Committee on Finance. - National Health Insurance Bill, 1941—Committee and Final Stages.
Section 1 agreed to.
SECTION 2.
(2) A copy of each report made by an actuary under this section shall be laid before each House of the Oireachtas.
I move amendment No. 2:—
In sub-section (2), page 3, to add at the end of the sub-section the following words: "A copy shall also be transmitted as soon as may be to the society".
This section provides for quinquennial and actuarial valuations, and for the submission of reports on the subject to the Minister. It also provides that a copy of each report made under the Act shall be laid before each House of the Oireachtas. It strikes me as being rather remarkable that the society, whose funds are under examination, is not to be furnished with a copy of the report of the actuary. I do not know whether that is an omission. If it is, it is one that ought to be repaired. I suggest that the Minister should provide that the society would get a copy of the report of the actuary.
I think it is unnecessary to put in a statutory obligation to furnish the society with a copy of the report. That would be placing the Minister more or less in the position of an intermediary. It has always been the practice to furnish copies of such reports to the society, and that practice will certainly be continued. I do not think that the obligation should be placed on the Minister to furnish the society with copies of the report.
Can the Minister say how the person described as the actuary could be compelled to discharge that duty? I take it that the actuary will not be a civil servant, but will probably be an outside person. It is going to be the duty of the outside actuary to do so.
I do not think the section will create any difficulty under that heading.
Not as long as the society knows what is happening.
Amendment, by leave, withdrawn.
Question proposed: "That Section 2 stand part of the Bill."
I understood that the quinquennial and actuarial report was designed to ascertain the actuarial value of the liabilities and assets of the insurance society or the benefit society, with a view to determining whether the assets were sufficient to cover all the actuarial risks outstanding, and if they were not sufficient, to ascertain what sum would have to be put into the capital fund in order to make the society solvent, or if there were surplus assets over liabilities to fix control of the funds, to see what additional liabilities they might legitimately create without endangering the solvency of the fund. As far as I can gather from the Parliamentary Secretary now, the Government has determined to depart altogether from the capital basis, and to form estimates from year to year as to what the probable income of the fund is going to be, what its probable outgoings are going to be; to endeavour to form an intelligent forecast of that from year to year, and to cut their cloth according to that measure.
If that is their purpose, it seems to me that annual actuarial investigations would be more appropriate than quinquennial valuations. Indeed I doubt if this new basis is a proper field for an actuary to function at all, because I doubt if an actuary will undertake, over strictly limited and short periods in the life of a fund of this kind, to make any forecast at all. I understand that the very essence of actuarial valuation is that there should be a reasonably long period of experience so that any unusual or untoward events would stand a chance of being corrected by some corresponding event in the period chosen.
I would direct the Parliamentary Secretary's attention to paragraph 5 of the Actuarial Report on the Financial Position of the National Health Insurance System which was laid on the Table of the House on the 18th February, 1942. There the actuary said:—
"Looking at the experience of the years from 1935 onwards, I reached the conclusion that the average of the three years, 1936-38, i.e., omitting the somewhat higher rates of sickness experienced in 1935 when the Unified Society was beginning its administration, is a fair standard by which to measure the probable future level of sickness experienced by insured persons."
Do I understand from the Parliamentary Secretary that in future we are going to measure our prospective sickness from year to year? On what basis are we going to proceed at all? What period are we going to take if we are going to deal with this matter purely on the basis of income and expenditure? Suppose the Parliamentary Secretary tells me that he is going to take the quinquennial period, what I want to point out is this: If you take quinquennial periods as the actuarial basis you should establish adequate reserves to meet any possible unforeseen expenditure but, if at the end of your quinquennium you find that the reserves established at the beginning are not sufficient, you declare a deficiency on the fund and take appropriate measures in the next quinquennium to correct that deficiency, either by way of levy on the members or by way of a reduction of the benefits distributed. If, on the other hand, we are going to deal with quinquennia but look upon them, not as periods in which we can determine the capital value of our assets and liabilities, but as periods in which we shall try to find what our annual income and outgoings are going to be, how are we going to make provision for the risks that an actuarial valuation on a capital basis is designed to provide us with?
I recognise fully that it is not the easiest thing in the world for the Parliamentary Secretary to go fully into the highly technical aspects of administration of this kind because I remember, when the Industrial Insurance Bill was going through the House, similar questions arose and it became extremely difficult to get Deputies to appreciate the distinction between an actuarial and an accountancy valuation and matters of that kind. I do not think I am wrong in saying that these questions go to the very root of the legislation which we are at present considering. Now, the Parliamentary Secretary can dissipate all anxiety by simply saying: "The Government has made up its mind to abandon the basis on which these funds were administered before and if the fund becomes insolvent the Exchequer has got to make up the deficiency." In that case, the whole principle of insurance has gone by the board. If, however, we are still maintaining the exterior of a self-supporting insurance fund, then this House ought to be satisfied that the fund will be maintained in a solvent position one way or the other before we proceed to legislate for increased benefits. Although I have read what the Parliamentary Secretary said on the Second Stage of the Bill, I have yet to hear from anybody in this House a clear and cogent description of what the Government had in mind in order to ensure the continued solvency of this insurance fund.
Discussion on the Committee Stage is confined to the section—in this instance whether there should or should not be a quinquennial actuarial valuation and report. The Deputy is discussing the solvency of the fund.
The question arises whether a quinquennial valuation is appropriate to this new basis. If the new basis is going to be an estimate of annual income and outgoings, I question whether the quinquennial valuation is appropriate, but we cannot make up our minds as to whether a quinquennial valuation is appropriate to the new system until the House fully understands how the Parliamentary Secretary proposes to approach the problem. Unless the Parliamentary Secretary says that he will let the quinquennial valuation stand and that the Treasury will guarantee the fund——
That is obviously matter for a Second Reading speech.
On this I want to make the point that unless we have some indication as to how the fund is to be guaranteed in some way, a quinquennial valuation is not sufficient. If we are not going to have income and outgoings with an accumulation of reserves based on an actuarial system, and the probable risks provided against, the Parliamentary Secretary must say that the Government will guarantee the fund for the duration of the quinquennium. Unless the Treasury does that, I think we should have an annual return made to the House showing whether the fund in that given year has paid its way, and if it has not, what measures the insurance society proposes to take in order to make up whatever deficit has arisen, to ensure that the fund will be solvent in the year to come.
The solvency of the fund does not arise on this section, nor indeed on this stage of the Bill at all.
What is the quinquennial valuation for?
That is not for the Chair to decide. The question of the solvency was properly debated on the Second Stage of the Bill. That matter should not be reopened now.
That is the whole root of the Bill.
Possibly, the root of the Bill, and therefore not in order after the principle has been approved.
How are we to make up our minds whether or not we should have a quinquennial valuation except by determining what it is designed to achieve? It is designed to achieve a certain condition of the fund. If you depart from the capital basis, my suggestion is that an annual valuation becomes necessary, unless the Parliamentary Secretary can say that a quinquennial valuation is sufficient, because the Government will guarantee the fund for the duration of the quinquennium. I think that is a point that should be met, and I suggest to the Parliamentary Secretary that he should explain to us in all the circumstances why he is satisfied on the new basis that a quinquennial valuation is sufficient.
Without intending in any way to be offensive to the Deputy, I suggest that if he had read the Bill, and certainly if he had been present at the Second Reading debate, we would not have the type of discussion we have had, nor would we have had such an alarmist speech as we have had from Deputy Dillon. Sub-section (2) of Section 1, as the Deputy will see, says:—
"Each of the following periods shall be a financial period for the purposes of this Act, namely,—
(a) the quinquennial period... ended on the 31st day of December, 1938."
It is in respect of the valuation for the five-year period ended 31st December, 1938, that the actuary has advised that a certain sum of money per annum may be made available for additional benefits. Each five-year period following the five-year period ended on 31st December, 1938, will be a further financial period and the actuary will be asked to advise at intervals of five years as to whether in fact we can with safety continue to make available £175,000 per annum, or any sum per annum, for additional benefits. Surely it is clear to Deputy Dillon that inasmuch as we are to-day, in 1942, dealing with the condition of the fund on 31st December, 1938, as per actuarial investigation, we are proceeding with proper care and caution, and that if we are advised in 1943 by the actuary that we would have to reduce the amount of money to be made available for additional benefits, the finances of the whole insurance scheme are not in any endangered. It seems to me that, whatever other criticism may be levelled at the Department or the Bill, the criticism certainly cannot be levelled that we are taking any risk whatever in respect of the funds of the society, or the stability of the society in the proposals before the House. I do not know if Deputy Dillon fully adverted to the fact that the scheme about to be put into operation on 1st April next is in respect of the financial position of the society on 31st December, 1938.
From a surplus disclosed at the end of that period?
What is going to happen in the following period?
The actuary will advise as to whether we can with safety continue to make that sum available.
That is as simple as A B C. If the Parliamentary Secretary had said: "We are going to continue the administration of the society on the capital basis laid down in the 1911 Act——"
The Deputy says that the point raised is fundamental. I quite agree, but the principle of the Bill has been approved on Second Reading. It cannot be redebated now on a section.
I have not the slightest desire to debate the merits of it, but the Parliamentary Secretary has just explained that the surplus he is going to distribute as from 1st April next is a surplus disclosed by actuarial valuation in respect of the quinquennial ending in 1938.
Is not that what the Parliamentary Secretary has just said?
It is not correct. There is no surplus disclosed.
On the basis of the financial position on 31st December, 1938.
That is another question.
The Parliamentary Secretary used the word "surplus".
Between you and him it is.
Do not let us get into that discussion. I understood the Parliamentary Secretary to say that I was remiss in not having adverted to the fact that the £175,000 which it is proposed to expend as from 1st April next is the result of a surplus ascertained by an actuary for the quinquennial ending in 1938.
That is not strictly correct. I do not accuse the Deputy of deliberately misinterpreting me, but it is not as a result of a surplus on the basis of a capitalisation system of actuarial investigation, but on the estimated surplus that would be available if the assessmentism system were in operation.
The Parliamentary Secretary used the word "surplus".
It is not what a man says that matters but what he means, and there has been a hypothetical valuation—I think I may so describe it —for the period ended 1938. My whole point is: Is it safe to proceed on the basis of quinquennial valuation in the future? The Parliamentary Secretary seems to reply to me: "Inasmuch as we are not going to make the distribution until after the quinquennial, what is the danger?" My answer is that, up to 1938, we were operating on the capitalisation basis and I assume that although the valuation on which this extra benefit distribution was based is hypothetical, the true capital basis actuarial valuation was borne in mind. If we are going to operate in future without the capital basis altogether, we are going to have only this annual income and outgoing calculation. I do not care if the Parliamentary Secretary says that the Treasury will make up any deficit that arises as a result of following that practice but, if he does not, I say that there ought to be annual valuations. Does the Parliamentary Secretary not take that point? Surely the quinquennial procedure is indissolubly associated with the capital basis for a fund of this kind and not with an income and expenditure basis? Is there any other fund to which he can refer us which is operated on the basis on which he now proposes to operate the National Health Insurance Fund, which is protected only by quinquennial valuation? If there is such a fund, I should be glad to know of it, so that I can study its practice and procedure with a view to a determination as to whether it is a suitable procedure for this fund. Does he know of any such other fund?
No, I cannot offhand give the Deputy any parallel.
I do not believe that anybody else can, either.
Question put and agreed to.
Question proposed: "That Section 3 stand part of the Bill."
Sub-section (1) says:
"The Minister shall, as soon as may be after the passing of this Act `having regard to the report of an actuary dated the 28th day of March, 1941, on the financial position of the national health insurance system' ..."
Surely that report should be scheduled to this Bill? The report as laid upon the Table is here, but, as a matter of fact, I very much doubt if any Deputies have ever read it. This Bill, if it becomes an Act, will be incorporated in the whole code of national health insurance legislation and doubtless from time to time it will be expedient for those concerned with the Act to refer back to the report mentioned in its body. I do not think it would be inconvenient, and it certainly would be desirable, to schedule the report by the actuary, which, after all, is given statutory existence by the reference to it in the Bill.
I think the Deputy's point is sufficiently met by making the report available to Deputies.
Is there any inconvenience involved in scheduling it?
Is it not customary to schedule a document to which reference is made in a Bill? For example, the only copy of this report available to members of the House is at present before me, so that if any other member wants it he cannot get it.
If others want it they can get a copy of it.
You cannot get it in the library because I have the library copy in front of me.
And I had it before the Deputy.
It seems to me to be common sense that if you refer to an actuary's report, dated so-and-so, it ought to be scheduled. This refers to the actuary's report, but it does not even mention that it must be laid on the Table of the House.
My information is that a minimum of four copies of such reports is usually deposited in the Oireachtas Library.
I have this one, and I could not find any other.
That is the usual procedure.
Question put and agreed to.
SECTION 4.
(1) The society may, before the commencement of any additional benefit period, prepare and submit to the Minister a scheme for expending, during each year of such period, among insured persons who are members of the society the amount made available for additional benefits in such year on any one or more of the additional benefits including the administration thereof and, upon any such scheme being sanctioned by the Minister, the society may provide additional benefits in accordance with the scheme, subject however to any withdrawal of sanction by the Minister under sub-section (3) of this section.
(6) Any moneys unexpended out of the amount made available for additional benefits in any year of an additional benefit period may, with the approval of the Minister, be expended.
I move amendment No. 3:—
In sub-section (1), page 3, to delete in lines 45 and 46 the words "before the commencement of any additional benefit period" and in line 47 the word "such" and to substitute for the word "such" the words "any additional benefit".
When the Bill was being prepared it was considered that it would be passed in sufficient time to allow of a scheme to be prepared and submitted before the 1st April. We now think that it would be safer not to impose this time limit, and the amendment provides accordingly. It seems to be outside the region of possibility now to have a scheme prepared before the 1st April.
Amendment agreed to.
I move amendment No. 4:—
In sub-section (1), page 3, to delete all words from the word "among" in line 47 to the word "society" in line 48, inclusive, and to substitute therefor the words "by way of an increase of sickness benefit or disablement benefit among insured persons who are members of the society and who are married or who have any children wholly or in part dependent on them" and in lines 49 and 50 to delete the words "on any one or more of the additional benefits".
If this amendment, including the Minister's amendment, were accepted, sub-section (1) of Section 4 would read like this:—
"The society may prepare and submit to the Minister a scheme for expending, during each year, of any additional period by way of an increase of sickness benefit or disablement benefit among insured persons who are members of the society and who are married or who have any children wholly or in part dependent on them, the amount made available for additional benefits in such year including the administration thereof and upon any such scheme..."
And then the original section follows on to the end. The amendment seeks to secure that the £175,000 now being made available for additional benefits would be applied as increased cash benefits for persons who had family responsibilities on them. I do not want to labour that point. I just want to indicate again the inadequacy of the position. The present cash benefit is 15/- a week. Under the unemployment insurance scheme, a man with a wife and five children would get 35/- a week. Under the unemployment assistance scheme, a man with a wife and five children would not only get 23/- unemployment assistance payment, but would also receive, according to the amount of money that he had to pay in rent, anything from 5/- to 10/- from the relief authorities, and as well would receive food vouchers providing milk, butter and bread to the extent of another 10/7½, the whole amounting to something over £2 a week. The new compensation scheme which the Minister for Finance proposes to introduce, by way of a new order, would provide for a disabled man with a wife and five children a sum of 57/6 a week. I associate these figures with the remarks I made here previously.
I think that nothing the Parliamentary Secretary can do in the way of distributing any other kind of medical benefits is more necessary, from the point of view of health and the future security of the fund, than additional cash benefits. On the medical side, I indicated before that throughout the whole country you have very considerable machinery for giving medical benefits. You have widespread machinery for dealing with all matters affecting the eyes and the teeth, and other special branches of medical provision. There is no reason at all why anybody who is a member of a national health insurance society need be in want of any particular kind of medical attention. In my opinion, what is more urgent and necessary than anything else is increased cash benefits, particularly for people who have the care of a family on them.
The effect of this amendment would be to substitute for the list of additional benefits, which is a comprehensive one, one additional benefit of a special type limited to a particular section of the insured population to the exclusion of others. It seems to me that the acceptance of the amendment would cut across the general framework of the Bill. The Bill provides that the society will, within a certain time limit—that has now been removed— submit a scheme of benefits to the Minister. If the Deputy's amendment were accepted the society would have no say whatever in the selection of the type of benefit to which the limited amount of money available ought to be applied or could best be applied. Apart altogether from the merits of the Deputy's amendment and his viewpoint as to the facilities for medical treatment that are already available to the insured population, I think that the society ought to be brought into consultation as to the type of benefit that it is proposed to provide. Deputy Mulcahy's special type of benefit could be provided, if it was deemed to be the most desirable type of benefit to provide out of the scheme, because one of the additional benefits set out in the list under the Act of 1911 is as follows:
"Increase of sickness benefit or disablement benefit in the case either of all members of a society or of such of them as have any children or any specified number of children wholly or in part dependent upon them."
Within the framework of that provision, additional cash benefit can be provided. The society can expend money, if the Minister agreed with it that it was the best type of additional benefit to provide. If we accept the Deputy's amendment we exclude the society from consultation. It does not matter what they think about the particular method of expenditure: we can have one benefit and one benefit only. If every Deputy in this House who is interested in this question expressed an opinion as to the best manner of spending the £175,000 that is available, I am quite sure no two or three of them would agree as to the particular scheme that would confer the most benefit on the insured population. Perhaps Deputy Mulcahy would not press his particular point of view, in view of the fact that it can be taken into consideration in determining the scope of the scheme.
Would the Minister agree that there is very little use in giving spectacles or false teeth to a man with a family who is getting only 15/- a week?
I think it is a mistake for Deputy Mulcahy to put up cash benefits versus certain types of additional benefits. I agree with him that the present type of cash benefits is absurd—giving a man earning £3 or £4 a week only 15/- when he is ill, when he needs more money for nourishment, and expecting him to keep a wife and four or five children on that. It is amazing that we should introduce legislation with the title of national health insurance when we throw a sick man 15/- a week and tell him to get well as soon as he can.
Surely that is not done under this Bill.
Deputy Mulcahy is making the case that he should get more. I assume it is in order for him to move his amendment.
There were two borderline amendments—one submitted by Deputy Norton and one by Deputy Mulcahy. I have allowed both.
Surely there is no doubt about the present amendment?
I wish to put this point of view to Deputy Mulcahy. Having regard to the ultimate object he has in mind—the improvement and codification of the whole insurance legislation—it probably is not good tactics or wise to put cash benefits in contest with additional benefits. I would like to see cash benefits increased substantially, as I think they are absurdly low, but there is considerable value to the insured person in additional benefits and perhaps the scheme of additional benefits ensures a much more diffused distribution of whatever money is available.
For instance, a person may be in good health and may not be in a position in which he requires to absent himself from work and, consequently, get cash benefits; but, at the same time, he may need dentures or optical treatment, or he may need another type of treatment which would not necessitate his absence from work. If that person is to get any benefit from the funds now being made available, under Deputy Mulcahy's proposal he would have to report sick and so make himself worse off than he is at present, in order to get that benefit. To concede Deputy Mulcahy's claim would mean that the man earning £3 or £4 a week would have to report sick so that, instead of getting 15/- a week, he might get £1; but he would be still £3 a week worse off. On the other hand, if additional benefits are given to the man who needs dentures for which he cannot pay, he may continue to work, getting £3 or £4 a week, and may get the society to pay the whole or half of the cost of the dentures. From my experience as secretary of a national health society on one occasion, I know the Deputy will find, as I found, that there is very considerable importance attaching to the provision of dentures and optical treatment and a variety of treatment of that kind.
I would suggest to the Parliamentary Secretary that there has been no lay-man's examination of the whole question of national health insurance in this country and, if I am any judge, the passage of this Bill through the House will be regarded as a reason for dropping the anchor in respect of the improvement of national health insurance legislation for the next ten years. I would be very surprised if we see another amendment in such legislation for another ten years, and I am sure, when we advocate such legislation, we will be told that it is not long since 1941, when we introduced the last amendment.
Will the Deputy not be over here in the next ten years?
There would be a change then. I am assuming the continuance——
No; the Deputy just forgot.
I am prepared to assume the continuance of our misfortunes and that there will be no change of Government. I would suggest to the Parliamentary Secretary that, when he gets this Bill through, there should be some effort to get a commission of progressively-minded people in national health insurance to evolve a scheme suitable to this country.
The Deputy has strayed from the point.
Only away in the sense that I wish to say to Deputy Mulcahy that, while I like his amendment if it is going to bring additional benefits in the form of cash, I dislike it if it is going to deprive them of other benefits. The sooner we get a balanced view representative of the man in the street and of the insured population, the better. I would like to see the whole question examined, not from a purely actuarial or financial point of view, but from that of ordinary intelligent people, representative of the whole insured population, to see what, in their opinion, is the best type of benefit, the best way to provide it, the best type of contribution and the best way to administer it, having regard to the fact that we have a code of insurance legislation which we inherited from Britain and which may not suit the conditions here at all.
The attitude of the Parliamentary Secretary on the case I put up shows me that there is no hope of carrying this amendment. I feel satisfied that I have got the opinion of the House as a whole, both on the Government benches and the others, that nobody is satisfied with the position in which 15/- a week is the amount of cash coming from an insurance scheme into the house where the head of the family is laid low by sickness. I feel there is an appreciation of the fact that it is utterly contrary to the type of government we would like to see here that a man stricken down by sickness has to go to the poor law in order to maintain himself and his family. I think we have established that there is no group in the House which wishes to perpetuate that.
I realise there is no use in pushing the Parliamentary Secretary in regard to this particular matter. I do agree that a very great wrong has been done a large number of people in the smaller societies which were under the scheme before it was unified and who had increased cash benefits as well as other medical benefits and who have been deprived of those under the working of the unified society. It may be desirable, under the society, to begin the administration and application of medical benefits of one kind or another which would bring more reality into the scheme than there is at present and would result in getting a more balanced view of the kind of national health insurance administration we really need. Therefore, I have no desire to press this amendment against the generally expressed wish of the House, but I think it is a matter that cannot be indefinitely disregarded in the way in which Deputy Norton seems to think it may be. Something in what the Parliamentary Secretary has said in regard to the work of the InterDepartmental Committee that is sitting on certain aspects of the question of family maintenance suggests to me that before very long we may have proposals put before us that will improve that situation.
Amendment, by leave, withdrawn.
I move amendment No. 5:—
In sub-section (6), page 4, line 18, to delete the words "with the approval of the Minister".
I do so because this provision in this sub-section seems to be an innovation so far as national health insurance administration is concerned. While I say so without offence, it seems to me to be the effort of the civil servant administrator to gather unto himself all the power that he can to prevent the society from exercising any rights which it normally would have, without the approbation of the person who feels that he should be applied to before these rights can be exercised. My main anxiety in putting down the amendment is to make sure that the National Health Insurance Society is not going to be harried or impeded in its work and that the necessity for securing Ministerial approval for a carry-over of expenditure will not in fact be used as a kind of lever by the Department to compel the Society to accept conditions which they would not be obliged to accept if they had the power to expend this money of their own accord within the general framework of expenditure. What we are doing in this Bill is simply this: we are setting aside a sum of money, approximately £175,000, to be spent in each of five years. If, for instance, the society spends £100,000 in the first year, there is then a carry-over of £75,000 which, added to the £175,000 in the following year, makes £250,000. The society cannot expend more than £175,000 in a year, but what I am puzzled about is this—if the society spends only £100,000 in one year, why is it necessary for them to secure Ministerial approval to spend the unexpended balance plus the normal amount to be expended in the following year? What is the need to insist upon Ministerial approval for what is merely a routine activity, a carry-over, from one year into another, of an unexpended balance, particularly when we have put down in this Bill in such definite terms the precise amount to be expended and when we exercise the control that is exercisable under this Bill over the expenditure of the money?
From 1921 to 1934 schemes of additional benefits were administered by various societies. It would happen in a particular year that they would not spend all they intended to spend. Then they carried over the unexpended balance into the following year, and it was not necessary to secure Ministerial approval for that action, which had the endorsement of 23 years' experience and activity. I think it is a mistake to put each of the five years into a water-tight compartment. I think it is a mistake to impede or harry the society by insisting on putting each of the five years into a water-tight compartment. I think once you indicate to the society that it is permitted to spend not more than a certain sum in a particular year, the society ought to have the right to carry over the money automatically to the following year, provided all the time that it does not spend more than the maximum amount allotted to each year. It does not seem to me to be a matter of importance to carry over £20,000, £30,000, £40,000, £50,000 from one year to another. It would be serious if they spent £20,000, £30,000, £40,000, £50,000 more in a year than they were entitled to spend. Once they keep within the definite limit of expenditure, it seems to me to be an unreasonable shackle to require the society to secure Ministerial approval for what ought to be merely a routine activity, particularly having regard to the relationship which exists between the society and the National Health Insurance Department.
One would understand a provision of this kind if we had in this country, say, 65 or 80 societies as we previously had, but where you have only one society, with responsible officers, with a responsible committee of management, presided over by a high ecclesiastic, what is the necessity for shackling them with the obligation to secure Ministerial approval for the carry-over of a sum of money from one year to the next year? I think the Parliamentary Secretary should delete that requirement. It is treating the society as infants.
It seems to me that this amendment is inconsistent with the principles embodied in Section 4 of the Bill. That section provides that a scheme may be amended by the society with the approval of the Minister or the scheme may be amended by the Minister without the approval of the society. Under sub-section (6), any moneys unexpended out of the amount made available for additional benefits in any year of an additional benefit period may, with the approval of the Minister, be expended during any succeeding year of that period. Deputy Norton objects to the words "with the approval of the Minister", but suppose £50,000 remains unexpended at the end of any one year and that £50,000, in addition to the £175,000 already ear-marked for the following year, is available for additional benefits, surely the fact that there is that additional sum available for expenditure will be the means of radically amending the scheme. Deputy Norton will, I am sure, agree that the Minister is entitled to consultation as to what particular one of a number, perhaps, of additional benefits ought to draw on this £50,000 that has been unexpended the year before. The Minister and his advisers ought to have very sound views on that matter. I do not question for a moment the competency of the society to form a sound opinion on such a question, but I do hold that the Minister is entitled to consultation, and, in the long run, that the Minister is entitled to the last word as to whether a saving in any particular year should be ear-marked to one additional benefit or to another.
Surely the Minister could exercise that power by agreement without requiring approval for the carry-over of any sum of money. This is in respect of any sum carried over.
Quite. The sum may be a very large sum. For example, if it should be, perhaps, three or four months before the scheme that would operate as from the 1st April next becomes effective, there may be a very considerable sum left in the first year. There might not be time to expend it. Suppose dental benefit, for example, was one of the additional benefits provided, it might take a very long time to get that benefit operative. Consequently, half the money might not be expended within the year.
That may be true in respect of the first year, but this is a permanent Bill. The law will be the same five years hence.
It can occur in any year but it is not very likely to occur.
There is a question I want to ask the Parliamentary Secretary in connection with that. He speaks of money being unexpended. Suppose the money is appropriated by the society to certain applicants. Take dental benefits. Supposing provision is made for the supply of 10,000 dentures and the supply has been approved by the society in a given year, will the money appropriated to these 10,000 dentures which have been approved be deemed to have been expended or will there be a carry-over of liability and asset?
I should say it would be deemed to have been expended if a contract for expenditure had actually been entered into. At any rate, it is as broad as it is long, because the section gives power to carry forward any unexpended balance to the following year, and, if commitments had been entered into in respect of, say, a dental scheme that had not been fully discharged, of course that would have to be borne in mind in determining the purpose to which any surplus money would be devoted.
Has not the Minister sufficient power, by insisting on amendment of the scheme, to secure the objective which the Parliamentary Secretary says he has in mind? In the event of there not being a sufficiently extensive demand for a particular type of treatment, could not the Minister insist that the scheme be altered, and in that way secure the objective indicated just now? Why burden the society with an obligation to get the sanction of the Minister's Department for the carry-over of what might be a relatively trivial amount having regard to the financial activities of the society?
Why try to secure the Minister's undoubted rights by such a round about method as the Deputy suggests?
The Minister's rights are one thing, but this money belongs very largely to the insured contributors.
Amendment, by leave, withdrawn.
Question proposed: "That Section 4, as amended, stand part of the Bill."
Sub-section (4) of Section 4, says:
"A scheme under this section may determine the conditions to be complied with as respects the additional benefits thereunder and may provide for the reduction, suspension or deprivation of the said additional benefits as regards members of the society who are in arrears."
Those words are substantially taken from the original Act dealing with persons who are in arrears, but it seems to me that the first portion is new: "A scheme under this section may determine the conditions to be complied with as respects the additional benefits thereunder". Does that make it possible for a committee of the society to lay down conditions to be complied with as respects additional benefits under a new scheme, so as to restrict the availability of those benefits to certain classes of persons who are insured under the National Health Insurance Acts? If it does confer that power it is a complete departure from the existing principle of national health insurance in this country established by the amalgamating Bill. The whole evil which obtained before amalgamation was that certain approved societies gave additional benefits to their members, while other approved societies were so poor that they could not do so. The whole object of the amalgamation was to ensure that, if any additional benefit were made available for the members of the National Health Insurance Society, all insured persons would be equally entitled to them.
I think the Deputy does not fully understand the purport of the section. It is not proposed to depart from established custom at all. Title to statutory benefits—sickness, disablement, maternity and marriage benefits —is subject to waiting periods. For instance, no insured person is entitled to sickness benefit until he has been at least 26 weeks in insurance and 26 contributions have been paid. A reduced rate of sickness benefit is then payable, and title to the full rate of sickness benefit does not commence until after 104 weeks in insurance and payment of 104 contributions. There is a similar waiting period of 42 weeks and 42 contributions for maternity benefit, 52 weeks and 52 contributions for marriage benefit, and 104 weeks and 104 contributions for disablement benefit. Some such conditions as the conditions attaching to the statutory benefits will be necessary in respect of the additional benefits provided in the Bill.
I thought that was covered by sub-section (5)?
The Parliamentary Secretary will observe that, according to sub-section (5), "A member of the society shall not be entitled to an additional benefit provided by a scheme under this section unless such conditions, relating to the period of membership of the Society and the number of contributions paid during that period, as may be prescribed with respect to that additional benefit are complied with".
Those are two fundamental conditions which are laid down, but there may be other conditions as well.
Quite. It appears to me that, inasmuch as ordinary matters about membership and stamps are specifically provided for under sub-section (5), the words of sub-section (4) appear to give the society power to lay down conditions which will operate to confer benefits on certain classes of persons within the society which will be withheld from others. Could the Parliamentary Secretary devise some words which could be inserted in sub-section (4) so as to make it manifest that, though the society might lay down the rules which would have to be complied with, no rules, could be made which would operate to confer benefits on one section of the insured community which would not be available to any other section of the insured community who desire to comply with the rules?
The principle embodied in sub-section (4) is taken from the original Act of 1911.
It is Section 37, sub-section (2), which says:—
A scheme made under this section may prescribe the conditions to be complied with as respects any additional benefits conferred by the scheme and every such scheme shall so far as practicable provide for the reduction, suspension or deprivation of the additional benefits conferred by the scheme in the case of persons who are in arrears.
I think all the powers taken in sub-section (4) are already embodied in sub-section (2) of Section 37 of the Act of 1911. While it is quite possible that the interpretation which Deputy Dillon reads into the section is a possible reading of it, that is not the intention, and the section will not be used for the purpose that Deputy Dillon apprehends.
I have no doubt that, so long as the Bishop of Clonfert is chairman of the society—he is a very conscientious man—he would not allow it to be used for that purpose, but we are legislating here to ensure that the National Health Society will be operated on the lines laid down by us no matter who may be chairman. I had seen the sub-section of the original Act to which the Parliamentary Secretary was good enough to refer me just now, but I think the Parliamentary Secretary will agree with me that the sub-section in the original Act does not find itself linked up with any sub-section such as sub-section (5) of this Bill. Sub-section (5) of this Bill makes it quite clear that provision is being made in the fund to deal with the period of membership and number of contributions. Therefore, some other conditions are envisaged by sub-section (4). All I am concerned about is that the principle enshrined in the amalgamation Bill—to put all members of the society, no matter what their position in private life may be, on an equal footing vis-a-vis the funds of the society—should be preserved. For instance, would it not be possible, under sub-section (4), to provide a scheme of additional benefits, a scheme for dental benefits, providing that the beneficiary was a member of an approved society that was giving dental benefits on the date of amalgamation? Would it not be a perfectly legal proviso under sub-section (4)? I think the Parliamentary Secretary will agree that if there were statutory powers in the committee to make any such proviso, it would be at variance with the spirit of the legislation.
The scheme has to be submitted to the Minister and approved. Assuming that the society might do such a thing as the Deputy has in mind, it would not become effective unless the Minister approved.
I suppose that is a safeguard. I think that has no place in the legislation subsequent to our amalgamated Act of some years ago, where we were dealing with approved societies established in 1911. We were starting off de novo and groups of persons were envisaged running their own affairs, operating for their own benefit. Now we are dealing with a very much less personal body. I think it should be within the power of the committee to impose the type of condition which I have envisaged and I think sub-section (4) gives them that power.
Let us take a case in point. Suppose a condition were put in that additional benefits should be applied to ex-service men, including ex-service men from the British Army and from the I. R. A., on the ground that they had a special claim. I do not think that would be right. I do not think the National Health Insurance Society is the sort of place where a discrimination of that kind could be made. I think it is quite possible that a political Minister might feel himself constrained to approve a proposal of that character. Does the Parliamentary Secretary think that if there was a proposal that additional benefits should be made available, provided the insured persons have given national service over a certain period, it would be possible for the committee to make such a proviso? I think not. I think sub-section (4) gives the power and that power ought to be withdrawn and a mandatory duty placed upon them to make additional benefits available for all members of the society without distinction, provided they conform to the requirements envisaged in sub-section (5).
Section 4, as amended, and Sections 5 and 6 agreed to.
SECTION 7.
(3) When the amount of unclaimed sums in respect of any accounting year has been finally ascertained, the said sums shall be applied as follows:—
(a) so much thereof as does not exceed fifteen thousand pounds, shall be appropriated in aid of moneys provided by the Oireachtas for the expenses of administration of the Acts and this Act,
(b) so much (if any) thereof as exceeds fifteen thousand pounds, shall be carried to the Reserve Fund.
(4) The amount of unclaimed sums in respect of each accounting year shall be estimated during the financial year commencing on the 1st day of April in that accounting year and there shall be paid out of the proceeds of sales of stamps during the said financial year a sum (which shall be appropriated in aid of moneys provided by the Oireachtas for the expenses of administration of the Acts and this Act) equal to the amount which would, if the amount of the said unclaimed sums as so estimated were the amount as finally ascertained, have been applied under paragraph (a) of sub-section (3) of this section.
(5) If, on the final ascertainment of the amount of unclaimed sums in respect of any accounting year, it is found that the amount paid under sub-section (4) of this section is less or greater than the amount required to be paid out of the said unclaimed sums under paragraph (a) of sub-section (3) of this section, then, the sum next payable under sub-section (4) of this section shall be increased or reduced accordingly.
Can the Parliamentary Secretary give us any description of what is the machinery whereby the Committee satisfies the Treasury that no change will be made in respect of certain stamps that have been affixed— those are the unclaimed sums mentioned in paragraph (a)?
The amendments must be first disposed of. Private Deputies are, of course, prohibited from making proposals, the effect of which would be to increase the charge on State funds. In view of that prohibition, amendment No. 6 required careful consideration. I have decided to allow the amendment. It does not prescribe the expenditure of money. It does not impose a positive charge. The object is to divert to the reserve fund of the Insurance Society certain savings which the Bill proposes to appropriate in aid of moneys provided by the Oireachtas. It seems to me that the aim of the Deputy is quite legitimate; he is quite in order and the amendment is allowed as being analogous to a saving of expenditure or a reduction of taxation. I take it the three amendments are interdependent.
I move amendment No. 6:—
In sub-section (3), page 5, line 27, to delete the words "applied as follows" and to insert "carried to the reserve fund"; and in lines 28 to 33 to delete paragraphs (a) and (b) of the sub-section.
In Section 7 of the Bill provision is made that when the amount of the unclaimed sums in respect of any accounting year has been finally ascertained, the said sums shall be applied as follows:—
(a) so much thereof as does not exceed £15,000, shall be appropriated in aid of moneys provided by the Oireachtas for the expenses of administration of the Acts and this Act....
What we are establishing in this section is the principle of raiding the unclaimed stamps account. This section could be written more briefly in this way, that the purpose of Section 7 is to raid the unclaimed stamps account to the extent of £15,000.
The unclaimed stamps account contains, from time to time, a considerable sum of money. The account arises from the fact that a great quantity of insurance stamps is sold by the post office and paid for by employers, and those stamps do not find their way back to the controller of national health insurance. As the proceeds of the sale of insurance stamps belong to the Department, the sums representing the value of the non-effective stamps find their way into this account, which is kept for that purpose by the Department. That account has never formerly been raided for the purpose of meeting administrative charges or expenditure which properly devolved upon the State. In this section we are setting out to raid that fund to the extent of £15,000 and that will be applied to purposes for which, in the ordinary course, the State Exchequer should be liable.
The Department has no right to that money; it belongs to the insured contributors and to the employers of insured contributors who fulfilled their statutory obligations. Whether there is any right to that money by the insured person, the one thing clear is that the Department has no right whatever to it. In this section it sets out to raid the account to the extent of £15,000. A raid on the account at any time would be bad, but I do not think a raid to the extent of £15,000 represents the last word in raiding. We remember the Unemployment Assistance Act of 1933. In order to get it over it was provided that the Unemployment Insurance Fund, which had nothing to do with the liability of the Unemployment Assistance Fund, should be raided in order to finance the Unemployment Assistance Act. That raid was carried out, perhaps not to a very extravagant extent at first, but the position has altered very radically since then and the Unemployment Insurance Fund is now contributing £300,000 per year to finance the Unemployment Assistance Act.
We may find eventually that this unclaimed stamps account will be utilised to a very considerable extent to finance the State grant towards national health insurance administration which, up to now, was a direct State charge. This is establishing a very undesirable precedent and it is creating a situation in which this fund can be raided for the purpose of the State discharging, through the medium of the spoils gained by raids on this fund, liabilities which properly belong to the national Exchequer and which should be paid over by the national Exchequer.
The issue at stake in this amendment has the advantage, anyhow, of being very clear. Under Deputy Norton's amendment, if it were accepted, the £15,000 that would be appropriated in aid and repaid to the Exchequer would remain in the stamps account fund or presumably in the new fund to be established under Section 6. Now, Deputy Norton talks about raiding the unclaimed stamps account, and he, of course, very strongly objects to any such raid, but the alternative is to raid the Exchequer. This Bill provides that the additional benefits shall carry with them the two-ninths contribution and will cost the State, approximately, £39,000. In these circumstances, it is not unreasonable to make this appropriation and to relieve the Exchequer to that extent. The Exchequer contributes very largely to national health insurance, and I am sure Deputy Norton is fully aware of that. In the year 1942-43 the State contribution, under the National Health Insurance Vote, will be £306,000, but to that must be added the cost of services rendered by other Departments, amounting to £30,000, and £24,000 as the liability that will fall on the Exchequer as a result of the measure before the House, if it becomes law. So that, in fact, the Exchequer will contribute to national health insurance in the coming financial year no less than £360,000. Now, when it is considered that the Department of Posts and Telegraphs contributes £13,250, and the Stationery and Printing Office £2,700, towards the service of national health insurance, I think it is not unreasonable in all the circumstances to make this £15,000 available out of the unclaimed stamps account.
The society cannot establish any claim to these stamps. These stamps are stamps that have never been surrendered or that have never been affixed to cards and surrendered, and the society does not assume any responsibility on account of the moneys accruing in the unclaimed stamps account. Seeing that they do not shoulder any financial responsibility in respect of these claimants, I cannot see how any good case can be made on which their claims to the moneys could be very well founded. The money involved, however, £15,000, is not a very big sum and would not make a very big difference to the society by way of providing additional benefits. Deputy Norton will say, I suppose, that compared with a total of nearly £40,000,000 or so, a sum of £15,000 would mean very little to the State.
What is the amount in the account at the moment?
Only £50,000 in the unclaimed stamps account, but Deputy Norton, I hope, will agree with me that the burdens on the State and on the Exchequer at the present time are becoming very heavy and are daily increasing. Now, you may tell me that savings could be made in other directions, but when you turn to look for the other direction it is not so easy to see how or where these savings can be made. The fact that an additional £24,000 will be borne by the Exchequer in the coming financial year, as a result of this Bill, is in itself, I think, a fairly full reply to Deputy Norton's request that we should impose a further burden of £15,000.
My main concern in this is the principle of raiding this fund, and I am rather anxious that, even if it is expected to make a certain contribution because the State is going to pay two-ninths of the grants-in-aid towards the additional benefits, whatever contribution it is going to make now ought not to be regarded as a precedent for raiding it to a still greater extent at a later stage. The reserve fund is obviously in need of money because, notwithstanding that reserve fund, notwithstanding the actuary's report, and notwithstanding the departure to a considerable extent from the capital method of valuation, we are still, in respect of cash benefits, providing the insured person with only 15/- a week during sickness, and 7/6 a week, both being maximum sums, during disablement. So long as that is the position, obviously raiding a fund, which, if it were not raided could be utilised for the purpose of strengthening the reserve fund, is something which is highly undesirable. Can the Parliamentary Secretary give us some assurance that it is not intended capriciously to raid this fund every time the Exchequer feels impecunious or that the Minister for Finance feels that he has got to raid some place in order to make good some anticipated budgetary deficit?
Yes, I think I can give the Deputy that assurance, that it is not intended further to raid this fund.
Would the Parliamentary Secretary repeat that?
I can give that assurance, that it is not intended to encroach further on this fund, and I would avail of the opportunity to inform the Deputy that the reserve fund, being constituted under Section 6 here, is not in quite as precarious a position as Deputy Norton seems to think.
I know that it is not, but you are putting it in an artificially precarious position because of the way you are looking at it.
Well, no. The average amount in the unclaimed stamps account would be about £17,000 a year. We take £15,000 of that, and at any rate there would be a couple of thousand pounds for the reserve fund, but as well as that the amount of the new reserve fund at the present time would be about £432,000, and that will earn a substantial interest, and with the £2,000 or £3,000 that may be available from the unclaimed stamps account that fund will grow substantially, should it not be necessary, as it probably will not be necessary, to encroach on it.
Amendment, by leave, withdrawn.
Amendments Nos. 7 and 8 not moved.
Sections 7, 8, 9 and 10 put and agreed to.
SECTION 11.
(1) All sums received by the Minister or the Minister for Finance in respect of interest on investments held by them on behalf of the Irish National Health Insurance Fund shall be apportioned amongst such accounts and funds maintained under the Acts (including accounts of the society and the Military Forces (International Arrangements) Insurance Fund) and in such manner as the Minister may determine.
I move amendment No. 9:—
In sub-section (1), page 6, line 24, to delete the word "Irish".
What is the explanation of this amendment?
The word "Irish" there is superfluous.
Amendment agreed to.
Section 11, as amended, put and agreed to.
Sections 12 to 16, inclusive, Schedules 1, 2, and 3, and Title, put and agreed to.
Bill reported with amendments.
When will the Report Stage be taken?
I wonder would the House have any objection to giving the further stages now? It is not open to amendment.
I would have had no objection if the Parliamentary Secretary had been a little more communicative as to what type of additional benefits he was disposed to provide.
I am not so sure that the Parliamentary Secretary is as helpless as he pretends to be. Will he take the Report Stage and the Fifth Stage next day the Dáil sits on the understanding that he will tell us the type of benefit that will be provided?
I explained to the Deputy already that it is not any question of cussedness or reluctance on my part, but I will not be in a position to give such indication until the scheme is actually submitted. Friendly conversations between the society and the insurance section of my Department are the farthest that matter has gone yet. There is no use my giving an undertaking which I may not be able to carry out.
That is perfectly true, but will the Parliamentary Secretary give an indication as to when this scheme will be got under way?
As soon as we possibly can. We are all anxious, once we get the legislation, to bring it into operation with the least possible delay.
There are people who would be more optimistic, but I would hope to have it operating by the 1st July.
Agreed to take the remaining stages now.
Question—"That the Bill, as amended, be received for final consideration"—put and agreed to.
Question proposed: "That the Bill do now pass."
The Parliamentary Secretary mentioned during the discussion that an inter-Departmental committee was sitting on the question of costs of family maintenance. Can he say when he expects that committee to present its report, and whether it is proposed to present that report to the House?
I am afraid the Deputy will have to address that particular question to the Minister for Finance.
He is not far away from the Parliamentary Secretary and I think he would not object to giving the Parliamentary Secretary a helping hand.
Perhaps the Deputy will give the Minister notice of it.
Question put and agreed to.
