“DOCTORS’ BILL”

Evening Star, Issue 24004, 1 October 1941, Page 5

“DOCTORS’ BILL”

Important Concessions Patient May Pay Doctor Personally Subsequent Recovery From State Bask Fee Raised To 7 r 6 , No Relaxation Of Critics 7 Objections (Special.) WELLINGTON, September 30. Important amendments proposed in the Social Security Bill dealing with the medical practitioner service announced prior to the debate being resumed in the House to-night did not cause any relaxation in Opposition criticism to the principles of the measure. The Minister of Finance, Mr Nash, whose speech had not concluded when the previous debate was adjourned, took the opportunity for nearly another hour of answering some of the great volume of criticism heard in the country since September 11. The amendments which the Minister of Health proposes to insert in the committee stage were summarised by ' him as follows: — “ 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,” the Minister said, “ will ensure that where a doctor does not wish to claim directly from the Social Security Fund the 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. Two methods of payment will be included in the measure —one making it possible for a doctor to claim from the Social Security Fund direct, and the other making it possible for the patient, after paying the doctor and obtaining his receipt, to secure a refund in terms of the Bill from the Social Security Fund. “The 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 shall 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 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 the doctor is unusually time-consuming. “ A fourth important amendment is to clause 9a of the Bill,” Mr Nordmeyer added. “It is proposed to strike out the words ‘demand or accept’ from the clause, which will then read ‘ That no medical practitioner shall be entitled to recover from a patient or any other person any fees in respect of any general medical service or pharmaceutical requirements.’ ”

ANSWER TO CLERIC OBLIGATIONS OF MINORITIES Mr Nash, dealing with public criticisms of the Bill, said ho was concerned more than anything else regarding the statement of Archdeacon Bullock, a competent and able preacher in the Wellington diocese. To answer his criticism that the Bill was likely to be deleterious in its results on medical practice and undemocratic in principle, he would, he said, quote the greatest authority on public health, Sir Henry Brackenbury, who had stated in New Zealand that lie saw no reason why the universal medical service should have any harmful effect whatever on the patient, provided the doctor was adequately paid. “ There is not a word in the Bill,” continued Mr Nash, “ that could in the slightest degree affect the standard of medical practice except to make it higher, if that is possible. If they are freed entirely from the idea of money and fees, I see no reason why their standard should not he higher.” He admitted that the scale of fees would be controlled, but the total would he tlio same, and payment was made by tlie State on behalf of the patient, ft was not intended in any shadow of degree to interfere with the standard of practice, or the right of the medical practitioner to do all he desired, how and when it ought to he done for the maintenance of the patient’s health. AGREEMENT NECESSARY IN DEMOCRACY. “ It is impossible to work a democracy 1 ,” continued Mr Nash, “except by consent of the democracy. It is important to stress that in this particular instance, if there is any section of a community so powerful in its influence that it can say: ‘ We will not render the service that the majority of the people think ought to be rendered,’ as I believe that body called the B.M.A. may be. then you cannot deny that right to other 'sections of the communitv. You can impose conditions inside a dictatorship philosophy, but must gqt agreement inside the democratic philosophy.”

Mr Goosman: Is there agreement here ? Mr Nash replied that it was important that there should be some element of agreement from minorities where the majority said certain things were in the interest of the community as a whole. Mr Bodkin: Where are the rights of the minority here? Mr Nash: The right to make their case. If we are going to give all minorities the right to determine how they shall render services there can be no ordered Government. If we are to have complete individualism, it will ultimately become anarchy.” WORK IN THEIR OWN WAY. The doctors would work in their own way, and the only difference was that they would get their income from the whole of the people instead of a few. To suggest that the Government had not talked to the doctors was unfair. His records showed that on December 19, 1938, the B.M.A. said it was willing to discuss a fee for service. The basis of tbe present Bill provided for payment in accordance with service rendered, and it was not party politics to endeavour to find some way of achieving the ideal. Though the B.M.A. actually discussed regulations and procedure, it eventually said; ‘No, we don’t like that type of scheme.’ He had 20 pages of notes of the discussion with the B.M.A. and other competent men. The Government had discussed the question with Sir Henry Brackenhury, whom the B.M.A. brought out, and the Government got an eminent actuary, Mr Maddox, to go into the whole procedure.” Mr Kyle: And he did not agree with the Government’s policy. Mr Nash, continuing, said the Government also brought to New Zealand the greatest living authority on procedure, Sir Walter Ken near. For four years it had done nothing else but try to find the best way. RELATIONS WITH PATIENT. Discussing criticism that the Bill interfered with the relations of patient and doctor, Mr Nash pointed out that if a doctor declined to take fees from the State there was procedure under which he would he paid by the patient, who would recover from the fund. The friendly societies, he contended, were fully protected, and there was a clause definitely providing that they would

get the attention needed, the doctors being reimbursed for the services rendered, and he was informed by the Minister of Health that under the procedure operating 13,500 friendly society members had already applied for this payment, and it was being made. FORGED LABOUR STILL A COERCIVE MEASURE OPPOSITION BELLIGERENT “It does not matter whether the doctor gets os or 7s (Id,” declared Mr Doidge (National, Taui'anga). ‘‘The itssue is that the Bill proposes to put into operation the principle of forced labour'. Jt is a coercive measure, and we light it because we are certain, as the medical men are certain, that it will mean deterioration of the medical service throughout New Zealand.” (Government dissent.) Mr Doidge added that he did not know why the Minister had confined his remarks to a cleric of one denomination. Was he not aware that the clerics of other denominations had become concerned? Had he read an article in the brilliantly-edited publication issued by the (lonian Catholics? Mr Lee: The organ of the clerical Fascists. Mr Doidge went on to say that this article was headed 1 Hide of the Bludgeon, ’ and condemned an attempt to interfere with individual liberty. Had the Minister read Sir Henry Brackenbury’s hook on the relation of patient to doctor, wherein he declared that it could not be guaranteed or secure under any system that placed the family doctor in the position of a whole-time salaried State servant? QUACK BILL. "It is a quack Bill,” continued Mr Doidge, “ containing quack remedies inspired by quack doctors.” Why, he asked, was the Government rushing the Bill on the eve of a General Election? Was it because for three years it had mulcted the people of millions and failed to provide what was promised? Sueh a scheme should not be introduced during wartime, and if the Minister did not proceed with it the people would understand his difficulty, with 300 doctors either overseas or called up for Army work in New Zealand, leaving only 600 active practitioners to attend to 1.700,000 people. He believed that in Auckland 59 doctors were looking after 270,000 people; in Wellington 35 were attending to 140,000. Obviously such a Bill would double their work. He bad asked Dr Jamieson how many people a doctor could attend daily. His answer was, in emergency 15 or 16, but normally he preferred to attend not more than seven or eight patients. 6,000 ON ONE PANEL.

“ I am reliably informed,” continued Mr Doidge, “ that in one city in the South Island there is a young doctor, not highly qualified but ambitious, who, when the capitations scheme came into operation, rushed in, and has accumulated no less than 6,000 names on his panel at 15s per head. I am not so much concerned about the amount, but the service. • . , . . The Prime Minister: Wo will get a bit of that back in, taxation. Mr Doidge declared that such a mystery was obviously a ramp. He believed that in Wellington one doctor accumulated not less than 4,000 names. Obviously the consulting rooms would become clearing stations and the hospitals would become choked. Such a system was made easy by the New Zealand Federation of Labour, which was helping to exploit the misery of the masses. It was sending out to all members medical benefit cards with directions how they were to be used. Was it, he asked, a coincidence that the State Fire Office was circularising doctors offering to insure them against claims for damages? ONLY FORCED LABOUR OUTSIDE GAOLS. If the Bill passed it would make the doctors the only section of forced labour outside the gaols. Those overseas would come back to forced labour. But there was an clement of sportsmanship in the community which would refuse to allow the doctors to be doublecrossed during their absence. If the House passed! the Bill it would be an act of treachery to those doctors. Mr Lee raised a point of order; ‘‘ I may be voting for this Bill before it goes through,” he said. “ Is the member accusing me of an act of treachery if I vote for it? ” ■ Mr M'Keen, Acting Speaker, said if Mr Doidge’s remark referred to the members of the House it was not in order. “ That makes it worse,” declared several Government members when Mr Doidge repeated bis criticism. He was then asked to withdraw the statement. In doing so be declared that if the Bill was put on the Statute Book the people would regard it as a betrayal of the men overseas. OTHER POINTS IN DEBATE Mr Clyde Carr challenged Mr Doidge to point out any clause in the Bill which called for forced labour or, imposed coercion. No patient was compelled to consult any particular doctor. The relationship was a mutual one and did not interfere with the relationship between doctor and patient. If a doctor did not wish to attend any patient he did not require to do so, nor was a patient compelled to go to any particular doctor. If any deterioration occurred in the service it would be because of the action of the medical profession, but he did not believe the medical profession would allow such deterioration. He did not believe that any doctor would allow his service to any patient to deteriorate. Medical service was one on which the very life of the community depended. The Bill did not make State servants of the doctors, but merely guaranteed them adequate remuneration and ensured that the medical service would be available to all. Mr Bodkin said he agreed that there was no mention of compulsion in the Bill, but this had been overcome in a subtle way. The capitation system had failed because the doctors were satisfied with the existing position, but the Government set out to destroy their practices by fixing a fee for service. The Government knew that by doing this it would be forcing the doctors into the capitation scheme. In an astute way the Government was seeking to establish a State monopoly of the public health services. The adjournment of the debate was moved by Mrs Drearer. The Prime Minister, Mr Fraser, stated that the debate on the Bill would be resumed to-morrow, when he would

ask for urgency for the second reading. Mr Doidge: Has any date been fixed for the elections? Mr Fraser: What would the honourable gentleman suggest? Mr Holland: November 22. (Laughter.) FULL SUPPORT FOR MEASURE (P.A.) CHRISTCHURCH. Sept. 30. A largely-attended meeting of waterside workers, seamen, and Harbour Board employees, held at Lyttelton, to-day 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 that the doctors will see their way clear to co-operate with the Government in seeing that a free medical service is given to the people of this Dominion.”