Handing out medical cards on the basis of illness is the wrong way to go

Opinion: Resources will inevitably be taken away from others with greater financial need

‘We’ve been down this dubious road of universal entitlement before. Free university fees were sold as the way to get working class kids into college but ended up overwhelmingly subsidising the education costs of the middle classes. The distribution of free medical cards for all over-70s had to be reversed within a decade.’ Above, people taking part in a protest about  medical cards for those aged 70 and over, in 2008. Photograph: Eric Luke

‘We’ve been down this dubious road of universal entitlement before. Free university fees were sold as the way to get working class kids into college but ended up overwhelmingly subsidising the education costs of the middle classes. The distribution of free medical cards for all over-70s had to be reversed within a decade.’ Above, people taking part in a protest about medical cards for those aged 70 and over, in 2008. Photograph: Eric Luke

Wed, Jun 11, 2014, 00:01

Given the debate that has taken place over the last month, you might be forgiven for thinking that a harsh bureaucracy, egged on a heartless political class with no mandate, has savagely ripped medical cards out of the hands of sick children and their families.

There may be some truth to the various elements of this statement, but it is hard to find. There has been a drop of 30,000 in the number of discretionary cards, and a drop of about 55,000 in the total number of medical cards.

Some of these changes are due to people being moved between the different variants of card, others are a result of people returning to work.

The centralisation of card processing has hit people living in areas where discretion was being applied more generously than elsewhere. About 3 per cent of reviews of discretionary cards has resulted in removal.

Scores of cases have been reported in the media in which people have cried foul over the removal of cards, or the refusal to grant cards. Even Government Ministers have said they couldn’t stand over what happened in some of these cases.

Problematic decisions

But the tone and scale of the problem as portrayed in reports is well wide of the mark. Problematic decisions, while they exist, are a small fraction of the overall number of card reviews. There are appeal mechanisms and fallback entitlements in situations where a medical card has been refused.

The State is not miserly in the granting of medical cards. There are almost two million in circulation, so the poor and the low-waged are covered.

There are times of illness when our medical needs soar, possibly beyond our means. That’s why the discretionary process is there. The exercise of discretion in granting a medical card wasn’t working very evenly, with patients in some parts of the country six times more likely to get a card this way. Or, more pertinently, patients in other parts of the country were six times less likely to get a card through the exercise of discretion.

Where a person fails to qualify for a medical card, there are other options. They may yet qualify for a GP visit card, which doesn’t cover the cost of drugs. For certain conditions their medical costs will be covered by the long-term illness scheme. It was wrong that successive ministers refused to update the list of conditions covered by the scheme.

Drug payment scheme

The next fallback is the drug payment scheme. Thresholds here have been raised but at present no family (not individual) has to pay more than €144 a month for drugs.

That caps their spending at well under €2,000 a year, a sizable sum without doubt but one that upper-middle class families should be able to afford.

Little of this context was provided in the highly emotive presentation of the controversy over recent months. Claims that people were asked by officials if they “still had MS” or if their child’s Down syndrome “has got better” became part of the folklore.

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