AMENDMENTS MADE

Timaru Herald, Volume CL, Issue 22066, 12 September 1941, Page 6

AMENDMENTS MADE

Free Medical Service Bill

No Important Changes In Principle (P.A.) 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 general medical practitioner service. The committee reported back to the House to-day with a recommendation that the Bill should be allowed to proceed with amendments, of which there are several. Tire amended BUI provides that where a doctor is informed that a prospective patient is not entitled to medical attention under any special arrangement and he gives the patient service in good faith, the patient is to repay to the Social Security Fund any amount paid from the Fund to the doctor.

Another amendment stipulates that where a doctor In an emergency supplies any 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 requirement 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. An additional, provision is that if any question arises whether any service is included as general medical service or as to what amount shall ’ paid from the Fund, it is to be decided by the Minister after consulting the committee set up under the origin .1 Act. Clause 8 of the Bill empowering the making of regulations to prescribe higher fees in certain cases and clause 9, stipulating that payments from the fund must be accepted in full satisfaction. have been deleted and redrafted. A restriction is still placed on the right to charge fees in excess of the amounts payable from the Fund. Doctors are forbidden in general to demand or accept any fees for general practitioner services if they have received or are entitled to receive payment ..n the Fund. If a patient refuses to acknowledge the service given, the doctor may recover from the patient the amount which he would have been paid from the Fund. Power is taken to make regulations to a ithorise any general practitioner to receive higher fees than those provided in the Bill, to prevent abuses and to prescribe punishment for offences against the regulations.

Minister’s Explanation An outline of the points which had induced the Government to introduce the amendments was given by the Minister of Health (Hon. A. H. Nordmeyer) in the House to-night when he moved the committal of tne Bill. He stated that those who had been loudest in their condemnation of the Government for not introducing the tree general practitioner service were now the most vociferous in their criticism of the Bill. He had no intention of occupying the time of the House in replying to the hysterical criticism of the measure which had appeared in certain quarters, notably in press editorials, letters to editors and by some of the doctors themselves. The Minister went on to outline the proposals which were contained in the Social Security Scheme when first introduced and what had since been done to Implement these proposals. There had been many 1 people who were not supporters of the Government wno nevertheless had blessed the Government lor the Introduction of the tree hospital treatment scheme. Dealing with the arguments which had weighed with the Government in introducing the free general practitioner scheme, Mr Nordmeyer said the State must be mindful of the wellbeing of the people, and every individual must be a more valuable asset to the State if fit and well. It must have been with something of dismay that many people learned of the number of men examined who had been rejected as unfit for the army. He then quoted the following figures which, he said, showed the position up till about three months ago: Of 5225 men examined for service with the Navy, 1947 had been classed unfit. In the case of the Air Force 11,350 men had been examined and 4600 had been classed unfit, and with the Army 146,290 men had been examined and 53,000 had been classed unfit. The total was 162,865 men examined and 59,000 or 38 per cent, classed unfit.

Mr J. A. Lee: Militarily unfit. Some are great athletes. Mr Nordmeyer: Maybe, but the plain fact of the matter is these figures are an indictment of the health scheme of the community. An Unfair Burden Continuing, the Minister said that another consideration which had induced the Government to introduce the Bill in wartime was that the cost of medical service under the old system often fell unfairly on some people in the community, and he instanced the case of a soldier’s wife who had to meet a bill for £l4 medical expenses and did not know where the money was to come from. “Let me be fair,” he continued. “Some medical men are treating free of charge families of soldiers. All honour to them, but the wife of a soldier should not have to receive this service as charity but as a right.” Everyone knew of cases, he added, where the cost of medical service was an intolerable burden on individual families. The Minister then outlined what had been done in Great Britain in the way of social legislation during wartime. He also quoted the opinions of medical authorities in Britain, Australia and South Africa in favour of a State medical service. Referring to the negotiations which had been conducted between the Government and the B.M.A. in New. Zealand, the Minister said members would know that it had not been possible io secure the active co-operation of the B.M.A. which had contended that the Government had not been ready to meet the doctors. His answer to that was again and again the Government had conferred with them and again and again the Government had sought to meet the profession. The Government was still willing to meet the profess'cn and compromise with it. The med..’.al men retorted that they had submitted a scheme to the Government whicn had been turned down with scorn. The scheme divided the community into tour sections. It had been rejected by the Government, and he believed teat it would also have been rejected by the members of the Opposition. He felt that there were many doctors themselves who would repudiate st.ch a scheme which was completely foretan to the whole social outlook of the people. Mr Nordmeyer also said that doctors a few months ago had stated, if friendly societies accepted any State money they would refuse to render ser-

vice to their members. That threat was i most unfortunate from the medical 1 men s point of view, because it had i alienated the sympathy of a large number of people who previously had been sympathetic to the profession. No Interference Mr Nordmeyer said that all the Bill did was to prescribe doctors' fees ana make it possible for those fees to be paid by the State. It did nothing to interfere with the relationship of doctor and patient. It left a doctor free to carry on his practice as in the past. Dealing with the objection that such a Bill should not be introduced wnile many doctors were overseas, the Minister explained that the Government had placed the position of doctors overseas beyond doubt by guaranteeing that in cases where a doctor’s practice might be interfered with he woul-1 receive up to a year after his ret’ - n an amount equivalent to what he earned during the last year before he left the Dominion. It was true that since the war began 250 doctors had joined up, but only 122 of them were in actual practice in New Zealand and some ol that number were specialists not affected. Mr Nordmeyer said the exact form of specialist service would be defined in the regulations. A specialist would not be entitled to a fee for something a general practitioner could do quite well. He could only claim payment for doing specialist work. Any argument that the scheme would lower the standard of medical practice was a libel on the medical profession. He refused to believe that the medical men of the Dominion would allo y their professional standard to deteriorate because they would no longer receive their fees from the individual but instead receive payment from the State. The Government had been willing to meet the profession at all times and was anxious to understand its difficulties, and was appreciative of its services. The Government at no time had coerced the profession. Socialistic Ideas Implemented The Leader of the Opposition (Mr S. G. Holland) said there was much more behind the Bill than had been stated. He quoted a number of extracts from speeches made by the Prime Minister from 1930 onwards with a view to showing that the Government was determined on a policy of socialisation. In one of these quotations Mr Eraser had been reported as saying that he personally believed in equality of income for the people of New Zealand. The Bill implemented the socialistic ideas of the Government. It made for the destruction of the enterprise, system and freedom of the medical piofession. It fcould bring about equality of Income. The same fee was to be charged for every service whether the time occupied was two hours or two minutes. It was a piece of legislation designed to give effect to the policv of the Government that it would bee .me the only employer. There had nevei been a more coercive measure placed on the Statute Book of New Zealand than the present Bill. Mr C W. Boswell (Labour, Bay of Islands): What about conscription? Mr Holland contended that conscription was introduced by regulation and nobody could deny that the present Bill was designed to socialise a noble profession. Mr Holland said it would be argued that the Bill was not socialistic liecause doctors were free to practise, but the fact remained that under the Bill every doctor would become a State employee The administration of the Bill would be conducted by regulation. Rules would come later, he said, and it appeared that New Zealand was to have a collective medi-’.ii profession. Collective everything seemed to be the Government’s objective, continued Mr Holland. Its method was apparently to take one step at a time. It assured everybody that they had nothing to fear, that it would protect the interests of this and that industry and then it took them over one at a time. The Acting Prime Minister had said m 1939 that the Government was anxious to safeguard the position of the friendly societies who had rendered a wonderful service. Now it was proposed to sweep them away. He said that the Government had sold the public a service and taken the public money for three years and had then failed to deliver the goods. If that had been done in the commercial world it would have been called fraud. If it were right to bring doctors under a scheme, why not dentists, lawyers, accountants, newspapers and. perhaps, parsons, architects and carpenters? It would end in the Government having all the services and the whole of the people’s income to pay for them. It was a philosophy that people did not want. He thought there was a case for improved service and any proposal to give it merited support, but the Government's proposals did not provide for an improved service. Mr Holland mentioned that many doctors

took post-graduate courses overseas. The Bill fixed the fee at 5 - a visit no matter what the doctor’s qualifications might be, and doctors would be worse off through taking post-graduate courses because they would sacrifice income and would not be able to make up any leeway by extra charges. Amendment Moved Mr Holland then moved the following amendment: — “That in appreciation of the conspicuous services which are being rendered by members of the medical profession on active service overseas, and in view of the present serious shortage of doctors, which will become increasingly acute as the war proceeds, consideration of the Bill be deferred until the return of our fighting services and, in the meantime, consideration be given to the feasibility of relieving the public from the taxation levied to provide a State medical service.”

The Acting Prime Minister said he was glad to note that the Opposition opposed the Bill, for that made the issue clear on a policy which the Government had followed tor live years of trying to get the doctors to work in harmony with the Government in order to carry out the policy it had promised. Since 1936, continued Mr Nash, the Government had made every effort to get the doctors to co-operate. It was not right to say that there had been no discussions, for they had gone on for months. Sometimes the doctors said they would have nothing more to do with the scheme, but discussions had been resumed. He denied that there was no harmony between the Minister of Health and the doctors. He knew hundreds of doctors who wanted to work under the scheme. There was a tremendous lot to be said ab°ut sticking to one’s organisation, and he was not going to blame the doctors tor sticking to the 8.M.A., but he would suggest that those who felt this scheme ought to go through and who had ideals that the people should have the attention which it provided should make their voices heard.

Payments to Profession Mr Nash quoted returns for the last financial year showing the amounts received by the doctors in salaries and fees for work done for the State, public hospitals, conducting examinations and in doing other work and operating the maternity medical benefits scheme. In these fields they had beer paid last year £499,000. There had also been another £lOO,OOO for other work, and all this money had been provided by the State. Mr Nash also asserted there had been no coercion in connection with the doctors. He then gave a survey of the negotiations that had taken place between the Government and the B.M.A. The Government had offered to give the doctors the income they declared for taxation and 5 per cent more, and had told the doctors that they could distribute it among themselves. It had offered them complete control outside the safeguards against fraud. The Nash emphasised that co-opera-tion between the doctors was required, and stated there was one aspect of the Bill which failed to satisfy him. That was that the preventive side was not covered. He believed that compstent men should be charged not onlv with the curing of people but also with preventing ill-health. The system provided in the Bill would prevent the health of the community from deteriorating, and it was the foundation for the ideal he had indicated. The debate was interrupted by the adjournment at 10.30 p.m.