Medical Card Scandal

I happened to have my first professional experience with a Form MC1 Form today or in English a Medical Card Application Form. As a tax head the following caught my eye that is outlined on the Form. You’ll have to bear with me if I get a bit technical for a little while but I’ll explain it all jargon free in a bit.

Who may apply? “Anyone who is ordinarily resident in Ireland can apply. Ordinarily Resident means that you have been living here for at least one year or intend to live here for at least one year”

Now that might sound fair enough, except that is not what ordinarily resident means. Ordinary Residence is defined by S820 of the Tax consolidation Act as

“For the purposes of this Act an individual shall be ordinarily resident in the State for a year of assessment if the Individual has been resident in the State for each of the 3 years of assessment preceding that year”

For the purpose of this article it is important to note that it takes three years to lose ordinary residence also- you have to be non resident for three years- this will become important.
Big difference. Since 1991 Millions if not Billions in the difference.

As the tax acts definition covers tax legislation and is to be confined to such I did a bit of research.

Medical card eligibility is covered by the Health Act 1970 as amended by the Health Act 1991.

It is the 1991 Act that introduced the concept of ordinary residence as a condition for a medical card. It is not definded but rather the Minister may issue guidelines

Guidelines on "Ordinarily resident in the State".
4.—The Act of 1970 is hereby amended by the insertion of the following section after section 47:
"47A. The Minister may issue guidelines to—
( a ) the chief executive officers of health boards, and
( b ) persons appointed or designated by him under section 47 (1),
to assist each of them in deciding whether or not a person is ordinarily resident in the State for the purposes of sections 45 and 46".

http://www.irishstatutebook.ie/1991/...tml#zza15y1991

In the HSE’s own guide to the Medical card application procedure it outlines what those guidelines issued were:

http://www.hse.ie/eng/services/Find_...guidelines.pdf

Following consultation between the Department of Health and the Health Areas, the Minister for
Health is, under Section 47A of the Health Act, 1970 (as amended by the Health (Amendment) Act, 1991) issuing the following guidelines on the interpretation of the criterion of ordinary residence.

The guidelines deal with the interpretation of ordinary residence under the following headings:
• nationals of non-EC countries;
• nationals of EC countries other than Ireland;
• Irish nationals who have been resident outside Ireland

References in the guidelines to “satisfying the Health Area” imply satisfying the Chief Executive
Officer or any officer to whom the function of determining eligibility for health services had been
delegated by the Chief Executive Officer. In all cases the Health Area is entitled to seek such
evidence as it may require in order to reach its decision.

1 Nationals of non-EC countries
1.1. An non-EC national should be regarded as “ordinarily resident” in Ireland if s/he satisfies the
Health Area that it is his/her intention to remain in Ireland for a minimum period of one year.
Examples of the evidence which may be sought in this context include

• proof of property purchase or rental, including evidence that the property in question is the
applicant’s principal residence;
• evidence of transfer of funds, bank accounts, pensions;
• Alien’s Registration Book (“Green Book”), residence permit as stamped on passport;
• work permits or visas, statements from employers etc;
• where necessary, the signing of the affidavit by the applicant

1.2. A non –EC national who is in Ireland as a student should be regarded as “ordinarily resident”
if s/he is attending a registered course of study of at least one academic year’s duration.
1.3. A dependant of a non-EC national must also satisfy that criterion of “ordinary residence” in
order to establish eligibility for health services here i.e. the fact that a non-EC national has
established his/her eligibility does not imply that non-resident dependants are also eligible.
1.4. A non-EC national may have established an entitlement to cover under EC regulations as a
result of residence or employment in an EC country. In such cases, the arrangements set out in
Paragraphs 2.1 and 2.2. apply.

2 Nationals of EC countries other than Ireland
2.1. Arrangements under EC regulations supercede the provisions of the Irish eligibility system is
respect of certain categories of nationals of other EC countries:
• social security pensioners of other EC countries who are not covered by an Irish social
welfare pension (as recipient of dependant), and who are not employed or self-employed
here, receive a Medical Card;
• persons resident here who are insured workers in the territory of another EC country receive
a Medical Card;

3 Irish Nationals who have been resident outside Ireland
3.1 Where an Irish national who returns to Ireland following residence in another EC country is
covered by any of the arrangements made under EC regulations, the same approach as that set out in Paragraph 2.1 should be taken.
3.2 Where and Irish national returns to Ireland and is not covered by any of the arrangements
made under EC regulations, s/he should be regarded as “ordinarily resident” here if s/he

• is employed or self-employed here; or
• satisfies the Health Area that it is his/her intention to remain in Ireland for a minimum period
of one year.
56
3.3 Where an Irish national is working abroad on a short-term contract but satisfies the Health
Area that it is not his/her intention to take up residence outside of Ireland on an indefinite basis, the status of “ordinarily resident” and eligibility for Irish health services may be retained. The Health Area may take account of the nature and duration of the contract as well as evidence such as the examples in Paragraph 1.1 in arriving at its decision.
Health Area is satisfied that the person did not establish an entitlement to health services in any other country, the Health Area should (if Paragraph 3.2 does not apply) regard the person as “ordinarily resident” in Ireland if s/he requires treatment on returning to Ireland. This guideline is intended to ensure, in particular, that persons who emigrate do not lose their health services eligibility on residence grounds before they have been able to establish eligibility elsewhere. It would not apply where a person is covered by EC Regulations and, in particular, it would not entitle a person temporarily resident in another EC country to have the Health Area extend the Form E111 beyond the normal period.

4 Persons deemed not to be “ordinarily resident”
4.1. Where a person is deemed not to be “ordinarily resident” in Ireland, and where none of the
other provisions set out above apply, the Health Area may either
- apply the full economic charge for any services provided;
Or - provide urgent necessary treatment at a reduced charge or without charge
(as deemed appropriate by the board) where application of the full economic charge
would cause undue hardship.

5 “Urgent necessary treatment”
5.1. The references to the provision of urgent necessary treatment free of charge to temporary
visitors from another EC country (Paragraph 2.1) and to persons deemed not to be “ordinarily
resident” here (Paragraph 4.1) do not cover
• non-urgent or elective treatment which can reasonably be postponed until the person’s return
to his/her own country;
• any case in which a person travels to Ireland for the specific purpose of obtaining treatment.
Department of Health
7 July 1992

What the hell was the Department of Health thinking. And how has this thinking (if you could call it that) been allowed to exist for almost 20 years. By incorporating the meaning of ordinary residence as it is outline by the tax acts this country could have saved billions in Medical expenditure on people that have turned up in Ireland, paid for a mickey mouse English course and allowed to have free medical treatment and then up sticks and went home. The department had to issue guidelines to cover Irish nationals that may have spent a year abroad and suddenly would not be entitled to medical treatment. Incorporating the tax legislation definition would guarantee them treatment for up to three years. There is provision in the Guidelines for urgent necessary treatment for those that need it free of charge. Why are we opening the door for those that do not require urgent medical treatment free of charge just because they are resident for part of the year? One year. Free medical card. This sort of thinking is the reason that A&E is overcrowded and we are propping up medical treatment for those that in my opinion should not be entitled to it and wasting millions in taxpayers money for those that have made little or no contributions to the Tax system to subsidise their treatment. It is nothing short of a scandal.

NAMA -Underpants Gnomes in Action

Flicking through the recent developments on NAMA one is reminded of South Park's underpants gnomes experience. These little fellows invaded South Park to collect underpants to their underground lair in the all encompasing task of raising a profit. The only caveat was how to get there. NAMA is leading the way to these industrious little fuckers and damned if they don't wear suits instead of pointy hats.

Here's is the underpants gnome logic as illustrated: Step one: collect underpants, Step two: ? Step three: PROFIT. Nice..............

Here is the NAMA business plan: Step one collect pants loans, Step two: ? Step three: PROFIT. Nice....................

Now here are the recent development with the banks, the proven financial whores and tinkers. NAMA as referred to in my previous posts did not even bother to audit the loan files before suggesting their billion euro purchase scheme and then, shock horror, were "flabbergasted" at the state of the loan files. The same bank, Anglo, that 8 days before they went into financial meltdown had the gall to make a presentation to the department of finance that they were in the best shape of their financial lives misrepresented the loan book- wow, who would have thunk it.

The newest unreported development is that the banks liquidated the majority of their performing "good" loans before they were transported to NAMA. Hense NAMA is mopping up the junk. The crap that is so toxic that even the underpants gnomes want no part in it and here's the fun bit. NAMA is applying a discount based on the long term vitality of these loans. The logic of the discount is simply this, "Okay Mr. Bank, some good, some bad, so we'll take them off your hands at a discount for the useless ones, cash in the good ones and we'll work out even. Cheers". The result of the banks flaking on transferring the performing loans means that we are giving a discount, albeit a higher one than envisioned on the basis that there are performing loans which no longer exist, and as any third class mathamatician would tell you, you can multipy zero by any number of years and it still is zero.

So what's the alternative. Well it's quite simply. Screw the premium, transfer the loans at their current net book value. NAMA will be lucky if they files don't catch fire on the way over. If there is any return, yipee for the taxpayer. Remember him, the dude that bailed Anglo out to the tune of 20 odd billion and rising. And while we are at it, why don't we just nationalise the bloody banks while we are at it. Every foreign bank has pulled out of the Irish market when they realised that the Irish government was propping up it's pet banks when they failed. The stock is worthless, AIB and BOI could be merged and the fact that they both have a premises in practically every provincial town leaves a lot of surplus premises that could conceivable be sold off. You don't need a firesale that would deflate the price, heck convert the buildings to apartments and stick social housing in there. Ah social housing. Remember that old trick. Times were that you needed to include 20% social housing in every new development but hey we don't want to be living next to poor people, those nurses and teachers and minions that earn less than 55K per year do we, so what did our lovely government do- allowed developers to literally buy their way out of these provisions by making financial contributions to the local authorities. What a wonderful way to avoid social responsibilities and have a convenient financial stream for bribes to be explained away, but that wouldn't happen now would it...........................

Israel Scuttles International Sympathy

Okay, lets start with the facts. On Monday the Israeli military used commandos to storm a floatilla in International waters that was carrying aid and supplies to the Gaza strip. The aid would seem to have consisted of 10,000 tonnes of concrete, glass and other building supplies that were destined to help rebuild Gaza after the numerous Israeli offensives into the strip that had reduced large parts of it to rubble. A lot of this rubble was caused by Israels use of cluster bombs and white phosphorous weaponry on an enclosed civilian population. The other half was caused by the sheer poverty that exists in the strip as any transfers of funds into the strip are illegal and Gazans cannot cross the borders for work.

The floatilla was surrounded by Israeli navy ships and was boarded from the sea and from the air. What happened next is of contention. The Israeli military claims it was fired on first and returned fire and yet MK Hanin Zouabi (Balad) a member of the Israeli parliament claims the protesters were unarmed. In any case, when the smoke had cleared nine of the activists were dead and another twenty five injured for the loss of, no Israeli dead and five lightly wounded. 

The UN went into closed session with four of the permanent security council members wanting to order international sanctions and the US opposed. 

The scramble by both sides to drum up the propoganda machine has started early. Israel claims that it's soilders were only armed with paint ball guns and pistols. 

Here is a quick you tube video that would paint that to be a lie: http://www.youtube.com/watch?v=tR2GQQBGTlY

According to this first hand report they were being hit by grenades, tear gas and live ammunition in International waters and completely illegally. Israel was operating outside it's jurisdiction. 

There is no avoiding the heavy bullshit that has come down in the last 24 hours. I have read some interesting logic and arguments that seek to paint the innocent civilians killed as some sort of trouble making rebel rousing terrorists, but in short, for me personally there is no way for Israel to justify the murder, and it is murder of unarmed civilians in international waters. Of course Israel has been murdering civilians for quite some time and it's excuse has been that there is no way to identify Hamas from the civilian territory in which it operates. In it's defense Hamas is pretty adept at murdering Israeli civilians too. However it is quite one thing to employ that flawed logic as some sort of justification to drop high tech weapons banned under international laws to be used on civilians and quite another to storm an unarmed ship carrying innoculous cargo and murder multi ethnic hippies. Israel has isolated a people, bombed them, burned them, murdered them and when an international group tries to bring some aid in it receives the same treatment. Well, it's clear the world doesn't give a perverbial about the Gazans lives, it has shown that in the past the question is does Israel's disregard for ours be allowed fly too and here's the thing, do we value our own lives more than theirs and what kind of hypocrites does it make us if we do.........

Lies, lies and damn statistics.

The minimum wage has become a division point in Ireland's current economic crisis. A statutory beating stick say employers and a threshold of poverty say it's supporters below which we dare not risk a race to the bottom.

The governments move this week to allow an “inability to pay” provision to be extended to employers in the agriculture, retail, catering and hotel and retail sectors which are currently under Registered Employment Agreements (REAs) is sure to place this issue under the scrutiny of public opinion. A Registered Employment Agreement is where representative groups of employers in certain industries have sat down with Unions and agreed a minimum threshold for that Industry. The respective employers are then bound by this agreement and cannot pay below it. In every case the REA thresholds are above the minimum wage and constitute an increased minimum wage.

Having a quick look at the facts: the current minimum wage is €8.65. If employers are unable to pay this amount due to financial difficulties they can apply to the Labour court to pay below this amount in certain circumstances. The court will examine the employer's finances and will in certain cases grant an exemption from the minimum wage for up to 12 months. This weeks move by the government has extended this procedure to employers that were previously paying a rate higher than the minimum wage because of REA's. Effectively then it allows employers in financial difficulty to pare back salaries to the statutory minimum of €8.65. The logic from the governments perspective is simple. If an employer cannot afford to pay €9.25 an hour and has to leave staff go then perhaps jobs will be saved or created by allowing this reduction to take place where employers are under pressure. Previously there was no mechanism for employers to pay below the REA agreements and persons would presumably lose their jobs.

As to the minimum wage itself this is before the Labour Court for review and the Minister has promised not to move on it until they have presented their report on it. For those that are curious it's been there since November 2008.

Before entering the debate on the minimum wage and various Chicken Lickens start rolling out of their pens and come exclaiming that the skies are falling down I thought I'd try to examine objectively the facts and figures that are being bandied around on both sides. There are two basic economic trenches to examine here. The price of goods and the facts about unemployment rates in Kerry.

According to the live register there were 7,930 persons out of work in Kerry in January 2008. Of this 1,380 were under 25 and 6,550 were over 25.

By December 2008 this figure had risen to 12,364 persons unemployed. Of this 2,285 were under 25 and 10,079 over 25.

In the most recent figures available for December 2009 the jump of unemployed in Kerry was to 15,923. Of those 2,880 were under 25 and those over 25 was 13,043. The under 25 figure peak in August 2009 at 3,310. The reduction to December was presumably due to emigration. For the over 25s the peak is December 2009. In short in 24 months the numbers out of work in Kerry has almost doubled. Whilst people can debate the causes of the increased unemployment the trend is alarming.

Of consideration also is the recently released Consumer Price Index released by the Central Statistics Office in December 2009. The figure that has been picked up in the National Media and its discussions is the overall price fall of 5.0% in the year to December 2009. Drilling down into the figures themselves makes interesting reading however. Mortgage interest repayments decreased on average by 40.0% in 2009. As a result while prices on average fell by 4.5% in 2009 the consumer price index excluding mortgage interest decreased by only 1.2%

The following recorded decreases in price in 2009:

Food and non alcoholic beverages purchased in supermarkets, small shops and petrol stations were down 3.5%.

Clothing and footwear which includes not just retail but laundry, dry cleaning shoe repair and dress alterations were down 11.7%.

Housing, Water, Electricity, Gas and other fuels were down 22%. This includes rents (down 14% with private rents falling in excess of 17.4%) mortgage interest repayments (down 40%) waste collection and disposal charges, goods and services in relation to dwellings and domestic energy products. (while the price of electricity and gas rose marginally the cost of home heating oil fell by 32.4% in 2009)

Transport which includes the purchase of new and second hand vehicles, spare parts, car maintenance, public transport and services such as parking, car washes, toll charges, driving tests, licences and car hire was down 4%.

Household furnishings and equipment was down 3.1%. This includes furniture, carpets, textiles and soft furnishings. Household electrical appliances and other household items.

Recreation and Culture was down 0.3%. This includes all services connected with recreation and culture and includes music and DVDs, games and toys, sports and recreational goods, gardening items, sports and cultural activites, newspapers, package holidays and other items connected with recreation and leisure.

Restaurants and Hotels actually recorded no change in the entire year 2009 but prices were down 0.4% in December 2009 in isolation. This includes meals in restaurants and hotels, fast good takeaways, cafes, canteens, alcohol on licenced premises and accomodation services.

Conversely the following recorded increases in prices in 2009:

Alcohol products and tobacco were up 6.3% on alcohol purchased in off licences and supermarkets but excludes alcohol in licenced premises which are under Restaurants and Hotels. Changes in tax have to be borne in mind.

Health costs were up 3.5%. This includes medical products, appliances and equipment, hospital charges and outpatient services supplied by doctors, dentists, opticians and practitioners of alternative medicine.

Education was up 6.4%. This included primary, secondary and third level and other training such as night courses and play schools and examination fees. A factor in this is the increase in student registration fees at third level.

Communications was up marginally by 0.5% which included post and telecommunications.

Miscellaneous Goods and Services were up by 7.6%. This remaining category covers a wide range of items including hairdressing and other grooming, goods for hygiene, hair and body care, personal items such as jewellery, handbags and wallets, childcare and other social protection services, insurance and financial services and other services including funerals, weddings, legal and professional services.

Now it's all well and good to examine prices in isolation but one has to bear in mind the realities of the situation. Just because prices have increased or decreased speaks nothing of volume or turnover. While detractors may point to the cost of a haircut going up the average hairdresser may point to the number of customers walking in the door. There is no central register for that. The closest thing we have is the level of tax take and employment figures which is reflective of the economic activity as a whole and the tax take has taken a nose dive in every sector. Income tax and VAT takes have evaporated over the last 24 months and the government is borrowing billions to keep the country afloat. So too as we have seen unemployment in Kerry has almost doubled in the last 24 months.

In short the issue of the minimum wage is a complex one, both moral and economic. To take a distorted average price figure and use it as justification to slash social welfare, which has happened, and minimum wage is far too simplistic an approach and does not reflect the realities of the situation. To lean on employers who have seen huge drops in turnover to pay a minimum wage they cannot afford leads to redundancies. The question therefore becomes, does reducing the burden of minimum wage and social welfare in conjunction with the governments plan of reducing the public sector paybill lead to controlled deflation? Only time will tell but there are no easy answers to this recession. Only hard questions. If they are not answered soon we may soon see another “stabilisation of the live register” as Ireland youngest and brightest proliferation abroad turn the trickle into a flood that washes away the immediate future of the country.