An unhealthy price paid for entitlements

FREE stuff is great. Back in the day, when I was allegedly a student, free drink was the big thing. An alcohol company would sponsor some college event, and throw in a few barrels. That beer went down really smooth. While knocking it back, myself and a friend might catch each other’s eye across the room, raise our glasses and exchange conspiratorial grins to acknowledge that we were on the pig’s back.

An unhealthy price paid for entitlements

The problem was that pretty soon the only college events worth attending were those offering free booze. It came to be regarded as nothing less than an entitlement. How could you be expected to get through any of these events without the aid of a soft lens of alcohol, poured free gratis? There is nothing easier to engender in a human being than a sense of entitlement.

Whether the issue is completely trivial — or even obnoxious as above — or involves the most primal instincts, once a person believes they are entitled to something, a sense of grievance will attach if they are denied it. This is particularly the case when the matter at hand is free of cost.

So it is bound to go with the serious issue of free GP care for children under six years of age. The measure, announced in conjunction with last week’s budget, is being advertised as a progressive step in the area of health care. A sceptical view might be that it is little more than a political stroke. At a time when austerity fatigue has set in, the Government needed a sweetener, something to damp down political fall-out from more cuts. What better defence than to declare: “Don’t hit me with free healthcare for the child in my arms.”

The line being propagated is that this is the first step in the coalition’s commitment to provide free GP care for everybody. Do you believe that? Do you really believe that at a time when the health system is creaking and leaking, the cost involved in free GP care for all will be thrown into the mix? The smart money says that by the time the next election comes around, free GP care for all will feature in the coalition parties’ respective manifestos. Inevitably, those who find themselves in the next government will then put it on the never, never, Meanwhile, the measure announced last week is to come into force next year.

Thereafter, it will quickly come to be regarded by parents everywhere as a cast iron entitlement. In political terms, this means it cannot be touched, unless there is an economic collapse to rival that which occurred in 2008.

Who will pay for this new entitlement? The Government has put the cost at €35m. Back in 2001, when the then Fianna Fáil/PD administration introduced medical cards for all Over-70s, the cost was put at €20m. It actually cost nearly four times that and was rising all the time before the scheme was partially cut in 2009.

By the previous year, it had cost €89m.

One of the main reasons for the serious underestimate of the cost was that the Government hadn’t negotiated with GPs prior to the announcement. Then, with the measure already out there, the doctors had the Government over a barrel, and demanded four times what they were receiving for each existing medical card.

The man negotiating of behalf of the GPs at the time was the then chairman of the IMO, one James Reilly.

You might think that he, above all people, would have put the benefit of his experience as a poacher to inform the decision he was now making as a gatekeeper.

You might think he would insist on negotiating cost with the GPs prior to the announcement. Not a chance. To do that might be to bring logic and prudence to a politically driven decision. Let’s hope that this measure doesn’t cost four times the original estimate, but have no doubt that it will cost a lot more than €35m.

Where will the money come from? Certainly not tax. That would be charging citizens for free stuff, which defeats the political purpose.

Instead, it will have to be found from somewhere within the health budget. Maybe the money can be rooted out of the medical card scheme, which is earmarked for a saving of €113m.

Already, most observers who are familiar with the details of health economics find this projection to lack all credibility, but let’s just look at what’s already underway in gathering in these savings.

It is now quite obvious that the HSE has tightened the rules in granting discretionary medical cards. There are around 20,000 fewer discretionary cards than there was three years ago. Among those who have been told by the HSE to whistle Dixie are a number of children with disabilities, such as 8-year-old Ronan Woodhouse.

As reported in the Irish Examiner last week, Ronan is Down’s syndrome and suffers chronic asthma, sight difficulties, hearing loss, and thyroid problems. He stood in the cold for three hours outside the Fine Gael conference in Limerick last Saturday in an attempt to meet Enda Kenny and ask him why his medical card was withdrawn.

Children like Ronan don’t have an entitlement to a medical card because people with disabilities do not have rights attaching to their conditions in this country. Instead, their plight is treated with compassion when times are good, and callousness when resources are tight.

This is the context in which the new free GP scheme should be viewed. A 7-year-old with even the severest disabilities will have to pay for her doctor’s visit and medicines if her parents are above the threshold for qualification for a medical card. At a time of bare State coffers, no account is taken of the disproportionate cost involved for the family. No account is taken of the non-financial stress involved in caring for a child with a disability. Decisions are made on bare figures and legal entitlements.

Yet a healthy 5-year-old from the same socio economic background can be brought to the GP if he as much as sneezes, with no cost to the parents. From now on, running to the GP on the flimsiest of bases will be regarded as an entitlement, whatever the cost to the State.

This is what passes for governance in an alleged Republic. The health system is fashioned to accommodate political imperatives rather than the best healthcare for all citizens. So adults or children with disabilities cannot be afforded rights based on their conditions because it might cost the state too much. Yet healthy children are afforded such rights, irrespective of cost to the State, including the curtailment of other services.

We’ve been here before. The free medical card for Over-70s was a blatant political stroke. The abolition of third-level fees in 1996 echoes eerily with the current free GP proposal. In both cases, the Labour party needed to arrest a slide in the polls by giving out free stuff under the cynical guise of egalitarianism.

Isn’t it amazing, that despite all we’ve been through in recent years, how so little has changed?

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