Legislation for free GP care for under 6s


[Speaking in the Seanad during Second Stage of the Health (General Practitioner Service) Bill 2014]

It is obvious that circumstances have changed somewhat since this Bill first saw the light of day in a context when radical changes were taking place in the provision of medical cards. We had a new Bill which, taken on its own, could only be welcomed. Anything that seeks to expand the access and reach of the medical card scheme can only be seen as a positive thing. Taken on its own, it is not particularly progressive. It is expanding access to medical cards but, given the context of what was happening at the time, originally denied but now all but tacitly acknowledged – the attempt to row back on the interpretation of who would qualify for a medical card in other age groups on the grounds of need due to the alleged stringencies of probity – we now know there was a double-edged approach to the issue. The overall effect of this would have been to decrease the number of people who had medical cards, to reduce the expense of the system. While we were taking cards from people who, by virtue of illness and age, were more likely to incur an expense to the State through their medical cards, we were giving them to a demographic who in relative terms was less likely to cost money. One would have to say – I am sorry if I sound unduly cynical about this – that these two measures together, in the absence of a more fundamental approach to health reform, would appear to have been populist, vote-getting measures rather than substantive efforts at reform.

Who could oppose this Bill? I will not oppose it, but I cannot let the opportunity pass to make a few points that need to be made. Others have made them and I am sorry if I sound repetitive, but I work in one part of our health system and I am a close observer of the other parts. The hospital-based system is highly dysfunctional. It is unfair. It systematically incentivises inefficiency and inactivity. Its core business plan is to keep people on waiting lists as long as possible, because once they come off the waiting list they cost money. In this time of stringency, the only good that we are advocating in the health services is to come in under budget. We have an incredibly dysfunctional public hospital system which urgently needs reform.

We have quite a functional GP system. It works quite well. The major problem with GP system as presently constituted is that for some people who do not have medical cards it is a bit expensive. We would welcome as a society any attempt to roll out free GP care, and most of the GPs I know would too. If this under-six scheme is the beginning of a roll-out, I ask the Minister of State – I am delighted to see he has a pencil in his hand – to give us the timeframes for the roll-out to under-eights, under-15s, over-70s and over-65s. When does it become a comprehensive free GP scheme? If it is part of a phased introduction of free GP services, the logic of it would seem to be that there will be further milestones along the road. Instead, it is impossible to escape the conclusion that when this was conceived it was taking with one hand what was being given with the other, which was meeting a pre-election commitment to expand GP care to a particular age group while at the same time funding the expansion by taking services away from people who needed them the most. Collectively, the two initiatives, thankfully, were caught out by the political process at the time of the local and European elections. This, as has been admitted by members of the Minister of State’s party and the other party in the Coalition Government, caused a certain amount of soul-searching and has led to a change. It has had the unintended effect of making this better legislation.

I will support the Bill. If one takes away the attempt to remove medical cards from others, this as a stand-alone Bill makes more sense. We will try to pin the Minister of State down to the timeframes and scale of the roll-out and whether it will be phased or whether we are waiting for the great moment – as they used to say, after the revolution – that moment when suddenly we will have universal health care for all. Everything is on hold until then.

One Response to “Legislation for free GP care for under 6s”
  1. Tom Hogan says:

    Targeting Medical Cards and GP Cards to those with greatest need: a new approach.


    (1)Targeting of assistance to those with greatest medical expense relative to their income,
    (2)An income-related ceiling on non-reimbursable medical expense Nett of tax relief for any individual or family,
    (3) Transparency,
    (4) Amenability to simple legislation,
    (5) Ease of incremental adjustment,
    (6) Possible near-seamless adjustment over time to universal “free” GP care. If the process stalls, it will stall at a fair point.
    (7) Minimal bureaucracy and administrative costs.

    Allow any individual or family to purchase a Medical Card or a GP Card by making a voluntary agreement with the Revenue Commissioners to pay an income levy on all taxable income above twenty thousand (?) euro per year.
    Opt in or opt out on a quarterly basis at three (?) weeks’ notice.

    TSH /10/07/2014

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