their medical cards this year. This figure does not include the thousands of sick people who will lose their cards under automatic review, not to mind 100,000-plus people who would have lost their cards if Public Expenditure and Reform's fantastical figure of €133m for probity was pursued. The HSE got this probity figure down to €20m after much haggling with Public Expenditure and Reform.
As a result of the purposeful political underfunding of the Health Budget in 2014, the HSE is already over budget. A letter to hospital CEOs last week detailed a potential 8-10pc cut in services so that they will live within their unrealistic budgets this year.
The Government needs to realise that the fallout from their Budget choices is tens, potentially hundreds, of thousands of people who really need their medical cards, losing them. If hospital budgets are to be cut to the extent directed last week, hospital cutbacks will put medical card losses in the ha'penny place.
In response to the exit poll on Saturday morning, Mr Howlin stated that 94pc of the programme for Government had been delivered. He obviously has not had a read of the 80-plus commitments in the health section recently. Very few of these have been realised and some, such as "more and better care for older people", have been blatantly denied.
If this Government is going to redeem itself in any way, if it is really interested in "renewal", then it needs to start paying attention to the direct consequences of continuing to cut the health budget. Continuous underfunding of health is now backfiring – not just for James Reilly and Enda Kenny, but crucially for the Labour Party, which has prioritised party political point-scoring over health policy goals.
Decisions made in health could still bring down this Government. The Government collectively needs to face up to the choices in hand.
Sara Burke is a health policy analyst and post-doctoral research fellow in Trinity College Dublin. Twitter: @sburx
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