From a health point of view, the big question about Budget 2002 is: will the Government yield to demands to ease the means test for the medical card? The answer is that we don't know, but probably not.
The announcement this week that medical card limits would not be increased until 2003 brought cries of outrage from doctors and the Society of St Vincent de Paul.
But what was preoccupying Joe Duffy's radio listeners the next day was not medical cards - it was the apparent massacre of Taliban in Afghanistan. That's not a particularly scientific way of gauging the strength of public opinion on an issue but it suggests this one may be a slower burner than might have been expected.
There is no doubt that poverty groups and the Irish Medical Organisation will continue to embarrass the Government on the issue - but the change may come in the election manifesto (some time in the next six months or so) and not in the Budget.
The Budget, traditionally, is of less significance for health services than for other areas of spending. Usually, health spending is outlined in the earlier Estimates and there is little extra in the Budget.
But this is not a normal year. Health is a big issue, an election is looming and the Government may want to regain some of the ground lost over medical cards by addressing other health issues. The possibilities are:
Nursing home subvention: At a maximum of £150 (€190) per week for the most dependent people, this subvention falls far short of the cost of nursing home care which can be as high as £500 a week or more. The issue affects urban and rural families and a move on this would be popular. Uncertainty arises, however, as a result of the view of the Minister for Health and Children, Mr Martin, that an increase in the subvention earlier this year simply led to some nursing homes putting up their fees. But this may not put off the Minister for Finance who paints in broader brushstrokes than his Cabinet colleague. And there may be an announcement of funding for a pilot scheme to pay a subvention to families to keep older people out of nursing homes and of a grant to pay for two weeks' respite care per annum for dependent older people. Such a subvention has the support of Mr Martin and forms part of the national health strategy but initially it is likely to be introduced in some areas on an experimental basis.
Cigarette prices: Often seen in purely fiscal terms, the pricing of cigarettes is increasingly seen as a health issue. The Office for Tobacco Control - an official body which advises the Minister for Health - has been making much of the running on this, calling for a doubling of cigarette prices to deter children and teenagers from taking up the habit. Indeed, the national health strategy states that "a reduction in smoking will continue to be targeted through Government fiscal policies". If words mean anything, this should mean a hefty rise in the price of cigarettes - but will the Minister want to hurt smokers in what is the run-up to a general election?
Extra GP visits for infants: The Government is committed to paying for four extra GP visits under the Maternity and Infant Care Scheme, for the first year of life, to cover general childhood illnesses. Currently two visits a year are covered. Such a move might be portrayed in such a way as to take some of the sting out of the freeze on extending medical card eligibility but it is doubtful if anyone will be convinced. Nevertheless, it would be of value to parents in the first year of a child's life and was referred to by Mr Martin during the week while defending the decision on medical cards.
Dublin allowance for nurses: There is a growing consensus that nurses working in Dublin should be paid a special allowance to help defray the high cost of accommodation and hassle with transport. Such a move is supported by hospital managers and by the Irish Nurses' Organisation. The fear is that everyone else in the capital will want a "Dublin weighting" too. However, it may be possible to ringfence such an allowance and confine it to the hospitals and to nurses and paramedical, many of whom share the desirable characteristic of living in Mr McCreevy's constituency.
Carers' Allowance: The State's cares prop up the health services by looking after incapacitated relatives who would otherwise have to be institutionalised at enormous cost. But the means test for the Care's Allowance has been a constant source of dissatisfaction among tens of thousands of cares. Some improvements might be expected in the Budget. For instance, the means test may be eased or the Care's Allowance may be disregarded for income tax purposes. But cares have been disappointed in the past and this Budget may be the same.
