Is there a doctor in the house?

The 'doctor-only' medical card was introduced in 2005 to help low- and middle-income families, who wouldn't qualify for a full medical card under current income criteria. It was estimated that up to 200,000 such cards would be issued, and Mary Harney, Minister for Health fought a major battle with the Irish Medical Organisation to get the scheme off the ground.

However, several months on, only a couple of thousand people have applied for these new cards.

This very low take-up of the “doctor-only” medical cards suggests a major systemic problem in the way rights and benefits are delivered in this country. It surely can’t be a lack of demand, given that your local GP might well charge you €50 for a 5-10 minute visit to the surgery.

I believe the self-interest of politicians lies at the heart of the problem, with (at least) two key flaws in the system.

Firstly, TDs have voted themselves large allowances to run “constituency clinics”, at times and places of their own choosing, instead of adequately investing in professionally-staffed information and support services at local level. These TD clinics should more accurately be termed “re-election offices”. The funding for these clinics should be diverted into well-advertised advice bureaux - there should be one in every medium-sized town.

Secondly, far too many rights and benefits are categorised as “discretionary“. This often means that those most in need fail to receive them, while those who do apply often believe they might need the local TD to pull some strings on their behalf.
TDs do nothing to dissuade their constituents and will happily claim credit for any positive outcome, regardless of whether they’ve made any representations at all, or simply passed on an application form.

Those who don't know their rights, who don't vote and who are generally unable to advocate on their own behalf are the main losers here - yet they should, in fact, be the sector of society which is the focus of a disproportionately high level of resources.

It should be a priority of the next Government to eradicate these deficiencies and abuses, but will the self-interest of politicians win out again? I'm not holding my breath.

Footnote: A version of this published as a letter in the Irish Times and the Irish Independent.