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Over 70s medical cards – an idea.
Read more about: Comment, Fianna Fail, Fine Gael, Health 
I’m talking out of turn here politically, but if anyone is interested in a practical solution to the over 70s medical card fiasco, there’s my tuppence worth.
I might be asking a rather obvious question here but if the GPs charge the state €640 (the figure itself isn’t really relevant at the moment) for giving people over 70 a level of care consistent with a medical card then shouldn’t it be possible to set a number of bands of support and tailor the subvention from the state towards that €640 annualised figure that would relate to your income (we could look to factor in assets too but that would probably be really messy and costly to administrate).
So let everyone under 17K (or whatever the annualised figure for the minimum wage is) per annum get 100% of that GP yearly charge paid by the state,
those between 17K and the average industry wage gets 75% of the figure paid by the state and pays 25% themselves (which at 100 odd quid for as many visits as you like isn’t very bad value.)
Those at the 130% of the average industry wage pay 50%
those at 150% of the AIW pay 75% and
those on pensions over twice the AIW can pay the full whack or pay per visit.
I wonder if anyone will take the idea up, I’ve also no idea how much it would save. But this is the sort of pragmatic idea that our politics lacks. I believe that the government has acted in bad faith by removing the cover, but it also acted badly by providing the cover in such a profligate manner by giving the cover to all and sundry irrespective of income or wealth. I’ve long believed that the all or nothing status of the medical card is just plain wrong. This idea could be extended to all citizens. In effect I’m suggesting that you would be able to get GP cover for an annualised fee if you so wished and depending on your income the state would subvent part of that.
Perhaps someone from the department of finance might look to run the numbers…
Dan,
I like the way you are thinking, but it seems a bit complicated to me.
A similar, but I think simpler, solution would be to make it like the DPS (Drug Payment Scheme).
Under the DPS I get as many prescriptions as I have to from my pharmacy, but only ever pay a maximum of €100 per month. So if you just go for €30 of antibiotics you pay €30. But if I go and get €500 of complex blood pressure tablets, I pay €100 (per month) and the state makes up the difference.
So perhaps there could be a medical card which would ensure that an person over 70 would pay a max of €200 per annum on GP visits, with the excess covered by the state?
In part the idea has been superseded by this “Because doctors get € 480 for the new over-70s medical card holders as against €135 for over-70s who qualified on the basis of a medical card, GPs in affluent areas with many older patients have benefited most.
Dr Reilly described this as an “unforeseen consequence” of the deal. The €1,650 annual cost of a medical card for over-70s would be more than exceeded if they were forced through lack of medical attention to spend a single day in hospital, he pointed out.”
taken from here
http://www.irishtimes.com/newspaper/ireland/2008/1018/1224279408567.html
So it appears the cost of the GP side of providing the coverage is less than one third of the total cost of the scheme. This means that my idea/proposal would only be addressing less than 1/3 of the cost. However, it also means that the Taoiseach’s talk over the last 48 hours of talking with the IMO would also be touching on only one third of the cost and so it will all be next to useless. Also, there is the not so minor legal matter that as doctors are self employed the IMO can’t do a deal on their behalf now because to do so would amount to price fixing! Where does the rest of the money go I wonder? Drugs? Didn’t the HSE already tie itself in legal knots recently trying to reduce the amounts paid to chemists? Was the scheme itself canned because the government realised they no longer have the means to control the costs?
I think the politics and the furore have run ahead of basic common sense. To me it always seemed criminally wrong to give free medical care to wealthy individuals over 70 while leaving families just over a limit without cover. It was called for what it was when it came out – a stroke to pull votes. It was wrong then and it is wrong now and should be unwound. (I happen to be in favour of a more generalised health system where access is pretty much free for everyone, but I’m against selecting wealthy people for free care simply because they usually vote)
Having said that, there are times when the political momentum gets to big even against sound ideas (though I admit the idea in this case was poorly thought out and badly explained).
In the end I think Cowen is going to have to do a form of U-turn. It remains to be seen what kind of nuts and bolts are involved. In any case the amount to be ‘saved’ here is irrelevant when you see the size of the hole in the finances and I’m inclined to agree with those who say the problem with this budget is that it doesn’t come close to solving the overall problem – though I’m certain that in the weeks and months ahead there will be a drip drip of substantial cuts in departmental spending, much of which is only being worked out right now.