At a time when the costs of drugs and GP visits are rising, fewer and fewer people have access to medical cards, writes Olivia Mitchell.
Despite a break-out of what my colleague Richard Bruton described as Gombeen politics at the Fianna Fáil ardfheis at the weekend, there was one chink of light on offer.
The one moment of honesty in the midst of this Government's brazen attempt to buy off the electorate - again - was when the Taoiseach finally conceded that his Government's promise to end waiting lists was not going to be achieved. Not in the two years promised. Not ever, in fact.
With the Taoiseach in such confessional mode, I wonder will he consider looking down the list of outlandish promises made in the run-up to May 2002, most particularly to the commitment to increasing medical cards by 200,000?
This item should be next on the Taoiseach's list for any confessional-style interviews as a series of parliamentary questions tabled by me and subsequent research has exposed this empty promise for what it is.
The facts are that there are 46,500 fewer people qualifying for medical cards than there were at the start of 2002. This is a far cry from the Government's promise at election time to bring an extra 200,000 people on to the scheme.
It also gave assurances in the health strategy that "significant improvements will be made in the income guidelines in order to increase the number of persons on low incomes who are eligible for a medical card, and to give priority to families with children, particularly children with a disability."
The actual outcome is quite different. While income guidelines for the medical card have increased by a mere 8 per cent since May 2002, the monthly threshold for the Drugs Refund Scheme has increased by 46 per cent, charges for A&E have increased by 42 per cent, and the cost of a public bed per night has increased by 36 per cent.
Since January 2002, the number of people covered by the medical card scheme has dropped by a staggering 46,500. The percentage of the population covered by the scheme has fallen from 31.24 per cent in January 2002 to 29.43 per cent in January 2004.
It is lowest in the eastern region, where a fall of 20,000 people with medical cards has resulted in the percentage coverage hitting an historic low of 24 per cent.
When I raised this in the Dáil, Health Minister, Micheál Martin claimed the fall in medical cards was related to a decrease in unemployment. However, CSO figures tell us that at the start of February 2004 there were 20,000 more people on the live register compared to May 2002.
He also washed his hands of the problem by saying that health board CEOs have discretion in allocating medical cards in cases of hardship or medical need.
In reality, that discretion is limited by the size of the health board's budget. In fact cases that in the past would have been regarded as extreme medical need are now routinely refused medical cards.
If we look at one case study the absurdity of the changes becomes apparent.
A family with two children surviving on the national minimum wage of €280 per week is not eligible for a medical card. It would be a catastrophe for this family should even one child fall ill because a trip to the doctor costs €45, antibiotics cost at least €25, and a follow-up visit to the GP will cost a further €45, eating up approximately 40 per cent of the family's weekly income.
This is clearly unsustainable, and forces the family to make unbearable choices, with the SVP telling us that low-income groups are now neglecting their health because they simply cannot afford a GP visit.
It is tragically ironic that at a time when the cost of medical care such as drugs, GP visits and A&E visits are all rising by 30 per cent, 40 per cent, or more, fewer and fewer people have access to medical cards.
Apart from the short-term hardship inflicted on those on lower incomes by the Minister's failure to fulfil this election-year promise, there is a longer-term consequence that the whole health system will have to face up to.
With more people being squeezed out and denied basic healthcare, the inevitable consequence is that relatively minor ailments will deteriorate, and more and more people will develop serious conditions.
As the health of those least able to protect themselves is sacrificed in the interest of a short-term balancing of the Government's books, the long-term impact will see more admissions to hospital, more expensive treatments needed and, ultimately, a greater cost financially for the system to bear.
Olivia Mitchell TD is Fine Gael spokeswoman on health and children