Medical card failure shows wrong set of priorities

Cartoons about old-style consultants with wretched bedside manners used to carry the label "Trust me, I'm a doctor"

Cartoons about old-style consultants with wretched bedside manners used to carry the label "Trust me, I'm a doctor". This week, the logo changed.

Virtually every elected representative with an interest in healthcare differed on the merits of the new strategies according to party affiliation, yet showed a common thread: "Trust me, I'm a politician".

The claims came fast and furious as various experts debated the merits of the Government's very complicated plans. Facts piled upon facts, details on details. But what was verifiable? In the real world, people continue to get sick, get better, or die. And most will continue to pay dearly for the privilege.

The bottom line for people who aren't experts, which means most people, is whether Government is putting their money where its mouth is. The mouth talks about "product" and "consumers"; the money will total some £10 billion over time. But there's a nagging absence of commitment to people who most need care now, and nothing so far relieves that doubt.

READ MORE

Medical cards are the one area where money and mouths coincide - who gets them, when they get them, and what services they can buy. As a measure of the Government's commitment to its own policy, this would seem among the first places to start.

Yet the Minister, Micheβl Martin, has said that his priority is to put product first, meaning that there'll be no change in medical charge eligibility for at least another two years.

This is a staggering reversal of Fianna Fβil's election slogan way back in 1997 when posters of Bertie Ahern were captioned with the promise Putting People First. Somehow, Putting Product First doesn't have quite the same ring.

The facts about medical cards and fairness have been clearly stated by health professionals and people in need. The cost of visiting a doctor puts many people off accessing healthcare when they need it. The evidence is indisputable: the richer you are, the better your health and the less access to healthcare you need. The poorer you are, the more you need professional help.

It all seems glaringly obvious. But even allowing for Mr McCreevy's stated suspicions about the claims of what he called "the poverty industry", it is puzzling why the Government does not make a gesture on medical cards now. Low levels of eligibility mean that families on little more than a minimum wage can't get them. The cut-off point for two adults and two children is approximately the same as the individual salary increases the Taoiseach, Tβnaiste and other Ministers voted for themselves this year.

Extending the cut-off point has clear political advantages because it gives people instant reassurance that this Government means business. Polls and surveys confirm repeatedly that Irish people say they are willing to postpone short-term personal gain in the interest of the bigger healthcare picture.

This practical altruism is worth noting, and the same trend in the UK led the Chancellor, Gordon Brown, to suggest to the British Parliament this week that better healthcare might justify a small increase in taxes. So far, his counterpart here has made no such sounds, despite consensus on extending medical card eligibility from groups as diverse as the Irish Medical Organisation and the St Vincent de Paul.

It goes without saying - let's say it anyway - that there's no defensible reason why Government should have delayed until now. The politics of health are not so personality driven that they had to await Micheβl Martin's arrival as Minister, or Brian Cowen's departure from the job. But the plan has arrived, and won notable if not universal support; as any change in public policy takes an average five years to deliver, its specific targets deserve a certain amount of time.

At the same time, this fundamental rebranding of the health sector pretends to rely for its presentation on accepting that a new drama is being written where character will determine plot, provided everyone comes on board. So delivering it depends in the first instance, apparently, on the state of relations between Charlie McCreevy and Martin, with Bertie Ahern and Mary Harney as the fairy godmothers who will ultimately decide its fate. This puts voters in a bind: the complexity forces you to rely on the expertise of strangers, yet the outcome has direct effects on daily life.

You can empathise with how, after so much negotiation and discussion, the Minister for Health in particular has become a planoholic, and is in love with the symmetry of what his strategy may achieve longer term. He showed similar enthusiasm for various campaigns against smoking and teenage drinking, although the figures for both have actually risen over the life of this Government.

But what is the point of improving the product when those in most need will find it just as hard to access? People deserve assurance that the choices on which they'll be asked to vote are as clearcut as the Minister claims.

The dichotomy between people and product he identifies has no immediate basis in fact other than his own words. "Trust me, I'm a politician?" A novel claim.

mruane@irish-times.ie