DOCTORS AND THE STATE

Evening Post, Volume CXXVI, Issue 69, 19 September 1938, Page 8

DOCTORS AND THE STATE

In his reply, published in "The Post" on Saturday, to a recent statement by Dr. McMillan, M.P., on the medical provisions in the Social Security Act, the president of the New Zealand branch of the British Medical Association (Dr. Jamieson) clarifies some important points in the attitude of the medical profession towards the Act. It had been suggested by Dr. McMillan that Sir Henry Brackenbury, the distinguished British expert on, health insurance, who visited New Zealand some time ago, approved of the medical scheme in the social security proposals. Dr. Jamieson says that "on the question whether a universal scheme would lower the standard of medical practice, the utmost Sir Henry would con-!

cede was that lie 'could conceive a universal health service in which the medical service would be quite high, if certain principles were maintained.' " It is obvious, adds the president of the 8.M.A., that he saw no such possibility in the New Zealand Government's scheme, for he advised that the strongest opposition should be given to it, and he recommends the association at Home to give the fullest possible support, financial and otherwise, to the New Zealand branch. Then again as to health insurance having raised the standard of medical practice in Great Britain Dr. Jamieson states that Sir Henry made it perfectly plain that the standard had been raised only by comparison with the practice under the old "club" conditions, which have no strict counterpart in New Zealand. Only in so far as there might be lodges in which practice is not very satisfactory did Sir Henry think that the standard would be raised in this country. Sir Henry held, with the medical profession generally, that the best standard of practice was fostered when patient and doctor make their own arrangements privately. There is also a vital difference, from the point of view of the profession, put by Dr. Jamieson, in the relationship between the State and the doctor in New Zealand under the Social Security Act, and the relationship between the State and the insurance doctor in England. In England the insurance doctor has the right of private practice in addition to his insurance work, which is remunerated I from an insurance fund constituted by contributions of employees and, i employers, to which the State contributes a subsidy to cover the cost of administration. In New Zealand under the universal scheme with the so-called "free" hospital, the general practitioner will have no private practice, and will be wholly remunerated by the State from the proceeds of an income tax. As Dr. Jamieson put it, whatever name may be invented to cover his ignominy, lie will be a civil servant without the status, liberties, amenities, and protections of a civil servant. There seems little doubt that this is no exaggeration of the doctor's position under the Act. Under such circumstances the public are bound to suffer. If a universal health service was deemed desirable —and there is jmuch to be said for it—it is a pity that the Government did not take the medical profession fully and freely into its confidence, and [ ascertain on what principles and conditions a health service could be devised to suit all the parties concerned. This was surely not beyond the limits of practical statesmanship. jThe introduction of a version of the British system on a universal scale will inevitably be found unsatisfac- ■ tory to all.