OPINION:Establishing universal entitlement flew in the face of our two-tier medical system but it promoted social justice, writes Orla O'Donovan
IRRESPECTIVE OF the motivations and miscalculations, the introduction in 2001 of universal entitlement to a medical card for people aged 70 and over was a profoundly progressive measure and should be retained.
The planned abandonment of this automatic entitlement represents a U-turn on an important and exceptional extension of social welfare provision.
The extension of entitlement in 2001 was significantly at odds with both the historical resistance on the part of the Irish medical profession and others to the socialisation of medical services in Ireland and with the more recent all-pervasive logic of the market, which has undermined commitments to collective responsibilities and extolled the individual responsibilities of citizen-consumers.
Ever since the 1950s debacle over the Mother and Child Scheme that sought to introduce universal entitlement to free medical care for mothers and their children up to the age of 16 - a level of entitlement that has not as yet been secured - governments have always bowed to pressure to protect private medicine.
For example, in order to secure the agreement of the medical profession to enter the General Medical Scheme, the 1970 Health Act limited the provision of medical cards to 40 per cent of the population, irrespective of people's needs.
Due to high levels of unemployment during the 1980s this limit was approached and instead of extending it, medical cards were withdrawn from students.
The extension of universal entitlement for the over-70s also flew in the face of successive governments' commitment to neo-liberalism that has resulted in the privatisation of many health services, including nursing home care, and the transformation of those services into commodities.
It was also significantly at variance with the undermining of a sense of social entitlement and security entailed in the policy of encouraging people to make provision for their own medical care by purchasing private health insurance.
With more than half of the population now consumers of private health insurance, Ireland has one of the highest levels of private health insurance consumption in the OECD.
Supporters of the withdrawal of this universal entitlement make their case on the grounds of equity, arguing it is unfair to have the healthcare costs of those who have the means to pay themselves paid out of the public purse, public money that could be spent on the less well-off.
This argument overlooks the hugely significant way in which the establishment of entitlements promotes social justice by cultivating a social attitude that goes against the individualism of the world of the market.
From this point of view, the extension of entitlement to the medical card embodies a commitment to reciprocal obligations whereby younger people recognise the contributions to society of their elders and demonstrate solidarity with them, a form of solidarity from which we will all eventually benefit.
As a form of social security, it also establishes access to general practitioners and other services as a social right for older people.
Such universal entitlement is perfectly in accord with a taxation system in which the rich (including rich elders) are taxed most and which serves as the primary means of redistributing wealth.
But let's not get carried away. While universal entitlement to a medical card for people aged 70 and over should be celebrated and retained, we cannot lose sight of the deepening inequalities between public and private patients that characterise the Irish healthcare system.
Lest we forget what the tragic story of Susie Long told us, universal entitlement to healthcare in this country can translate into entitlement to die on a waiting list.
• Orla O'Donovan is a lecturer in the Department of Applied Social Studies at University College Cork and specialises in health issues