It has come to something when a highly successful political machine threatens to seize up completely in the face of an entirely predictable backlash from a Budget decision to end the automatic entitlement of people over 70 to a full medical card. Panic has gripped the Government backbenches and it threatens to destroy Brian Cowen’s fledgling administration, unless he can find a way of maintaining older people’s entitlements while reining in skyrocketing costs.

The resignation of Wicklow TD Joe Behan underlines the strength of public anger and the deep political unease among Fianna Fail backbenchers on this issue. Mr Cowen will be lucky if this is the only resignation letter he reads. Fianna Fail TDs are notoriously well-disciplined and though the newer recruits have known nothing but bouquets up to now, the older ones have taken their fair share of brickbats. But all of this may be too much even for some of them.

The spectre of Ernest Blythe, who has never been forgotten for taking a shilling off the old-age pension, is stalking the corridors of Leinster House once more. Except this time it has come back to haunt not his own hapless lot, but the party whose longevity in government is due in no small part to a defter political touch.

As one Fine Gael politician remarked to me recently, his is a party of strands that never quite connected with the communities they try to embrace; Fianna Fail is a party rooted deeply in the communities that sustain it. This decision now threatens to poison that root system.

<strong>The certainty behind the demand</strong>

Anyone who listened to South Tipperary TD Mattie McGrath interviewed on national radio would immediately have sensed the brewing rebellion.

That in itself is unusual for Fianna Fail. The party’s legendary iron discipline was clearly under enormous strain. What struck me most about it, though, was the certainty behind the demand, which came from strength in numbers, that nothing less than an about-turn was going to quell the firestorm that had been unleashed. Mattie McGrath wasn’t on his own. But he was the one prepared to come out in public and say what others felt.

And once the genie was out of the bottle, there was no putting it back. Joe Behan’s resignation underlined the political reality that in the absence of effective forward planning, any substantive change to a universal welfare provision like this is impossible to carry off.

To be fair to Ministers, they’re trying to restore some kind of balance to the public finances, and they’re damned if they do and damned if they don’t. It’s easy for the Opposition to carp and criticise. That’s their job.

And no matter how much Ministers would like to blame the Opposition spokesman who negotiated what has proven to be a lousy deal for the taxpayer, the reality is that politics isn’t fair, the public aren’t listening to reason and this won’t go away.

Brian Cowen’s only concession is to propose a process, which would see family doctors take a reduced fee for treating the over-70s. In theory, this would deliver some of the savings required while ensuring more people hold on to a medical card. But on the core issue of means testing, he is refusing to budge. The IMO hasn’t yet indicated a desire to deal, only a willingness to listen. However, it will be acutely conscious of events long ago and is likely to take a pragmatic view.

In financial terms, the over-70s’ medical card deal has been a triumph for those who have drawn the most fees and a travesty for the taxpayers who are footing the ruinous costs of the scheme as it is currently structured.

Yet it has given a warm, well-earned reassurance to tens of thousands of pensioners who could themselves face ruinous personal costs from the escalating costs of medicines and medical care. At this moment, it’s the pensioners who are in the firing line. The belief in Government is that prescribers should take their place. Whether they will or won’t, nobody yet knows.

Implicit in that is the assumption of a very cunning plan by Government. There is no such plan. The decision to introduce this inequitable scheme was an inexcusable vote-grabbing ploy by the last administration. However, we are where we are. Attempting to reverse a decision that was wrong in principle with another that is wrong in practice is worse.If we are about maintaining some sense of social solidarity between the generations at this time of crisis — and it is a time of great crisis — then there is an opportunity for many healthcare professionals to make a contribution.

If GPs are willing to accept a reduced fee, then community pharmacists, who also get a higher dispensing fee for the over-70s compared to the rate other medical card patients, might also accept a reduced reimbursement. I think many doctors and chemists would look favourably at that. They see the fear and uncertainty in their patients and most won’t want to add to it.

<strong>Competition law</strong>Questions have now been raised by the Competition Authority about the implications for competition law of any discussions involving the Government and the IMO on the question of remuneration, even in a context where the intent of such discussions and the consequence of the desired decision would be to reduce the prices paid to healthcare professionals. To this simple-minded observer, the introduction of such a complication would itself be a travesty.