In the days running up to the Cabinet reshuffle, some colleagues of Leo Varadkar believed he would not become health minister, because the Taoiseach wanted to see a period where the department was kept out of the headlines.
One minister observed that, instead of treading carefully to avoid all the landmines in the department nicknamed Angola, Leo would walk in and pick up each explosive device and deal with them one at a time.
Ultimately, he got the job and few around him doubted he would make an impact and, in the short time he’ll have before the next election, would introduce a level of competency in addressing the health system’s many weaknesses.
One prediction has proven correct: Less than two weeks into the job, he has been making headlines and stirring debate — on the thorny issue of medical cards.
The health minister has explained that plans to introduce a new type of medical card, based on medical need or a specific condition such as Down Syndrome, may not be practicably possible.
“Personally, I think it’s going to be very difficult to create a hierarchy of illnesses and, even with illnesses, there is severity within illnesses, and also co-morbidities as well,” he told reporters on Friday.
“And if you look at the international classification of disease, things like obesity and overweight are considered to be illnesses too. So, you would be potentially extending the medical card to almost the entire population, which would not be realistic.”
His comments appear to mark a significant shift in the Government’s plans — drawn up hastily in the days after the election drubbing — to bring in new laws governing who should be entitled to a medical card, based on their medical requirements. They have created some uncertainty for the 13,000 people who have begun having their discretionary medical cards restored in recent weeks after the Government admitted it could not stand over many cases of cards being withdrawn from seriously-ill patients. Those cards will expire next July, and provide only a stop-gap measure until the new legislation is in place.
Mr Varadkar’s comments have angered parent groups, who protested outside the Dáil yesterday and demanded the Taoiseach clarify where the policy stands.
His words caught the attention of some Fine Gael backbenchers, faced at their doors by queues of constituents who have complaints about either losing their medical cards or not being able to get one in the first place.
Some of the TDs had initially wanted the laws allowing for cards based on illness or condition to be passed ahead of the Dáil summer recess.
They still insist they will hold the Taoiseach to his commitment that the issue will be addressed.
“I would prefer to hear the minister talk about how he will deal with it, rather than pouring cold water on the idea,” one Fine Gael TD said last night.
Campaign group Our Children’s Health said that the minister had shown a “personal lack of commitment” to following through on the changes.
Mr Varadkar has stressed he will await the outcome of an expert panel deciding what conditions should result in medical card eligibility.
However, far from trying to create uncertainty, he is simply tempering expectations there will be a quick fix for this complex issue by saying there will be significant challenges in bringing in any such laws.
“You would need to have the wisdom of Solomon to decide which illnesses should entitle you automatically to medical cards and which ones should not,” he said in a follow-up statement yesterday. “But if the expert panel can come up with proposals that are fair and affordable, I’ll consider them in depth.”
The plan to award medical cards based on medical need was always going to very tricky. Determining that one set of illnesses or conditions should result in automatic entitlement will inevitably leave other groups feeling aggrieved, if excluded.
With such strong utterances — including from the Taoiseach, who expressed “sadness” at how some people were treated — there was a fear many groups will be lining up to ensure they are included in any new medical card regime.
Mr Varadkar needs to lay down a marker on coming into office that not everyone will get their way.
As the minister points out, there are levels of severity within illnesses. So, a person with an illness or disability not classified as a deserving a medical card might miss out, even if they are far sicker than a person who is legally entitled to a card.
Furthermore, the Department of Health is likely to meet similar legal obstacles to those that got in the way of plans to provide free GP care for those with long-term illnesses.
Moreover, the Cabinet still has to find the money to pay for an expanded system. Some €113m of savings were envisaged through the ‘probity’ exercise in last October’s budget — a figure later pared down to €23m.
If these new laws are to get across the line, then they will take longer than expected and will leave many people unhappy.
The minister, it seems, is preparing the public for such a scenario.
If the laws prove too tricky, then it might be back to the system of discretion that has applied for more than 30 years — something that would prove to be politically costly.
Either way, it seems the controversy over medical cards is not going away.