Government medical card crisis deepens

19 October 2008  By Pat Leahy and Aileen O’Meara

The government was in the midst of a full-blown political crisis this weekend over the withdrawal of universal medical card coverage for the over-70s, as ministers struggled to deal with the massive public fallout from the budget decision.

Government TDs insisted that the partial climbdown announced by Taoiseach Brian Cowen on Friday night did not go far enough, and were telling ministers this weekend that the plans to amend the medical card scheme would have to be at least postponed.

With a Dáil vote scheduled for Wednesday on a Fine Gael motion on the issue, the controversy is now threatening the future of the coalition.

Crisis contacts between ministers continued over the weekend, and the Taoiseach’s office considered delaying his departure to China on a trade mission today.

Despite insistence from the Taoiseach and Minister for Health Mary Harney that universal coverage for the over-70s was not sustainable, TDs said that the decision should be suspended to allow for a review of the arrangements with the Irish Medical Organisation to take place.

Senior political sources said that Mary Harney had threatened to resign if the Taoiseach announced a complete U-turn on the issue, though sources close to Harney said that resignation was not an issue.

Nonetheless, usually reliable sources said that several ministers had advised the Taoiseach that there was no alternative to reversing the decision, given the extent of the public outcry.

The government could lose Dáil votes on the issue, either on the Fine Gael motion next week or on the social welfare bill or the finance bill to come, they warned.

Such a defeat would prompt a general election.

A spokesman for the Green Party said that it would not pre-empt the review of the medical card arrangements, but he declined to back the ending of the universal provision. Senior Greens believe the decision will have to be reversed.

Sensing the government’s vulnerability, the Labour Party said there were many other cutbacks in the budget that would cause as much public anger as the medical card decision, pointing to the 1 per cent income levy and the increase in class sizes.

In an effort to shift the focus onto doctors, the government will now ask the IMO to review the fees its members charge the state for medical card patients.

The lowest capitation fees for family doctors treating medical card patients would rise in any future agreement with GPs, a spokesman for the Minister for Health has predicted, as the Department would be offering a payment in the ‘‘middle ground’’ between the lower and higher fees currently being paid.

From the beginning, the scheme created huge benefits for GP practices in better-off areas, but further disadvantaged doctors’ practices based in poorer areas.

‘‘The figures show that the scheme was completely skewed in favour of the so-called ‘gold coast’ practices, many of them in south county Dublin. In any new arrangement, we would be bringing up the basic fee to the middle ground," the spokesman said.

Fees to doctors account for €86m of the €100m proposed savings in the abolition of the full medical card for one-third of the existing pensioners who receive it.

The full cost of giving free medical care to all over-70s is €245 million.