21 October, 2008

Medical card changes


That's the only word I can use to respond to the hurt and difficulty suffered by so many older people and their families over the last week.

The changes announced this morning (Tuesday 21 October 2008) have involved raising the income limits to €700 per week (€36,500 pa) or €1,400 per week (€73,000 pa) for a couple. Older people on this income or under will receive a full medical card. In addition, those with incomes above the threshold experiencing difficulty in meeting their medical needs will be eligible to apply for a medical card under the discretionary medical card scheme.

A huge amount of the debate in my head has been about means testing. Just what should the State provide to everyone, regardless of their income or assets? Whether we like it or not, that answer has to change, depending on the state of the economy.

One thing is certain; this is only the beginning of a huge challenge to tackle the economic difficulties of Ireland Inc. There may be a ten billion hole in the finances, and the hundred million euro mentioned in the context of medical cards is perhaps only 1% of the gap in the nation's finances that will need to be filled in the near future.
It begs the question as to whether we should continue to provide tax relief at source on mortgages and also on private medical insurance. The sooner we have a full reality check on the state of the nation’s finances, the quicker we’ll recover.
People have remarked on Brian Cowen’s ability to hold the line in the past, but this issue was different. This was unscripted, un-choreographed and straight from the heart. Many of the phone calls and emails have been from people who had difficulty sleeping since Budget day; people who have a State Pension, and sometimes only €2500 or even under €500 a year on top of that. Ironically, many women have small pensions because they had to leave their jobs due the marriage ban and only returned to work when that was reversed. That means they only contributed to a private pension for the last ten or fifteen years of their working life. Their pensions are small, and their fears are real.
I hope that today’s changes go some way towards meeting their concerns.


Unknown said...

Hi Ciaran,
What a missed opportunity for the Green Party to speak out. Ok, be responsible members of government, but for goodness sake don't be struck dumb!
The most logical suggestion that I've heard on the issue came (I think) from Joan Bruton - provide a universal over 70's Medical Card, with no means test. Fund it by taxing the wealthy properly in the first place.
Either we believe in the principle of free health care for the elderly or we don't.
Next Budget issue - education. How on earth does it make sense to cut in this area while we are already behind in class sizes and support?
Michael McElree

Dermod said...

I agree with Michael. Universality is the point, it's not about penny-pinching. And when it comes to health, especially that of the elderly, universality matters.

The Greens in cabinet have proved themselves unable to stand up to the right-wing PD ideology of low-tax, small government. It's time they armed up.

Dermod Moore

Ciarán said...

But universality can create more inequality than it solves. I've had people complaining to me about being over the joint threshold of €36,500, or jointly €73,000.

That is over three times the State pension of €10,000. I believe that those on decent incomes should pay something towards their medical costs. When you look at the demands on Government in the area of local authority housing, the needs of people with disabilities, class sizes, it is clear to me that some contribution should be made by those who are better off.

In the area of education look at the rise in the use of grind school by children in fee-paying secondary schools. The rise in grinds schools occurred after free third level education was introduced, and I feel the money might have been better used if third level was means tested. Then perhaps more State funds could have gone into improving State primary and secondary schools.

Dermod said...

Those on decent incomes over 70 have paid something towards their medical costs - a lifetime of high taxes, up to 60% of their earnings at times.

Universality in health matters much more than education - because health costs diminish if people are in regular contact with their doctors, and if all over-70s are being looked after by the same public health scheme, then intrusive but cost-effective health screening regimes can be put in place to nip disease in the bud. Also, the public health system such as public health nurses etc is much better than what is available to private patients. After a lifetime of high taxes, why shouldn't people have access to that?

I have elderly parents. Like many people across this country, I have hated that they have been made so anxious about medical bills over the past while - because when you're old, no matter how wealthy you are, worry is endemic, and peace of mind is essential.

Unknown said...

Will there be any saving if you consider the administration costs of charging a small percentage of the population?
My point remains the same - tax the wealthy properly, provide universal medical care for the elderly.
I believe that well-off elderly people will in most cases be covered by private health insurance.
And as Dermod points out, health care cost will be reduced if people are encouraged to attend a doctor early, rather than late. Prevention is not only better, but also cheaper than curing.

Anonymous said...

Your income threashold does not take into account people who have huge medical bills eg 783.13 euro that I paid this month alone and I still have to get tablets and pay 90 euro for them (soon to be 100 euro). I will not be voting for any member of the green party again. By the way I am not yet 70 but have lost all hope that I will be safe when I reach that age.

The Galway Tent said...

Who Needs a Medical Card When They Will Be Killed Prematurely?

The planned Dublin Bay Incinerator at Poolbeg will cause up to 300 premature deaths per year (1). Perhaps that means an extra three thousand sick people per year.

Boston, not Berlin.

With 3,000 extra sick people why not sneak in Not-Universal American style health care! That adds to GNP, will increase growth, and will pull The Galway Tent out of the recession.

The Bush controlled US Environmental Protection Agency values Human Resources at about $7.22 million(2). So let's get rid of health care for old people, they have no economic value apart from their life-time savings.



Passively confirmed by Dick Roach (Dail Ref: 12568/07). http://galwaytent.blogspot.com/2008/04/incineration-amsterdam-example-300.html

"By reducing the value of human life, which is really a devious way of cooking the books, the perceived benefits of cleaning up the air seem less," said Frank O'Donnell of the District-based group Clean Air Watch. http://galwaytent.blogspot.com/2008/07/cosmic-markdown-epa-says-life-is-worth.html

A small incinerator in rural Tippereary was stopped by Bord Pleanala after lawyers for John Magnier’s Coolmore group had argued that the facility would be prejudicial to animal health.

Ringsend Death Risk is 20-80 Times Higher With Incinerator.


Conor McCabe said...

ciaran, you got less first preference than Richard Boyd Barrett last time, but more transfers. you think that'll happen next time?

do you think "sorry" is going to let people forget the lacerations that you and your party have given to the old and the poor?

and do you think that there's going to be a pre-election budget splashout in any of the next four years that'll get youse out of this?

you went into this budget hoping to look "tough", but you've only succeeded in looking like bullies.

you shares are lower than Anglo Irish these days. And like Anglo Irish, you both have a government "guarantee" to protect you from the outside world.

But that won't last forever. One of these days the Greens are going to have to leave the Dáil and face the people.

I wouldn't expect a generous respnse.

Anonymous said...

Hi Ciaran,
Just to echo Conor's comments. I've been a supporter of the Greens, in particular Mark Deary in Dundalk (a good example of someone in the party who actually walks the walk), since I got the vote 12 years ago. I've been bitterly disillusioned by the party since the coalition. The medical card thing is the final nail in the coffin. I will find it very difficult to vote Green again.

Kind regards,
Paul McClean

Unknown said...

Conor and Paul,
I can understand your anger at the Green party over the medical card issue, but I feel that taking your vote away from them in the next election is a little premature. They are still the only party to fully recognise the scale of the environmental challenge that we all face, and certainly the only party that can force the FFers to make a genuine effort to face the crisis. After all, if not the Greens, who would you support? They are in government for the first time, and half of their time must be spent in tempering the worst excesses of the gombeen men.
Michael McElree

TheVirginiaAndrew said...

I think a lot of the problem had to do with the stigma around means testing. I lot of people fear it involves intrusive bureaucrats going through your cupboard and seeing what you can afford. So long as means testing is conducted without the presumption that the recipient is dishonest, then it really isn't that bad.
Also, I'm yet to see a convincing argument as to why there should be an upper age limit to the wealthy paying their way in society. There is the old argument that they have 'paid their way' long enough. But just because they managed to stay alive into their seventies - and put together a good pension along the way - is no reason for them to receive additional state support at a time when there are other areas that need such funding.

Conor McCabe said...

Hi MicMac, just to clarify something. I'm one of those people who always gave the Greens a transfer - going back to the 1980s. So, as far as a first preference goes, I'd normally give it to a Labour candidate (I am not a member of any party), and then transfer to the Greens. So, I'd be a "soft" Green voter, but a Green voter none the less. And it's that "soft" Green vote that's been completely alienated by the Green party's actions over the past year, culminating in this budget, their first with TWO cabinet ministers at the table, which has seen an attack not only on the elderly, but also on the Combat Poverty Agency (scrapped), widespread and reprehensible cuts in Education (one of our few competitive advantages in this globalized market), while at the same time authorizing €500 million euro of taxpayers' money to be used in a farcical attempt to prop up property prices via this ridiculous home loan scheme.

And that's before we get into the fact that unproductive capital in Ireland remains almost untouched, while productive capital and labour gets taxed to its eyeballs. In economic terms, in this climate, well that's suicide.

The Greens have got to ask themselves, given the fact that the majority of their TDs scraped home on transfers, whether my reaction as a "soft" Green voter to never vote for these Greens again, is the exception or the rule.

If ye think that my reaction is the exception, well then, stay in government and ride it out.

If, however, my reaction is the rule, well then, get the hell out of government now, because in the next general election ye will be decimated.

Unknown said...

Hi Conor,
To echo a well worn phrase - I am not now, nor have I ever been, a member of the Green party. Or any other party, for that matter.
That does not detract from my opinion that going Green is the only intelligent and rational way to use my vote at the moment.
There are more people with a genuine concern for the welfare of the people and the future of this country in the Green party than in the other parties combined. To punish the Greens for their partial success in directing the blind beast of FF/PD government is hardly fair.

Ciarán said...

Dermod, I accept the point about the vulnerability of older people. Many of those who contacted me were fearful about ANY change..

Michael, the point about administration costs is a fair one, that is always a downside to having any thresholds.

If anything characterised the emails, letters and calls that I received, it was that people seem prepared to pay additional taxes to prevent reductions in health (or education) coverage. That's my view also, but I wonder was that the general consensus a month ago?

Ria, the costs would be a maximum of €1,200 per annum I presume for someone on over €36,500, but if you believe in universality, then you might well disagree with any charge.

Galway Tent? I've made my objections known through the formal process on the Ringsend Incinerator, and I'd be concerned if the Dublin Local Authorities were changing the ground rules on waste collection to ensure that an incinerator was being guaranteed a supply of fuel.

I don't think a Trotskyite approach will solve this recession. My gut feeling is that green collar jobs will be one of the ways out, rather than increasing State control of production

A question for Paul and Conor: How much blame to you put on us, and how much on our Coalition partners?
Do you feel that the minority party can dominate proceedings on every issue?

The VirginaAndrew. Good point. A typical example is a couple in their 40s, 4 kids, household income, €45,000, and two of the older kids have asthma. How less deserving are they of a medical card than an over 70 year couple with €65,000 household income?

I take the point about the need to tackle unproductive capital. There WAS an increase in Capital Gains Tax, but I'd be happy to see much greater tax increases on higher incomes.

On a different issue: some good news on extraordinary rendition in the Irish Times this morning. In my mind these kind of achievements reflect the limited, but important role of the Greens in government. 6 TDs or two Cabinet Ministers can't dominate Government at every turn, but we do have an important role to play.


Anonymous said...

Hi Ciaran,
All i can say is roll on the local elections.
As someone who stupidly thought the green party might honour some of the pre election promises to deal with isssues including Shannon,Corrib,the environment,Dublin bay incinerator and now with the savage attacks on the elderly,young and those living near or on the poverty line i hope you do as much as you can in the next few months as i doubt you or any of your green party colleagues will see another government infact i would be surprised to see the Green party at all.
Roll on the local elections as i doubt the people who supported and voted for you will forget how you sold them down the river.

Regards Cormac

(PS i notice your green colleague in clonskeagh is driving a lovely 4 x 4 these days,kind of suits the greens in a way).

The Galway Tent said...

Follow Up Comment to "Galway Tent: ... I'd be concerned if the Dublin Local Authorities were changing the ground rules on waste collection to ensure that an incinerator was being guaranteed a supply of fuel.:"

* Is Dublin City Council creating a monopoly of cash-flow for foreign Waste-To-Toxics incineration corporations?

* Who benefits from the apparently legal Directorship and Consulting Doors Revolving between DCC, DDDA, Covanta (Poolbeg), Energy Answers (aka Covanta Rathcoole), EPA-Ireland and Anglo-Irish Bank?

* So far, DCC has spent in excess of €19,000,000 to promote a one-sided case benefiting foreign corporations in the Waste-To-Toxics business. Cynically, no money has been available to provide balanced public information. Who is working for the taxpayers in Dublin?

* DCC's competitor Panda said the main reason the city council wants to re-monopolise the collection system is because DCC has entered into a contract to provide 320,000 tonnes of rubbish per year for the planned municipal waste incinerator at Poolbeg in Dublin.

More at:



Ciarán said...

Galway Tent - That's exactly what I meant

Conor McCabe said...

Ciaran, you reap what you sow. Everybody but the Greens saw this coming. This aint going to get better for you. If the greens can't even muster enough votes to get a councillor in Dublin, what chance a general election? Get out now, for your own sakes.