Sorting out that medical card mess - at last!

  • Niall Hunter, Editor

Scene - the office of one of our moderately-paid health officals.

Official 1: (hesitantly entering the office). Begob, you look like you're in a bad mood. Don't tell me we're setting up another helpline for anyone with concerns about whatever the latest thing is that we've fecked up. Maybe we should set up a special helpline for people who are distressed by all those helplines we're setting up.

Official 2: (peering up from his computer screen). No, don't worry, no new helplines, nobody died - not yet anyway, but the day is still young. How do you spell 'discretionary'?

1: Give us a minute while I go and get my Shorter Oxford English Dictionary. Haven't you heard of goggle, or boggle or whatever they call it?

2. It's just that I'm drafting a new questionnaire for the ungrateful and unwashed on discretionary medical card reviews.

1:Ah jaysus...are you undergoing some sort of disciplinary action and this is your punishment? BTW, ha ha ha etc re ironic reference to hell freezing over, rarity of disciplinary action scenario in bureaucratic behemoth (insert derogatory epithet as appropriate) that is this great organisation.

2: Pardon me if I omit to laugh. Although this does seem like cruel and unusual punishment, ie. asking a moderately paid public servant to remind the sick, the halt and the lame of their duties and responsibilities under the relevant section of the 1970 Health Act re eligibility for medical cards. I mean, have they even read the Act (Sections 58 to 61 and relevant regulations) for God's sake?

1:Perhaps you should look up how to spell 'indefensible' while you're at it.

2: The ungrateful so and sos. How many times has Alex 'no change in the rules regarding eligibility' White had to explain it to them? If you read the latest Dail report he quite clearly states:'It is important to note that where a medical card is withdrawn, irrespective of its having been awarded based solely on means or where the HSE has exercised discretion, it is not withdrawn due to the cost implications for the HSE. In accordance with the Health Acts, a medical card can only be withdrawn due to eligibility not having been established'.

1: I see what you mean. It's as clear as day. So, for example, If I was dying of cancer, and my medical card was withdrawn, and I no longer had the luxury of various services I would be entitled to under the medical card, it would be of great comfort to me in my death agonies to know that the card I had previously been given was being taken away, not, thanks be to jaysus , due to the cost implications for the HSE, but due to us upholding the principled, sea-green incorruptible policy of 'eligibilty not having been established' (your honour).

2: Quite. You're not thinking of running in the local elections by any chance? Now back to my problems. Give us a hand with this questionnaire. Question 67 (b) 'Declaration by recipient of free services as to maintenance of eligibility for said services under relevant sections of 1970 Health Act.' I'm just having a problem with the wording.

1: Eh, OK, but I have a bad feeling about this...

2: Under subsection (iv) of subsection B of Question 67 we must ascertain 'state of existence of applicant/reviewee' in cases where the person has a terminal illness. now I'm just thinking aloud here but I thought the best way to put it would be: 'In relation to said terminal illness are you -  a.Still alive? or b.Clinically dead? or c.Likely to cease existence in the near future? If a. please proceed to question 68, if b. proceed no further, if C. await further instructions.' How does that sound, Plain English-wise and all that?

1: Oh, the humanity. All this is giving me a terminal illness, or at least a terminal existential crisis. Anyway, I thought aul Chalky White said the whole medical card Byzantine bureaucratic Kafkaesque eligibility mess was based on means , not illness.

2: Silence! You're not being much help. Let's go back to question 64...

1: How many questions are there exactly?

2: In document one or in all three? They cost a fortune to post out you know.

1: Perhaps we should send them out a copy of the relevant sections of the 1916 Proclamation. You should read it some time.

2: What?

1: Nothing. Go ahead.

2: Ahem...question 64, let's just take a subsection at random- subsection 25. 'Determination of maintenance of illness/disability status. If you have been diagnosed with a disability such as Down's Syndrome/autism/cerebral palsy, please state whether a.You still have it. or b. Have been cured of it. If B, please submit Ryanair return flight ticket stubs to Lourdes along with medical card, cut neatly with scissors into two equal halves. If A, send us back your medical card anyway, It'll save us an awful lot of trouble in the long run.'

1: Hmm, now I'm no technical expert, but I can foresee some problems with the wording there.

2: Well, smartypants, you come up with a better solution. We're having terrible trouble trying to elicit this information by ringing people up and asking them these things. Thet can be so unhelpful, you know. And quite rude. And if that wasn't bad enough, the next 10 questions have to be in German. I'm sending them over to the boys in Berlin for vetting - we're farming out half this stuff abroad these days.

1: Can I just interject something here boss...Well firstly, the relevant section of the 1916 Proclamation I was referring to was: 'that we 'guarantee religious and civil liberty, equal rights and equal opportunities to all our citizens, and declare our resolve to pursue the happiness and prosperity of the whole nation and all of its parts, cherishing all of the children of the nation equally'.

2: Give me a break-Sinn Fein propaganda. And don't start spouting about there having been a change in policy, there has merely been a 'a standardisation of the application of the procedures and the guidelines'.

1: Ah well, what's widespread abuse of the English language between friends? Here's a humorous old-fashioned dictionary definition of 'policy': 'a prudent or expedient conduct or action.'

2: What was your second point?

1:Well, I know it's a bit embarrassing and folksy and all that and we're all such hard bitten cynics etc but how about that a boy who can't walk, talk or go to the toilet and has to take 31 medications a day has had his medical card removed? Is that an expedient or a prudent conduct or action? Probably more expedient than prudent, but maybe I'm just a cynic.

2: Mere details my friend. Anyway, all of this Dickensian soap opera is going to end shortly.

1: What, with free GP care for everyone?

2: Allow me to interject an interjection in response to your query. Ha ha ha. Never going to happen. The GPs will look for a bloody fortune. Some of them haven't been able to change their Beemers for three years you know. As for UHI, the middle classes won't be too happy about subsidising access for the plebs to the Blackrock Clinic.

1: And I thought I was a cynic.

2: No, what I was talking about was James Reilly's 'Third Way'. A third tier medical card system.

1: Allow me to interject a howl here: Noooooooooooooooo!

2: It's quite simple, under Minister James 'let me make this clear' Reilly's plan, there will be three medical cards - a full medical card medical card, an almost but not quite doctor visit medical card, and the new 'I can't believe it's not a medical card' card. Or the 'I can't believe we're going to do so badly in the local elections unless we pull some cheap stunt pronto' medical card.

1: I repeat, Noooooooooooooooo!

2: I've got a 150 page internal memo on it here. It provides in certain circumstances for limited services for those who, inter alia, do not meet the eligibility criteria for medical cards. It provides for a wide range of new eligibility criteria which will be implemented on a discretionary basis, discretionately. The criteria are available on application in a 500 page explanatory booklet from the HSE, Berlin Office Park, Berlin, Co. Berlin, Germany.

1: I repeat, Noooooooooooooo? Seriously though, It's about time the medical card system was made a bit more complex. It's all been a bit too easy so far.

2: Anyway, we've more work to do. We've got to draft a statement stating in a statesmanlike way how many A&Es we're not going to close before polling day.


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