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Damien Kiberd Health is not just Angola, it’s the original Heart of Darkness

What’s to become of the very sick who can’t afford insurance cover and who don’t qualify for medical cards? Does anyone – including Reilly – know?

DID YOU VOTE for Fine Gael or The Labour Party last time out? If you did you may have thought you were voting for free access to GPs for everyone who is sick. And for a universal health insurance scheme similar to the one they have in Holland.

Two years later health strategy is all over the place. Tens of thousands of families have been priced out of health insurance completely, creating a crisis for the four insurers. The forced exodus from private cover will have accelerated in recent days as Michael Noonan cut tax reliefs on premiums.

Simultaneously the government wants to take up to 150,000 medical cards from the elderly and from people who hold them due to a lack of “probity”.  To add to the confusion it will be printing thousands of brand new GP cards for the under-sixes, including the children of the super-rich.

What’s to become of the very sick in the squeezed middle who can’t afford cover and who don’t qualify for cards? Does anyone know?

The confusion

The Health Minister Dr Reilly shrugs his hands a lot these days. Asked last week to explain the Budget Day savings estimate of €113m on medical cards (the “probity” ones) he indicated that it was a target set for him by “government” and/or “Cabinet”.  He used the terms interchangeably, ignoring the fact that he is both deputy leader of Fine Gael and a senior member of Cabinet.

No government minister could give a precise estimate when asked how many of the existing 1.9m cards would be cancelled.  An unpublished consultants’ report from PwC apparently claims the figure could be somewhere between 60,000 and 180,000.

Grasping at straws unnamed official sources say many cards exist for people who have died or left the country.

Capitation fees for nothing

If that is so then GPs have been getting capitation fees of €400 per year for cardholders who – barring miracles – will never darken the door of their surgeries again.

This is a major issue. Radio phone-in shows last week were jammed by callers who claimed that people suffering from acute medical problems – including cancer, cardiovascular problems and severe physical and intellectual disabilities – were already having their “discretionary” cards confiscated.

If this is true, then why have both the Troika and the government allowed scarce money to be paid to GPs for looking after the dead and the departed?

Policy morass

The confusion over health insurance is another policy morass.

Noonan, under pressure, claimed 577,000 would pay higher health premiums as a result of his Budget day tax changes. He gave “credit” for this number to the Office of the Revenue Commissioners, which hasn’t been administering the 20 per cent relief for years.  The insurance industry, which actually provides the tax relief at source to the insured, claims the number exceeds one million. It says 90 per cent of policyholders will be affected.

Official sources say the net effect is to increase premiums by 3 per cent. The industry says the figure varies from 8 per cent to 20 per cent.

Reports claim – almost unbelievably – that Dr Reilly learned of the tax change either when it was relayed to him at a cabinet meeting just before the budget or during the Budget speech itself. The change took effect from midnight on Budget Day.

Insurers, who are legally obliged to give 30 days’ notice of price changes, shut down their websites abruptly rather than sell cover at a loss.

Joined-up thinking?

Is there any evidence of joined up thinking here? A cynic might say that the under-sixes got GP cards in order to provide political cover to the Labour Party whose poll ratings had slumped to 6 per cent. Meanwhile the back-of-the-envelope numbers on medical cards and health insurance reflected a last minute scramble to cobble together both the health department’s budget and the overall budget for 2014.

The health budget contains yet more big numbers that are so far unexplained including a ballpark figure of €268m for savings on pay – a figure which has the unions baffled. It is unclear if this number includes savings agreed during the “Haddington Road” process.

Meanwhile the boss of the HSE Tony O’Brien told an Oireachtas Committee that further cutbacks to the health budget of up to €1bn a year could be necessary as a result of legacy issues such as changed demographics and the system of hospital budgeting.

Flying squad from Merrion Street

For the past week the under-fire Department of Health has been shovelling responsibility for various financial projections back onto the Department of Finance. Meanwhile the top brass at the Departments of Finance and Public Expenditure are preparing to send a team of senior officials into Health to try to get the grips with numbers for which, apparently, they are themselves responsible.

Sending down the flying squad from Merrion Street offers no guarantee that further confusion can be averted.

Some years ago a previous FG/Labour government in need of cash announced a 9 per cent levy on the life assurance industry. The levy never made it into the Finance Bill because somebody from the life and pensions sector explained to the Department that implementation of the new policy would literally close down the life and pensions business in Ireland for good.

The Department of Health has had a lot of problems meeting its spending target over the last two years, but the A-team from the Finance Department, when it arrives, may get sucked into grave forecasting problems of an even bigger nature. Health is not just Angola, it’s the original Heart of Darkness.

Damien Kiberd: Budget 2014 arithmetic not just iffy – it’s scary>
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