Occasions where our politicians manage to set out detailed plans for the future are rare, but this week was one of them. Mary Harney could have lobbed the hot potato that is the funding of long-stay care for the elderly out past the next election; it would have been the easier and more political approach. Instead, characteristically, Minister for Health Mary Harney had the courage to publish radical proposals in the lead into the election, writes Noel Whelan
The issue touches many raw political nerves. Not only does it concern policy on how we care for the elderly, it also forces politicians to consider how public services generally can be best funded in an equitable way. Policymaking in this area also comes with additional political risks, because it pokes at the Irish obsession with home ownership and at presumptions about rights to inheritance.
We live in uncertain times, but one certainty is that our population is ageing and ageing relatively rapidly. In the coming decades both the baby-boomers of the 1960s and the pope's children of the 1980s will hit the 65- year-old threshold. Like most other European countries, Ireland is also experiencing a dramatic increase in life expectancy.
These demographic changes should not necessarily, or only, be seen as a problem. On the contrary, many social and economic benefits will come with a growing ageing population. However, in political terms a number of particularly significant consequences will flow. One of the largest of these - second only to the pensions' time bomb - is the funding of long-stay care.
The Central Statistics Office predicts that the number of people in Ireland over 65 years of age will more than double in the next 30 years - it is currently approaching 500,000 and by 2036 it will reach 1.1 million. Even allowing for improving public health, about 5 per cent will require long-stay care.
To date, the issue of funding long-term care has been dealt with in an ad hoc and incremental manner.
Changing policy on this issue in a manner necessary to deal with the rising demand both for nursing home places and for improved standards of care cannot be done without financial pain for somebody.
In her proposal Ms Harney has managed to impose that pain as equitably as possible and to cushion it considerably by deferring the patient's limited contribution to the cost of care until his or her estate ultimately comes be settled after his or her death. She has also capped the contribution, since the maximum to be clawed back will be 15 per cent of the value of the patient's home where both parents require care for three years or more, and 7.5 per cent where only one does.
What is depressing is that notwithstanding the fact that the contribution to the cost from the estate which Ms Harney has suggested is modest, proportionate and equitable, her proposal has been met with a near hysterical response from some quarters.
Some, including Age Action Ireland, have advanced the simplistic proposition that because we pay taxes and PRSI we should be entitled automatically, if we require it, to high dependency long-term care irrespective of its cost and irrespective of how long we need it without any further contribution from our income or out of our assets.
Contrary to the scaremongering of some Opposition politicians, the reality is that the scheme outlined by Ms Harney will not put an additional burden on older people. For many, particularly those availing of private nursing homes, it will relieve the burden currently carried by family members or which is currently met by selling the family home.
Every ageing person can now have the comfort of knowing that irrespective of their own means or that of their family members (and irrespective of the nature of their relationship with their family members), they will be provided with the care they need, and still be able to dispose of the substantial part of their assets after their death as they wish.
The Harney plan has not come out of the blue. It follows on from a series of detailed studies of the scale of the likely demand for long-stay care. It also, interestingly, comes after a detailed exploration of public attitudes on this issue in a comprehensive opinion poll conducted by the ESRI in 2004.
It also follows painstaking consideration of these studies and the options, firstly at official level and then repeatedly at the Cabinet table itself.
While that process has been going on, the Opposition parties have had little to say about how they believe this care should be funded. Enda Kenny was very loose with his language this week when he talked about how the Harney proposals amounted to a death tax. One of his frontbench colleagues even characterised it as grave robbing.
The closer we get to the election the more Kenny and his putative partners in Labour are going to have to tell us what they would do in areas like this, and how they would fund their proposals. They now have four months before the likely polling day to outline their alternative to Harney's proposal.
If Fine Gael and Labour are suggesting that the rising bill for long-stay care for older people should be met from the general tax fund, then they must say what effect this will have on their commitments not to increase tax rates.
If they are suggesting it should be paid out of the Social Insurance Fund then they must set out at what pace and to what rate employee and employer PRSI will have to rise.
There have been too many issues on which the current Government has been unclear or indecisive. It is to the credit of Ms Harney and her Cabinet colleagues therefore that on this issue, at least, they have not been afraid to make hard choices.