23 March 2004
Dr. Henry: I thank Senator Norris for sharing his time.
Something that concerns me about the presentation of the Bill is that it seems to be taken as though it is in isolation and does not affect people in any respect other than through increases which are definitely being given. I am most concerned with the appalling decline in the number of people who now have medical cards, and as a pharmacist the Minister of State will know this very well.
Ten years ago 35% of the population was covered by medical cards and now we are down to 29%, despite the fact that everyone over 70 years is now included as a medical card holder. When the Department of Health and Children was calculating how many people would be entitled to cards they decided it would be between 30,000 and 40,000, though as the Minister knows it was nearer 70,000 people. Despite this huge increase in numbers we still have a drastic fall in the numbers entitled to free medical treatment and the Minister of State will know that is hitting people very hard.
Married couples earning just over €206.50 per week have to pay €40 to attend a general practitioner and some of them simply do not go because they cannot afford to. There are still people on low pay in the country who would have been covered some years ago, but despite the increases a section of the population is worse off now for health cover than ten years ago. For example, even people with medical cards must pay to see a chiropodist. As the Minister of State knows, it is ten years since there was an increase in the amount of money given to chiropodists for visits by medical card holders. The equivalent of €18 may have seemed fine at that time, and whatever the Minister may feel about people not deserving an increase for their services - I doubt he feels that - materials have increased enormously in cost. Older people must now pay a top-up fee to many chiropodists and this is not helped by the fact that there has been no agreement since 1997 on what qualification for chiropody or podiatry is recognised by the Department of Health and Children. These matters are hitting very poor people.
There is also an increase in the amount people must pay per month -€78 - if they are on long-term drug programmes. Many people who are just outside the medical card threshold are affected by this. Those earning approximately €220 per week have to pay one fifth of their wages for a visit to the doctor while payment for drugs, if necessary, will account for another fifth of their monthly earnings. Those are very large amounts of money for some people and I wish such a huge chasm was not developing between the Departments of Health and Children and Social and Family Affairs. Those two Departments must work together.
The Government is proud of the increases it has introduced, which have been very good. At the same time, the cases of those who are losing out must be examined. I remember a triumph for those on low incomes who did not receive the benefits of those on State payments, such as the free telephone allowance. This was when Proinsias De Rossa was Minister for Social Welfare and I explained to him that many people on private pensions got little more than those on public pensions and got none of the benefits. I was glad he extended some of those benefits to private pensioners within 20% of the State pension and I am pleased these have not been touched, as such a move would have been very regressive.
I have always admired the staff of the Department of Social and Family Affairs in that they try to understand that there are people trying to exist on very limited sums of money. I realise the Government is trying to do its best for them but one Department must look at what is happening in other Departments. People are becoming marginalised and there are problems such as the serious decrease in the number of medical card holders.
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