Why getting it wrong can be so harmful to those most in need

For such a complex issue, the ongoing medical card crisis — which is quickly descending into scandal — was explained in remarkably simple terms at Thursday’s health committee meeting.

In the final moments of the marathon four-hour discussion, Independent senator and co-founder of the Jack and Jill Foundation, Mary Ann O’Brien, raised the story of a terminally ill baby, who had to wait for vital, time-specific care.

“I have a case where a baby was born in the Coombe who was transferred to Our Lady’s in Crumlin. It took a week to get the child a medical card.

“In fact, Crumlin and the Jack and Jill had to pay for the supply of equipment to feed the child, to get the child home, so the child can die at home,” Ms O’Brien said, before explaining: “We have two realities here.”

Those five simple words cut through the growing forest of confusion surrounding the medical card dispute, and show why it is fast becoming the biggest budget battle.

Due to the €666m worth of cuts imposed on his department, Health Minister James Reilly is under intense pressure to save the sector money. This includes a massive €113m officials claim can be taken out of the medical card fund.

But while the minister says genuine patients in need of help have nothing to fear by the “probity” measure, a lengthy line of cases — the latest of which is detailed today — show the exact opposite is taking place.

In health’s attempt to cut back on costs, genuine patients are being wrongly targeted, either by accident or by design. And the result is a situation which should bring shame on those involved.

It is important to note the €113m medical card cuts figure was, according to health service officials, foisted on them by the Department of Public Expenditure and Reform after 11th-hour discussions last weekend.

This issue is part inter-party politics and part poor maths.

The €113m figure is based on an Apr 2012 PwC report which suggested €65m to €210m could be cut from the system by removing cards from people who have already died, have moved abroad or who no longer need them.

Nobody is saying such a step is a bad idea.

But what appears to have been missed by government officials in calculating the savings rate based on the PwC document is that a disclaimer in the report said the figure was not based on any audit or analysis of who is receiving the cards.

The HSE made this exact point to this newspaper 18 months ago, and it was repeated again by the Comptroller and Auditor General just last month.

But for some, unexplained reason, this calculation — which has put even more pressure on the health service to cut back on patient services — appears to have been missed during Public Expenditure and Health inter-department talks.

Legitimate medical card holders are now even more likely than before to pay the price.

To his credit, Dr Reilly was moved after hearing the case of the terminally ill child at Thursday’s health committee, and insisted the situation should not be allowed to happen — regardless of the financial situation.

He is a medical professional, and there is no doubt he took the health portfolio to help — not hinder — those in need. However, as the past week has again shown, this is far from easy amid an economic crisis and while inter-departmental wrangling is impacting on what the health service has at its disposal.

Since the Irish Examiner first revealed the discretionary medical card crisis in early July, Dr Reilly has been at pains to state no one who genuinely needs the help will see it taken away.

The best way to prove this is to ensure such tragic cases do not occur in the first place — and to accept that, despite the official line, there is a serious problem in the medical card system.

Q. What difference will the tax relief changes make to me?

A. Up to now, if you were a health insurance customer with a €1,500 policy, you got 20% tax relief on the entire payment. This tax relief was taken out at source so you only paid €1,200. However under the new plan, you will only get tax relief on the first €1,000 that you pay so you will end up paying €1,300 and you won’t get tax relief on the final €500.

Q.There has been talk about the elderly being worst affected by this. How?

A. Very many elderly people, because they use medical services more frequently, tend to have more expensive policies as they want access to private hospitals without having to first pay a €400 excess as is common with the cheaper policies taken out by young families. Many old people are on plans such as VHI Plan B, which now costs €2,771 but would cost €3,400 without the 20% in tax relief that is deducted at source.

Q.How will I avoid this increase as I’m being put to the pin of my collar trying to keep up my insurance as it is?

A. The advice would be to shop around to see if you could get sufficient coverage on a cheaper plan as the bottom line is that the cheaper your policy is, the less tax you will pay.

Q.But what about the future? Surely this tax will cost more and more as premiums increase.

A. Yes, that is the fear. Already, the health insurance industry is expecting a €30m bill next year when the health minister starts, for the first time ever, charging private patients the full cost of a bed in a public hospital. This will further increase premiums next year and as the basic premium rises, we will be expected to pay more without tax relief.