STATE MEDICAL PROPOSALS

Otago Daily Times, Issue 24710, 12 September 1941, Page 6

STATE MEDICAL PROPOSALS

NATIONAL NEED ' HEALTH OF PEOPLE COST OF MEDICAL CARE •THE GOVERNMENT’S CASE (0.C.) WELLINGTON, Sept. 11. “Those who were loudest in their condemnation of the Government some ■ time ago for not bringing forward this or a similar measure are most vociferous to-day in condemning the Government for doing the very thing they chided us with not doing," said the Minister of Health. Mr A. H. Nordmeyer, when moving the committal of the Social Security Amendment Bill, providing a universal general medical practitioner service, in the House of Representatives to-night. From one end of the country to the other, the press and members of the Opposition had criticised the Government for . failing to introduce the medical benefits portion of the social security scheme, yet they now condemned it for attempting to introduce a scheme. An interjection was made by Mr C. A. Wilkinson, (Ind., Egmont) that the criticism was on the collection of moneys and not giving the benefits. “ I have no intention of replying to the hysterical criticism of this Bill that has been voiced in pertain quarters,” continued Mr Nordmeyer. “I refer particularly to the editorials in the daily press,, to obviously inspired letters to the editor, and to the wholly intemperate and sometimes illogical statements of certain members of the medical profession. Some arguments have been produced against the Bill which are constructive, temperate and helpful. ,We shall attempt to meet those arguments, and .the House need not waste its time upon the hysterical nonsense that some people have indulged in.” Mr H. S. S. Kyle (Opposition, Riccarton): Mind you don’t get hysterical. Cost of Medical Care Dealing with the benefits already provided under the Social Security Act, the Minister said that many persons who were not supporters of the. Government had blessed the Government for making it possible for them or their depnedents to receive medical care irf institutions free of charge to the individual. Notwithstanding thecomplexities of the war situation, it was imperative that a free general practitioner scheme should be introduced for the country. One of the first things that would be recognised was,that the State must be tremendously concerned about the health and physical wellbeing of its people. A large capital divestment was represented in the bnngins into the world and the bringing - up g to maturity of the child who was one of the nation’s greatest assets. It was one of the functions of a Government to promote and preserve the individual’s health. . , .. . Another factor which moved uk. Government in its desire to introduce a scheme of this kind, the Mimst r said, was that the cost of medical care fell so unevenly upon the community. Some people escaped for years from payment, while- there ’ were others on whom the cost’fell as an intolerable bU “Le"'me be fair and say that there are some members of the medical profession who are treating free' of charge the wives and children of _ soldiers, M Nordmeyer said. - “All hohoxir,;to them. The point is that if the- writ of a soldier is in need of medical care she should receive that, not as a charity, but as a right.” , . Every member, he said, knew oi cases where for years persons had been trying to meet doctors accounts and everybody knew of cases where the costs of medical care represented an intolerable burden on families. The Government scheme was to alleviate the cost and to make' it less of a burden on the individual. He knew that some persons would say. it was not the. time to do it. . , Mr J. A. Lee (Democratic Labour, Grey Lynn): It is more the time. * War-time Legislation Answering criticism that social legislation should not be introduced during war-time. Mr Nordmeyer quoted the social benefits introduced in Great Britain. It w°uld also be of interest to know, that in Britain, which was in the war zone,, steps were being taken to reform the whble system of medicai practice A Planning Commission had been set up to study war-time development and other effects on the country’s • medical services, both present and future.-, by the British Medical Association. It was' also .reported that • the Medical Practitioners’ Union, confronted with the slow extinction of private practice, had asked for a S.atesalaried medical service, free to everyone. and the Lancet had said that the only, solution was the enrolment of the whole, profession in a national medical service. “■Did I (hear someone say coercion? ” Mr "Ft W. Doidge (Opposition, Tauranga) said that the British proposal was for war time. “ The war demands that the old form of medical . attention must go.” replied Mr Nordmeyer. Mr Doidge: For the duration of the war. . , j The Minister replied that he had further quotations, indicating that both during and after the war the growing sentiment was that the medical profession must be completely reorganised to meet the nation’s needs. In Australia and South Africa it was the same story of laying the ground plan ,for a great State medical service. Attitude of Doctors “ Members will know that it has not been possible to achieve the co-opera-tion Of the B.M.A.- in New Zealand.” the Minister said. “The suggestion has been made from time to time that the Government has not met, and has not been willing to meet, the medical men. My answer to that is that again and again conferences have taken place between representatives of the profession and the Government. I want to emphasise that the Government has been willing to meet and discuss matters with the profession and to compromise with the profession again and again. The medical men report that they have submitted a scheme to the Government which the Government rejected with something like scorn.” That scheme proposed to divide the community into four sections, which he enumerated. Government cries: A means test. ■ Mr Lee: They wanted the loot. “ The Government rejected that scheme, and I think I can give members of the Opposition credit that they would have rejected it also,” Mr Nordmeyer continued. “I think that many 'of the doctors themselves would repudiate a scheme of this kind. It is completely foreign to the whole social \ outlook of the people of this Dominion.” The Minister said that the decision of the doctors some months ago not to * give treatment to friendly society members if they accepted a contribution from the Government was most unfortunate. It alienated the sympathy of a large mass of the people. It was a most misguided action.

DOCTORS OVERSEAS STATE GUARANTEE PROVISIONS OF BILL EXPLANATION BY MINISTER (0;G.) WELLINGTON. Sept. 11. -. The question was asked why a Scheme of this kind was being introduced when so many medical men were overseas, the Minister of Health, Mr Nordmeyer, said in the House of Representatives to-night, in his speech on the general medical practitioner scheme. The position of those men Was placed beyond doubt by his announcement on behalf of the Government that those doctors who had left New Zealand and whose practices might be interfered with would be guaranteed upon their “return an amount equivalent to that which they earned in the last "year before they left, these shores. The Minister said that since the war began some 250 doctors had joined the forces, 50 serving in New Zealand, but only, 122 of that number were in active practice, and some of those 122 were consultants and specialists who were not affected by the Bill. The others came from public hospitals. In 10.29 and 1940, 80 doctors graduated, and 70 would graduate this year. Two Important Changes “The first thing that must be made clear is that the Bill makes two separate and important changes in the law.” Mr Nordmeyer said. “ One clause enabled the Minister to define, any area as a special area, and to permit to be worked within that area any scheme which seems substantially similar to that laid out in the Bill. If there is in any district, town or province a doctor who prefers not to be saddled with the collecting of fees, then I shall be only too happy to see that he is paid substantially the same amount as he would get if he accepted the payments prescribed in the Bill. Two or three men in one area or town may team together, and they will be paid an amount that can be divided up between them in any manner they think fit.” The Minister said he repudiated completely the argument that the Government desired to surround the medical men with miles of red tape. On the contrary, the Government was prepared to give them the utmost freedom. The Bill also prescribed the kind of services that were to be available, services which were to be medical. The proper and necessary services did not include those of a specialist, consultant, or anaesthetist, or maternity service, which, was already being given by the Government. The question of major or minor surgery did not come within the scope of the Bill, and regulations would be brought down to show where the service of a doctor began and ended. Question of Payments Referring to the question of payments to doctors under the Bill, Mr Nord Nordmeyer said that Professor J. B. Dawson, president of the Otago Division of the 8.M.A., had stated that the financial provisions appeared to be not unfavourable, and the Otago Daily Times had stated that the scheme would benefit the majority of the medical men in the Dominion. Mr F. W. Doidge (Opposition, Tauranga): You are not saying that the papers endorsed the Bill? Mr Nordmeyer: I would not make such a ridiculous statement. I wpuld be surprised if they did endorse it. . The Minister said the Bill made provision for the bringing down of regulations which could authorise the payment of a higher fee than that provided» in the Bill and this fee could be made payable for special classes of services where, say. a doctor gave service that was unduly time consuming. Specialist services would also be defined under the regulations,. Standard of Service

One criticism of the Bill, the Minister continued, was that it would lower the standard of fne'dical practice in the Dominion, but he believed, as had been pointed out by the Parliamentary Select Committee which had investigated the scheme, that’the evidence was in the other direction. They were satisfied that if the doctors were fairly remunerated they would render the highest possible service. To say otherwise was a libel on the medical profession, a libel which the doctors were not tired of directing against themselves. To-day. there were doctors in the public hospitals who were not receiving a high reward for their services, but who were giving of their best.

Mr Doidge: The doctors have given ample evidence that the standard will deteriorate.

Mr Nordmeyer: If a statement is evidence, then evidence has been obtained. but a mere statement does not mean that the standard will deteriorate. The doctors will be free from the worry of having to collect their fees. ; ' Mr Nordmeyer also referred to the criticism that the payments prescribed did not make any distinction between night and dav service, and said that most of the doctors to-day charged a flat rate. He believed there, was a good case* for the maintenance of that flat rate, but if it co.ld be demonstrated that the reward; was not sufficient for a doctor , going out to an isolated case he .would take into consideration the questhn of increasmg the fee. Another criticism of the Bill was that it did’ not try down any hoursfor the doctor, but the answer to that was that the doctor, with the exception of the specialist, was on call for 24 hours a day already. Coercion Denied “ The Government has- been reasonable, fair, and willing at all times to meet the profession, anxious to understand its difficulties, and appreciative of its services”,the Minister concluded, “and it has not dragooned or coerced the profession. -It has met it in a spirit of sweet reasonableness, and the Bill represents the least the Government could do consistent with its promises to the people of the Dominion.’’ The Minister was applauded by both sides of the House at (he conclusion of his speech. - ' MINOR AMENDMENTS REPORT OF COMMITTEE 10. C.) WELLINGTON. Sept. 11. No important changes of principle are embodied in the amendments made by the Public Health Committee to the Social Security Amendment Bill which is designed to provide a free genera! medical practitioner service. The committee reported back to the House of representatives to-day with a recommendation that the Bill shauld be allowed to proceed with amendments, of which there are several. The amended Bill provides that where a doctor is ...informed that a prospective patient is not entitled to medical attention under any special arrangement, and he therefore gives the patient service in good faith, the patient, .if his statement is untrue, is responsible for the repayment to the Social Security Fund of any amount paid from the fund to the doctor. Another amendment stipulates that where a doctor in an emergency supplies anv medicines or appliances not covered'by the Pharmaceutical Supplies Regulations. 1941, and thus cannot recover from the fund, he may recover a reasonable cost from the patient. The method of claiming payments from the fund has been slightly varied and there has been deleted the reauirement that a certificate must be obtained from the patient that he has received the doctor’s services. At the same time, the clause stipulates that claims must be accompanied by such certificates as may be prescribed.

SPIRITED PROTEST COERCION OF DOCTORS SOCIALISTIC MEASURE IMPROVED SERVICE UNLIKELY (0.C.) WELLINGTON. Sept. 11. “ Never has there been a more coercive measure introduced in this House,” said the Leader of the Opposition, Mr S. G. Holland, during the debate on the Social Security Amendment Bill in the House of Representatives to-night. Mr Holland, who followed the Minister of Health. Mr A. H. Nordmeyer. spoke at length, and was frequently interrupted by interjections .from the Government back benches. Mr Holland quoted extracts from speeches mades at various times in the past by men now prominent in the Government, and said the Bill was based on those old ideas of Socialism and was aimed at the destruction of enterprise and of the freedom that the doctors as .a section of the community had enjoyed. The Bill was based on ideas of equality of income, and it did not matter whether a doctor was occupied with a patient for two minutes or two hours, the fee would be the same. The Minister of Supply, Mr D. G. Sullivan: The rest of the community has submitted to price fixation. Mr Holland: Because they had no option. The Minister was the only one who had any say, but there has never been a more coercive measure introduced than this in this House. Mr C. W. Boswell (Govt., Bay of Islands): How about conscription? •« Mr Holland: Was that,introduced by legislation? . _ , Mr J. A. Lee (Democratic Labour. Grey Lynn) and Government members; Yes, . Mr Holland: No. It , was introduced by Regulation. Let me hear anybody deny that. There was no reply. State Employees “This Bill is designed to socialise the medical profession, a noble profession,” he continued. Mr Lee: No nobler than plulnbing. Mr Holland: Every doctor who goes under these provisions will become a State employee. New Zealand, it appears, is to have a collective medical profession. Why not have collective hairdressing or collective farming? Mr W. T. Anderton (Govt., Eden): Why not? Mr Holland; We are extracting a confession from the Government of the policy it has for years been trying to conceal. The Government’s policy apparently is to take one step at a time, to assure the people that there is nothing to fear and that everybody will be protected, and to take them over one by one. Mr F. W. Doidge (Opposition, Tauranga): The method sounds familiar. Mr Holland: It is very much in line with modern war technique. Dictatorial Method “ This is the method of a dictator,” Mr Holland continued. “It has been alleged that the profession is to blame because there is not a service in operation. The fact is that the Government, like a bad broker, went to the public and sold a service. It took the public’s money for three years, and then did not have the service to deliver, and. moreover, it had made no arrangements .to provide that service. It took money for something it was not able to deliver, and something it had made no arrangements to obtain. If that was done commercially it would be called fraud. Politically, it is at least reprehensible." Mr Holland said that if it was right to socialise doctors it was right to socialise dentists. Then lawyers could be brought into line arid, then perhaps accountants and newspapers.. parsons. ..architects, and carpenters. - “And as we get these various services gradually under State dictation we will find it necessary to take an ever-increasing amount out of the pockets of the people to pay for the services, and in future years the Government will be giving the whole of the service and taking the whole of the income,” he said. "F know the name of that philosophy.” Mr Holland continued, “and it is not wanted in New Zealand. This is the first step, and they have taken the doctors because they believe they are riot able to stand up for themselves. They have some friends who are prepared to stand by them through thick and thin, and that is what I am doing.” Weaknesses of Scheme Mr Holland said the vital issue in the Bill was the quality of service. He thought there was a. case for*en improved service, and any proposal leadihg in this direction,merited approval. There was also a'case for a complete service for the needy; but the Bill did not . provide it. It did not give any consultant service, surgeon’s service or therapeutic service, or any home nursing; , There was a case for clinics and medical research, but the Bill was significantly silent on all these. The measure made no pretence at improvins the ,service and not even the Minister claimed it did. He had quoted figures showing how many young men were unfit for service, but he did not say a word- about nutting it right. “ This Bill merely socialises the doctors and makes them ‘State employees,” he added. Neither in this country nor in any other did any good result from forced labour. The edict went out, and they could either serve, starve or leave the , country. Mr Lee: Move a conscientious objectors’ amendment—(Laughter.) Mr Holland added that no service was more dependent on goodwill than the medical service, and no service would deteriorate faster if those who operated it felt they were having forced on them something that was repugnant to them. It was certain there would never- be harmony between the doctors and the Government while the present Minister took the attitude he had adopted to the profession. He would have to give up attacking the people from whom he hoped to get service. Burden on Doctors Mr Holland predicted a greatlyincreased load on the doctors as a result of the Bill. The same thing had happened when the hospital service became free, and to-day many people were waiting to get into the hospitals. The hospitals were overcrowded, and people were waiting in hospitals for medical attention. Mr Nordmeyer; In no case where medical care is required is the patient required tp wait. Mr Holland: I will undertake to supply the name of such a hospital in the Kaipara electorate.