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Dáil Éireann debate -
Thursday, 27 Apr 1933

Vol. 47 No. 2

National Health Insurance Bill, 1933—Second Stage (Resumed).

Question again proposed: "That the Bill be read a Second Time." (Minister for Local Government and Public Health.)

When I moved the adjournment of the debate last night, I had drawn the attention of the Minister to some of the reasons which I believed were responsible for creating the situation which the Minister is seeking to deal with now. I expressed the view that unification was not the best way of meeting the situation. I said that we had embarked upon an experiment in unification of which nobody had experience and that the difficulties which had arisen might have been overcome partially by amalgamation and partially by extension of the Old Age Pension Scheme if and when possible, as also by a readjustment, if necessary, of the contributions of insured persons. Seeing that the Minister has decided to make an experiment in unification, our business is to make such suggestions as may assist him to make unification as successful as it can be made. The Dáil should bear in mind that, no matter what form unification takes, some of the approved societies are going to suffer. Certain approved societies, by prudent management, have accumulated satisfactory surpluses and are in a position to give extra benefits by way of dental and optical treatment as well, sometimes, as a higher rate of sickness benefit than their neighbours give. Some societies, by the peculiar character of their membership, have been in an exceptionally favourable position. We must bear in mind that both these classes of society are going to be brought down and not up to the statutory rate of benefit. That should be constantly present to our minds when examining the details of the scheme which, I have no doubt, the Minister will open more fully in the course of the debate.

The next point that arises is as to how the employees of the approved societies and the national health insurance system, as a whole, are to be dealt with. The scheme in the Bill is not one of superannuation but of compensation. In my opinion, that is a mistake. Some of these men and women have been working for 21 years in the approved societies. They are so circumstanced now by the lapse of time and by the fact that the best years of their lives have been given to this service that a lump sum in compensation is not an equitable way of meeting their claims. There is a good precedent in the Railway Acts of 1924 and 1926, in the Blessington Tramway Act and in the Electricity Supply Board Acts. Superannuation on a much more generous basis was provided under these Acts than the compensation proposed in this Bill. I suggest to the Minister that it would be well to consider the desirability of changing this part of the Bill in Committee Stage and of accepting the scheme proposed by the approved societies representatives who met and considered this question. That scheme is, I think, based upon the legislative precedents we had here for superannuation. The Minister, speaking in 1929 on the Committee Stage of the National Health Insurance Bill, referred to these precedents. He moved an amendment there in connection with the compensation of secretaries and other officials of not less than five years' service whose income from other employment did not exceed £200 and he based his scale of compensation on the Railways Act of 1924. He approved of that as a fair and reasonable precedent for the scale of compensation that should be adopted in connection with a Bill that Deputy Mulcahy was then steering through the House.

When we consider compensation we have to consider the classes into which the employees will be divided for the purpose of seeing whether they are eligible and to what extent they shall be eligible for compensation. It seems to me that they fall broadly into four classes. One is the whole-time employee who has no other source of income and is in the direct employment of an approved society. The next is the part-time employee of an insurance and approved society. That class can be sub-divided because I think you have men who are directly on the pay roll of the approved societies for part of their time doing national health insurance work and part of their time on the pay roll of the insurance companies. Then you have another type of employee who is in the employment of insurance companies who are members, for instance, of the Irish Amalgamated, and who are doing the national health insurance work on foot of a contract with the Amalgamated Society, that contract having been approved by the National Health Insurance Commissioners. In that case I think the insurance companies receive a lump sum from the Amalgamated Society and they arrange for the routine national health insurance work to be done by certain members of their staff and these men are part-time. Part of their wages is paid out of this lump sum that the insurance company gets from the Amalgamated Society for doing the work. Whether the Minister will consider these men are entitled to compensation, in the event of their suffering as a result of the abolition of the Amalgamated Society, is a question which I would like him to speak about later on. The next class is the part-time rural agent who derives the greater measure of his income from his work as an agent of a national health insurance approved society and who is provided for in the Bill. The fourth is the same class of agent whose revenue is not largely composed of earnings as a national health insurance agent. I understand that these men are not going to get any compensation. I am not yet quite clear as to who is to be the deciding authority as to whether a rural agent is in fact deriving the bulk of his income from his agency or from some other occupation. Probably the Minister will take occasion to explain that later on.

The actual proposal made by the Minister is in Section 21 and I submit to the Minister that that is a departure from precedent for which there can be little justification. I cannot imagine why the Minister has extended the five years period which he himself sponsored two years ago to ten years under the Bill. In that regard I sincerely trust that the Minister will hold himself open to an amendment which will involve the national health insurance funds in very little additional cost, and which will set right what would seem to be otherwise something amounting to a grave injustice. In that connection we should also bear constantly in mind that the proposal for a more generous scheme of compensation under this Bill will lay no burden on the taxes or rates of this country. The compensation or superannuation proposed by the Bill will be borne by the savings anticipated by the Minister under the unification, and in dealing fairly with these men we are not asking people who are gravely embarrassed by other circumstances in the country to contribute anything more by way of taxes or rates. This is going to be a self-supporting scheme which will be in a position to pay its own superannuation without looking to the Central Fund or any other Government fund for assistance.

The compensation is to be on the basis of one-eighth of the annual remuneration for every completed year of qualifying service. I hope the Minister will consent to reduce that period to five years and I do not think he would be going too far if he went on to give a person who had completed five years' service, who was about to be compulsorily retired, to whom he was not prepared to offer any alternative employment, one year's salary in lieu of notice. I think the equitable proposal would be that the figure there should be reduced to five and that the fraction should be increased to one-fifth.

In sub-section (2) (b) a very arbitrary restriction is introduced. I cannot conceive the frame of mind of whoever proposed it for the Minister's consideration. It reads: "In case such person has ten or more completed years of qualifying service, a sum not exceeding in any case three times his annual remuneration, and subject to that limitation a sum calculated on the basis of one-sixth of his annual remuneration for every completed year of qualifying service." That means that you are going to give credit for 18 years as the maximum service, that the man who was in this business since the beginning, who did all the spade work, who did the difficult work, who got the machine going, who unravelled the multitudinous complications that existed in the early stages of national health insurance work, is not to be compensated for the three years in which he worked hardest. My experience, if I might say so with all respect, of the Minister for Local Government in handling legislation in this Dáil gives me encouragement to hope that it is only necessary to draw attention to a matter of that kind to ensure that the point will be met on the Committee Stage and what seems to be a serious injustice removed.

When I say that, I am advancing arguments on the basis that the Minister will not consider the proposal which I believe to be really the only means of doing full justice to these people and that is by superannuation. The bulk of these employees will not come under this provision at all, because the great majority of them will be taken over. They will have to be taken over in order to make it possible to work this scheme at all. But I am suggesting that those who are not taken over should have the option of a fair and even a generous measure of superannuation and I am convinced that if he is prepared to accept that point of view he will remove from his path what is otherwise going to be a serious difficulty and a cause of grave discontent amongst a body of men and women to whom the State owes a material debt for hard and unostentatious work.

Another question arises which, it may be, is capable of explanation. My study of the Bill may have been inadequate to get the information I look for here. I can find no guarantee in the Bill that a person at present employed by an approved society will be offered any degree of permanency in his employment after he is taken over, or that he will be offered a position approximately the same as he had before he was taken over. I raise the point now in order to give the Minister an opportunity of dealing with it at the conclusion of the Bill. What consolation is it to a man to be taken over on Monday and dismissed on Saturday? The Bill as it at present stands entitles the unified society to take over the employees of an approved society and dispose of them in a month's time, thereby depriving them of their rights under the Statute. I fully appreciate that the unified society would not intentionally or fraudulently deprive men of their rights under this Bill, but at the same time I will suggest a case to the Minister whereunder that very difficulty could arise. Before doing that I should like to draw his attention to this point. Under the terms of this Bill, what is to prevent the unified society from notifying the secretary of an approved society that they are going to take him over and give him a job as claims clerk? What is to prevent the administrators of the unified society from taking over a man who has been 15 or 20 years secretary of an approved society, controlling the activities of dozens of claims clerks and ordinary clerks, and offering him a position on a stool beside one of his most junior officials? Surely that is not justice. Surely in drafting a measure of this kind we should ensure that if we take over an official compulsorily—because if he does not consent to come over he sacrifices his right to compensation—we should provide that he will get a position in no sense inferior to the position he enjoyed before being taken over, and that if we offer him a position inferior to that which he previously enjoyed he will have a right to compensation or superannuation in accordance with the terms of the Bill.

Secondly, I respectfully submit that we should further provide that where we take over an officer from an approved society he should have the right to the compensation or superannuation which is provided in the Bill if he is dispensed with for any reason other than that stated, misconduct, within, say, two years of his being taken over. A situation may arise in which an officer is taken over by a unified society and after he has been at work for six or twelve months the officials responsible for the unified society may say "this man's competency or temperament does not suit the work we have available for him, and in the best interests of everybody it would be better to superannuate him and get in a man who is more fitted for the job." So long as we make fair provision for that, no one can complain; but a situation of the greatest difficulty will arise if the responsible officers in the unified society take over a man in good faith, give him an alternative position, and then discover that while he was suitable for the particular kind of work he had in the approved society the work that they have made available for him in the unified society may be entirely unsuitable to him; they are married to him for the rest of his natural days, or else they must dispense with his services and leave him without any of the benefits available under this Bill. I feel that a discretion should be given here, unless we are prepared to face the danger of serious injustice arising in the future.

I do not propose to go at length into the superannuation proposals that have been laid before the Minister. I think many Deputies have had copies furnished to them. They are exceedingly long; it would take me practically half an hour to deal with them exhaustively, and that is quite unnecessary, because the Minister is well aware of the details proposed. Most of the Deputies interested in this legislation have also studied the proposals, and I think will agree that, taking everything into consideration, they are equitable and fair. They are completely supported by precedents which have already been established by this House, notably the Railways Acts of 1924 and 1926, the Blessington Steam Tramway Act which was passed by this Government in 1932, and the Electricity Supply Acts of the relevant years.

The Minister may rest assured, so far as I and this Party are concerned, that we believe that that scheme is the one calculated to best serve the interests and the purposes he has in mind. We are, however, in no sense desirous of blocking or hindering him, and any information or co-operation we can give him, we need hardly say, is at his disposal. We would urge him strongly to accept the superannuation proposals, but in the alternative—if after mature consideration he feels that that cannot be done—we ask him to consider favourably the amendments which it is our intention to put down for the purpose of bringing the compensation proposals which he has incorporated in the Bill more into line with what we believe will be equity, not to speak of generosity.

I conclude from some of Deputy Dillon's remarks that while disapproving very definitely of the proposal to have a unified society, he proposes to give a benediction to the Bill, and, I think he said, to give his assistance in every possible way to the Minister to make it a success. When he speaks of the scheme before the Minister, I take it that he refers to an alternative scheme for compensation, rather than to any alternative scheme put up by the association of approved societies for dealing with the difficulties of the approved societies other than by unification.

Perhaps the Deputy would allow me to make that clear. I said that I regarded unification as an unjustified experiment, and that I would prefer amalgamation, but that if the Minister had made up his mind to that form of Government policy I believed the next best thing was to do everything I could to help him to make as great a success as possible of unification. The reference I made to the approved societies' proposals was to their superannuation proposals, which, I think, have been submitted to the Minister.

The Deputy then would appear to fall into the frame of mind which Deputy Norton has fallen into when he says: "The State, as part of a general policy, have decided on unification." The attitude is that when the State, whoever that is, has so decided, there is no purpose—even when dealing with the Bill on Second Reading—in opposing the thing which you consider is not the proper thing. However, I have apparently interpreted the Deputy aright, and I would suggest to him that it is an unreasonable stand to take, because he says that he will assist the Minister in every possible way he can to make the unified society a success.

The Bill says in Section 4, sub-section (3), that there shall be three men, and in Section 10 it says that they shall scrap the whole present business. Later on it says that they shall hand it over to a committee of 15 members. Those 15 members shall be composed of three persons nominated by the Minister, I think, as trustees, three persons nominated by him as representative of the employers, and nine persons elected by the members of the unified society, that is that having scrapped the original idea of having a Seanad election for the whole country as in the Constitution, we are now to fall back on that for the purpose of electing nine members from an electorate of 491,000 to run this important piece of machinery, which affects the well-being, as Deputy Morrissey pointed out last night, of a tremendous number of people in the country. The present number affected is 451,399, according to the figures given by the Minister yesterday. What assistance the Deputy can give the Minister in saying that things are going to be run along the right lines if we give approval to that particular principle, I do not know. I hope he will be able to give some assistance, as I submit it will be wanted. I think the House has considerable reason to complain of the small amount of information given it by the Minister in his introductory speech. On an earlier occasion, on the 1929 Bill, the Minister went at length over a considerable amount of ground covered by the Report of the National Health Insurance Commission. In doing so he rather disclosed that he did not favour either unification or nationalisation, that he simply favoured simplification of the organisation in some way.

Now, when he comes to present proposals for dealing with the difficulties, he tells us that unification is both feasible and necessary. We got no information as to the lines upon which the new society is to be organised, so that we may see to what extent it is feasible, with due regard to the necessities of all parties concerned, to carry out the unified scheme that the Minister proposes at the present stage. He tells us it is necessary. But he does not tell us for what particular object it is necessary, and what are the financial reasons which press him to do it. The only information he gives us is the necessity, financially, for unifying all the societies, pooling all their resources, and all their prospects. He points out that on the 1923 valuation there were a certain number of societies representing a membership of 378,821, which had a surplus of £626,811, and that there were other societies to the number of seven, with a membership of 29,213, with a deficiency of £13,163, making a net surplus of £613,000 odd for a membership of 407,944. He informed us that the actual surplus earned in the five years period 1918-1923 was £50,000. As the Minister stated, when the next valuation came on for the year 1928 there were ten societies, with a membership of 117,000, in deficiency to the extent of £51,000, and 73 societies with a membership of 291,000 which disclosed a surplus of £513,626, and generally that the societies as a whole during that year lost £50,000. We have no means of knowing what all that means. It is on that information we are asked to say that the general machinery of the societies should be scrapped and the whole business unified.

For instance if we look at the Minister's statement that the actual surplus earned in the five years period 1918-1923 was £50,000 and compare it with the Report of the National Health Insurance Commission issued in 1928, we find that it was possible as a result of the five years period to have a disposable surplus that gave increased non-cash benefits to the extent of £162,000, and increased cash benefits to the extent of £145,992. There was a total capital sum of disposable surplus of £308,000 for the subsequent five years, with which to give additional benefits to the extent of £48,800 a year, out of what the Minister says was the actual surplus in the period of five years 1918-1923 of £50,000. If the surplus of £50,000, which is the point the Minister lays stress upon, was able to keep the societies generally in the position of spending £48,800 every year for five years in additional benefits who could figure out what the additional benefits after 1928 would be when the £50,000 earned is turned into £50,000 of a loss? I am completely unable to estimate it.

That is the information upon which we are asked to base a decision to wipe out all the insured societies, and the further information that, I think, the Minister gave yesterday, that he referred the present position to the actuary and asked him to make a forecast as to what the position would be at the end of the present quinquennial period in 1933. I think the Minister told us that he got the report. At any rate he suggested that he asked the actuary to report whether a financial breakdown was not approaching. My recollection is that he gave some figures and indicated that the actuary thought so. But although that actuary's report is supposed, in the minds of the Minister and of the Executive Council, to ring the death-knell of these societies, no single paper in the country thought it worth while to print what exactly the death-knell sentence was. If the Minister has a report from the actuary forecasting what the financial position of the societies is likely to be at the end of 1933, I think we ought to see a copy of that report, or some rather elaborate details from it. As against the gloomy picture suggested, the Minister made some reply to a question by Deputy Broderick yesterday, and, on the face of the figures quoted by him, I think the House could scarcely of itself come to the conclusion that the whole position with regard to national health insurance was in the position the Minister suggests. The House would require some gloss on the information the Minister has given and some explanation of it.

The figures given are an extension of the figures with regard to national health insurance given in Tables 105 and 106, page 93, of the Statistical Abstract, 1932. We are told that the number of persons actually insured has risen from 436,159 in 1931 to 451,399 in 1932. We are told that the contribution of employers has risen from £554,110 in 1931 to £610,392 in 1932, or by £56,000; that the State contribution has decreased by about £57,000, but that in spite of that the receipts for the whole year were almost on a level with the receipts last year—that is, that as against £1,028,927 for 1931 the total receipts were £1,029,110.

The Minister stated that the increase in benefits was one of the things that created difficulties for approved societies. The Minister told us yesterday that the benefits paid during 1932 amounted to £777,916. That figure is below the average for the last three years. We are told that at the end of the year 1932 the accumulated funds were £3,416,687, an increase of £155,000 over last year. In fact, the increase in accumulated funds from 1928, when they were £3,004,375, was approximately £85,000 in 1929, £94,000 in 1930, £76,000 in 1931 and £155,000 in 1932. Deputies will want to know from the Minister what "accumulated funds" in connection with national health insurance imply with regard to the position of the scheme as a whole, and how an increase of £155,000 last year in the accumulated funds indicates that a financial breakdown is approaching. Deputies who were members of the House when other national health insurance Bills were going through, Bills which made a considerable amount of improvement in the general scheme itself as well as producing economies, are aware that in the period 1921-22, following the Great War, there was considerable unemployment in what was then the United Kingdom. Legislation was introduced which gave consideration to the arrears that people were in, in respect of their national health insurance commitments as a result of being unemployed. Certain arrears were excused, and what was called prolongation was introduced by which persons were kept as a burden on the national health insurance scheme although they had not paid their statutory contributions. It was not until 1927 or 1928 that both excused arrears and prolongation of insurance were done away with here. The quinquennial period ending 1928, in which there was this loss of £50,000, was a period in which, in accumulating number, there were up to 90,000 additional persons—names, at any rate—on the national health insurance scheme drawing a certain amount of benefit. We would like to hear to what extent the burden that was implied in excused arrears and in the prolongation of insurance was responsible in any way for the £50,000 loss on the quinquennial period ending 1928. On the financial side alone, I suggest these are matters that must create anxiety in the minds of Deputies. I am sure they would like to have them dealt with before they assent to a proposal which their own judgment and the experience of a lot of people concerned in this matter must regard as a wrong step to take.

Then, again, there is the position with regard to the societies. It is a fact that there are societies in nearly every part of the country that have made good. There are big societies in a good condition and big societies in a bad condition. There are small societies in a good condition and small societies in a bad condition. Probably it would be found that there are more big societies in a bad condition than there are small societies. This is a very serious problem that is under discussion. We think that the Minister, without pointing to any particular society, should in fairness take a bad small society and a good small society, and give us the benefit of the experience of the National Health Insurance Commission as to what created conditions for the bad society. In the same way I think he should give the House some information as to how it is that some big societies have flourished and given good benefits, and why some big societies have failed, because it is notorious, I think, that some societies have not been well managed. When deposit contributors as well as exempted persons were done away with, legislation was introduced to prevent societies refusing to accept a person who came forward for membership unless the applicant offended against any of the rules of the society that he claimed to join. We ought to hear, I think, from the Minister whether the rules that are framed in connection with certain other societies have been the cause of making them flourish and of making other societies fail by driving into them what might be regarded as the less desirable class of applicant.

We have to ask ourselves what is the intention of this Bill. Is it to give the ordinary benefits and the extended benefits that some societies have been able to arrange? For the 1928 quinquennial period it was possible for some societies to give not only additional cash benefits but dental benefits in a dental hospital, medical and surgical appliances, optical benefits, payments in hospitals to nurses and so on. Deputy Norton spoke of one society that he was connected with that gave very elaborate benefits. On the subject of societies it has been possible to run societies successfully in the Counties of Sligo, Monaghan, Longford, Westmeath, Galway, Offaly, Tipperary, Limerick, Kildare, Wicklow, Cork. As a matter of fact there have been outstanding cases of small societies—as many as three in the City of Cork—with a membership of 9,000 or 8,000.

Again in the City of Waterford there is a society with a membership of 8,000 and two in the City of Dublin, one with 11,000 and another with 6,000, that have made, as far as we can tell, an outstanding success of the scheme. I should like to hear from the Minister whether the three outstanding successes in Cork, as distinct from the successful societies there, were societies who simply took in select classes or whether they were societies that were open to receive every applicant. If it is possible for societies in Cork and other parts of the country to run their business successfully, I think in making a sweeping change like this, and in doing it in such a drastic way, we should hear something as to why other societies could not have succeeded as well as those which did and that we should particularly hear why those societies which have been well run should now suffer reductions in the benefits their members are going to get, for the purposes of amalgamation which is supposed to bring about efficiency and economy.

Deputy Norton considers that it is unfair that persons in one society should receive better benefits than those in another. If you take successful societies or, at any rate, societies that are supposed to be successful, such as the Distributive Workers and Clerks in Dublin, the Tramways and Omnibus Employees in Dublin, the Dublin Typographical Provident Approved Society, the Dublin Operative Plasterers' Society, the National Amalgamated Bakers' National Health Insurance Society, the Irish National Painters' and Decorators' Trade Union, the Great Southern and Western Railway Employees, the Dublin United Brassfounders, I should like to hear from anyone on the Labour Benches whether these societies are to suffer in their benefits, in cash or otherwise, in order to make up for the bad running of the Irish Trade Union Congress Health Insurance Society. While Deputy Norton may complain about the Minister not giving him information enough to enable him to judge of the financial position, I suggest very definitely to the Deputy that he is able to find what the position of these societies is in the City of Dublin. The Minister simply having made up his mind that he is going to have a unified society even if he has a majority of one, and possibly that he has the benediction of the Labour Party in the matter, if he does not want to go into the elaborate detail that no doubt would be necessary to make the situation a little plainer to the House, I think in all fairness to the workers in the City of Dublin that Deputy Norton might let us know whether in fact those people in societies in the City of Dublin, whom I have named, are going to be called upon to make sacrifices to make up for the bad running of the health insurance society run in the name of the Irish Trade Union Congress.

I think it was Deputy Morrissey who asked what exactly was behind this scheme. I should like to be assured that it is not simply that the Irish Trade Union Congress are getting themselves and their prestige out of a difficulty by using the Labour Party here to support the Minister's sweeping and, for him, no doubt, easiest possible proposal. On the face of it there is some suggestion like that. I think the Minister should also tell us why it is that some of the bigger societies are in a bad position. As I say, the situation is a very complicated one. No doubt it could be reduced to a certain number of very simple statements with regard to successful societies and failure societies, or a few simple statements with regard to finances. We should have also some statement from the Minister as to what his objective is in the matter of providing those benefits with which the national health insurance legislation was originally intended to deal.

When the Minister was dealing with the National Health Insurance Act of 1929, he said, as reported in col. 95, volume 32, of the Official Reports:

"Because these two things have been ignored, because the Government for the time being has not thought fit to deal with them, we ask that the amendment be adopted (that is the amendment not to agree to the Second Reading of the Bill) and that the Government be asked to reconsider the Bill, and bring it in later, including in it some scheme of simplification or unification but certainly medical benefit."

The Minister had previously said as reported in column 94:

"The two big things that appeal to us, and on which we would like to do all we could to impress on the Ministry the desirability of holding back this Bill for the purpose of reconsideration are the questions of simplification of the organisation— unification if you like or nationalisation—but simplification with the reduction of the cost of administration and the inclusion of medical benefit."

Further on he said:

"The matters of big national import that we think ought to have been dealt with courageously by the Executive are the two I have mentioned. They have been ignored; the Executive for one reason or another decided not to legislate upon them but to ignore the recommendations of the Committee and the clamant demand that I think we have evidence of from insured persons— the inclusion of medical benefit."

The Minister was not quite convinced at that time as to the desirability or necessity for unification. He wanted simplification and above all he wanted the inclusion of medical benefits. Now, we have his Bill before us. It says that we are to have unification. He wants powers to say: "Let us put three men in charge, let them scrap the whole system and let them put up something else." We are not told anything of the benefit which the Minister anticipates will be available for the general body of members under such a society. Deputy Norton tells us that the present payments from members themselves, from employers and, I suppose, from the State, are not sufficient to give the present benefits. We should, therefore, hear from the Minister what benefits are going to be given. Are they going to be given at the present price? Above all, I think we should have some explanation as to why the Minister, having changed his mind on the question of unification as against simplification, does not give us any real indication as to why unification is necessary.

Again, I think we should know why the Minister has dealt with this Bill and said nothing about medical benefits which he thought of the utmost importance, of such great national importance, in 1929. In view of what the Minister has said and in view of the little information he has given us now and the small analysis of the general situation, as distinct from the effort he made to deal with it on the last occasion on which we were dealing with this measure, it seems to me that the Minister has got tired of the difficulties in front of him and says: "For goodness sake, will you get me three men to scrap the lot and put up something else?" He is simply taking a leap in the dark and, for all the information he has given us, we are asked to take the same leap in the dark. I suggest to the House that the interests of 451,000 persons and what national health insurance means to them, are such that the House ought not to take that leap in the dark. They should get more information.

Mr. P. Hogan (Clare):

The only thing I learned from Deputy Mulcahy is that the ghosts of his former misdeeds in the Department of Local Government are coming to hand. That is probably the reason why he objects to amalgamation by unification. The ghosts of the amalgamation of the public institutions, the effects of which we are trying to repair to the present day, surely haunt the slumbers of the ex-Minister and probably induce him to object to this scheme of unification that is before us. The great difference I noticed between the two main speeches from the Cumann na nGaedheal Benches in respect of this measure—the difference between the speech made by Deputy Mulcahy now and the speech made by Deputy Morrissey yesterday evening—was that Deputy Morrissey plumped for nationalisation and, in that way, he showed his clear understanding of the problem facing insurance in the Free State to-day.

By way of personal explanation, I said that, as between unification and nationalisation, I should far prefer nationalisation, which is the better of the two.

Mr. Hogan

There is very little difference. He plumped as against this for nationalisation. Deputy Mulcahy did not tell us what he would do at all in the present chaotic state of national health insurance. He did not tell us whether he was in favour of holding the present societies, of amalgamating them, as, under his own administration, I think, was attempted, or whether he is in favour of nationalisation.

No; I said: "Tell us about the chaos?"

Mr. Hogan

Surely the Deputy was long enough in the Department of Local Government to know what is the position of national health insurance at the present time. If he does not, he cannot expect me to endeavour to inform him at this stage. There is, and everybody who spoke, including his colleague on the Cumann na nGaedheal Benches who spoke yesterday evening, said that there was, a serious problem facing national health insurance to-day, a problem that had to be faced. The Minister has faced it in this fashion and the one regret I have is that the Minister did not go the whole hog and nationalise national health insurance, which would be the best course, and which, in the end, would solve the problem completely. This measure will not solve it at all.

I do not know what arguments the Minister would put up against nationalisation but let me put this one argument to him, that, in the matter of unemployment insurance, you have a national scheme dealt with by a Government Department and paying benefits under a Government Department, with officials who are civil servants and with all the advantages that such a system gives to the people who are being paid. You have 294,847 people affected by that scheme and, in the operation of national health insurance, you have over 450,000 people and, surely, if it is necessary to have nationalisation in order to deal with unemployment insurance for nearly 300,000 people, it ought to be equally good, equally sufficient and equally necessary in order to administer national health insurance properly where there are 450,000 people concerned. That is an argument that the Minister should sleep on and see if he cannot see the wisdom of it.

While everybody admits that there is a financial problem facing national health insurance, I think that very few people have analysed the problem properly and fully. I said here on several occasions when discussing national health insurance estimates that the actuarial estimate on which national health insurance was based was fallacious and wrong. I think that when you look at the two accounts presented on all occasions, you will find that, where there is a deficit, the deficit is on the benefit side and that, wherever you find a surplus, the surplus is on the administration side. That is, so long as the surplus is allowed to stand as a surplus but, human nature being what it is, the administration accounts very rarely present a surplus, so that, therefore, that is one of the reasons why national health insurance at the present time is in the bad financial position it is in.

Then, there is the position of noncompliance. I hold and I believe that compliance could be furthered much better than it is at the moment. I believe that sixty per cent. of the people who are liable for national health insurance are not paying national health insurance and when you look at the figure of 300,000 people paying unemployment insurance and realise that there are only 150,000 more paying national health insurance, you realise that there is a discrepancy somewhere which has to be accounted for. The number of people liable for unemployment insurance in this country is small relative to the number of people liable for national health insurance and the mediæval methods employed by the Department concerned in endeavouring to secure compliance is one of the causes for the chaotic condition of national health insurance at the present time. Sometimes a file six inches thick has to be procured in order to secure a sevenpenny stamp. These are mediaeval methods, and, if the Minister would look into some of these things, he would possibly find some reason for the present chaotic condition of national health insurance other than in the offices of the approved societies.

This is a very far-reaching measure which involves a good deal for 450,000 people. We propose in this measure to take 450,000 cards twice a year; we propose to issue 450,000 arrears cards; we propose to pay something like £800,000 a year in benefits; we propose to collect certificates—I cannot give the exact number of people drawing benefit—from a large number of insured persons who are drawing insurance and we have to issue record cards and to make 450,000 records in a unified society here in Dublin. What is going to happen in the interim? What is going to happen to the benefits of the people while this is being brought about? How are the people who are looking for their 15/- —even their 15/-, apart altogether from the increased benefits—and the £2 benefit going to be affected? I should like to hear the Minister on what is the machinery by which this is going to be brought about. It is machinery with which, to a great extent, I am concerned. Certificates come up here to a unified office. Whom are the cheques going to be sent to? How are they going to be delivered and with what dispatch and how soon are they going to reach the people who are in need of the benefit?

That is a very important question. I would like the Minister to tell us what is going to happen in that transition period and how he is going to expedite it. The position at present is this: in the local societies you have payment weekly or fortnightly. You have certificates readily available and the cheques are readily available in a week or a fortnight. What will happen now in the transition period while the unifying of the societies is going on? There may be very great hardship to the people entitled to sick benefit. I am anxious to know about that. I would like the Minister to give us some information with regard to the transition and as to what machinery he proposes to set up to keep the Act in operation during that period. A good deal has been said with regard to compensation. I think the Minister does not fully realise the hardships he is going to inflict owing to the small compensation to be paid. The compensation to people of long service should, I think, be based on a pensions scheme. I hope the Minister will consider that matter fully. In the case of agents I do not know how it is to be proved whether those people get the greater part of their income from their insurance work. I know that a great many of them get what is not only a very large portion of their income from the societies, but what is a very large part of their livelihood. Then as regards officials there are large corporations acting here as approved societies. They are in reality large insurance companies approved for the purposes of the Act. Is it supposed that the secretaries of such a corporation, who are nominally the secretaries of an insurance society, are to be compensated while people who have done the spade work of the societies are to be ignored? Officials of approved societies do practically what is Government work, but with none of the advantages and protection which are extended to Government employment. Now it is proposed to dispense with their services and to give them the minimum amount of compensation, and to some none at all. I ask the Minister to consider those people who have built up national health insurance without Government help. I ask him to consider the position of agents who are endeavouring to eke out a precarious existence, as agents, but which meant a good deal to them. I ask the Minister what is the position of secretaries of those insurance corporations to which I have alluded, which have become approved societies for the purposes of national health insurance. And again I would ask him to give us full details as to the machinery he proposes to set up in order to secure that no one will suffer in the interval between the coming into operation of the unifying society and the present system.

Deputy Mulcahy quoted the Minister as saying that this measure was feasible and necessary. I suppose it is feasible, but I, for one, do not realise the necessity for it. As to the necessity the Minister says there are 60 or 70 solvent societies with a membership of 200,000 or 300,000 people, and eight or ten insolvent societies with a very much smaller membership to be dissolved, and one society inaugurated from these 80 odd societies good and bad. That appears to be what the Bill proposes to do. I should like to ask the Minister this: Is there going to be any guarantee, in the Bill, that the solvent, efficient and well-conducted societies are going to derive any benefits from this measure? I am not concerned with what is to become of the seven or eight insolvent societies. This Bill seems to me to be a measure not to rob Peter to pay Paul, but to rob Mick, Pat and Bridget, and the rest, in order to pay Paul. I should like if the Minister could tell us definitely to what extent the solvent well-conducted societies are going to benefit by this Bill. It is not sufficient to tell me that they will lose nothing and that they will get the benefits they at present receive. That will not be sufficient for the people down the country; and it is down the country the solvent societies are to be found. The people in the country will not be satisfied with the Minister's assurance that they are going to lose nothing. We want it to be proved that they are going to gain something.

We have in the southern portion of Ireland a good number of small and middle-sized societies, which are solvent societies, and some of them giving extra benefits. Is the Minister going to scrap all these and leave us, not at the mercy of the gods, but at the mercy of 15 or 16 picked men who are to control insurance in this State when this Bill becomes law? The Minister quoted numerous figures. He went so far in that direction that I believe the House did not actually follow him. Some Deputies on his own side rather ran away from the Minister's figures, if the Press reports are right to-day. But one can almost prove anything by figures. An actuary might even undertake to prove that this Bill of the Minister will be successful when it becomes law, but no actuary, and no set of figures are going to prove to the members of the small societies in Limerick, Cork and other places, which at present are paying benefits and doing good work, that they are to gain anything by this Bill. Those of us who represent counties in which these solvent societies exist must be in opposition to this measure. Unfortunately, also, in this Bill there is no security for the insured person as regards facilities for looking for his ordinary benefits. Proximity means a good lot to the ordinary insured person. It means a good deal to the humble insured person, in the country, to know that his society is near at hand. He will have no trouble in going to the office of his society and he is generally successful in working out his case.

In a central society he will not have those facilities. Apart altogether from the argument one might put up against what are the financial benefits that will arise to anybody—if there are going to be benefits to anybody, and I do not believe that there will be, except to one or two societies which are in danger of breaking up—there are the benefits of proximity to your society which members of many societies are in possession of at the moment. These are not light matters. They cannot be disposed of lightly.

There is also, as Deputy Hogan pointed out, very inadequate provision for the officials of all the societies. It is unfortunate that officials of societies, and there is a great number of societies which were well and successfully managed, are now to be put on the scrap heap with practically no security for future employment. My sympathies are wholly with the officials of these solvent societies. As far as the insolvent societies are concerned, the less said about their officials the better. They might have managed their societies efficiently and not left to the Minister the necessity for producing this Bill. But there will be great hardship for the officials of small societies down the State who ran their businesses successfully and who will be, because of the passing of this measure, thrown on the unemployed list without any security of employment and with very inadequate compensation.

I do not intend to say very much more on the measure except to ask the Minister again to give us some assurance that the members of the solvent societies will be guaranteed a benefit— an increased benefit—by this amalgamation; not a benefit equal to what they are already receiving, because that would be no case for the scrapping of these societies—they want and they must get a guarantee from the Minister that their conditions will be improved by this Bill.

To a great extent I find myself in agreement with all the speakers who have dealt with this Bill. It is with regret that I realise the necessity for it because, I think, the Minister has found that the loss on the administration of the societies has got very serious—so serious, in fact, that it has to be dealt with drastically. I do not suppose any of us are in favour of centralisation, if it could be avoided, I think we are all in favour of decentralisation. But there are times when decentralisation does not work out economically. We have to look on this question not from a parochial point of view but from a national point of view. If it is proved to us that the work of health insurance, as a whole, all over the State, is in need of drastic retrenchment, I think that we have to face that fact and to accept any measure which may be taken to meet it.

I have before me at the moment the report of one of the local societies referred to by Deputy Bennett, and I think it is a great pity that such a society should have to be amalgamated. It is a society that is solvent and, as a result of good management, has been able to increase its benefits enormously. It gives medical benefits, dental benefits and optical benefits. It provides surgical appliances and hospital and special surgical treatment. I hope that, in the measure before us, such benefits will be retained for the people.

And increased.

It would be a great hardship to the people if they were to be deprived of these benefits. I am not in favour of centralisation at all but, forced as I am to realise that there has been a very serious loss all over the country, I must admit that there is no other way out of it. Perhaps a way could have been found if it were possible to have societies such as this one to which I have referred established instead of those which were losing money and badly managed; but apparently that was not possible.

I would also plead for the officials. I know many officials who made societies such as this solvent and who gave perhaps 20 years of their lives to making these societies solvent. These officials were in close touch with their members. They knew them all and knew their circumstances, and it is due to the fact that they did know them so well and were so well acquainted with the circumstances of the members that they were able to prevent a lot of fraud and to so administer their societies that they were able to give these increased benefits. There is always the danger in centralisation that the administration will not be, shall I say, so sympathetic; and that very often hardship will be caused by men who will act merely as officials and who are inclined very often to leave the human element out and to look at everything from a purely official standpoint. I think that the men who were acting as officials are deserving of consideration and I appeal to the Minister to give them every consideration.

Some of the statements of the Minister leave us rather in a difficulty in understanding what is the necessity for this measure. I take it that, apparently, the Government have found themselves faced with almost insolvency in certain of the societies and with a very wide range of benefits between the best and worst. When I say the best and the worst, I do not mean necessarily the best and the worst managed; but I mean those that are able to pay the greatest benefits or the least. How does the Government propose to deal with them? First of all, they suggest centralisation. Centralisation, for certain things, is very good; but they have been certainly against centralisation in industry and more than once have expressed themselves dissatisfied with the way things were scattered around the ports. Why should they centralise these societies? Apparently, the idea is that if unification takes place, the maximum benefits now obtained by some will be replaced by the maximum benefits for all. In other words, the lesser benefits, which are paid by some of the larger and insolvent societies, will be all that can be paid for the whole country. Why are the Government carrying out this step and in this way? There is, apparently, injustice, according to the Government, when people have gone into societies organised according to political opinions or to crafts or to various other matters, which had nothing to do with health insurance, but that have been organised along these lines, should then find widely different benefits paid to their members. But, surely, the members have a right to a say in the matter themselves? Those were the societies they wanted to join and which they contracted to join. I would suggest to the Minister that the saving that will be made by amalgamating the societies will be more than offset by the difficulty in dealing from a central source with members that are scattered up and down the country through various classes, et cetera, of the community.

The Minister has made a point about various crafts and Deputy Mulcahy read out a list of the various craft societies that are in Dublin and that are well managed. Surely everyone knows that when you get together persons of the same class it is much easier to find out opinions and it is much easier to do justice to them. In such circumstances persons would understand the particular trade with which they were dealing, and injustices would be much less likely to arise when you have an official who has been brought up practically for a generation with the members of a society and who fully understands the particular craft involved or the particular political views that might be expressed by members.

I suggest that what the Minister is going to gain in economy by centralisation he is going to lose by reason of the discontent that will be engendered when particular people have to deal with a head office at long range and possibly through a person who does not understand the precise complaint that the insured person may have to make. I suggest to the Minister that, people having made their contracts, they will be far more satisfied to be left alone and they will feel disinclined to be arbitrarily switched from an approved society, the members of which they know, to a soulless organisation. They will dislike being obliged to forward forms to Dublin, endeavouring to get their grievances redressed through the post or on the telephone.

I would like to know from the Minister if he has considered, as a solution of the financial end of the problem, extending the period for the redemption of the reserved values. This has already been done and possibly if it were done again it might do away with the existing financial difficulty. A point that strikes anyone who has to deal with national health insurance cards and the licking of stamps is why the unemployment card and the unemployment contribution are not used to check each other; in other words, why one card is not used for both, utilising possibly one stamp, a fixed percentage of which would go part to insurance and part to unemployment. I suggest that might solve some of the difficulties that Labour Deputies have in reconciling the numbers that ought to be insured. All this goes to show that the Government have not deeply considered this matter and have not introduced a scheme calculated to simplify, to economise and to improve the lot of the insured person.

I have purposely made no reference to the position of the officials of the various societies. Personally, I do not think they are being fairly treated. I take it that on the Committee Stage extensive proposals will be made for the Minister's consideration with the object of doing away with the more obvious injustices to officials.

I very much regret that I was not here when the Minister was speaking. I am always very interested to hear the Minister for Local Government and I would be particularly interested to hear what defence he had to make for this Bill. I was present when Deputy Goulding was defending the Bill. I was rather interested to hear him, as an opponent of centralisation, defending this Bill. It was rather interesting to see the Deputy standing up to defend centralisation in this instance. The position was certainly peculiar. One of the things that makes me curious about this Bill is exactly in what interest it is introduced. We all can agree that the position of insurance societies in the country is, in spots, in a rather bad way.

In order to meet the situation we have the proposals contained in this Bill which are more or less to the effect that societies that have made good, societies that are efficiently administered and that have taken pains and generally done well in the financial sense should pool their profits with the other societies that have not done so well and, from the ashes of the whole lot, the good and the bad, one central society should emerge. I think that is a very bad headline. I think it is a very unworthy example to set. It is certainly a bad precedent. What it means in effect is that consideration every time will be given to the individual or the organisation that goes bad; consideration will be given every time to him or it at the expense of those that have made good. I consider there is just a little bit too much of that going on and to perpetuate that state of affairs in the insurance life of this country, really at the expense of the solvent and well-managed insurance societies and, in the long run, at the expense of the insured people, is carrying things a little bit too far.

The next consideration is the position of the insured persons, the ordinary two-legged or one-legged individual who goes around the country. Everybody knows, and particularly the person moving around the country against the ordinary insured people, that the one protection the insured person had up to this was the right of transfer. If the insured person did not get fair play in one society he could always hold up his head and say: "I am not getting fair play. I will transfer to the next society." That was in fact the only guarantee that the ordinary insured person down the country had that he would get fair play.

There was the other thing also and that was that they were living close up against the administrators, that they were living close up against the people who managed their county insurance society or the small society functioning in their county. The human element entered into the matter. There was a certain knowledge as to the human element in the society. Now the proposal is to remove that human element, to replace that human element by a great machine. We will have officialdom in the bottom, we will have officialdom in the middle and officialdom in the top. We will have no humanity. We will have a big mass of red tape. We will have official efficiency at the expense of the insured human being. I regard the whole proposal as being monstrous, as being rather inhuman and as being certainly unsuited to the conditions in this country. That, as far as it strikes me from my point of view, is the position of the insured person and that is how it will strike him.

From the point of view of the official worker, the agent particularly in the districts that have been in competition with others, societies that either have made good or strived to make good, I consider that you have enshrined in this Bill the worst headline that you could put up before big agencies of employers in this country. You have enshrined in this Bill a principle that compensation will only be given to the workers who derive the maximum portion of their income from the work done for their society. If they have only derived 49 per cent. of their income from their efforts and labours for a particular insurance society, then because they derive only 49 per cent. rather than 50½ per cent. of their income they are unworthy of consideration, their efforts are to be forgotten and they are to get nothing by way of compensation. They are to be deprived merely of that particular source of income and forgotten.

Those who may be regarded as the privileged classes under this Bill are merely to be entitled to compensation and not continued employment. I consider that that is a disastrous headline. A person who is making good in his job or work, be it a lowly job or a big job, a person who has been giving satisfaction and doing his work efficiently and laboriously and with success is entitled to a guarantee of continued employment. Compensation and very modest and meagre compensation is not meeting the case. If I interpret Deputy Good's remarks properly I agree with him that it would be much better, in face of the fact that certain societies are insolvent and that certain societies are going to be insolvent while other societies are solvent, that the whole situation will be better met by wiping out those insolvent societies and extending the scope of the well-managed and solvent societies. If that is the proper interpretation of Deputy Good's remarks I heartily endorse his views. I agree with the plea put forward by Deputy Goulding and I hope that the Minister will consider a plea such as that. I think it would have been far better if the whole situation had been more extensively explored and the difficulties had been met by a gesture of approval for the societies that are well managed, giving them an opportunity of extending their scope and taking over areas covered by insolvent societies.

I was rather surprised that Deputy O'Higgins regretted not having been present when the Minister introduced this Bill. I believe if the Deputy had read the debates he would know that other Deputies spoke on this question, particularly Deputy Norton. Deputy Norton, in anticipation, referred to various matters that would have been left outside by Deputy O'Higgins had he been here and listened to the speech. Deputy O'Higgins started off by saying that this Government put a premium on inefficiency inasmuch as they were forcing this unification measure owing to the insolvency of certain societies; and that that insolvency was bringing about a situation which meant that benefits were better in some cases and worse in other cases where the societies had not been well managed.

I did not refer to that at all. I confined my remarks to the wiping out of certain societies and the establishment of a central society.

I understood the Deputy to argue on the line followed by other Deputies that because certain societies were mismanaged, or had become insolvent, those societies that are well managed were now to be put in a worsened position by this Bill. I understood the whole argument of the Deputy to mean that we were putting a premium on inefficiency and that we were setting a headline in that respect. I say the Government's duties go further than that. After all, approved societies are under certain legislative rights and there is the protection to the insured person to be considered. If the Government see a situation arising whereby there is danger of the insured person not being able to get his benefit; if that is becoming a danger surely it is up to the Government to interfere and to prevent such a situation arising, bearing in mind that the first consideration should be to the insured, and not to the country, as such.

But why interfere with the societies that are solvent?

I am coming to that. Deputy O'Higgins by his argument shows how little thought he has given to that matter, because if he had, he would not argue in that way. The Deputy argued that one of the guarantees to the insured person was that if he did not like a society he could shift into another society. The view of the Government is that if anybody finds that the company he is in is insolvent he ought to be protected holus bolus from insolvency and from being in an insolvent company or society. Then, again, if persons in societies that were insolvent were all to walk out and to join another society and make new claims on that society how would that society, being as it would, in the position that it had not built up the necessary resources, be in a position to meet the claims of these transferred persons?

Might I ask a question? The Deputy says that if everybody suddenly came to the conclusion that a society was insolvent and made up their minds to go into another society so and so would happen. Surely if the whole population made up their minds that the society they were in was insolvent, then there was no other society to move into. It was a case of a mass move by the whole population of the country.

The Deputy is taking it a little bit far. First of all, the Deputy knows that benefits can only be claimed when disability or sickness arises.

They can transfer whether they are sick or not.

They can transfer for the purpose of having better security in the event of disability or sickness. That is what I mean, as the Deputy knows very well. The Deputy does not seem to realise that unification will mean a step towards greater security and solvency. Personally, I should be better pleased if I had seen a Bill introduced which would nationalise the whole service and put it on a par with unemployment insurance. But the scheme under this Bill is better than the present position, so far as the public are concerned. The Deputy also argued that, from the humanitarian point of view, there was great security for the insured person in being insured in an approved society, which might be a craft society or, as Deputy Dockrell said, a political society, where the insured person's complaints would be better understood. I did not know that political complaints would allow a person to draw benefit but perhaps the Deputies opposite have discovered a new source of illness or complaint which entitles persons to benefit either by way of permanent or temporary incapacity. The Deputy who has just spoken surely knows that there is a Department of State for the purpose of refereeing as between approved societies and claimants. When a claimant is certified by a dispensary doctor as being unable to work and entitled to draw health benefit and when that person is turned down by an approved society, as happens in many cases, he has a final appeal to the Department of Local Government, who have a court of referees. In many cases, the decision is against the approved society and it is instructed to continue to pay benefit, so that the humanitarian consideration of belonging to a society of one's pals in a craft or persons with the same political outlook, as Deputy Dockrell said, does not apply at all. Unification will secure more uniform working from the point of view as to what is to be reckoned disablement and sickness.

The Deputy dealt with the section which fixes the compensation to be paid to employees of approved societies who will become disemployed through the instrumentality of this measure. I agree with those who have pleaded for further consideration of this matter. I was hoping that, as a result of the appeal made by Deputy Norton yesterday, the matter would be left at that and that when we came to the Committee Stage we might hear something in that regard from the Minister. I can understand the plea in the case of Deputy Norton but I cannot understand it in the case of Deputy O'Higgins. As Deputy Norton pointed out yesterday, if you examine the clauses of the Electricity Supply Acts dealing with compensation, you will find a sad story. If we were to follow the headline set there, it would be worse than the position of affairs under this Bill because, in that case, the State confiscated the whole system of electrification, took away the livelihood of people, under local authorities in many cases, and yet the scale of compensation allowed was absolutely miserable.

Not as bad as under this Bill.

I challenge Deputy Morrissey to cite the figures in the Electricity Supply Board Acts and show how they are better than the figures under this Bill. I happen to know the ordinary workman. I am talking of the ordinary labourer. Deputy Morrissey may have forgotten him altogether.

It is very lately you began to think of him.

It is never too late to do a good thing.

Hear, hear!

But it is always too early to do a bad thing. The Deputy has certainly forgotten the treatment of the ordinary labourer who, when his employment was taken from him, was awarded miserable compensation and, in some cases where the persons concerned got pensions, the pensions were only sufficient to keep them in misery. After their years of service, they are too old to get work in the labour market.

That is why you are bringing in a Bill to reduce them.

This does not reduce them. I challenge the Deputy to quote figures for analogous cases.

Are you not going to reduce the wages of employees of the E.S.B., under the Economies Bill?

Not under the National Health Insurance Bill.

It will come up next week.

There are certain gentlemen in the country and I would stand for a reduction of the salaries they are getting.

Will you stand for all?

We will deal with that when it comes before the House.

Will Deputy Corish raise a row when it is being done—Sequah?

You raised no row when you cut the old age pensions.

It is really amusing to hear all sorts of expressions of sympathy for people whom certain gentlemen never thought of until quite recently. As an illustration, we have Deputy Mulcahy quoting all kinds of statistics about the unemployed. And yet when he was Minister for Local Government——

The unemployment figures were not half as high.

Because they were not being allowed to sign.

The old age pension allowance was much less.

There were a lot more employed.

There was no such thing as free milk for the destitute then. We heard nothing about that from the humanitarians on the opposite benches, who have suddenly realised that they have some duty to perform in this world.

The Deputy is anxious to deal with everything in the world but the figures in the Bill.

If the Deputy would not interrupt, Deputy Briscoe might confine himself to the Bill.

I shall leave the interruptions aside. I should have liked to see nationalisation of health insurance for one of the reasons mentioned by Deputy Dockrell. You could make sure by the simple process of one stamp for both purposes, if you like, or by an added contribution, that everybody who should be insured under the national health system would be insured. I have not the figures as to persons insured under the national health scheme, but I am sure the Labour Party would be able to give an approximate estimate. I do not believe that half of those who should be contributing to the national health scheme are contributing.

There will be fewer if this Bill goes through.

Deputy Morrissey is a good authority about the future.

I know something about this service, which the Deputy does not.

I do not get up and volunteer information that I happen to be a member of an approved society. I do not hold forth as if I were looking for transfers of insured persons. Every Deputy does not get up and tell us what he knows or what he does not know. Deputy Morrissey can say that I know nothing about this service. That is only his opinion. I could say that, in my opinion, Deputy Morrissey knows very little about it, but I do not say that. I leave Deputies to judge for themselves. As I was saying, I should have liked to have seen nationalisation for the reasons introduced by Deputy Dockrell. I do not believe that it would mean a very great addition in the way of extra officials or of bookkeeping, because practically the same system would do. I am, however, very glad to see this unification measure introduced by the Government, because if a time should come when the society under this measure gets into a position where it could not give the standard benefit, the State would have to come to its assistance and contribute what would make it solvent, which is not the position that exists to-day. For that reason alone I am glad to see the Bill introduced. I hope some time to see this Government or some other Government nationalise this as one of the essential social services.

I hope and believe that the Minister will give the suggestions made by Deputy Norton his consideration. As Deputy Norton says, it is very hard to expect men who have been carrying on a certain kind of work, even if they do get a few hundred pounds compensation, to feel sure that their future is secure. I believe that in the present state of affairs some consideration should be given to them either in the shape of alternative employment on the same basis as at present or that some other basis of compensation should be found. My experience of people who have been put out of employment by Government legislation, whether they received a lump sum in compensation or a small pension, is that they have become useless to the State and to themselves and a burden on their families. I hope in that connection that the Minister will give serious and sympathetic consideration to the points suggested by Deputy Norton.

Most of the criticism I desired to make has been dealt with more or less by Deputies who have spoken. I had the advantage, unlike Deputy Hogan, of listening to the Minister introducing the Bill. I followed his statement carefully and certainly I failed to see any justification put forward in his speech for the introduction of the Bill. He quoted no doubt a great many statistics as to finance and so on, and the reason for the introduction of the Bill apparently is, that the financial scheme on which the present system is based has more or less broken down. If there is any form of national service or activity in which de-centralisation should be the principle on which it would work, I would say that it is this system of national health insurance. We are losing by centralisation the work of the voluntary workers all through the country on these committees who have given their time free. We are losing the human touch, which has been referred to in the administration of this branch of national activity. We are losing all that, and we are substituting for it a machine. I do not use the expression "machine" about the Civil Service in any depreciatory sense, but every big Department of our Civil Service as a body, or any big branch of it, necessarily works by routine and, if you like to put it that way, by a system of red tape. That would be very injurious to the interests of the poor people who are the beneficiaries under the national health insurance scheme.

There will be necessarily a certain amount of red tape in administration. There will be a lack of the human element, the local touch, the local knowledge as to people's requirements. All claims will have to come to the central office in Dublin to be signed and countersigned; inquiries will have to be made; cases will have to be remitted to the country for further inquiries, and instead of getting relief immediately, as under the present system as worked by the approved societies, there will necessarily be delay. Instead of getting benefit in a matter of a few days, the people will sometimes have to wait for weeks. These are the defects in the scheme proposed by the Minister.

Has the Deputy ever heard of the committees dealing with old age pension administration?

Mr. Rice

The Deputy showed by his own speech that he knew absolutely nothing about the subject he was talking about, and he had better listen to other speakers and try to learn something.

Did you ever hear of these committees?

Mr. Rice

I would advise the Deputy to do that, and I decline to answer an impertinent and an irrelevant question from the Deputy. This will result, as I say, in tardy administration. Deputy Hogan, and I think other speakers, referred to the pooling of the resources of the societies. Some of these societies are, no doubt, in a bad way financially owing to causes that were alluded to, I think, by Deputy Norton. The personnel of a good many of these societies belongs to a class of people amongst whom unemployment is more or less rife, at least more common than amongst other classes, and also amongst whom sickness is more liable to occur. These societies, through no fault of their own, owing to that kind of personnel, have become insolvent and not able to give the benefits given by other and more fortunate societies. That is not in itself, I submit, a sufficient justification for levelling down the societies that have been doing good work and giving good benefits to their members. That is not sufficient ground in itself for levelling down and taking the resources from the prosperous societies and pooling them with the lack of resources of the poorer societies.

A good deal has been said on the subject of compensation and a good many appeals have been made to the Minister to reconsider his scheme in that respect. If he decides to go on with this Bill in its present form and to centralise the system of national health insurance, I do join with those others who appealed to him to reconsider the terms of compensation outlined in the Bill. He will have an opportunity of doing that before the Committee Stage is reached. I think there is a breach of elementary justice in the proposal that people who are only part-time employees for national health insurance work are to get no compensation whatever. Deputy Norton referred to the case of a man who was earning £1 a week at one occupation and 15/- at another. That man is to get no compensation for the loss of three-sevenths of his income. I say that is a breach of elementary natural justice and that it should be seriously reconsidered before the Minister decides to go forward with it. Fifteen shillings per week out of 35/-, as Deputy Norton pointed out, is a very serious matter to a man of that income. It means reducing him from a position in which he, at all events, can buy food to practically a condition of starvation. In respect of the rosy views taken by the Minister and his colleagues as to chances of future employment in this country, I suggest that employment for these people will be very difficult to get. Employment is not becoming easier to get in any country, and certainly not in this country. With our increasing population, even if we have a good deal of the prosperity that some Deputies on the opposite side expect, there will be a largely increased number of young people to be provided every year with employment. Men who have been a number of years at this national health insurance work are necessarily not very young now, and it will be difficult for them to compete for new employment with the young people growing up. I submit that a man who spent part of his time, even though it was not his principal occupation, at this work has the same right to compensation for what he loses as the man who loses the whole of his employment.

Allusion was made to the scales of compensation given under previous Acts. The Minister for Local Government himself in 1929 when a scheme of this kind was before the House made an appeal to the then Minister to consider more generous terms than were outlined at the time.

I think that there is practically unanimous feeling on all sides of the House that the Minister, in dealing with compensation under this Bill, should do that too. Allusion has been made to the terms of compensation in various other Acts. We had the Railway Act of 1924, and the Railway Act of 1926, which amended the former Act as regards compensation. Under those statutes, first of all where there was a complete loss of employment, a system of compensation was provided. In the adoption of amalgamation the House made it compulsory on the railway companies that a man should also be compensated if he was required to perform duties not similar to the duties he had formerly performed, or if he had an unreasonable addition made to those duties. He was to be compensated if he suffered any diminution in wages, or in emoluments, because railway workers apart from wages had other rights and benefits which were of some peculiar advantage to them. The Government in 1924, in passing that Act, and in the Act of 1926, was so mindful of their rights...

In the 1926 Act? Ask Deputy Morrissey about the 1926 Act!

Mr. Rice

I am referring to the 1926 Act as merely improving in detail the scheme laid down in the Act of 1924.

Ask Deputy Morrissey about that.

Mr. Rice

I am talking about compensation as laid down in the Act of 1924 and amended in the Schedule of 1926. I have had some experience of the fact that a great number of railway workers have gone out under that Act, and got compensation.

The Board has hardly functioned since.

Mr. Rice

The arbitrators are functioning, and in a case of the railway company at present being heard in the High Court the sums they had to pay under this are so heavy that they do not like the arbitrator.

Be guided by Deputy Morrissey!

Two wrongs do not make a right, anyway.

Mr. Rice

Any one who was placed in a worse position by reason of the amalgamation scheme was entitled to compensation. A scale was laid down, and no such limitation was put on the number of years' service as is proposed to be put here. Here the maximum number of years' service to be taken into consideration is 18. There was a more generous provision made in the Railway Act of 1924. I do submit to the Minister that, when he comes to reconsider—as I hope he will—the terms of compensation, he should give terms at least as good to the employees of the national health insurance societies as were given by the late Government in 1924 and in 1926. I think that the Minister should have informed the House as to how he considers that the work of national health insurance will be benefited by the change he proposes to make. Although he quoted figures and statistics as to the funds and finances of the societies he did not give us any estimate as to what economy was likely to be effected by this scheme. He did not inform us how many new positions, with salaries attached to them, will be created by reason of the passing of this Act. I should also like to know whether it is the intention of the Minister to give those appointments to persons who were already engaged and skilled in the work of national health insurance. There are a great many matters of that kind with which I think the House is entitled to expect the Minister to deal when he comes to close this debate.

Another matter that might be considered is that under this scheme the collecting agents will disappear, and that they were persons who were extremely useful in carrying on the work of national health insurance. They were the people who went around and who saw that persons who were insurable were insured. They did everything that could be done by them to get new members into the societies, and to secure compliance by employers with the provisions of the law. Those people, who were in close touch with the workings of the societies and with seeing that there was compliance given by the employers, will disappear under this scheme. They will disappear in the crowd of other people who are not whole-time workers in the national health insurance, or who are not principally employed in that work; they will disappear also without compensation. I hope that the Minister will deal with these various matters when he comes to close the debate.

We heard a good deal this evening about what the unified society will not do for the insured members. In fact, we are told that the unified society, when it becomes an established fact, will not be able to give any benefits to insured people. We are told that very many societies had surplus valuation, and that as a result of having that surplus they were unable to give extra benefits to their members—dental benefits, hospital benefits, and so forth. I should like to point out to the House that those societies had no guarantee that at the end of the next valuation period they would be in the happy position of being able to provide those extra benefits for their members. Societies that had a surplus in 1923 had no surplus in 1928; other societies who had no surplus in 1923 had a surplus in 1928. There was no sense of security so far as societies were concerned as to what the future would hold in store for them. A well-managed society did not necessarily mean a society that was being efficiently run, nor on the other hand did what has been mentioned here as a badly run society necessarily mean a society that was run by inefficient officials. A wave of illness for a prolonged period over a district, or for one or two years, would make all the difference as to whether a society would be solvent or insolvent, or whether it would be considered an efficient or an inefficient one. I might say that practically no societies have made good except those which had the opportunity of selecting as their members people who in ordinary life were not open to the same source of infection and sickness as others. Even though extra benefits were paid by societies which are in a good position, there is no guarantee of what will happen at the end of the next valuation period. As the Minister pointed out in his statement, the increased benefits paid during the last seven or eight years show that in the near future, if matters are allowed to go on as they are, these payments will become so heavy as to result in the bankruptcy of practically all the societies.

We have been told that people should have the opportunity of transferring from one society to another, if they were dissatisfied. When people transferred heretofore, I take it that they did so mostly for selfish reasons, because a society was in the position that it could pay more benefits than another society, or because they might have been dissatisfied with some decision of the committee. In Section 30 of the Bill the Minister has power to decide any disputes that may arise between the unified society and its members. The members will consequently have a greater guarantee of security, and all the unnecessary time, labour, expense, and cumbersome machinery that had to be put into operation in the case of transfers will be unnecessary. We have been told that payments will be reduced to the level of 15/- per week, the ordinary statutory benefit laid down. The Minister gave no indication that the amount of the benefits would be reduced. He stated that the benefits that were being paid would continue up to the next valuation and that societies paying 17/- or 18/- weekly, and giving dental and hospital treatment, would continue to do so. Can any Deputy guarantee that after the next valuation the societies would be able to do so? It is quite possible that after the next valuation the unified society, when all the assets and liabilities are taken into consideration, will be in a position to increase the benefits, and that 16/-, 17/- or 18/- a week may then be the standard rate. I think we may safely take it that dental treatment and hospital treatment will then become universal for all insured people, instead of for five years as was the case heretofore. Previously people who received dental treatment often found that they were unable to get the full treatment to which they were entitled. I take it that there is every possibility of the standard rate being increased and of extra benefits being given. Some Deputies on the Cumann na nGaedheal Benches deplored the fact that some small societies are being wiped out. But amalgamation was the policy to which that Party was favourably disposed a couple of years ago, which would have resulted in smaller societies being swamped by the larger ones.

Can the Deputy say where that is stated?

Mr. Kelly

It was stated during the debates in 1929.

Indeed, it was not.

Mr. Kelly

It was suggested that part of the difficulties with regard to societies in a bad way could be overcome by allowing them to be amalgamated, leaving 15 or 16 societies. Having 15 or 16 societies necessarily meant that the larger ones would swamp the smaller ones.

Not necessarily, but that the large good societies would be used to absorb the bad ones.

Mr. Kelly

Eventually it would turn out in that way. In this particular service centralisation will not do the same amount of harm that centralisation of other State services could do. If it leads to more efficiency in dealing with the insured people, and if it gives better benefits, there will be no cause for complaint. We have been told that the insured people in the country districts will be compelled to send their certificates to Dublin, and will have to wait for a fortnight or three weeks for their benefits. The Minister did not state what machinery would be put into operation, and did not say whether people will be able to get their benefits weekly or fortnightly. I will withhold judgment in that matter until I hear the Minister's reply. As to compensation for officials, I will also wait to hear what the Minister has to say regarding the suggestions that have been thrown out. The unified society will overcome the difficulties experienced hitherto of having a proper collection of the stamped cards, and full compliance with the Acts. Many large societies and many small societies were operating in each district, and there was overlapping, the result being that it was difficult to get statistics and to know who was insured and who was not insured. I take it that the unified society will be able to find out the people working in a particular area and see that their cards are stamped. There will be, I hope, a better response in regard to compliance with the Acts, and generally a better appreciation of the merits of insurance.

I find it more difficult, as the days pass, to understand the attitude of the Fianna Fáil Party. Looking at this Bill from a reasoned point of view, the only future that one can foresee for it is that it will do grave harm to the worker. Instead of doing what has been suggested, namely, increasing benefits for all, it is bound, as far as one can humanly see, to lead to a general decrease in benefits. The worker is the person who will be bound to suffer. It is almost impossible to foresee anything different. The case made by the Minister rests entirely on this fact, that certain societies, the large ones, show actuarially a deficit; that certain others, the small ones, show considerable surpluses, and that by pooling all he proposes to get rid of the deficit with some and reduce them all to the same level—those that have been able to meet their liabilities fixed by Act of Parliament at a certain standard, above which the small societies were able to pass and which the larger societies have not been able to pass. In other words, instead of what we have just been told is likely to occur, the very reverse is likely to occur—of all being reduced to the one common level.

The Minister tried to argue that the position with regard to the small societies, hitherto, was due to some selective power. I do not think for a moment that that can be substantiated. Figures show that such selective power as they had has always been exercised to a very small extent. One society that I happen to know something about —it happens to be in a favourable position largely because of the prudent manner in which its affairs have been managed and by not using its surpluses to outbid other societies by offering excessive benefits—has never exercised selective preferences to the extent of refusing anything like one per cent. of the applicants. Such a refusal could not have affected its funds to any serious extent. Even if all the applicants had been accepted the final result would not have been very different from what it is. The real point is this, that the small societies, because of the very valuable voluntary help given in connection with their working, have been able to look after details in a way that a big society cannot do. That voluntary help has been of the greatest value so far as the finances of the society are concerned. These small societies, by provident and prudent management, were able to establish themselves in a sound financial position before they undertook the giving of extra benefits at all. The Minister is now proceeding by this Bill to wipe away the results of that providence and prudence. I cannot imagine that he will do anything more than stop for a time the financial difficulties that seem to me to be bound to follow the working of one large society. It will be impossible in that one large society to look after details as they are looked after at present by valued voluntary workers in the small societies. To speak quite plainly, it would be impossible to see that cases of applicants for relief, if feigned illness or illness which should not incapacitate a person from working, will not be met by grants, and it is these cases which make all the difference between financial soundness and financial unsoundness.

I speak on behalf of the worker in this case. It is the worker who is a member of one of those prudent societies of which I have been speaking who will suffer by this Bill. The principle that underlies it is that the good are going to be made pay for the bad in order that all may be brought to one common level. There is no justice and no sense in it, and no improvement is going to come to anyone. The statutory benefits will be retained for those who are getting them at present. What steps will have to be taken in order to continue those statutory benefits for the societies which are in an unsound financial position is quite another matter, but it is not a reasonable or a just thing to throw the onus of doing that on societies which have hitherto, by their providence and prudence, established themselves in such a position that they are able to promise for the future benefits entirely beyond what the Act demands. The last speaker said that the benefits given by these societies were going to be continued. They are going to be continued until the present contracts expire. After that it will be entirely a matter as to what the unified society will be able to do, and the unified society will only be able to do what its combined funds will enable it to do. It would be a miracle if its combined funds, without outside help, whether from the State or otherwise, enabled it to comply with the statutory demands. I do not suppose there would be much use in making an appeal to the Minister in this matter, but I do not think he quite considered the real meaning of the proposal that he has put before the House.

The Minister to conclude.

I think that I have seldom listened to as many prophecies of evil as I heard in this debate. My belief is that all these prophecies of evil are not going to be fulfilled. In saying that I am, of course, acting in a little way as a prophet myself. I believe there is an opinion abroad that the national health insurance fund as a whole is insolvent. Some people seem to think that, but it is a misapprehension. The national health insurance fund as a whole is not insolvent. It is, perhaps, not in as healthy a state in this country, or in any other country where insurance of this type is in operation, as one would like to see it.

It is off the gold standard.

Well, we are not off the gold standard in national health insurance so far as the fund is concerned.

Mental standards we are talking about now.

Mr. Kelly

They do not appeal to me at all.

I did not know that the Deputy had become an authority on gold standards.

Mr. Kelly

Bi-metal.

I hope the Deputy has enough of both. What has happened is that certain societies—the number we believe is, unfortunately, increasing —in the past have become practically insolvent, and that when the next quinquennial actuarial investigation is completed the belief is—there is good reason for the belief—that quite a good number more societies will be proved also to be insolvent.

The big ones?

Big and small. The Deputy seems to suggest that it is only the big societies that are insolvent. The number of insolvent societies includes some large societies and some very small ones. It is not because societies are big or because they are small that they are insolvent. The reason probably is that the demands made on the societies have been excessive.

The demands made on certain societies have arisen out of the nature of the societies. You must remember that this system of health insurance is one that was not set up in this country after consultation with the people here as to what would be the best system of health insurance for the country. It was set up in the British House of Commons by a British Act and modelled on the British system. It was designed for a highly industrialised country such as Great Britain was and it would not necessarily follow that that system would be suited to this country. As a matter of fact it was if possible the most unsuitable system of health insurance that could be applied to this country. Our belief is that that is at the bottom of the trouble in national health insurance to-day. It was suited to a society that was highly industrialised. Our country was anything but highly industrialised. It was an agricultural country and the system was very unsuited to us. At the time that health insurance was adopted in England and put into operation there it was designed to be built upon friendly societies of which there were many in England then, and there are now, some approved societies with a membership not alone of one million but some of them I believe up to 3,000,000 members. Why, the whole insured population under health insurance in this country is little more than 450,000.

The system adopted here was not one that was best suited to this country. The fact is that the system of allowing people to insure in societies because of association in crafts or in religious societies or professional societies was not a proper basis for insurance purposes and was bound to lead to financial difficulties. There are societies that have gone through the last 20 years, survived and come out of the trial well. That can be accounted for by several reasons, one of which is that some of these societies are made up principally of the young and the vigorous people and in the case of others, because they have rules and regulations which enable them to select their entrants. In some of these societies that rule has been availed of. It may not be availed of in the society with which Deputy Thrift is acquainted but there are other societies in which it was availed of. In that way the societies preserved for themselves and selected for themselves good healthy members. If ordinary life insurance, fire insurance or ordinary insurance of any kind were to be built on the basis that the insurance society would need only to select the very best risks or the moderately good risks, there would be very profitable business but the basis of insurance is that they have to take all and chance that the good risks will outweigh in numbers the bad and that they will make a profit in the end. It is because the system proved a failure in a great number of cases so far as these health insurance societies are concerned, the system having been set up on a wrong basis, that we are in the position to-day that we know ourselves to be in financially so far as a number of the societies are concerned. Some Deputy said last night that it was because of the fact that in the last two or three years economic conditions in this country had not been what they were hitherto, that certain societies were in a bad financial condition but that cannot be true, if we remember that as far back as the 1928 valuation it was shown at the end of that quinquennial period—and that was not as bad a period economically; the amount of unemployment was not anything like as great as it is now—by the actuary that the societies as a whole had made a deficit of £50,000.

Deputy Norton, speaking last night, put in a plea for co-ordination of all social services. That might be a very good thing to adopt. He desires to have one comprehensive scheme to include not alone health insurance but workmen's compensation, unemployment insurance, perhaps old age pensions, other pensions like widows' and orphans' pensions and matters of that kind. It is possible that if we were starting entirely on the new in this country, and with resources to enable us to pay all these pensions, that a co-ordinated system of that kind might be adopted, but this Bill is brought forward to deal with what I regard as a crisis that is likely to arise at the end of this year. A very serious situation, certainly in the national insurance world, is bound to arise, and this Bill is an attempt to forestall or to meet that situation. It is not an attempt to deal with all the evils and all the grievances that are alleged against the present national health insurance system. The introduction of a co-ordinated scheme such as Deputy Norton suggested would necessitate a commission or committee of inquiry and a long and elaborate investigation of social and economic conditions here. The national health insurance situation at the moment would not allow us to spend the time that would be necessary on that investigation if it were to be a proper and full investigation. The situation was such that we had to deal with it knowing, as we did by the actuary's report, that the prospects at the end of this year are anything but good. Some may say that it ought to have been dealt with earlier, that perhaps it should have been dealt with last year. At any rate, even if it were dealt with last year, as far as I can see the method of dealing with this special particular difficulty would not be other than is proposed in the Bill.

We have this much in favour of the system of unification that we have adopted here that it was recommended to us by the Committee set up by the late Government in 1924, if feasible, and we believe that it is feasible. That Committee was not set up by this Government; it was set up by the late Government. It was a Committee of officials, mostly, with, I think, some members of the Dáil. They were Professor Magennis, then a distinguished member of the Cumann na nGaedheal Party; Sir Joseph Glynn, Mr. James Hurson, Mr. James Gray Kyd, actuary; Mr. McElligott, of the Department of Finance; Very Rev. Canon McHugh, P.P., another distinguished supporter of Deputy Mulcahy; Dr. W.J. Maguire, Civil Service Commission; Dr. Rowlette and Dr. Stevenson. These gentlemen, in so far as they were not officials, were leading members of the Cumann na nGaedheal Party when they recommended the adoption of this system.

Of unification?

As a pis aller.

They recommended unification and added the words "if feasible."

Surely, the Minister does not accept as correct everything that comes from the Cumann na nGaedheal Party?

Oh, dear, no. I accept very little that comes from it. I am just pointing out that the gentlemen opposite who are criticising unification are criticising some of their own most distinguished supporters.

The Minister is not accepting but adopting what they suggest.

I should like also to point out that Deputy Mulcahy himself it was, as Minister for Local Government, who, realising the condition that national health insurance was in and was likely to be in at the end of this quinquennial period, sent urgently for the actuary and asked him to make a special investigation, and that he did in December, 1931.

Is the Minister prepared to tell us something about his report?

You have here in the Bill the results of the actuary's work.

We are to believe that the actuary said the words and we are to take the Bill?

That is right. The Deputy and his Government had so far neglected to deal with the situation that they themselves had to send for the actuary to help to get them out of their difficulty. The actuary has reported. We have his report and I agree with Deputy Dillon when he suggests that unification is a pis aller but this, I believe, is not the time when we can set about recasting the social services by measures suggested by some of the Deputies here. The economic conditions are not such as to help us to arrive at the best conclusion and, as a pis aller, I recommend this unification. I do say this much, in addition, for it, that, if and when this House decides to unify the social services, if the House decides, possibly, after investigation, that it would be a wise thing to unify unemployment insurance, old age pensions and national health insurance, a necessary step would be the unification, first, of the approved societies associated with national health insurance.

What about the widows and orphans' pensions as well?

That matter is under consideration at present.

And it looks like remaining so for a good while.

The scheme was promised for the coming Budget.

It was not.

Yes, by the Minister for Finance.

I do not think so. However, the matter has not been so very long under investigation. I do not know when the report will be issued, but I am given to understand that it will be in the hands of the Government before very long. What the nature of the report is, whether it recommends a system of widows' and orphans' pensions by contribution or otherwise I do not know.

The Minister for Finance promised it in his last election speech.

That is not exactly correct, either.

Before the Minister leaves this point, may I say that we are not concerned with who said this or who said that, or what commission reported. It has been stated in various ways that certain policies were pursued and recommended from this side, and none of the statements that have been made on that matter is actually the fact, but the Minister is now telling us that he is recommending unification. He is pointing out that, in our time, we asked the actuary to report on the general situation, and I have suggested to the Minister that what we want made is some kind of a case for unification, and that we ought to have some details as to what the actuary did report. I quite accept the Minister's statement that the general finances of national health insurance are fairly sound. The figures he quoted yesterday, in answer to Deputy Broderick, indicate that, but what we want is the situation that necessitates interfering with the societies that are proceeding satisfactorily now. If the Minister has any kind of a conclusive statement from the actuary, I think the House ought to get it in the interests of the subject the Minister is dealing with.

Might I suggest——

The Deputy cannot make a speech at this stage.

I am merely asking a question. The Minister, in the course of his speech, has used a Gallic expression twice and might I suggest that he translate it into homely Gaelic for us?

Dá ndeinfhinn é sin, ni thuigfeá é. I understood Deputy Mulcahy to say that the statements I had made about unification having been recommended by a Committee were not correct.

No. I am saying that it is no argument for unification at this stage to say that, with certain modifications or qualifications, it was recommended by that Committee. What the House is anxious about is the much more pointed thing as to what the actuary did report.

I heard several Deputies complaining, including Deputy Mulcahy, that I did not give enough figures and as many more complaining that I gave too many, so many that they were unable to follow them.

The figures were very few.

I could not hear them.

I usually speak loud enough for Deputy Norton or any other Deputy to hear me.

Your election voice served you yesterday.

It did, and there was nobody in the House who had any right to complain that they could not hear me and, least of all, Deputy Norton. I spoke deliberately, slowly and as loudly as I am speaking now and I am sure the Deputy can hear me well.

I can, now, and I was one of the people who listened when only one other member of the Minister's Party was prepared to listen.

The Deputy ought to have heard all the better for that reason.

I did not.

The Deputy must have been asleep.

I was really being put to sleep by the Minister's speech.

I will try to keep the Deputy awake by talking a little louder.

If the Minister wants to do that, he will not read his speech again. Otherwise, there will be danger of our going asleep.

It would not matter much.

No, I suppose it would not matter much.

Let us have unification again now, please.

In my speech, I gave the results of the actuary's investigation.

It was not even quoted in the "Irish Press."

The "Irish Press," I am sure, gave as much interest to it as Deputies of all parties showed in the speech on national health insurance last night, including even Deputy Norton.

I could not hear it.

I was personally interested in the figures, and my complaint is that they were too few.

That is Deputy Mulcahy's complaint, and Deputy Norton's complaint is that he got too many.

I could not hear what I got.

That is not what the Deputy said last night.

So we are not going to hear what the actuary said?

I gave it last night and I will give it again. I hope Deputy Norton will hear it this time.

For this purpose an actuarial estimate has been made as to what the valuation at the end of the present year will disclose, if the system is not changed, with the following results:—

Certain societies will show surpluses of £335,000, while other societies will show deficiencies totalling £510,000. The contingencies funds of societies in deficiency will amount to £110,000 and the central fund to £120,000, so that even if these are used to the maximum there will still be a deficiency to be met in these societies of £280,000.

That is the result of the actuarial report that I read out last night, very plainly, very slowly and very distinctly.

So that the surplus still outweighs the net deficiency.

Deputies

No, no.

Certain societies will show a surplus.

How can the Minister explain if he is interrupted and not allowed to make a speech?

Even a Minister is entitled to be heard. If Deputies want to conduct conversations with each other they had better go elsewhere.

Certain societies will show surpluses of £335,000, while others will show a deficiency of £510,000. The contingencies funds of the societies in deficiency amount to £110,000 and the central fund to £120,000, so that even if these are used to the maximum there will still be a deficiency of £280,000.

I understand that there is a gross deficiency of £510,000. But these societies are entitled to the contingencies fund and the central fund and to credit against that deficiency the entire results of these funds. That would leave a net balance of £240,000.

You are taking in the other figure.

I am asking the Minister. If you take the deficits mentioned you get a net figure of £240,000. But you had surpluses in other societies of £335,000, so that if you joined them up together with a plus surplus of £335,000 you will get a net deficit of £280,000, and that leaves you a net surplus on the whole division of £55,000.

I want to make this final point. The figures already quoted by the Minister, in reply to Deputy Broderick, show that payments in benefits have not been particularly excessive, and that the accumulations of the national health insurance are well up. The figures that we got as deficiency for the year 1928 were £50,000. I submit we want to get some kind of explanation as to where the £510,000 deficiencies in certain societies are going to come from. It is little information to say, merely, that some societies will show a surplus of £335,000 and others £110,000. There is nothing in the general figures that give information as to where that deficiency is to come from.

I understood the position to be such that if things were put together and you got one united whole it would not be financially unsound, but the last remark of the Minister seems to indicate that the whole thing would be wrong to the extent of £280,000.

We cannot use the surplus of the societies that have a surplus. We have no authority to do so, but with amalgamation we will be in a position to use them.

And you will have a net surplus, after joining the contingencies fund and the central fund after amalgamation, of £55,000.

We will have a net surplus. I cannot say what that will be until after using up all those figures of the societies in surplus.

But the Minister will find that taking all those figures he laid before the House there will be a net surplus of £55,000.

There would be.

Perhaps Deputy Briscoe is now enlightened.

Perhaps Deputy Dillon does not yet know what he is talking about.

One other reason as to the cause of the present situation. There has been a steady increase in the annual expenditure and in the benefits. In 1925 the expenditure was £550,000. In 1932 it was £778,00. The contribution income has increased, and is shown in the figures for 1925 when it was £478,000 and in 1932 it was £650,000. That, certainly, is something that we are pleased with but we think that national health insurance, worked by a unified society, will get better results.

Does not the Minister seem to say that it is about time to stop the general increase in benefits?

No. If we get an increase in clients when the societies are unified the whole society will bear and carry the burden that certain societies have now been carrying.

How on earth does the Minister suggest that the approved societies have not acted in compliance with the Act? Surely that is what inspectors are for. I never heard of an approved society not in compliance with the Act.

If the Minister is anxious to get compliance with the Act is he not much more likely to get it if he allowed national health insurance to be conducted, voluntarily, rather than worked as a whole under the central society? That seems to be elementary.

It is not our experience. There are towns in Ireland where there are as many as six different societies. We would want to send inspectors into every house, and we have not got inspectors in every town in Ireland. We can have, and will have, one way of knowing all this and that is by putting national health insurance under one unified society. You will then have one record kept for everybody in the town and you will be in a position then to know those who should be contributing to that insurance. You are not in that position now. Mr. Morrissey seemed to think that with unification the administration would deteriorate. We believe that the contrary will be the result and that not alone will the cost be considerably less—the cost of administration—with the abolition of the duplication and triplication that is going on all over the country owing to the multiplicity of societies and officials, but that you will get better compliance, better administration, and I, certainly, am satisfied that the officials and agents of the society that will be appointed in every town will act, despite what some people seem to think, as humanely and with as much interest in the individuals and in the health of these individuals as any individual official of a health insurance society has done up to the present.

I should like to ask the Minister what way does he propose to make these appointments? Will he consider the claims of the older officials?

That question has been asked by several Deputies and I propose to answer it now. We hope to retain the services of a great many of the officials of national health insurance societies now operating.

Full time?

Full time or part time officials. Any type of officials that have been proved—and the vast majority of them are known to the officials and inspectors—to be energetic and competent workers, are well known and will certainly receive every consideration in any claim for employment when the new offices are being set up.

Will they be retained under the conditions of their present positions, or will the conditions of the present full time men be worsened?

I asked that question.

Deputy Dillon and others asked that question. That is a question to which I cannot give an answer right away with regard to everybody. There are certainly people that we would not take on at all. If you ask me to mention an individual case, I could not mention it; but I am sure that the people who will be making the appointments and who know these officials well will certainly say "No"—that there are certain individuals that they would not touch.

Could they degrade a man in transferring him?

I could not give a guarantee as to that.

Would he not have the right to walk out and take his pension?

If he were offered employment and refused to take it, I am not quite sure.

But supposing he was offered employment inferior to that which he enjoyed in the approved society, would you not give him the option?

I should say that that would be relative.

May I remind the Minister that in previous legislation of this kind, making provision for transfer or compensation, the existing rates and salaries of people affected were certainly worsened in no case that I know of so far as this House is concerned?

I should say that if Deputy Dillon or Deputy Davin suggests that we would ask a man, an accountant or an important official in any society, to come and take a post under this unified system and that we proposed to give him one-half or even two-thirds of his salary—I should say that we would be doing an injustice in offering him a similar position. I think they will be offered similar posts.

Carrying the existing salaries?

Yes, I believe that; or at any rate, the difference will not be material.

I am satisfied with that.

Of course, there is a great number of officials—I do not know how many—but there must be a number of them to whom such an offer will not be made. I do not know the number but there must be quite a number of them.

Deputy Costello, in the course of his speech last night, suggested that there would be injustice to individuals in the working of the unified societies. I cannot see where the injustice to any individual would arise by reason of the fact that the individuals in national health insurance will be dealt with by the officials of one society rather than by officials of a number of health societies. It is not, I think, the experience generally that, let us say for example, civil servants are willing knowingly to do injustice to any person in the State. I have had cases put up to me by members of health insurance societies where they believed they were injured by the officers of health insurance societies. Probably cases of that kind will be brought to the notice of Deputies as a result of the activities of officials of the unified society, but I do not think that there will be any greater percentage of delay or hardship, and certainly no more injustice—if anything, possibly less—done to any individual subscriber to health insurance by an official of a unified society any more than by any official of the smaller societies. There is a suggestion that injustice will be done to the members of societies who have been in the happy position of getting additional benefits. Well, the Bill provides that up to the end of the actuarial period the full benefits will continue. After that, it will naturally depend on what the financial position of the unified society is as to what benefits will be granted. The statutory benefits must be given but I am quite satisfied that the unified society will be in a healthy position and, while it is probably true, as Deputy Thrift and others have said, that some of the very best societies and their members may not have offered to them the full advantages that they are getting now, and have been getting for some time, their loss will be very slight.

But if you take the figures your actuary has quoted, the unified society could give no extra benefits anywhere. Is not that clear?

It is not clear. I am not satisfied that some of the additional benefits will not be available by the unified society.

But the figures show a deficit of £50,000.

Well, even with that, possibly some of the advantages will be available.

Deputy Morrissey seemed to recommend amalgamation rather than unification. We considered the question of amalgamation. We considered all the suggestions made at different times when the subject of national health insurance was debated here in former years. When considering amalgamation we were at once brought up against the question of the weaker societies—who was going to take over their members. We have had experience of attempts at amalgamation before. The main point was who was going to take over the membership of the poorer societies. No organisation with a surplus or in a good condition would be anxious to take them over. They would not like to take them over as a body; they would like to select them; they would like to go through the list of members and select those who they thought would be good lives. We had no power to force any society to take over their weaker brothers and look after their interests.

If this were going to benefit the members of the poorer societies I would not have said what I have said. The members of the poorer societies must get certain statutory benefits. Therefore my argument is that no other benefit can accrue to them. The only thing that must occur is that the workers at present receiving extra benefits will forfeit those benefits and everyone will be brought down to the statutory level. If what the Minister has suggested is going to benefit the members of the poorer societies I would take up a totally different attitude, but it does not do so.

That is not correct. What would happen these societies if, at the end of the quinquennial period, they were all in deficiency?

They must get their statutory rights. The State would have to come in to maintain them if necessary.

The central fund would restore their solvency.

There is that course open to them but, after all, this is an insurance and a contributory insurance scheme, and the whole bottom would fall out of the insurance and the contributory insurance scheme if that were allowed to happen. The other better off societies would be affected. The whole scheme would have to be recast in all probability and the better-off societies would have to allow their benefits to be reduced as well as the poorer ones; they would all have to be brought to the lower level.

There are other ways.

The only other way is to put our hands into the pockets of the Exchequer and thus impose a burden on the people.

There is still another way, but I do not want to worry the Minister too much at this stage.

With Deputy Dillon it would be my ambition, as Minister for Local Government, to bring in a Bill making old age pensions available at 65 years and to co-ordinate a lot of the social services and improve them in general. I would like to be in a position to do a number of things of that kind that would be for the benefit of the old and infirm. At the same time we have to take the measure of our own resources. As with old age pensions and other pensions, so it is with insurance. You cannot get more out of a pint measure than you put into it. Our resources are not illimitable.

That is what Deputy Hugo Flinn said.

It is a quotation from Deputy Flinn.

It is not very original, no matter where it came from.

Where is Deputy Flinn?

He is very ill. I think I have covered all the points made except points with regard to the position of officials who will not be taken in under the new scheme, and who will have to be compensated. There again it is a question of the measure of our possibilities. All this money for compensation has to come out of the administration fund, and there is a limited amount for administration. You cannot have a new organisation starting off in a semi-bankrupt condition. We have certain limited funds out of which to pay compensation. We are trying to be as generous as our limited resources will allow us. I am not arguing that these suggested measures of compensation are generous, but I do say they are as generous as our resources will permit.

Many suggestions have been made as to how they could be increased and improved. Before the Bill was introduced I went into the matter very carefully with the officials. I saw what our resources are, and I saw the number of officials who will likely have to be compensated, and I tried to measure the compensation accordingly. There is one point on which, perhaps, we can afford to reconsider the matter, and that is the question of the years raised by Deputy Dillon and others. They objected to the limit of eighteen years instead of the full period of service. We will give consideration to that point. With regard to the measure of compensation, that is how we are tied up. We are tied up because the administration fund is limited, and we cannot take more out of it than will leave a balance in the fund sufficient to enable the administration of the new organisation to be carried on.

Does the Minister not expect certain economies in view of the fact that a new society with the same administrative expenses will avoid a good deal of the overlapping and waste, with consequent inefficiency, that seems to be inevitable amongst 65 societies?

We do expect to make considerable economics, and we are anticipating using up a considerable proportion of these economies in paying compensation. That is what we are hoping to do.

Has the Minister any approximate idea of the amount of economics that will be effected—has he a capitalised figure?

I have not at the moment a capitalised figure of what these economies will be. If this matter is raised on the Committee Stage I will try to get figures for the Deputy.

In view of the fact that the Minister has already stated that the majority of the full-time officials will be taken over by the new society——

I did not say the majority; I said a great number.

——and that they will carry with them their existing salaries —and the Minister when in opposition supported compensation for persons who would lose their positions by reason of legislation passed here—will the Minister give an assurance that any of the full-time officials who lose employment will, after a period of over five years' service, get compensation by way of pension and that those with a period of service under five years will be given a gratuity?

I am standing over the terms of the Bill.

Mr. Kelly

Hear, hear!

Rigidly?

So far as I have gone into the finances and seen the statement of the finances likely to be available——

Is Deputy Kelly, who said "Hear, hear," aware that this is considerably watering down the compensation proposals passed by the Cumann na nGaedheal Government?

Will the Minister be prepared between now and the Committee Stage to hear representations made, if representations may be fairly made, showing him that alternative compensation proposals are within the financial resources at his disposal?

I will be glad to hear anyone who has what he thinks is a useful or constructive suggestion to make with regard to the compensation or any other clauses in the Bill. I will be at his disposal. So far as I have gone in an examination of the finances, that seems to be the limit of the compensation available.

We will do our best to enlighten the Minister.

We will be very happy to see Deputies on this matter. I think those are all the points that have been raised.

Would the Minister advert to the principle underlying Section 8?

It seems that it has been the practice of a number of men engaged in insurance work, particularly life insurance work, acting for societies having their headquarters outside of this country, to become also agents for some one or other of the national health insurance societies. They used the national health insurance societies for the purpose of getting into houses and into touch with families merely to purse their own avocations and to help them in their own business. Some of them used the national health insurance money to keep people in benefit in the industrial and life insurance companies. That has been often found to be a fact by the officials of the Department and we think it would be very unwise to allow the association of these two interests to continue.

I think that view would be all right in respect of a company having registered offices in England. It would not be right to co-operate with an English insurance company in order to spread their business here. But would it be acceptable to the Minister if an amendment were drafted restricting this section in its application to persons associated with insurance companies having their headquarters outside this country? As it stands it does leave itself open to a nasty interpretation and I wish the Minister would say——

This is the second speech the Deputy is making.

I am only asking the Minister a question——

The Deputy is making a second speech.

In that case, if the Chair thinks so, I will sit down.

I gave the Deputy every latitude but a second speech is not allowed.

I do not desire to go into any arguments. I am only just putting a question to the Minister. If the Minister would let us know whether an amendment drafted towards the end that I have indicated would be favourably considered on the Committee Stage I would appreciate it.

I should like to see the amendment first, but I think the same rule would have to apply to societies in industrial insurance whether their headquarters are in Ireland or elsewhere.

Question put.
The Dáil divided: Tá, 76; Níl, 48.

  • Aiken, Frank.
  • Bartley, Gerald.
  • Beegan, Patrick.
  • Blaney, Neal.
  • Boland, Gerald.
  • Bourke, Daniel.
  • Brady, Brian.
  • Corish, Richard.
  • Corkery, Daniel.
  • Corry, Martin John.
  • Crowley, Fred. Hugh.
  • Crowley, Timothy.
  • Daly, Denis.
  • Davin, William.
  • Derrig, Thomas.
  • De Valera, Eamon.
  • Doherty, Hugh.
  • Doherty, Joseph.
  • Donnelly, Eamon.
  • Dowdall, Thomas P.
  • Everett, James.
  • Flynn, John.
  • Flynn, Stephen.
  • Fogarty, Andrew.
  • Gibbons, Seán.
  • Goulding, John.
  • Hales, Thomas.
  • Harris, Thomas.
  • Hayes, Seán.
  • Houlihan, Patrick.
  • Jordan, Stephen.
  • Keely, Séamus P.
  • Kehoe, Patrick.
  • Kelly, James Patrick.
  • Kelly, Thomas.
  • Keyes, Michael.
  • Killilea, Mark.
  • Kilroy, Michael.
  • Brady, Seán.
  • Breathnach, Cormac.
  • Breen, Daniel.
  • Briscoe, Robert.
  • Browne, William Frazer.
  • Clery, Mícheál.
  • Concannon, Helena.
  • Kissane, Eamonn.
  • Lemass, Seán F.
  • Little, Patrick John.
  • Lynch, James B.
  • McEllistrim, Thomas.
  • MacEntee, Seán.
  • Maguire, Ben.
  • Maguire, Conor Alexander.
  • Moane, Edward.
  • Moore, Séamus.
  • Moylan, Seán.
  • Murphy, Patrick Stephen.
  • Norton, William.
  • O'Briain, Donnchadh.
  • O'Dowd, Patrick.
  • O'Grady, Seán.
  • O'Kelly, Seán Thomas.
  • O'Reilly, Matthew.
  • Pattison, James P.
  • Fearse, Margaret Mary.
  • Rice, Edward.
  • Ruttledge, Patrick Joseph.
  • Ryan, James.
  • Ryan, Martin.
  • Ryan, Robert.
  • Sheridan, Michael.
  • Smith, Patrick.
  • Traynor, Oscar.
  • Victory, James.
  • Walsh, Richard.
  • Ward, Francis C. (Dr.).

Níl

  • Alton, Ernest Henry.
  • Belton, Patrick.
  • Bennett, George Cecil.
  • Bourke, Séamus.
  • Brennan, Michael.
  • Broderick, William Joseph.
  • Brodrick, Seán.
  • Burke, James Michael.
  • Burke, Patrick.
  • Costello, John Aloysius.
  • Curran, Richard.
  • Davitt, Robert Emmet.
  • Desmond, William.
  • Dillon, James M.
  • Dockrell, Henry Morgan.
  • Dolan, James Nicholas.
  • Doyle, Peadar S.
  • Esmonde, Osmond Grattan.
  • Fitzgerald, Desmond.
  • Fitzgerald-Kenney, James.
  • Good, John.
  • Haslett, Alexander.
  • Holohan, Richard.
  • Kent, William Rice.
  • MacDermot, Frank.
  • McDonogh, Martin.
  • McFadden, Michael Og.
  • McGilligan, Patrick.
  • McGuire, James Ivan.
  • Minch, Sydney B.
  • Morrisroe, James.
  • Morrissey, Daniel.
  • Mulcahy, Richard.
  • Murphy, James Edward.
  • Nally, Martin.
  • O'Connor, Batt.
  • O'Donovan, Timothy Joseph.
  • O'Higgins, Thomas Francis.
  • O'Leary, Daniel.
  • O'Mahony, The.
  • O'Reilly, John Joseph.
  • O'Sullivan, Gearoid.
  • O'Sullivan, John Marcus.
  • Redmond, Bridget Mary.
  • Rice, Vincent.
  • Roddy, Martin.
  • Thrift, William Edward.
  • Wall, Nicholas.
Tellers:—Tá: Deputies Little and Traynor; Níl: Deputies P.S. Doyle and Bennett.
Motion declared carried.
Bill read a Second Time.
Committee Stage fixed for Wednesday 10th May.
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