Let’s be honest, ‘medical card probity’ is an excuse to save money

I never have my Concise Oxford Dictionary with me when I need it.

It’s big and bulky to carry, and it’s probably out of date by now. My edition, the eighth, carries the proud message on its cover ‘a new edition for the 1990s’. It includes words and phrases recognised by the dictionary for the first time, including ‘computer virus,’ ‘dosh,’ and ‘electronic mail.’

Of course, if you have the dosh, and access to electronic mail, you can subscribe to the most up-to-date and complete version. But my old version, had I only had it with me at the time, would have been useful to me in understanding the single most fascinating phrase in last week’s budget: ‘medical-card probity’. I didn’t know what it meant when I read it.

None of the budget documents were clear about its meaning. The Concise Oxford Dictionary is clear, however. The word ‘probity’ has only two meanings — uprightness or honesty. From the Latin ‘probus,’ which means ‘good’.

On that basis, the phrase ‘medical-card probity’ can only have one meaning. There are people in Ireland who secured their medical cards in a less than upright or honest way.

The number of such people is so huge that it is costing the rest of us €133m a year.

If that is the case, it’s a scandal that needs to be cleaned up. If there are thousands of people who have medical cards under false pretences, then the rest of us are being cheated.

Those medical cards must be removed immediately.

According to the HSE’s website, medicalcard.ie,there are only two circumstances in which a medical card is supposed to be granted. The first is if a person or family have an income that is within specified limits.

The second, quoting from what the HSE says, refers to “people whose income is over the financial guidelines, but the HSE decides that the financial burden of medical or other exceptional circumstances would cause undue hardship”.

That same website, incidentally, according to the most recent annual report of the HSE, is supposed to contain a weekly processing report of the number of cards issued. If the report is there, I can’t find it. I’ll come back to that point.

But the conditions are clear. Which of them, I wonder, applies to Eirin Nolan O’Connor? You may have read about Eirin, in this paper over the weekend. She is aged 8, profoundly disabled, and in constant pain.

She needs 45 syringes and 18 boxes of medication a day. And her medical card has been withdrawn. Eirin is now receiving extremely expensive care in our Lady’s Hospital in Crumlin.

I don’t know anything about Eirin’s family’s finances. I can’t imagine, however, that anyone objective couldn’t conclude that she is one of those Irish citizens covered by the phrase “the financial burden of medical or other exceptional circumstances would cause undue hardship”.

Is it possible that Eirin has been the victim of a crude paper exercise, designed to save money without any proper or decent examination of her circumstances? Of course it is.

The decision to withdraw Eirin’s medical card had nothing whatsoever to do with uprightness or honesty, nor with decency, compassion, or fairness. It happened as a result of a bureaucratic cull, carried out anonymously and behind closed doors. Reasons don’t have to be given for these decisions, and aren’t.

We know, from the large amount of anecdotal evidence, that someone somewhere has been carrying out sampling exercises. They’re writing letters to groups of people who have medical cards, and if those letters aren’t answered within the required time the card is automatically withdrawn.

That exercise, too, has nothing whatsoever to do with uprightness or honesty.

Of course, some kind of sampling is necessary. The overall statistics are frightening.

Again, according to the HSE’s own figures, the number of people covered by the medical-card scheme has risen by half a million since 2008 — from 1.4m people then to 1.9m by the end of 2012 (that includes 131,000 people covered by GP-only cards). And the cost of the scheme has gone up, too — by the end of 2012 it was a few bob short of €2bn.

If the Government believes there is €133m to be saved by an exercise of honesty and uprightness in relation to medical cards, that means, on average, that they believe one in every 16 medical cards was issued under false pretences.

The Government is refusing to say how many people will lose their cards as a result of the exercise.

I’ve lost count of the number of government ministers I’ve heard saying that people have nothing to fear. But if they believe that probity will produce savings of €133m, then what they’re saying, though they may not admit it, is that 127,000 people or families in Ireland, right now, have medical cards to which they are not entitled, or don’t need.

127,000 medical cards isn’t hard to work out, as a mathematical average. But 127,000 medical cards is 127,000 individuals or families. The assumption that there are that many people in Ireland who have cards and shouldn’t is huge.

It’s clear from the coverage of the budget that the assumption wasn’t made on the basis of honesty and uprightness, but to make the arithmetic add up. They needed to find €133m for that purpose, and the idea of medical-card probity was invented to enable the figure to be written down.

SO, this is not an exercise in hunting down and weeding out chancers who have somehow or other managed to get expensive medical cards to which they’re not entitled. It’s an exercise, like many others, in saving money.

But, now, it’s underway. And from the look of things, it will be carried out behind closed doors.

We won’t be told who is making the 127,000 or so individual decisions that will be necessary, what criteria will be used, what appeal system will be in place, nor how the entire exercise will be carried out.

Whatever happens now, this is a government decision. I don’t carry a torch for Health Minister Dr James Reilly, but the personal pressure being heaped on him in the aftermath of the budget is entirely unfair.

It’s entirely ludicrous when it comes to Fianna Fáil — their game-playing is a joke.

If we need reform of a system that has got out of control, it must be carried out with utter transparency. We are entitled to know who is going to be affected by these decisions, and who is making them. If these cuts are being made on the basis of uprightness and honesty, then the least we’re entitled to is uprightness and honesty in the way they’re implemented. But, if I’m being honest, I have to say I’m not holding my breath.