Drama on the cards in Cowen climbdown

The only commodity that has not diminished in value for Brian Cowen's Government is drama.

The only commodity that has not diminished in value for Brian Cowen's Government is drama.

This is the fourth time since Brian Cowen has come to office that a hastily arranged press conference has been convened to make a major announcement of national significance.

The first was in July when the Government first made public the parlous state of the public finances. The second was at the end of the summer when

it was announced that Budget was being brought forward. The third was a few weeks ago when the Taoiseach and Minister for Finance Brian Lenihan burned the midnight oil to serve up to the nation - like freshly-baked brown bread - a €440 billion bank-rescue plan early that morning.

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And this morning we had the fourth such moment of high drama. At 8.45am a press notice went out saying there would be a press conference only an hour later.

Quite patently, this was not planned. When Government people have talked about the events of the past week, they have referred to a "fluid situation".

That is a polite way of saying two things: we are flying by the seat of our pants and we are making it up as we go along.

It is beyond dispute that the Budget-day decision to withdraw the automatic right to a medical card from over 70s was a fiasco.

The rationale behind the decision is correct. If you were a poor person who had a medical card all your life, then the State would pay the doctor the same amount - €161 per annum – when you reached 70.

But under a gold-plated deal won by the IMO when the over 70 card was introduced, the State paid €640 (four times more) per year for everyone who qualified for it on grounds of age. Some GPs in affluent areas have become very wealthy as a result of this. There is a patent inequality for poorer areas, which had difficulty attracting doctors.

And it's getting more expensive. Our population is ageing. People are living longer. The costs next year would have been 14 per cent higher than 2008 if nothing had changed. According to one Finance official, if it had not been changed it could have the potential to "bankrupt the country" in the long run.

But the way the Government went about implement it was with a bludgeon, politically deaf to the sensitivities involved (a sign that Fianna Fail is losing touch with those on the ground). The Vulcan logic of it was correct, but the manner was just awful.

And this morning, we saw a momentous climbdown from the Government and from Taoiseach Brian Cowen.

Flanked by Minister for Health Mary Harney and Green Party leader John Gormley at the conference, he did express regret for the measure.

In perhaps the understatement of the year, he said: "Clearly it did not win popular support among those over 70. It did lead to vast confusion."

But he would not accept that what this morning's concession amounted to was a political collapse.

"I don't accept that there has been a collapse. I don't think that's a very accurate or fair description of what's been involved here. It's incumbent on the leader of the country to take account of the concerns that have been expressed over this serious issue."

There are two main strands to what has been announced. The first is that the income thresholds have been raised considerably, to €700 per week (or €36,500 per annum) for a single person, or double that (€73,000 per annum) for a couple.

In essence that means that the vast majority of those 140,000 who have medical cards on grounds of age will retain them – some 95 per cent according to Government spokespeople this morning. In addition, there will a discretionary scheme available for all those over the limit who are experiencing difficulties.

In essence, what that means that only the very wealthy will be excluded.

And on top of that – and finally showing sensitivity to the real fears of pensioners – there will be no means test. The system that will be put in place will almost be voluntary. Those who are not eligible will be asked to notify their circumstances. So it's self-regulation.

One of the potential pitfalls for Government in relation to this is how will it be policed. Cowen and Harney said that old people will not be put through a means test.

"We have simplified the process. The vast majority of older people are honest," said Harney.

In terms of monitoring it she said: "There are control measures open to the HSE to make sure that people comply. Many people excluded will be former senior public servants and the paymaster general will have their records."

The abiding impression is that the Government will rely on people's honesty and, once bitten, may not be minded to pursue too vigorously those of the present cohort who may be above the income threshold but have not notified.

The second essential of the compromise is that those who reach the age of 70 after 1 January 2009 will not be entitled to an automatic medical card. They will be means tested but many more will qualify because of the much higher threshold.

But that will potentially have a huge cost. So to balance that, the Government have started what is described as an "intense engagement". The purpose is to come up with a new capitation fee for over 70s medical cards, considerably lower than the profligate €640 figure that is unaffordable.

A retired secretary general from Finance Eddie Sullivan and IMO negotiator Dr Michael Barry will be involved in that process and are expected to come up with a figure in time for next week's Cabinet meeting, so that a decision can be made by November 1 in time for the Finance Act. What that will be is anybody's guess, anywhere between €161 and €640 on the scale.

Politically, it was important for Cowen to solve this huge headache before he departed for China. He has already delayed his trip by two days and did not want it to continue festering while he was a number of time zones away from the crisis.

It will certainly be enough to get the full support – almost unconditionally – of his parliamentary party who begin meeting at 12.30pm. It will also be sufficient to get the backing of the two independent TDs who still support the Government, Michael Lowry and Jackie Healy Rae.

The wider question though is will it wash with the wider public. The early indications are that after two aborted attempts to quell public unease (the long and inconclusive interviews Cowen gave to RTÉ) this big gesture measure this morning will just do enough to allow them survive the crisis.

However, it has done immense damage to Fianna Fáil and has severely tarnished Cowen's image as leader.

On a political level, he has climbed down on a major issue and one of principle. The perception will go out that he may be prone to concede on other things, that the tough-talking politician from Clara isn't a formidable a beast as we thought.