Mary washs her hands of Pharmacists and medical card holders

For the past week many medical card holders in the state have had significant difficulties collecting prescription medicines because of a dispute between the Department of Health and the pharmacists association (IPU). Effectively the minister has unilaterally cut payments to those chemists who administer drugs to medical card holders. Nobody likes when a unilateral cut in income has been imposed by a minister, as any public servant paying the pensions levy will quickly tell you. Minister Mary Harney has been her own worse enemy on many matters for some time and she has lost the confidence of the people because she has no mandate from the people.
However that does not necessarily mean that the chemists have the full support in the community. For a few weeks I’ve watched from the sideline while their medical card patients have had to endure great hardship to get medication. Essentially the patients have been used in a row about money to see who’ll blink first and come to the table. The facts are that the state has got poor value for money from administering, purchasing and dispensing drugs to medical card holders. It seems that for a long time the gravy train chugged along merrily. At one stage restrictive practises prevented competition between chemists and pharmacies had to be located a minimum distance from one another serving a verifiable need.
The market has changed hugely since towns have expanded and farming has reduced somewhat. The increase in competition from chains like Boots or McCaughley’s, increased rents on Main St and the establishment of a new school of pharmacy increasing the number of entrants to the market have led to extra outlets in the business. To set up a chemists shop needs compliance with the law in terms of premises location as well as the need to provide a qualified pharmacist on site. There are enormous costs but as long as the population climbs there’s something there for everyone. As part of the business mix, toiletries, drugs to medical card holders as well as non holders of cards and veterinary medicines will contribute to the chemists income. A pharmacist is a business person first and foremost.

However it is not sustainable to continue funding the drugs scheme as it is. Other professionals providing services to the state have seen professional fees cut and in some cases payment deliberately retarded. Pharmacist revoked their contracts to provide medical card holders with drugs, as is their right, to protest against how the department had treated them. If teachers had gone on strike when the pension levy was brought in, we’d have been accused of holding the children’s future hostage (as we were once accused by a parent’ rep). Chemists say that their income will be cut by 34%. I accept that they have overheads, staff to pay and so on but any chemists who I’ve passed by in the last few weeks are doing very little business as most of their customers are down in Boots getting their medication. How sustainable is it to tell the bank that is itself crucifying business by refusing to release money that you’re paying staff the same amount to do less work on an ongoing basis? Chemists feel that they have the department by the throat and that to set up an alternative outlet dispensary the HSE must locate enough qualified chemists and suitable premises to comply with the law. A hard job for the department, but not impossible. During the 2001-02 teachers dispute the Department of Education found a way round our threats on substitution and supervision and I would argue that teaching has suffered since. Chemists should learn from the mistakes of others before they irreversibly damage their industry. Once changed it’ll never return to the way it was before.

My sympathies are entirely with the patients on this one. As long as the stand off continues the more likely it is that chemists will lose good customers and that rationalisation of the industry will see the consolidation of chains at the expense of family run pharmacies in Ireland. There are other issues such as the use of generic drugs in place of branded one and the relationship between the industry and the HSE but these won't get discussed during the dispute. It’s time for the pharmacists to re-open, take up their contracts again and offer to negotiate with the minister. Anything else causes hardship to those who need it least.

The dreaded E Word, Is Election ‘08 likely?

Given the convulsion sweeping through the government after their decision to withdraw the medical cards for over 70’s, is it possible that we could be sleepwalking towards another General Election? It is unbelievable that broken promises form Election 02 are still tripping up this government.

I wonder about the possibility because with one seat vacant due to the death of Seamus Brennan, now a resignation by first time TD, Joe Behan, the incorporation of the PD’s into the FF fold now numerically brings Fianna Fail back to where they originally were numberswise. The reality that Finian McGrath and Michael Lowry are now semi-detached on the issue too leaves the Green Party playing the role which Michael McDowell played in Election ’07, will they jump won’t they jump and if so who cares? Under our law if a government falls on a budgetary measure it must resign. True Jackie Healy Rae remains on board but if the combined opposition were to vote in favour of the Fine Gael motion on medical cards there would surely follow a confidence motion. What then? A rearrangement or election? In the 80's Garret Fitzgerald fell from office when Jim Kemmy refused to back a budget plan to put VAT on shoes. This lead to the disastrous GUBU government

The Green Party’s credibility on this issue has been damaged because they are seen responding to FF back bencher pressure rather than concerns that they raised themselves in the run up to the budget. In every coalition there arrives a crunch issue for the smaller party when they stare into the abyss, For Dick Spring it was food subsidies and Reynolds passport’s for sale, for O’Malley being called a liar, for McDowell it was Ahern’s finances and for the Greens it’s the grey’s. How you handle this in the eyes of the electorate dictates your standing for the rest of that Dail.

The recent past showed how McDowell’s party imploded when he wanted to pull out during the campaign. This is surely weighing heavily on the minds of the greens as they appeal very much to middle class voters slightly younger than those who followed McDowell. As Labour found out in 1997 the middle class can be very unforgiving when it comes to crucial issues. I don’t think they’ve changed and indeed if anything the rapid changes in society show there are now many more out there in the long grass waiting as the middle class is significantly bigger than in the 90’s.

As Jackie Healy Rae once said when he threatened to walk out on FF, it may be time soon to get the bicycle clips! One way or another we're facing a fascinating week, if the government gets through it intact some one will have to back down. I'll cast my eye over the budget next week but in the meantime discuss and vote above!