MEDICAL SERVICE BILL

Press, Volume LXXVII, Issue 23448, 1 October 1941, Page 8

MEDICAL SERVICE BILL

Major Amendments Proposed HIGHER BASIC FEE; TWO METHODS OF PAYMENT (P.R.) WELLINGTON, September 30. Major alterations to the Social Security Amendment Bill, including a higher basic fee and power for a doctor to accept a fee from a patient instead of from the social security fund, were announced in the House to-night by the Minister for Health (the Hon. A. H. Nordmeyer). He said the alterations would be embodied in amendments to be moved during the committee stages, “I intend in committee to move a number of amendments, some of which will affect the bill considerably,” Mr Nordmeyer said. “It may help discussion at this stage of the bill if I indicate to the House now the main amendments that will be moved in committee.

"It will be obvious to members that the date named in the bill as the commencing date of this scheme will have to be altered, and the Government has decided that the scheme will operate as from November 1. "Another important series of amendments will ensure that where a doctor does not wish to claim directly from the Social Security Fund, a patient may pay him the amount of his fee, and recover from the Social Security Fund at his local post office the amount fixed as the fee in the bill. The two methods of payment will be included in the measure, the one making ii possible for a doctor to claim from the Social Security Fund direct; the other making it possible lor a patient, after paying the doctor and obtaining his receipt, to secure a refund in terms of the bill from the .Social Security Fund. “A third amendment alters the basic fee,” the Minister said. “In the measure before the House the fee is 5s for a consultation, and 6s 6d for a visit to a home, within any borough or city area. It is now proposed that the basic fee be 7s 6d for either a consultation at the surgery or a visit to a home. The mileage fee will remain at Is 3d a mile. It is also proposed to include in the regulations to be issued in terms of this Bill provision for the payment of 12s 6d to a doctor for a night call between the hours of 10 p.m. and 7 a.m. The regulations •will also provide for the basic fee to be increased in cases where the attention given by a doctor is unusually time consuming. "The fourth important amendment Is to Clause 9A of the bill,” Mr Nordmeyer added. “It is proposed to strike ou,t the words ‘demand or accept’ from the clause, which will then read: 'That no medical practitioner shall be entitled to recover from the patient or any other person any fees in respect of any general medical services or pharmaceutical requirements.” Attention for AH "The principle that the Government has in mind all the time is a single one—that is, to see that everybody, no matter who they are, should have the attention they require; that they should not go short of that attention because they have not the money to pay for it;' and that the person giving that attention shall be entirely free, to give that service according to jjua owl way and his interpretation ogaheagßßssion to which he belongs?’ Bam..«ie Minister fer Finance (the HcgC-j-rW• Nash) in concluding his speech on the Social Security Amendment Bill. Emphasising the importance of having the right to criticise Parliament and the bills coming before it, Mr Nash said criticism of the bill by Archdeacon Bullock had hardly any relevance to the principles of the bill. The first point by Archdeacon Bullock was that State control of a medical service would be deleterious and unfair in practice, and undemocratic in principle. In 1938 the greatest authority. Sir Henry Brackenbury, said he saw no reason why a universal system in this Dominion should have any effect whatever upon the treatment of the patient from the health point of view. There was not a word in the bill to affect medical practice, except to make it higher. It was not intended in any shadow of degree, to interfere with the standards of practice. It was impossible to work democracy without the consent of democracy, and it was important that some element of agreement should ccme from minorities when majorities said certain things were necessary in the interest of the community as a whole. Mr W. A. Bodkin (Opposition, Central Otago): Where are the rights of the minority here? “If we all have the complete individualism suggested by the questioner, the ultimate will be anarchy,” replied Mr Nash. While majorities must rule inside democratic procedure, they must think out the implications on the minority, and give maximum freedom to the rights of the minority. When a service was determined, it was the duty of every minority, whether miner, waterside worker, or medical practitioner, to render the service, and find out the best way to make it work. There was not a word in the bill which said that the State was to assume a monopoly of medical practice, maintenance, or treatment. The only thing in the bill was how that practice should be paid for. The profession could work in their own way, and determine what treatment was to be given and how it was to be given. The bill implied that they should get their income from the whole of the people, not a few. Archdeacon Bullock said that unfortunately the question had become one of party politics. The Government had not made it so. Conferences With Doctors It was unfair, Mr Nash said, to say that the Government had not talked to the doctors about the scheme. On December 19. 1938. the British Medical Association had offered a scheme based on payment for services rendered, yet denunciation had rung throughout the country in the last fortnight because the bill specifically provided,for payment for services rendered. "We have tried to work out this bill to get a section of the community that we respect as men to work as a body and give a service the community must have,” he said. “All that remains now is the form in which they shall be paid for that service. It is recognised that the people are entitled to the service. That is not party politics. It is plain, quiet, deliberative negotiation to try to find a way.” After that offer Dr. Jamieson and Dr. Lynch discussed regulations for payment for service with officers of the Health D?partment. They went back, and then said that doctors would not co-operate as they did not like the scheme. Discussions had been held continuously with the British Medical Association. The Government had done everything for four years to find means pf getting in touch with everyone; Mr Bodkin asked if the bill did not socialise the medical profession. Mr Nash: It does not in any way iriterfere with the rights of practice. Mr Bodkin: It makes the fee so low that it makes it unacceptable. Mr Nash said he thought there was a case for differentiations in fees for service at the surgery and at home, and that more should be paid for night calls. 'Answering statements that the bill interfered with freedom of choice of a doctor, he said the idea of a fee for t ? rvice was that the patient could go to or call a doctor at any time, and the State had to pay. The objection Jo retipoegg&ro jc£ .over by th£

Minister for Health stating that the Government would pay the patient. “I believe that the doctors will work this bill.” Mr Nash said. "When the principles are understood fully we will get along all right.” Already 13,500 members of friendly societies had applied for reimbursement, and payment would be made. In 1938 the present Prime Minister had written to Dr. Jamieson that remuneration was a matter upon which the Government was willing to enter into immediate discussion, and that the aggregate income should be better than it was then. The profession was asked to decide itself the method of distributing the aggregate income. “A Quack Bill” “This is a quack bill, providing quack remedies and inspired by quack doctors.” said Mr F. W. Doidge (Opposition, Tauranga). A clarion call for freedom had been sounded by the Leader of the Opposition (Mr S. G. Holland) when the debate began, and the repercussion had been meetings of protest against the bill throughout the country. Mr Doidge said the Opposition did not care an iota whether the doctors got 5s a case or 7s 6d. That was not the issue. But the bill proposed to put into operation the principle of forced labour. It was a coercive measure, and the Opposition fought it for that reason, and also because of the belief, shared with the doctors, that the bill would mean a deterioration of medical services throughout the Dominion. Mr Doidge said that the Minister for Finance had referred to the sermon given by Archdeacon Bullock. He wondered why the Minister had not mentioned other clerics, for all denominations were aroused. He wondered, for example, if the Minister had ever heard of the Catholic paper "Zealahdia,” and read a brilliantly written article on the subject. Mr J. A. Lee (Democratic Labour, Grey Lynn): The organ of clerical Fascists Mr Doidge: I know the member for Grey Lynn does not like it. Mr Dcidge quoted from the book by Sir Henry Brackenbury entitled “Patient and Doctor.” The author stated that two essentials: that the relationship between doctor r.nd patient should be the predominant relationship always, and that It should be a completely free relationship, could not be guaranteed or secured by any system family practitioner in tWipr.irfttpfrTif a whole-time salaried 'Statfr-wnTOW^ “Not the Right Time” Everyone was united in the desire and pledge to help the needy, ease suffering, and provide a medical service for the people who needed it, he continued. These objectives would not be achieved -by the bill before the House. The people requiring attention were the ones who would suffer under the co iditions set out in the bill. “Why is the Government rushing this bill?” he asked. “Is it not because we are on the eve of a General Election, and because the Government, in the last three years, has mulcted the people of millions on the strength of promises given and never redeemed?” The present was not the time to bring down such measures. There were about 1000 doctoi’s in New Zealand, and of these perhaps 100 were no longer physically fit to continue full practice. That left some 900, of whom there would be 300 either overseas or on Army work by the end pf the year. There were thus 600 doctors to attend to 1,700,000 people. In Auckland 59 doctors were available to look after 270,000’persons, and in Wellington 35 doctors for 140,000 persons. It must be clear that the time was not opportune for the measure. Mr Doidge said he had been told by Dr. J. P. S. Jamieson that in extremity a doctor could deal with 15 patients a day; but he personally would prefer no more than seven or eight patients a day. (Laughter from Government benches.) The capitation scheme was mentioned by Mr Doidge. He said he was reliably informed that in one city in the South Island a young doctor, not particularly highly qualified, but ambitious, had rushed in when the capitation scheme was introduced, and had accumulated 6000 names on his panel at 15s a head. Opposition voices: I wonder if that is Dr. McMillan. Mr Doidge: The point I want to make is that the people on that panel will not get the service they deserve. “The whole thing is obviously a ramp,” Mr Doidge added. He was told that in Wellington one doctor had accumulated 4000 names, and it was obvious that in such cases consulting rooms would become clearing stations for hospitals. Yet the Federation of Labour was exploiting the misery of the people by sending out medical benefit cards with directions how to use them. Mr Doidge said that there was no danger money for doctors who might have to treat highly infectious or contagious cases, nor was there dirt money, as was provided for watersides for handling unsavoury cases, ■ The doctors should have employed Mr Jim Roberts as secretary, and the bill would never have appeared before t’ - e House. Loss of Incentive Mr Doidge also raised the question of loss of incentive under the scheme for young doctors to travel abroad and take higher dgerees. The State had evidently anticipated a decline in the quality of service under the bill, as doctors had recently been circularised by the State Accident Insurance Office with offers of insurance cover against actions for damages. Government members: That is a usual thing. Mr Doidge said that if doctors wanted to make big money under the scheme they had only to become hocus pocus merchants and racketeers; but they would not do that because they thought more of their profession than of the money to be made out of it. He asked if the Prime Minister would tell the House what he really thought when he returned from abroad and found the bill rushed into the House, and already half-way to the Statute Book. Could he also say with a clear conscience that he was satisfied with the bill after what he had been sayabout the war for freedom during his stay in Britain? He would remind the Prime Minister of his support and approval of the eight-point charter enunciated by Mr Churchill and Mr Roosevelt. In it was proclaimed the right of all men in all lands to live out their lives in freedom. The bill provided that on their return from active service 300 doctors would come back to forced labour. The bill stabbed them in the back. The tfcili was manoeuvre the -

DANGER SEEN BY MR BODKIN

NO RIGHT OF APPEAL FOR DOCTORS (P.R.) WELLINGTON, September 30. The contention that the bill was a device to destroy the practices of doctors who relused to work the capitation scheme, was made by Mr W. A. Bodkin (Opposition, Central Otago) during the debate on the Social Security Amendment Bill in the House to-night. Mr Bodkin said that in view of the attitude of the great majority of the medical profession, the Government had to find means of regimenting them, so hence the bill now before the House. Referring to criticism of Archdeacon Bullock’s remarks, Mr Bodkin said that the archdeacon was one of the clearest thinkers in the Church to-day, and he had made a very sound analysis, both of the bill and of the trend of affairs which it represented in New Zealand. Government speakers had failed to point out that Archdeacon Bullock had said that there was a place for a State medical service; but had protested against a State monopoly. Mr Carr (Government, Timaru): Why did the people elect the Government? Mr Bodkin: When the member for Timaru was speaking he boasted that this bill was Socialism. Continuing, Mr Bodkin said that a few months ago President Roosevelt had stated that there could not be free labour without free enterprise. Under democracy as British people understood it, the rights of minorities were just as sacred as those of the majority. The Prime Minister (the Rt. Hon. P. Fraser); Aren't there any elements of compulsion in the law? Mr Bodkin: Not as far as the sacred rights of the individual are concerned. Mr Bodkin went on to say that every piece of legislation, whether transport or industrial efficiency, which the Government had brought down, and now this legislation, had denied the right of appeal to the courts of the land. In a Socialist state, every individual had to be regimented, and that was what was happening to the doctors. The sacred right of appeal had been taken away from the doctors. The Prime Minister knew that this was a step in the Government’s Socialist programme. Labour members had boasted that the Government had got the doctors where it wanted them. A Government member; That's a lie. Mr Bodkin said that where there was conflict between the rights of the jndividual and of the State, and the State insisted that its rights prevail, totalitarianism arose. That was the danger now. PUBLIC MEETING IN OAMARU (P.A.) DUNEDIN, September 30. A public meeting held in Oamaru tonight to discuss the doctors’ bill expressed opposition to the Government’s scheme for a general medical service, but welcomed the principle of national health insurance as a further improvement of the already high standard of medical practice in the Dominion. The last two clauses of the long resolution adopted were as follows: "In the event of the national health insurance scheme being agreed upon, with the consent of the majority of doctors both at home and overseas, this meeting is of opinion that even so, the freedom of the minority should be respected, so that anyone who chooses could continue to practise outside the scheme; that coercion of any section of the community is abhorrent, and that any trade agreement which does not provide for the submission of disputes to arbitration is contrary to all democratic tradition and principles.” ADDRESS TO WELLINGTON PAINTERS (P.A.) •■■WeLQNGTON, Sept, 30. A meeting of the Wellington Amalgamated Society of Painters and Decorators' Industrial Union of Workers, which was addressed last night, at its own request, on the subject of "The State and the Doctors,” by the Ven. Archdeacon Bullock, was not open to the newspapers. The address was decided on last week by the union executive. Recently Archdeacon Bullock delivered a sermon in which he dealt with the Social Security Amendment Bill, involving the free medical practitioner service". The union secretary wrote to him stating that members of the union had read with astonishment an account of the sermon. That Archdeacon Bullock had very definite views on the subject there was no doubt, stated the letter, and nothing would give members of the union greater pleasure than to hear them expressed by Archdeacon Bullock in person. It is understood that Archdeacon Bullock was given a courteous and reasondble hearing. He answered a number of questions and was accorded a vote of thanks. BILL SUPPORTED A largely attended meeting of waterside workers, seamen, and Harbour Board employees held at Lyttelton yesterday passed the following resolution unanimously;— “That this meeting of waterside workers, seamen, and Harbour Board employees pledges its full support to the Government’s Free Medical Service Bill, and congratulates it on its great work on behalf of the sick and suffering, and trusts the doctors will sec their way clear to co-operate with Ihe Government in seeing that a free medical service is given to the people of this Dominion.”

Opposition into an awkward position for the general election; but it had failed in that object. The people demanded, and they knew that they would only get, a sound medical service with the co-operation of the doctors. The people’s sense of sportsmanship would not permit the bill being put across (he doctors, and of the treachery committed against them. The .Acting-Speaker ordered the withdrawal of the term treachery. Mr Doidge: I withdraw the word; but I say that if the bill is passed it will be betraying the doctors overseas. “There is not one iota of justification for the suggestion that there is any coercion in this bill,” said Mr C. L. Carr (Government, Timaru). ‘‘This bill does not make doctors State servants. It merely guarantees them adequate remuneration, and ensures that their service will be available to all. “The doctors are citiztns, most of them are good citizens,” Mr Carr continued. “And they are subject to the laws, like any other citizens. They have no more right than any other citizen to dofy the law.” Socialism meant that whatever the people depended upon for their very lives, that should be provided by the people, although they should have to pay for ! it. That principle was being carried | out in the bill. Medical service was something upon which the very life of the people depended; but he challenged the Opposition to show where there was coercion of any kind or degree. No doctor, was compelled under the bill to attend any patient, nor was any patient compelled to go to any particular doctor. The whole thing was by mutual consent or arrangement. NO COMMENT MADE No comment on the new amendments to the Social Security Act was available from official sources in the city last evening. 1 The chairman of the Canterbury branch of the British Medical Association (Dr. L. C. L. Averill) said that he had no comment to make until the amendment* had be6n considered in detail by the New Zealand branch of the association