NATIONAL HEALTH SERVICE

Dominion, Volume 31, Issue 271, 12 August 1938, Page 12

NATIONAL HEALTH SERVICE

“Needy No Better Oft”

STANDARD OF MEDICAL PRACTICE Friendly Society Movement The national health service proposals submitted by the Government to a special Parliamentary Committee are discussed in the report issued by the three Opposition members on that committee. The view is expressed that the proposal* of the Government will have the effect of discouraging thrift and giving a reward to the spendthrift. The Oilposition members’ report states that the Government proposals claimed to provide for free genera’ practitioner service, free hospital treatment free mental hospital treatment, free medicines and free maternity treatment. No services that involved the taxing of those receiving the benefits or services to the extent of £3,000,060, or £2 a head of population per annum, could be called free services.

“We wish to record the fact that the Government has steadfastly declined to lay before the committee the working details of its proposals, as would be necessary in a Bill,” states the report. "For example, information is completely lacking as to (a) the rate of remuneration to be paid to the medical practitioner; (b) the conditions under which sickness benefits are to be paid; (c) whether sickness and incapacity benefits ore payable to women, and men, or to men only; (d) the category of persons able to come within the definition to qualify for the disability pension ; (e) the type of service to be provided under a general practitioner service: (f) the methods proposed for raising the money to finance the scheme. Practicability of Proposals. "We hold that it is imperative to know how it Is proposed to raise the necessary funds, before a conclusion can be reached as to the practicability of the proposals, and we disagree with the Government’s contention that the matter of how the money is to be raised is one solely for the Government and not one for the committee to consider at all.

“We repeat that It is essential to a proper consideration of the proposals that we should be made aware of the full details of the measures to be employed for raising the required amount of money. The English actuary, Mr. G. 11. Maddex, drew attention to the necessity of having the conditions under which sickness benefits are to be paid, clearly defined. “On this subject of lack of information, the work of the committee has, in our opinion, been seriously hampered by the refusal of a majority of the committee, including all Government members present: —

“(1) To call witnesses we have requested should be called, and who would have 'been able to give most valuable evidence on the Government’s proposals. These include the head of the Department of Labour, and the bead of the Treasury. “(2) To disclose the methods proposed to raise the money necessary to finance the schemes, which will cost almost £lB,ooo,ooo—or £l2 a head ot. the population —in the first year, and a steadily increasing amount thereafter. General Practitioner Service.

“From the information and evidence which has been made available to tlie committee, we have come to a number of conclusions in regard to the health scheme. In the first place, it is clear that much essential service that is provided by general practitioners at present will not be provided under the Government’s proposals.

"The poor and needy will be in no better position to obtain surgical, laboratory, radiology, consultant specialist, massage, physiotherapy, dental, optical, or home nursing treatment than they are now.

“The difficulty of securing a large panel in the country districts is bound to result in: (1) The best doctors coming into the towns where largei numbers of patients can be obtained, and a correspondingly larger income secured; (2) A more expensive service for country people, due to the bea'J extra cost of mileage when attending them. , “The application of the scheme is likely to result in the elimination ot the existing specialist and consultant services which now form an essential, and increasingly important, part ot our present medical services. /' Attitude of Profession.

“The Now Zealand branch of the British Medical Association lias clearly indicated that it cannot promise its willing support and co-operation n carrying out the scheme, and we consider that no scheme can succeed un der such circumstances. “There is no provision for relieving ratepayers, in either town or country, of the present, burden ot hospital rates. On the contrary, expert evidence was given to show that the scheme « ill increase the population of’our■ hospiita s to such an extent that considerable expense will be involved in additional accommodation, th r creasing rather than redticin, hospital rating.

“Generally, our opinion on the health scheme of the Government i. that it provides u basts for tl regimentation and socialisation o the medical profession, and for tbe ultimate control of the entire met cal service by the State.’

“The weight, of evidence is overwhelmingly opposed to the government’s health proposals in loin dnec lions:—(U They will rot improve the health of the people; (2) the standai of medical practice will steadily deteriorate: (3) the cost of the proposed State health service will be greatly increased, compared with the present system, without any improvement in public health. , (4) n 0 health scheme, such as the Go' eminent proposes, that deals excl us - ly with effects, and ignores causes, is sound. Effect On Existing Institutions. "Any person who, in any way whatever makes provision for his own security in old age, or who provides for his'own security in case of sickness, deserves and should receive the wholehearted co-operation and assistance of the State, whether such provision is made individually or by collective effort. Thousands of people in all classes of the community have already made provision for superannuation and for an adequate medical service to be available should it be required. Evidence given before the committee disclosed that large numbers of insurance and

superannuation schemes are already in existence, most of them being financed by a deduction from wages, with a contribution from the employer of an equal amount.

“The’contribution to these various schemes by the workers varies, but is about 1/- in the £ of the wages. There is little doubt that many of these excellent schemes will cease to operate if a compulsory State scheme is. inaugurated, from which participants in present schemes cannot lienefit (in respect of pension benefits, at least), although they are compelled to contribute to its funds. “A great many people are members Ol that, most excellent organisation known as the friendly society movement, which has rendered invaluable service to the community over a long period of years. Not only has the friendly society movement developed with marked success the social side of its activities, but it has also imbued into its. members a proper value of thrift, initiative and self-reliance—an attribute that has helped to build up a virile and prosperous population of free, independent and industrious people. The proposals under consideration discourage the continuance of these commendable schemes Effect of Proposals. “We are seriously concerned at the effect the Government proposals are likely to have on the friendly societies. It can hardly be expected that young people of limited means who have joined such societies will continue their membership in face of the fact that, in addition to their lodge subscription, they will be compelled to contribute a further 1/- in the £ of their income to the State scheme. It would appear unlikely that the friendly societies can expect young people to join their movement as in the past.

“In our opinion, the friendly society movement should be encouraged and supported, but we would direct public attention to the evidence given by the spokesman 'for the Dominion Council of Friendly Societies, as follows: — ‘Mr. Shrimpton said in relation to the new scheme, • that unless the friendly societies were given an important part to play in the new organisation, he envisaged the slow strangling of the friendly society movement.’ "The particular proposals of the Government would have the effect of discouraging thrift, putting a premium on improvidence and giving a reward to. the spendthrift;—all at the expense of the careful person who believes and practises self-reliance and thrift.

“In our opinion, it is a dangerous and mischievous philosophy that undermines industry, initiative, enterprise and willingness to w’ork, that has been so characteristic-of the pioneers who built up this country.

"Under the Government’s proposals, the only provision made for the relief of unemployment is £1,500,000 for sustenance, so that, in the event of unemployment increasing additional taxation will be necessary. Expenditure Involved. “The estimated cost ofi, the Government’s joint scheme is £17,000.000 for the first year, which, with the estimated cost of administration (£850,000) added, gives a total cost for the first year of £17,850,000. The estimated cost after five years is £20,400,000, after ten years £21,900,000, and after thirty years £25,000.000. “The reasons for these rapidly-in-creasing costs are numerous, but among the more important ones are: "(1) The increasing tendency for people to lean on the State by applying for pensions, a* shown by the following facts:—Up to 1930. 25 per cent, of the people of pensionable age actually drew tlie pension; front 1930 to 1936. 33 .per cent, did so ; in 1937. 40 per cent, did so; in future, 55 per cent, will do so (see actuary’s report). "(2) The population is steadily becoming older, due largely to the falling birth-rate and the low death-rate. The English actuary lias estimated that during tlie next 30 year* the total population will increase by 12 per cent., while the population over 60 years of age will increase by 94 per cent. "The factors of increased expense in providing additional hospital accommodation and increased taxation for heavier unemployment are also to be added to the bill of costs.

Cost In Future. “Further to the matter of cost, it is to be emphasised that, if wages iu the future are to bear the same share (42 per cent.) of the total cost of the scheme, as iu tbe first year (i.e., £t,500,000 out of a total cost of £17,850,000) and presuming that the proposed tax of 1/- in the £ is to be levied on the same basis as at present, then we will require an ‘aggregate private income of £216.000,000 ten years hence to finance tbe .scheme. There is no justification for assuming that our income will increase from its present record level of approximately £150.000,000 to £216.000,000 in the next ten years. Tbe aggregate private income for the seven years period, 1932-1935, has averaged only £113,000.000. • “The question of the ability of tbe country to carry the increased taxation burden involved in tbe Government's proposals mijst receive most careful consideration. “New Zealand is enjoying a record income from the sale of her surplus goods, but tbe fall of approximately £6,(MIO,000 in that income from tbe sale of wool this season, and the reduction in the volume of dairy produce, in spite of a most favourable season, should be a warning not to budget for an expenditure in social and other services that would require an income considerably higher than previous record levels to support it. “It would be disastrous to establish a level of pensions, etc., that could not be maintained in the event of price fluctuations on the markets which absorb our surplus production. and on which we so largely depend for a great portion of our national income.” (Continued on page 13.) SEVERAL BILLS PASSED Upper House Adjourns Till August 30 Because tl.e absence through illness of the Chairman of Committees. Hon. J. A. Hanan (Otago), tbe Hon. M. Connelly (Otago), acted as Chairman of Committees in the Legislative Council yesterday. The New Zealand Council of Law Reporting Bill and the Municipal Corporations Amendment Bill were put through the committee stages, read a third time and passed. Several minor amendments to the Surveyors Bill, chiefly in the clause defining the practice of surveying, were moved by the Lehder of the Council. Hon. Mark Fagan, and agreed to when the Bill was in the Committee stages. The measure was read a third time and passed. The Council, at its rising, adjourned till August 36.