A post-election poll after the recent local and European elections, in which the Government parties were routed, produced one especially disturbing result for the Coalition. It showed that for many voters, removal of discretionary medical cards from thousands of people – some with a life-long medical condition – had become a major concern.
The Government’s subsequent policy change, which has seen medical cards restored to 15,000 people, was a necessary and overdue response. But the Government’s decision to act also reflected a political imperative: to regain the initiative. And this week there was further evidence of that at work, with Taoiseach Enda Kenny’s surprise announcement of free GP care for the over-70s , regardless of financial means. Earlier, in this year’s budget, as a cost saving measure, the Government had once again changed the income threshold for those over-70 to qualify for a full medical card.
In 2001, the Fianna Fáil-Progressive Democrats coalition took an equally surprising decision: to give all those over-70 full medical cards, without an income test. This concession, which helped to capture the grey vote, contributed to the coalition’s subsequent electoral success.
In 2008, a Fianna Fáil-led government, against the background of the unfolding financial crisis, abruptly ended the automatic entitlement. The decision was greeted with dismay, and met with large public protests. The scheme had become unaffordable as costs mounted: the number of new beneficiaries had been greatly underestimated from the outset, as had the cost of GPs treating them.
For more than a decade successive governments have struggled with the medical cards issue, withdrawing some discretionary cards before being forced to restore them under public pressure. And now with the Government’s latest proposal, where all over -70s will be entitled at least to a GP visit card – but not to much else, as medicines and other related services are not covered – the move has been questioned, not least on the grounds of affordability. Meanwhile GP services are starved of adequate resources which places additional pressures on acute hospitals.
At a time when the Government has consistently failed to control health spending, which will exceed the €13.6 billion estimate for 2014, and when it also plans to introduce free GP care to the under-fives, which has already been delayed, it is proposing another major change in health provision. One for which, it would appear, no budget provision has been made. The chairman of the Irish Medical Organisation GP committee Ray Walley has described Government policy on GP services as being in "complete disarray". It is time for the Government to show otherwise.