For anyone wanting to understand the sheer fecklessness of the way we are governed, last week's report from the Committee of Public Accounts reminds us of a classic case study, writes Fintan O'Toole.
In the current dispensation, where everything is the fault of civil servants and Ministers openly declare that what happens in their own departments is not their responsibility, the debacle over the extension of medical cards to everyone over 70 is grotesquely illuminating. It shows how bureaucratic incompetence and the astute manoeuvring of vested interests are underpinned by gombeen politics.
In his budget speech of December 2000, the then finance minister, Charlie McCreevy, preened himself, as he never tired of doing, as the taxpayers' champion, the straight-talking, no-nonsense scourge of soft-headed pinkos who wanted to throw public money around like drunken sailors: "Addressing health problems, and indeed all aspects of public expenditure, is not simply a matter of additional resources. We must assure ourselves that we are getting the best value from existing expenditure."
In the same paragraph, he then unveiled a political stroke: "In my 1999 budget I announced that the income limits for medical cards for people aged 70 years or over would be doubled over three years, commencing in 1999. That process will be completed next March and it is now proposed to take the next step. I am pleased to announce that from July 1st, 2001, entitlement to the medical card is being extended to all those aged 70 years or over."
As this passage made clear, the move was well planned. The government had been building up to it for two years, as a key part of its strategy for the 2002 general election. Yet, even though the move had been long contemplated, we now know just how staggeringly inept was its implementation.
The most basic requirement of any minister for finance is that he should know how much a new measure he is proposing will cost and how it will be funded. In fact, even the officials in his own department were told nothing about the blanket extension of the medical card scheme until a matter of days before the budget speech. One of them, Michael Errity, told the PAC in 2002 that "the timeframe for this decision was very short. We were advised that the government had taken the decision to take this policy initiative very late in the day".
In a panic, the Finance officials got on the phone to the Department of Health. How much was this thing going to cost? This might seem to be a simple enough calculation. You work out how many people over 70 there are, how many currently have medical cards, and what the cost of each extra card will be. But, in fact, it was anything but simple. The Department of Health didn't have the numbers and had to get them from the health boards. They were sent to the Department of Finance just before the budget speech. But they were wildly wrong. The estimate was that an additional 39,000 people would become entitled to a medical card. In fact, by December 2001 63,000 new over-70s had registered and by December 2002 this had increased to 83,000. In other words, over twice as many new medical cards had to be issued than the government planned for.
But this was only the first act of the farce. For political reasons Charlie McCreevy announced the new scheme in his budget before the Department of Heath opened negotiations with the doctors and pharmacists who would have to deliver the scheme.
These professional groups now had the government over a barrel. Having been announced in the budget, the scheme had to be delivered - whatever the cost. When negotiations did take place, the GPs were in a position to extract an extraordinary deal: for each new person over-70 on their books they would get three times the rate payable on existing over-70s medical cardholders. The effect was that the cost to the State of the General Medical Service in 2002 increased by 55 per cent over 2001.
But the heights of idiocy have still not been reached. When all the new medical cardholders were added to the existing ones, the full scale of the fiasco became apparent. There were now more over-70s medical cards than people over 70 living in the State. This was because doctors were being paid for patients who had died or moved away. The Government is demanding that GPs repay some of this money, but there is fat chance it will get it.
The result of all this was that a measure that was supposed to cost €19 million a year has ended up costing €51 million. And this farce is also a tragedy - in the first three months of Mary Harney's tenure in Health, more than 8,000 people who actually need medical cards lost their entitlement to them, allegedly because the State couldn't afford the cost.
This confection of cynicism and incompetence is what we call government. Political strokes, administrative chaos and professional self-interest creates a system in which public money is thrown at anything except social justice. But don't worry - the good news is that no one is responsible.