Examiner June 20th 2014 by Jim Power
It should come as no surprise to anybody to learn that politics is a very cruel and callous business. This week the Minister for Health, James Reilly was forced to reverse course on the medical card issue. The proposal to issue medical cards on the basis of medical need has been shelved and over 15,000 of the medical cards that were removed on the back of a review process over the past three years are now due to be returned. This is being viewed as a major back down by the Minister for Health and has added to the belief that his term in the current office is now very finite.
Apportioning blame to Minister Reilly for this latest debacle in the Department of Health strikes me as pretty shallow. My understanding is that the Minister for Health was opposed to the policy towards the removal of medical cards, but he was given no choice by the Minister for Public Expenditure and the Cabinet as a whole. I may be wrong about this, but we the public deserve to be told exactly how the policy was decided upon and by whom.
Many bodies currently analysing Ireland’s public finances have identified overruns in the Department of Health as a key risk to the attainment of a budget deficit of 3 per cent of GDP or lower by the end of 2015. Some observers and commentators are prone to vilify Minister Reilly for those overruns, and I can already envisage the media headline when the overrun for the year is published. However, before we rush to judgment, the facts of the matter should be remembered.
The reality is that health is probably the most important public service that the state is tasked with providing. It is also a reality that high quality healthcare is a very expensive and complicated service to provide. No country does it perfectly, and for those that come close to perfection, there are serious question marks over its longer-term sustainability and affordability.
Ireland spends around 8.8 per cent of GDP on health. This compares to 11.6 per cent in France. On the surface one might be tempted to be critical of the lower level of GDP spent by Ireland, but if one considers the age profile of the Irish population, then criticism might be less valid. Ireland has a very young demographic profile. At the moment the median age of the population is around 35 and just over 50 per cent of the population is under the age of 35. In 2011, 11.6 per cent of the population was over the age of 65. This is projected to rise to 16.2 per cent in 2026 and 21.6 per cent by 2046. In France, 23.2 per cent of the population is over 60 years of age, compared to 16.4 per cent in Ireland.
As populations age, the demand for healthcare increases and the amount of resources devoted to it also has to increase. If Ireland was currently spending the same percentage of national income on health as France is, then we would be in a really serious situation, given how much younger our demographic profile actually is.
Another fact is that in 2009, Ireland’s gross current spending on health was around €15.5 billion. This year, it is targeted at €13.3 billion and just €13 billion by 2016. Given that these cuts in health expenditure are occurring against a background of an aging population and a growing incidence of obesity and other lifestyle illnesses, it is no wonder that the quality of health provision is deteriorating so markedly and that draconian measures such as taking medical cards from needy elderly people are being instigated.
One could get very depressed about the future health service here in this country. The fashionable thing to do is to blame and vilify the current Minister for Health, but his immediate predecessors were treated no differently. Regardless of who is in the Department of Health, it is a total no-win situation. What we need to do is focus on preventative measures such as reducing dangerous consumption of alcohol and make smoking even reviled than it currently is. Prevention is better than cure, particularly if the cure is not up to much.