Resoration decision may be all about the next election

For obvious electoral reasons, politicians normally hand out goodies to the population before an election, but the Government’s sharp U-turn on medical cards must be the first time such largesse has been showered on voters after the polls closed.

Yet the decision to return 15,300 discretionary medical cards that were legitimately taken away by HSE officials may have more to do with the next general election rather than last month’s local and European ballots.

The decision announced yesterday by a pleased Minister for Health James Reilly went much further than anyone expected, by backdating the reinstatement of discretionary medical cards to mid-2011.

The controversy blew up only in the past year but going back further to July 2011 makes for a clean demarcation line because that was when centralising the assessment of applications began.

Happily for the Government, that decision was taken by its predecessors, so backbenchers will be able to tell voters on the doorsteps that the medical card fiasco was, actually, all Fianna Fail’s fault.

It was a good day for Dr Reilly, who for the first time in ages managed to wrest extra cash from his Cabinet colleagues, although few are betting his political career in Health is saveable at this late stage.

The decision to second-guess entirely legitimate determinations made by public servants on medical card applications was taken after consulting attorney general Máire Whelan, yet the basis for it remains unclear.

The emphatic instruction given by the Government to the HSE was sufficient to overcome the latter’s earlier reluctance to reinstate cards.

The decision is both compassionate and unfair. Compassionate, because as everyone knows now, the removal of discretionary medical cards caused huge grief and anxiety for thousands of families going through the trauma of dealing with serious illness or coping with a long-term medical condition. But it is also unfair or unjust, because of the different way various categories of people are being treated.

Many people who lost their discretionary cards between 2011 and 2014 will get their cards back, regardless of how high their disposable income is.

Analysis shows us that three-quarters of those who had their cards removed over the last year were at least €250 a week over the income threshold. Compare this to the situation pertaining for people whose medical needs arise today or tomorrow and who must apply under the current means-based system.

Meanwhile, the regional variations in the way cards were handed out, and that provided the impetus for centralising the system, remain. Indeed, according to the figures used yesterday, they are even starker than we were told before. He pointed out, for example, that there were three discretionary cards per 1,000 population in Co Meath, but 53 in Co Cork.

The effects of these disparities were amply illustrated yesterday by Independent TD Denis Naughten, who accused the Government of "institutionalising discrimination". He pointed out that in Co Westmeath, people with cancer were traditionally issued cards under the old system. Yet across the county boundary in Co Roscommon, applicants had to prove financial hardship on foot of their cancer treatment before they got a card. Many were too sick to pursue this, he said.

In future, when medical cards are allocated on medical need, as the Government plans, this won’t matter too much. However, this day may be some time off, as legislation will be needed and this, the Minister admitted yesterday, will take some time. Just what this promise will cost is another matter altogether.