We’re paying a very high price for those yellow pack medical cards

SO, what happened to all the hype? The kinder, gentler government? The touchy-feely, Fr Sean Healy approach?

Wasn’t the first instalment going to be in the book of estimates, with more to follow in the budget?

Wasn’t that what the Taoiseach was talking about when he called himself socialist, and the Tánaiste when she said she was socially committed? How is all that to be reconciled with the new stealth charges in health, and with the new yellow pack medical cards?

Where’s the socialism, or even the social commitment, in yellow pack medical cards? The Tánaiste has said that the income limits for full medical cards will rise by about 7.5%, and that the yellow pack cards will be given to people whose incomes are about a quarter above that.

In the case of a married couple with no children, that means they will be entitled to a medical card if they have an income of around €222 a week. And they will be entitled to the new, so-called doctor-only cards if their income represents the princely sum of around €278 a week.

What’s the difference between the two types of card. First of all, the medical card is regarded as a test of eligibility for a lot of different things. Specifically in relation to health, a medical card entitles a family to GP services, prescribed drugs and medicines, all in-patient public hospital services in public wards (including consultant services), all out-patient public hospital services (including consultant services), dental, ophthalmic and aural services and appliances, and a maternity and infant care service. With the new card, the married couple on €278 a week have to pay for everything except the visit to the doctor.

Why was this new card introduced? To keep a promise, at least in public relations terms, and save money at the same time. No other reason. The promise, at the time of the last election, was for 200,000 extra medical cards, and guess what? There’ll be about 200,000 of the yellow pack cards.

The increase of 7.5% in the income limit for full medical cards will result in about 30,000 more medical cards for families who desperately need them.

Since it was first elected in 1997, this Government has effectively removed about 212,000 medical cards from the system, around 103,000 of them since they were re-elected in 2002. The only new cards introduced are the 30,000 in the book of estimates. They would have needed to introduce 212,000 just to catch up on the ones they have taken away from families, let alone to go anywhere near meeting the promise of 200,000 extra.

So, another broken promise. And in this book of estimates, the broken promise is compounded by all the new health charges. Guess who they will affect most? Yes, the people on low incomes who have lost their medical cards at the hands of the socialist Taoiseach and the socially-committed Tánaiste.

One of the ways in which they express their commitment to the poor and underprivileged, it seems, is by trying to keep them out of A&E departments. That’s why they have been steadily driving up the price of a visit to A&E. In 2002, they put it up from €31.70 to €40. In 2004, they put it up to €45. And now it’s gone up to €55.

Each time, they carefully try to arrange the increase so that bringing a sick child to casualty is around the same price, or slightly more expensive, than bring a sick child to a GP. This is crude economics - the principle is that people will do the cheaper thing. If it’s cheaper to go to the GP, all these low-income people won’t be clogging up the casualty departments with their sick children.

The assumption behind a policy like this, of course, is that people are abusing casualty. You bring a sick child to the casualty department, you wait four hours (if you’re lucky) to have the child seen, and another couple of hours for treatment. You might have to bring other kids with you because there’s no-one to mind them. You expose all your kids to the sometimes terrible sights that are to be seen in casualty departments. And all because you want to abuse the system and save a euro or two over the cost of a visit to a GP.

I’m sure there must be some people who are into that kind of abuse. But the truth is that the vast majority of people who go to casualty, especially with sick children, are frightened. They want the most help they can get for their child. And our socialists are using economics to drive them out.

THIS is the sort of thing the Government has become very good at over the years. They’re called stealth charges. The Government goes on and on about how much they have reduced our taxes, and all the time they are making essential public services more and more expensive. Shoving up the cost of a visit to casualty is a classic stealth charge, and it has another characteristic loved by this Government. The lower your income, the harder it hurts.

The people just over the medical card limit, the ones who might now qualify for yellow pack cards, will discover they have to pay for all drugs and medicines. Of course you can qualify for a refund, over a certain amount each month. But lo and behold, you’re about to discover another stealth charge. The Government has raised the refund threshold.

The threshold has gone up to €85 - in other words, you’re not entitled to any help with the cost of the drugs until you have paid out €85. This is the fourth such increase since the election of 2002. It has been increased from €53 to €65 to €70 to €78 and now to €85.

This represents a €32 increase in the cost of drugs per month since 2002 - that is a 37% increase in two years. In a calendar year, this will mean that an individual/family with no medical card, or with a yellow pack card, will pay up to €1,020 per annum for prescription drugs, or €384 extra per year as a result of the increases in the refund threshold since 2002.

And here’s another cheap and nasty stealth charge. The cost of an overnight stay in a public hospital (to a maximum of ten nights in a year) has been increased again to €55. This increase of €10 follows an increase of €5 last year and an increase of €4 in 2002 - a net increase of 35% in two years.

The Government constantly whinges about how much extra it is spending on the health services. They never tell us how much more expensive they are making it, for thousands of low income families, to gain access to the health services.

Increasingly, it is one of the factors in the development of the two-tier health system. In the hands of this Government, access by ordinary people to the health service they need has increasingly become much less a matter of ‘what’s wrong with you?’, and much more a mater of ‘how much can you afford?’