The Government came under sustained Opposition pressure in the Dβil last night to reverse its postponement of the extension of medical card eligibility to another 200,000 people.

Defending his record, the Minister for Health, Mr Martin, outlined the improvements in the health services, adding that when dealing with the Opposition, the expectations of reasonable people would always be disappointed.

"Once again, we are confronted with the desperate attempt of an Opposition overwhelmed by the indifference of the public to claw their way into contention. They have decided that health will provide them with the electoral magic bullet which will achieve what two new leaders and a merger have not." A Labour motion, moved in private member's time, demanded the extension of the scheme and expressed concern at the fact that many people on low incomes were denied access to adequate primary care for financial reasons.

The party's spokeswoman on health, Ms Liz McManus, said the Minister had justified his decision to exclude those people on the grounds that their unmet need would put pressure on the service.

"That is a terrible admission. Is he really saying that the unmet need is so great that he cannot set about now to meet it?" She added that when the Minister extended medical cards to the highest income group of over 70s, he got it wrong.

"He introduced inequity into the GMS system itself for the first time. GPs are rewarded three or four times as much for caring for this group of medical card holders compared to the payment they receive for caring for the poorest in our society."

The Fine Gael spokesman on health, Mr Gay Mitchell, said it was time for a targeted investment in primary care to remove the medical apartheid, thereby taking pressure off hospitals so that reform of hospital care could proceed. Fine Gael, he said, proposed extending free GP services to children up to the age of 18 years and beyond when in full-time education, all citizens over the age of 65 years, those in the lower 60 per cent of income groups, with special provisions for asthma sufferers and those with similar chronic disabilities.

Mr Martin said the current Government was the first to set out a comprehensive programme for delivering high-class and accessible health care for all.

"Equity in health care is not only about the income guidelines for medical cards. It is about a full range of services and supports. Equity is a core principle on which the strategy is based and one which this Government is committed to addressing in the implementation of the strategy and through service developments across the board." Services had to be built up, waiting lists reduced, activity increased and specific groups such as children and those with disabilities required targeted service developments if equity was to be served in a meaningful way, said Mr Martin.

"A broad strategic focus is essential to deal with these sort of problems and no single narrow approach will address the real need for better more equitable health care services for all." The Government, he said, would get on with the substance of delivery and face into the future, with the public recognising credible and sustainable policies over those "whose shelf-lives are as long as a sound bite" .

The Government defeated the Labour motion by 76 votes to 71.