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Dáil Éireann debate -
Wednesday, 23 Feb 1944

Vol. 92 No. 12

Committee on Finance. - Vote 44—National Health Insurance.

I move:—

That a supplementary sum not exceeding £23,450 be granted to defray the Charge which will come in course of payment during the year ending 31st March, 1944, for Salaries and Expenses in connection with the Administration of the National Health Insurance Acts, ]911 to 1942, and the Widows' and Orphans' Pensions Acts, 1935 to 1940; for services in connection with Food Allowances and with Supplementary Allowances to certain Beneficiaries under the latter Acts (Emergency Powers Act, 1939) and for sundry Contributions and Grants, including certain Grants-in-Aid in respect of the cost of Benefits and Expenses of Administration under the National Health Insurance Acts.

The additional sum of £23,450 is required to meet expenditure out of the Vote for the current financial year. The principal item in the Estimate is the sum of £22,000 in respect of State grants on expenditure on benefits and their administration. Two-ninths of all expenditure on benefits and their administration is recouped to the National Health Insurance Fund by the Exchequer. The expenditure in the current year on the ordinary benefits—sickness, disablement, maternity and married benefits—and on the administration of benefits has been slightly less than that provided for in the original Estimate. The additional sum required under this sub-head, therefore, is entirely accounted for by the expenditure on the additional benefits, dental, hospital, optical, etc., provided under the 1942 Act.

Mr. Dockrell

I should like to know how far the additional dental benefits are intended to apply to all the people applying for them. Does it mean that dental benefits are now available, because for some years it has been a very sore point in this House that when the old insurance societies were done away with, some of them were providing dental benefits and others were not? Does this mean that we are now on all fours and that full dental benefits are provided for everybody?

I should like to know whether the Parliamentary Secretary's Department has given any consideration to the question of providing extended benefits to persons suffering from tuberculosis. I think there is a growing recognition throughout the country of the necessity for dealing sympathetically and understandingly with persons suffering from tuberculosis, if we are to make any effective headway in combating and ultimately eradicating that disease. Many of these unfortunate people who are compelled to enter sanatoria for treatment find themselves faced with the prospect of a long period of enforced absence from work. They get the normal national health insurance benefit if they have sufficient stamps to their credit for a period of six months, and, at the end of that period, they get disablement benefit amounting to 7/6 per week. It is on that trifling sum that they are compelled to provide for a wife and three, four or five children. The sum is, of course, grossly insufficient for that purpose, with the result that the wife has to go to the home assistance authority and try to get some assistance to supplement the slender income from national health insurance sources.

I think it is generally recognised, and the Parliamentary Secretary is probably more aware of it than anybody else in the House, that the mental condition of a patient suffering from tuberculosis is an important factor in aiding the recovery of the patient. If we can do something to bring about a state of easement of mind, so far as the patient is concerned, that type of treatment is probably as efficient as any other type which the patient can receive while undergoing sanatorium treatment. There is on all sides a recognition of the necessity for dealing sympathetically with sanatorium patients, and possibly one of the ways in which additional and extended benefit can be provided is through the medium of the National Health Insurance Acts. I know it is a big problem to contemplate the payment of full wages to persons during enforced absence from work due to tuberculosis, but it is a problem which must be tackled. The cost, no matter how great from the sterling point of view, is really very small when we consider the vast number of human lives on the other side of the scale.

I should like to be assured that this matter is engaging the attention of the Department of Local Government and that the Department's mind is running on the same sympathetic lines as I think the minds of the rest of the community are running. I ask the Parliamentary Secretary to tell us if his Department has any plans in mind, either by the introduction of special legislation to provide such compensation for loss of wages for those undergoing treatment for tuberculosis, or by an extension of the National Health Insurance scheme such as would provide persons suffering from tuberculosis with a reasonable subsistence allowance, as nearly as possible equivalent to their weekly wages, so as to enable them to remain in sanatoria, where they can be cured of this disease and not be compelled to go back uncured amongst the rest of the community to spread the disease which everybody realises must be grappled with effectively, if we are to preserve the life of the nation, and indeed if we are to preserve the race at all.

With regard to Deputy Dockrell's question, dental benefits are available to all members of the society who have the necessary contributions to their credit. It does not follow that all members of the society who require dental treatment will, in fact, be able to secure it, but, in the current year particularly, a generous allocation for dental benefit has been possible by reason of the fact that other special benefits were not operating. The hospital benefit scheme was not operating, and there has been a transfer of a substantial sum of money, £41,000 in 1942-43, from the other special benefits to the Dental Benefit Fund. In the current year the sum available for dental benefits will amount to approximately £210,000.

With regard to the question raised by Deputy Norton as to special provision for insured persons suffering from tuberculosis under the National Health Insurance Scheme, no such special provision has been made so far, nor have I had any representations from the society to the effect that they propose to make any special provision for the treatment of tubercular patients. Insured persons do get preference in sanatoria under the control of local authorities and of voluntary agencies. But, if additional provision is to be made for the proper care and treatment of tubercular patients and of their dependents during the time of illness, it certainly will involve very heavy financial commitments. I do not think it would be appropriate on the Vote before the House to go into that, inasmuch as the scope of this Vote is very limited.

On the general question of making provision for insured persons under the National Health Insurance Act, such special provision can only be made by the sacrifice of some of the benefits already available to insured persons, unless the finances of the scheme are altered. When we come to consider how the finances of the scheme might be altered in order that more money might be available within the financial structure for special benefits for a particular purpose, namely, the treatment of all tubercular patients, we have to turn our minds to the possible sources where the additional contributions would be found. It seems to me there are only three sources within the scheme: the insured person, the employer, and the State. It has not been brought to my notice, so far at any rate, that either the insured persons or the employers are prepared to give special contributions for the purpose of financing special benefit schemes such as a particular benefit for tubercular patients. I do not know what the reaction of the general insured population would be to such a proposal, inasmuch as the levy would have to be general on the whole insured population for the benefit of a comparatively small section of it. There is, of course, left to them the third alternative—the shoulders of the State. I can say, so far as the State is concerned, that the burden of taxation is mounting fairly rapidly. On occasion there is a good deal of criticism of that. I do not accuse Deputy Norton of criticising expenditure for public health purposes, but it seems to me there is a limit to the social services that can be financed, a limit, at any rate, to the money that the State can place at the disposal of the community for these various social services.

If the society, in their wisdom, put up a scheme to us embodying special benefits for members of the society suffering from tuberculosis, it will certainly be examined with the greatest possible sympathy. But it is open to doubt whether, if we have to transfer moneys from, say, dental or hospital benefits in order to provide special benefits for a very limited section, that is a sound public health proposition. As I have said, the whole problem of tuberculosis is one of the greatest problems we have to face in the future. Whatever our solution for that problem may be, it will apply equally to insured and to other sections of the community. But, if we are to tackle it in the manner in which it might be necessary to tackle it, and if a satisfactory solution is to be found, we will have to be able to lay our hands on enormous sums of money.

I am sure the Parliamentary Secretary is sympathetically disposed towards reformation of our existing methods of dealing with tubercular persons. I do not think the cost involved need deter us from applying an early and efficient remedy in the matter. After all, we raised £9,000,000 every year for the last few years to defend the country against possible invasion. If that means anything at all, it means defending the people against the possibility of annihilation at the hands of an external foe. Here we have a situation where possibly an internal foe is making a more deadly and devastating attack on our people than any foe we know of. If we can raise money for the purpose of resisting invasion, surely we ought to be able to raise money to save human lives. Assuredly, if we go on as we are going, we will simply have mass burials each year of people who have died from preventible tuberculosis. If we want that situation to continue, let us drift on as we are doing. If we want to deal with that situation, we can only do it by facing up to the responsibility involved in spending the money.

Question put and agreed to.
Mr. O'Leary rose.

I have put the question. I will not permit the Deputy to ask any question now.

I have had representations on behalf of a patient in the county sanatorium in Wexford, who is in receipt of 7/6——

I told the Deputy that I would not permit him to put that question. I gave him an opportunity to sit down, but he did not do it.

Will you not give me a chance to put a question to the Parliamentary Secretary? It is a very important one.

If the Deputy will write to me I will deal with the matter. The Chair has ruled that it is not in order to discuss it now.

I want to discuss it in the House. This is a case where a person in a sanatorium wrote to the National Health Insurance Society and was granted 5/- out of 7/6 for extra comforts. There is no doubt that the national health insurance scheme as administered to-day is a scandal.

The Deputy must not continue. The Vote has been put and agreed to.

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