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Opinion A million people have no health cover as low-paid families are excluded from access to the medical card

Since 2012 there has been a 66% increase in the number of people with no private or public health cover, writes Feilim O’Rourke.

MORE THAN A million people in Ireland now have no health cover – that is they don’t qualify for the medical card but they don’t have private health insurance either.

And the number of households who are left out in the cold by our two-tier health system has shot up since 2012 when it was 640,000. That is a 66% increase in the number of people with no cover. 

While the population is growing, there also appears to be a deliberate policy of removing medical cards from low-paid households.

The methodology employed is pretty clever too, the government didn’t have to lower the income limit for the medical card at any stage – it just hasn’t raised it since 2006. Every year they fail to raise the limit, fewer workers qualify for the card. 

Back in 2006, the income limit for access to the medical card was set at 18% above social welfare rates, meaning that very low-paid families had access to free healthcare.

People who get all their income from social welfare have an automatic entitlement to a medical card, but for workers the income limit is now set below the level of the Job Seekers Allowance for all households, whether they are individuals or families.

For those people the impact of this can be devastating, if they experience illness and need hospital treatment they will have to pay, if they can’t afford to, they get into debt increasing the stress of having an illness. 

Just before Christmas, the Irish Cancer Society called on the HSE to stop using debt collection agencies to pursue cancer patients for monies owed.

Those who are dependent on social welfare get the medical card, the higher income group get tax rebates linked to their private health insurance but low-paid workers and their families are forgotten about.

The Minister for Health must be held responsible for the on-going erosion of Irish citizens access to healthcare. 

Excluded

The Republic of Ireland has a population of approximately 4.8m. There are approximately 1.6m households with medical cards, 2.2m with private health cover and that leaves around 1 million people with no health cover.

Since health care is so essential, we have to assume that most of those people who don’t have any are low-paid and can’t afford private health insurance. 

During the period from 1998 to 2006, the Medical Card income limit was regularly adjusted and remained above the level of Job Seekers Allowance.

In 2006 the Medical Card income limit was set at 18% above Job Seekers Allowance rates but that income limit has not changed over the last 12 years, so now it has fallen below social welfare rates, which have increased by 35% in that time.

Any person whose entire income is from social welfare automatically gets the card.

Some low-paid workers have access to the card because certain forms of income such as Family Income Supplement aren’t counted as income for medical card assessment purposes. Also, some expenses, such as childcare and other costs of going to work are deducted to arrive at the net income for assessment. 

Because of these factors, it is hard to define precisely who does and doesn’t get the card but what is clear is that every year the government fails to increase in the income limit, more low-paid workers are being excluded. 

Safety net

Some low-paid workers, who don’t qualify for a medical card have been issued with GP cards but that is not the same thing at all. It only covers GP visits and doesn’t provide access to the range of health services people might need. 

The medical card provides for outpatient, inpatient and A&E services in public hospitals, some free dental work, vision and hearing treatment, reduced prescription charges and priority access to community care services.

It is also linked to other essential services which are exclusively offered to medical card holders, this system was developed when many low paid workers had the card. Those services include free school transport, free entry to state exams, cheaper childcare and a maternity grant.

Excluding low-income workers from access to the medical card is likely to be a significant disincentive for some people to return to work.

As such the system needs to be radically overhauled to bring low paid workers back under the safety net of free healthcare, to which they previously had access. 

When the Irish Cancer Society called on the HSE to stop using debt collection agencies to pursue cancer patients, the HSE responded by saying that they act “in a socially responsible, ethical, efficient and cost-effective way”.

But their actions are not ethical at all. They have silently removed access to the medical card from many of Ireland’s working poor.

It is time for the Minister of Health to intervene and increase the medical card income levels by 35% in order to restore public health care access to those who cannot afford to pay for it. 

Felim O’Rourke is an economist from Sligo with a particular interest in the impact of tax and welfare policy on ordinary workers.

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    Mute Keith Byrne
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    Mar 28th 2016, 11:06 AM

    Brilliant stuff Christine – looking forward to seeing how this pans out over the coming hours/days :)

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    Mute Damien Dineen
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    Mar 28th 2016, 2:11 PM

    This is a brilliant read! Thanks guys!

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    Mute hjGfIgAq
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    Mar 28th 2016, 2:48 PM

    Thanks Damien, much appreciated.

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    Mute An Observer
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    Mar 28th 2016, 12:10 PM

    Policeman has just been shot outside Dublin Castle. This is getting serious. I’m going down to the GPO, my brother works there as a messenger,he might know what’s going on in the city.

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    Mute domas1507
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    Mar 28th 2016, 4:01 PM

    Me and my sister are heading to the Jacobs factory. Heard all the shops close by are vacant. We haven’t eaten in a few days . Mam told us to stay away bu she’s looking after our little brother now and I don’t think she will be angry when we bring back food. She looks so sad recently. We really can’t wait to put a smile on her face. I’ll let ye know how we get on

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    Mute domas1507
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    Mar 28th 2016, 4:20 PM

    We’re standing on bishop’s street now. The shops aren’t vacant they are all smashed up. There is food we could never imagine eating just sitting there. Come on Mary let’s get it. “That’s stealing christy, mam will kill us for doing that”. Look if we don’t take it someone else will,and look at all that bread and cakes. Jesus we could eat for a week on that stuff. I know it’s missus murphys shop but she’s always been good to us and I think if it’s going to be taken shed like us to have it. You wait here Mary I’ll go and get it yiu just let me know if anyone comes ok? “OK christy but be careful the army are everywhere “. I’ll be grand , just imagine the feed we are going to have tonight

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    Mute domas1507
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    Mar 28th 2016, 4:32 PM

    Mary here. Here come christy now . I’ve beverage seen such a smile on his face . Look at all that food he has . He was right we will eat for a week on what’s in his arms. …why has he stopped running? “Chrisy get up your after dropping all the food” “CHRISTY ….CHRISTY … CHRISTY”. he’s not moving. I have to go and see what’s wrong . I’m coming christy … Jesus what’s that pain … I can’t stand . Mam is going to be really angry with us now I think

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    Mute Beano
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    Mar 28th 2016, 12:31 PM

    I really hope the rebels help achieve freedom. Can you imagine if in 100 years time we have streets full of British shops, buy British goods, support British football teams and watch British TV….what a travesty that will be! ;)

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    Mute Noah Wilson
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    Mar 28th 2016, 12:39 PM

    And a bunch of Tories running the country.

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    Mute An Observer
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    Mar 28th 2016, 1:11 PM

    I was just talking to one of the rebel fighters, I found a pistol on the ground and I’m joining them. I see what they are trying to achieve,I couldn’t before but she made me see it has to stop. I want my grandchildren to live as Irish citizens and in control of their own destiny. Shots are being fired now, this is madness. I’ve never used a gun before but if anyone believes in a free Ireland, join us. This is our chance.

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    Mute monkeysocks
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    Mar 28th 2016, 10:35 AM

    Bugger….I was all set to go

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    Mute Suzie Sunshine
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    Mar 28th 2016, 11:48 AM

    Great idea , this will be interesting . well done TheJournal. !

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    Mute Lucy Legacy
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    Mar 28th 2016, 2:11 PM

    What a great idea Christine and the Journal. On bus into town and half expecting to hold witness

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    Mute hjGfIgAq
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    Mar 28th 2016, 2:48 PM

    Thanks Lucy, appreciate that. Be careful out there :)

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    Mute An Observer
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    Mar 28th 2016, 12:50 PM

    Christine, a man named Pearse read out a Proclamation outside the GPO over 40 minutes ago. He was declaring Ireland a Republic,whatever that is. People don’t know what’s going on, my brother was evacuated from the GPO but I can’t find him. Now Davy’s pub at Portobello has been stormed.

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    Mute hjGfIgAq
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    Mar 28th 2016, 1:17 PM

    Be careful if you go out looking for your brother. There are British troops around Sackville Street trying to get close to the GPO and there’s a good bit of gunfire between the two sides right now. You might want to leave it for a while and see if he can make it home by himself.

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    Mute Ciarán
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    Mar 28th 2016, 1:22 PM

    I’ve just spoken to your brother, He said meet him down by the five lamps.

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    Mute An Observer
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    Mar 28th 2016, 1:24 PM

    Me Ma is looking for us both, she s going around the city. I think my brother is sending messages to other rebels in the Jacobs factory…

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    Mute Welshhibby
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    Mar 28th 2016, 3:37 PM

    I hear there were Boos and jeers when he read it out. This seems very unpopular.

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    Mute An Observer
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    Mar 28th 2016, 10:47 AM

    I don’t see how these fellas are going to change anything. Not against the might of the British. Sure what advantages will we have by being separate anyway?

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    Mute Socrates Is Alive
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    Mar 28th 2016, 12:49 PM

    Brilliant idea! I’m refreshing every few minutes. My poor battery

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    Mute Sean @114
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    Mar 28th 2016, 3:40 PM

    Well done Christine and Co. Fascinating reading. I didn’t realise that there was a Finn and a Swede taking pot shots from the GPO as well. Great to read the minute by minute account though. Maybe the rebels will win this time.

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    Mute hjGfIgAq
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    Mar 28th 2016, 4:48 PM

    Thanks Sean, appreciate it. The story of the Finn and the Swede is so interesting. They were both in the GPO all week. It seems the Swedish man made it home soon after the Rising, but the Finnish man was kept prisoner in Kilmainham afterwards. You can read more about it here, if you’re interested: http://www.thejournal.ie/readme/ordic-rebels-%E2%80%93-the-swede-and-finn-who-fought-in-the-gpo-1916-1230007-Dec2013/

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    Mute Sean @114
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    Mar 28th 2016, 7:25 PM

    Thanks for that. Really interesting side story. A close relative was in the GPO fighting. I should imagine that they crossed paths at some stage. I’ll never know though. He was imprisoned in Wales though but was released at Christmas along with the others in Frongoch.

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    Mute For Connolly
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    Mar 28th 2016, 3:30 PM

    Just seeing this article now. Brilliant stuff Christine!

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    Mute hjGfIgAq
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    Mar 28th 2016, 4:49 PM

    Thanks very much. There’ll be a good bit of stuff about your namesake to come over the week!

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    Mute I Pee Freely
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    Mar 28th 2016, 10:40 AM

    But it wasn’t a hundred years ago today it was was only ninety-nine years and eleven months.

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    Mute hjGfIgAq
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    Mar 28th 2016, 10:54 AM

    We had this discussion a lot about whether to do this on the actual date of the anniversary or on the date when all the State commemorations are taking place. In the end, we decided to go with the latter. We will of course still be doing a series of articles on the actual dates (24th April – 29th April) but this liveblog will be following events from when they began on Easter Monday 1916.

    Anyone got any thoughts on this, feel free to throw me a mail. I’m christine@thejournal.ie.

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    Mute Jason
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    Mar 28th 2016, 11:03 AM

    How about a bit of coverage for events outside Dublin?

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    Mute OU812
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    Mar 28th 2016, 11:04 AM

    If you made a decision to follow events the events of Easter Monday, you’d be doing them on April 24th.

    This is NOT the centenary.

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    Mute Pat Mangan
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    Mar 28th 2016, 11:17 AM

    In 1916, was the day chosen because it was April 24th or because it was Easter Monday? Go for it Journal.

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    Mute I Pee Freely
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    Mar 28th 2016, 11:20 AM

    Hi Christine some very valid points there can we discuss this further over dinner perhaps?

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    Mute Ciarán
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    Mar 28th 2016, 11:21 AM

    Well it took place in Dublin, Why don’t you tell us what’s going on outside of Dublin?

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    Mute hjGfIgAq
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    Mar 28th 2016, 11:21 AM

    @Jason: You can see all of our coverage here (including some events from around the country yesterday in the liveblog, and there’ll likely be some later today too): http://www.thejournal.ie/1916/news/

    @OU812 I understand where you’re coming from on this, and as I said above, it was something we talked about a lot – but since all of the main commemorations are taking place this week, we decided to run the liveblog now to coincide with Easter Monday.

    @Pat Mangan: Thanks, much appreciated!

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    Mute Jason
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    Mar 28th 2016, 11:24 AM

    Ciaran, Enniscorthy rose too; it’s why the state are holding a full ceremony here today. Enniscorthy rose and didn’t surrender until may 1st.

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    Mute hjGfIgAq
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    Mar 28th 2016, 11:25 AM

    @I Pee Freely: Let me get through today’s liveblog first :)

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    Mute Gene Parmesan
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    Mar 28th 2016, 12:20 PM

    Well Christine…tis a work of fiction. I can clearly see trams working in those pictures.

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    Mute The IMF are here
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    Mar 28th 2016, 12:25 PM

    Out of curiosity, when did the State or indeed its people decide to commemorate Easter Monday’s rising every Easter Sunday?

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    Mute Ciarán
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    Mar 28th 2016, 1:07 PM

    I call for a joint blog so, For the comrades of Enniscorthy to be included and be remembered for there brave stand with the Men and woman of the Dublin Rising. Their story is seldom told. Go Raibh Maith agat.

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    Mute Lazlo Saint Pierre
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    Mar 28th 2016, 4:37 PM

    Hi Christine, The text in the article is almost unreadable in “night mode”, a lighter colour is needed.Thx.

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    Mute Neal Ireland Hello
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    Mar 28th 2016, 6:02 PM

    Yes but most of us will be at work that day.

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    Mute Larry L'Oiseau
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    Mar 28th 2016, 6:59 PM

    Jeez,
    From reading the comments above you can see one of the reasons why the Rising was doomed to failure.

    Lads, its only makey-uppey, it isn’t really happening so suspend disbelief for a while and just go with it ffs.

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    Mute Eamon Mac Gowan
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    Mar 28th 2016, 12:26 PM

    It was mad to go digging trenches in the Green, they should have taken Dublin Castle instead.

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    Mute Jason
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    Mar 28th 2016, 10:53 AM

    Enniscorthy is the place to be today. Full state service and air corps flyover. Community based events. Weather great, gonna be a great day for an old historic and proud town.

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    Mute Ciadhra
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    Mar 28th 2016, 1:28 PM

    Ah Jason you’re ahead of our time.

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    Mute Dermot Bohan
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    Mar 28th 2016, 2:52 PM

    Great idea.

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    Mute hjGfIgAq
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    Mar 28th 2016, 2:59 PM

    Thanks Dermot, much appreciated. Solid surname you’ve got there by the way :)

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    Mute Ghandi
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    Mar 28th 2016, 3:33 PM

    Mayhem! I’m gonna cycle into town via the backstreets now and help myself to that cutlery in Clery’s that I couldn’t afford yesterday. WOOHOO!

    14
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    Mute Ian Begley
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    Mar 28th 2016, 12:59 PM

    Balls, I slept it out! Next time around I’ll be there, lads.

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    Mute An Observer
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    Mar 28th 2016, 4:29 PM

    I’m still looking for me brother. Mr Doyle from Great Britain street says that he saw him running from the British soldiers at Kingsbridge Railway station. I hope he’s alright, he was carrying messages for the Rebels. If they catch him,he’s in for it. I made my way back to the GPO, one of the soldiers left me in through the boarded up window so I can wait for him. The mood is so tense now. The Rebels know the Lancers are going to want revenge for the killings outside.

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    Mute Garry J
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    Mar 28th 2016, 4:44 PM

    This is great stuff, proud Irishman following along here from Canada

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    Mute Martin O Donnell
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    Mar 28th 2016, 4:42 PM

    Great stuff

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    Mute NiallD
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    Mar 28th 2016, 11:51 AM

    They took the GPO at 11.45. Think that’s import.

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    Mute Supremo
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    Mar 28th 2016, 12:10 PM

    They were freedom or resistance fighters

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    Mute Patricia Ryan
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    Mar 28th 2016, 8:55 PM

    Have been following this all day… Just fantastic. Looking forward to tomorrow’s updates. Safe home……

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    Mute Trevor Weafer
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    Mar 29th 2016, 2:41 PM

    Really gives a sense of what went on back then. Thanks for the live blog Christine.

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    Mute Ghandi
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    Mar 28th 2016, 5:03 PM

    Bumped into The O’Rahilly there across from Rotunda. He’s late to the party as usual. Muttered something about an alarm clock before congratulating me on my haul from Clery’s front window.

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    Mute Alec Byrne
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    Mar 28th 2016, 10:42 PM

    The man shot at 12.13 in GPO was John Kealy who was married to my mother’s first cousin. His brother-in-law Charles Donnelly was also in the group in the GPO . Charles Donnellys father and my grandfather were brother’s. John Kealy was the Volunteers first death.

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    Mute Pat O'Connell
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    Mar 29th 2016, 12:32 PM

    Very enjoyable.

    No mention of the “first shot of the rising” which is claimed to have been fired in County Laois late on Easter Sunday night/Monday morning as the local Volunteers participated in the demolition of a section of the railway line at a location near Colt.

    This was to prevent British military reinforcements from reaching Dublin via Waterford after the Rising had started.

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    Mute Seán O'Ceallaghan
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    Mar 28th 2016, 6:19 PM

    The awkward moment when people forget we invited the English over in the first place.

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    Mute Spoddgy
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    Mar 28th 2016, 8:34 PM

    No the king of Leinster did

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    Mute Happy Dude
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    Mar 28th 2016, 6:20 PM

    These terrorists must be stopped. #prayfordublin

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