Dáil Éireann debate -
Wednesday, 19 Mar 1947

Vol. 104 No. 17

National Health Insurance Bill, 1947—Second Stage.

Minister for Social Welfare (Dr. Ryan)

I move that the Bill be now read a Second Time. This Bill has been introduced principally to give effect to the amendment in Section 19, which raises the insurable limit to £400 in respect of non-manual workers. Deputies are aware that manual workers are insurable, no matter what their remuneration may be. When the National Health Insurance Act was first brought in, in 1911, the limit was £160. It was increased to £250 in 1920 and has remained at that figure. Owing to the increase in wages, particularly during the last few months, a number of people who were hitherto insurable have passed beyond the insurable level and I think the opinion was expressed by practically all Parties in the Dáil that we should raise that limit from £250 to some higher figure. We have inserted this figure of £400 as a reasonable figure, being somewhat related to the £250 when you take into account the increase in wages over the last few years. I might mention here that where a person passes over the insurable limit for national health insurance, the same applies to widows and orphans and that may be even a more serious question than the question of national health insurance. If this amendment is accepted it will apply to widows and orphans as well as to national health insurance.

It is true, of course, that these people could continue their insurance on a voluntary basis but very few do that, for one reason or another. They do not seem to think of it in time and when they do think of it the amount of arrears to be paid up is a deterrent and they are not inclined to go on. That is Section 19.

When bringing in the Bill I thought it well to take advantage of the occasion to re-enact the provisions of Emergency Powers Order No. 381, which was passed last June, and that is dealt with in Part II of the Bill. First of all, Section 3 deals with the question of people who continued to contribute even though they were not insurable because they had passed over the limit for insurance. Section 3 legalises their payments when they were made in good faith and really continues their cases as live cases when they come back into insurance again now with the raising of the limit. Section 4 deals with the free period of insurance which up to this was 12 months but which is now raised to 18 months. That is necessary because, in the interests of economy, the National Health Insurance Society issued cards recently for 12 months instead of six months and, in order to give a period over the 12 months for these cards to be returned, the insurance society would need a free period of 18 months instead of 12 months. It will, of course, be all to the benefit of the insured person also.

The remaining three sections in that part are dealing with the Army, in particular, soldiers who enlisted for the period of the emergency. There was no such period of enlistment contemplated in the Act of 1926 in dealing with members of the Army and these sections are necessary to clear up certain points that were in doubt.

Part III of the Bill deals with the members of the Military Forces International Arrangements Insurance Fund which was brought into being in 1923 and was established for ex-members of the British Army. At that time the insurance societies, a number of which existed, were not inclined to take on some ex-members of the British Army because they were not very good risks. A special scheme was prepared for taking these people on and that scheme has continued up to the present. It is proposed now to do away with the scheme because it is uneconomic to work a separate scheme by the Department for the sake of a few thousand members. The whole thing is being transferred to the insurance society. No member of the fund will lose in any way by reason of this merger. There are a number of clauses there but they have the effect only of transferring these people over and giving them the same rights they had in the fund. There is also a provision with regard to keeping certain accounts, so that if some of these people go back again to Great Britain it will be possible to send the history of the case, as they will be eligible for insurance on the other side.

Part IV deals with persons who are in receipt of pensions from the British Government in respect of disablement arising out of the recent war. There are two clauses there, one which deals with men who have got a pension who are members of the forces, and the other, which deals with men or women who have got a pension who are not members of the forces. In the case of members of the forces, where they got a full pension for 100 per cent. disability, they do not get sickness allowance here. Where they got what was not a full pension, in fact, less than the national health insurance would amount to here, they would get the sickness allowance on this side. In the case of civilians who got compensation for injury, coming back here from Great Britain, they would be treated exactly as persons who had been compensated under the Workmen's Compensation Act, that is, that if the allowance was less than the allowance given for health insurance on this side, they would get the difference between what they were in receipt of and what would be now 22/6 a week.

Mr. D. Morrissey

Do I take the Minister as now saying in relation to sickness benefit that that applies also to disablement benefit?

Dr. Ryan

Oh, yes, it would, because, I think, they would all start on sickness benefit here.

Mr. D. Morrissey

It would automatically come on to disablement benefit?

Dr. Ryan

Yes.

Mr. D. Morrissey

I take it the person who gets 100 per cent. disability allowance on the other side will not be entitled either to sickness or disablement benefit?

Dr. Ryan

No.

Mr. Norton

If he got anything less than 100 per cent. he would.

Dr. Ryan

He would have to qualify here in the ordinary way by going back to work before qualifying for national health insurance here.

Mr. Norton

The position would be different if he had less than 100 per cent. disability allowance.

Dr. Ryan

Then he would get the difference between that and what he would be entitled to here on sickness benefit. Part V contains two or three provisions. The first is Section 17 which makes a change in the method of payment by the Exchequer into the National Health Insurance Fund. As Deputies are aware, the ordinary payment up to this was two-ninths. There was considerable difficulty in the administration of this supplementary payment of 50 per cent. extra on national health insurance payments. We had to bring this clause in in order to make it legal for the society to pay out the supplementary allowance along with the 15/- that they had been paying up to this. The fund will not be injured in any way by this clause. The fund will receive the two-ninths that it would have received if this supplementary allowance had not been given and it will receive in addition to that the 50 per cent. allowance, but it was necessary to legalise the payment in this way.

General Mulcahy

On what will the 50 per cent. allowance be based?

Mr. D. Morrissey

Existing statutory benefit.

Dr. Ryan

The person getting sickness allowance gets 15/- and gets 7/6 extra; a female getting 12/- at present, gets 6/- extra and, of course, in the case of disablement, the man getting 7/6 gets 7/6 extra and the woman getting 7/6 gets 6/- extra. This supplementary allowance will be paid by the National Health Insurance Society but will be all drawn from the Exchequer.

Mr. Norton

When the Minister uses the phrase in Section 17, "such sum as in the opinion of the Minister and of the Minister for Finance will be payable," etc., that really means the figures the Minister has just quoted and not capricious figures?

Dr. Ryan

It would take a very elaborate Bill to set out all the little details and this is the simplest way of doing it.

Mr. Norton

But you intend to pay on the old mathematical basis?

Dr. Ryan

I want to assure the Dáil that the fund will not suffer. The fund will receive the two-ninths that it would receive on the ordinary payment and it will also receive all the supplementary payments, whatever they may be, from the Exchequer.

The next clause deals with the investment of funds. Deputies will remember that last year a Bill was brought here by the Minister for Finance to enable him to invest funds that were in, I think, the Post Office Savings Bank, in certain ways. I mean, otherwise than in trustee funds. They could be invested in certain ways for Exchequer purposes, and so on, and this is to bring the National Health Insurance Fund into line with that provision. I have already dealt with Section 19, which was the principal cause of this Bill being brought in and that is to raise the limit over which people must be insured, that is over which non-manual workers must be insured, from £250 to £400 per annum.

Mr. D. Morrissey

So far as this Bill goes, I would like to welcome it. It is certainly not before its time, and whilst I do not agree that Section 19, or rather the scheme which Section 19 is set up to implement, goes as far as I think it should go not only to give present-day real values to paid workers but to give those who are claiming sickness benefit some chance of recovering their health—while it does not live up to what I think it should in that respect—I welcome it as far as it goes and particlarly as we have been assured by the Minister that this is merely a step towards a further and a fuller scheme. I do not want to open up a wide general discussion on national health on this Bill. I realise that it is rather limited in its application, but I want to take advantage of it to suggest to the Minister, this being one of our largest social services and one of our most important social services, that the sooner he gets down to work on the scheme as a whole the better. The whole machinery under which national health insurance is operated in this country, apart altogether from the amounts of benefits, is completely wrong. I could go into several aspects: I do not want to do it. The whole system of medical certification in relation to national health insurance is notoriously wrong and has been for years, probably since the inception of this scheme, and no attempt has been made to deal with it and apparently no attempt is going to be made to deal with it. The question of malingering has never been faced up to and I doubt if it ever will. I mention those two matters particularly because, of course, they have a greater bearing on the financial position of the National Health Insurance Society and its ability to pay more than the statutory benefit than any other factors which, so far as I know, enter into its operation. However, I do not want to develop the matter, but I am mentioning it now, Sir, to the Minister in the hope that he will tackle this matter in the way in which it should be tackled, in a realistic manner, and that he will give the House an opportunity fairly early of going into the matter.

Now with regard to the Bill before us at the moment, I welcome this increase from £250 to £400. It is really, of course, no increase, having regard to the real value of the figures; if anything, I suppose one would be inclined to say that the £400, the new figure fixed, is really lower than the actual £250 which we had there all the time. So far as I understand the Minister's immediate proposals, I would like if he would tell us when concluding when it is proposed that these new rates will come into operation. The intention is to increase existing sickness benefit by 50 per cent. and to increase disablement benefit by 100 per cent. There may be some variations between men and women, boys and girls, and so on, but that roughly is the scheme. This of course is only touching the fringe of this national health insurance problem and much less the question of national health itself. So far as the section dealing with the extension from 12 to 18 months for keeping people in insurance is concerned, I think that that action will be welcomed. We have had innumerable cases, particularly over the past ten or 15 years, of workers who had been contributing to this fund from the beginning of the scheme and who, through no fault of their own, were completely at the loss of their entire contributions over a long period of years. The Minister may say to me that legally they were entitled to keep their contributions alive. That is so, but those men in the circumstances in which they were very often did not advert to that and I think I can say, as one who knows a little about it anyway, that in the majority of cases—I am not criticising the society on this point because so far as I know both since and before unification they did their best to enlighten the members in this regard —but I think I would be safe in saying that a very considerable number of members were ignored on that principal safeguard which was there for them. I do not want to take up the time of the House any longer. As I say, there is a lot I could say and a lot I would like to say on this whole matter but I am afraid the Bill does not give us that opportunity now. However I hope that the Minister, as I have already said, will give us an opportunity of going into this matter fully and not only tighten up the machinery but, I hope, make a complete and radical change in the whole national health insurance machine.

Mr. Norton

So far as it goes this is a very useful Bill. It in no way restricts any of the existing provisions in the national health insurance legislation and in some respects it extends the scope of our existing legislation in very useful directions. To that extent, I welcome the Bill but, like Deputy Morrissey, I realise at once that even when we have passed this Bill our whole code of national health insurance legislation is still in a very unsatisfactory state. I have said before, and I do not think it can be repeated too often, that what we call national health insurance legislation is neither national in its concept nor helpful in its scope and, in fact, provides no adequate insurance at all, having regard to the proposals which confront the breadwinner. He has got to rely on what one can only describe as the miserable allowances which are paid under existing national health insurance legislation.

I do not want, on a Bill of this kind, to travel over the whole domain of our existing national health insurance legislation. I think, as soon as the Minister gets down to the question of having that legislation examined, for example, in the sympathetic and comprehensive way undertaken by his Lordship, the Most Rev. Dr. Dignan, the sooner we are likely to evolve legislation of a kind calculated to make a tangible contribution to the provision of real insurance against disability and ill health in this country. I think it is rather a good omen that our national health insurance legislation of the future is to be under the control of the present Minister for Health and Social Services. So long as it was the responsibility of the Minister for Local Government and Public Health one felt that he would always be obliged to justify that unseemly dispute in which he was involved with his Lordship, Most Rev. Dr. Dignan.

An Ceann Comhairle

I do not think that has anything to do with this little Bill.

Mr. Norton

I know that.

An Ceann Comhairle

I am glad the Deputy realises it.

Mr. Norton

But I do say that it is a very good omen to have this whole question of national health insurance legislation taken out of such ill-starred hands. I am hopeful that the new Minister will apply himself diligently to an examination of the whole problem of national health insurance with a view to evolving a much better scheme than we have at the present time. The Minister must know that to offer persons the small sums payable at the present time under the National Health Insurance Acts and expect them to be able to provide for themselves and their wives and children on what is ofttimes less than 25 per cent. of the wages they were earning when in employment is not making any substantial contribution to alleviating the economic plight of a family when the bread-winner is unfortunately stricken with illness. Furthermore, to imagine that we help to provide in that way a remedy for the ills of a family so circumstanced by making available weekly benefits on a very inadequate scale, whilst in fact making no effort whatever to treat the sick contributor, is a complete and utter mockery of all proper steps in national health insurance legislation. What happens at present when the insured contributor reports sick? He draws national health insurance benefit and he gets well the best way he can.

An Ceann Comhairle

The Deputy is going now into the general sphere of the national health problem.

Mr. Norton

I was not going very far into that sphere but I submit that on the Second Stage I am entitled to point out to the Minister the shortcomings of his Bill.

An Ceann Comhairle

Of this Bill.

Mr. Norton

This Bill.

An Ceann Comhairle

And this Bill deals with very specific points.

Mr. Norton

Sir, I do not propose to travel very far over that field beyond bringing to the notice of the Minister at the first opportunity that presents itself the deficiencies in our existing legislation, and expressing at the same time the hope that the Minister will apply himself to the task of remedying the complications in that existing legislation.

General Mulcahy

On a point of order, Sir, may I be allowed to intervene? I do suggest that when we have an amendment of the national health insurance code it provides us here with an opportunity seldom afforded to the House for a general review of the whole system of national health insurance. Since that will subsequently be dealt with in a comprehensive way I think it would be desirable that we should not now be choked down by a ruling which would create a precedent.

Dr. Ryan

May I mention that I think I shall have to bring the Estimate for the Department of Social Welfare before the Dáil next week? If I do not do that at the earliest opportunity there probably might be some difficulty about the supplementary payments.

Mr. D. Morrissey

But we could not say anything about legislation on the Estimate.

General Mulcahy

We would be completely stymied because we could not say one word on anything concerning legislation.

An Ceann Comhairle

That is so.

Mr. Norton

Can we write to the Minister about this if we are not to have an opportunity of discussing it now?

An Ceann Comhairle

The Deputy has already said quite a lot.

Mr. Cafferky

There is no danger of being put in gaol.

An Ceann Comhairle

I do not understand the Deputy's reference. Judging by the Bill, I do not think much scope is required in the matter.

Mr. Norton

We have not been any more than a quarter of an hour on the Bill already.

An Ceann Comhairle

The Chair has no objection to the Deputy travelling a certain way, because the Deputy will not be able to discuss legislation on the Estimate.

Mr. Norton

We very rarely have a National Health Insurance Bill introduced in this House. There is one section of the Bill which I particularly welcome and that is Section 19. The purpose of that section is to extend the salary ceiling for the non-manual class from £250 to £400 per annum. At the present time those who are employed by way of manual labour are insured for national health insurance purposes no matter what their earnings are. In the case of the non-manual worker, he ceases to be insurable under the Acts when his remuneration exceeds £250 per annum. I have asked questions in this House on a number of occasions as to raising the ceiling from £250 per annum. I suggested to the Minister on one occasion—or rather to his predecessor— that the ceiling should be raised to £500 per annum. I still think £400 is too low a ceiling. If you can allow a manual worker to be insurable when he earns at a rate of £500 per annum there seems no reason why a non-manual worker should not be insurable compulsorily when his remuneration does not exceed £500 per annum. I think the Minister should realise that under present circumstances non-manual workers, whose remuneration exceeds £400 per annum, should not be deprived of the benefits of the National Health Insurance Acts and more particularly of the cover for widows' and orphans' pension purposes. You cannot qualify for widows' and orphans' pension benefit unless you have already got cover under the National Health Insurance Acts. I strongly urge upon the Minister, therefore, that he should amend Section 19 by substituting £500 per annum for £400 per annum. On the Committee Stage of this Bill I propose to move an amendment to that effect, but I would like to have from the Minister now an assurance that an amendment in those terms will be welcomed by him.

We should, as far as possible, provide cover for the non-manual worker in respect of widows' and orphans' pension benefits. We cannot do that adequately if we fix a low ceiling of £400 as income for the purpose of insurability. It must be remembered, too, that when we talk of £400 per annum it is not £400 per annum salary but £400 per annum from all sources. It has been held in numerous court cases that any kind of payment whatsoever apart from salary, either in cash or in kind, can be assessed for the purpose of ascertaining the income of a person in respect of his insurability under the National Health Insurance Acts. I hope that the Minister will see his way to extend the scope of the Bill by raising the ceiling to £500 per annum.

I would like at this stage to get from the Minister some clarification of the provision of voluntary contributors under the existing National Health and Widows' and Orphans' Insurance Acts. Take the case, for instance, of a person who is being paid at the rate of £240 per annum and who jumps from £240 to £260 per annum. That person ceases to be liable for compulsory insurance and that person can become a voluntary contributor when the free insurance year has expired. If he becomes a voluntary contributor he is liable to pay his own portion of national health insurance contributions in order to keep himself a live member for national health insurance purposes and for widows' and orphans' pension purposes.

A considerable number of persons, who were originally compulsorily insurable under the National Health Insurance and the Widows' and Orphans' Pensions Acts, elected to become voluntary contributors when the rate of remuneration exceeded £250 per annum and they are at present paying the total contribution. What is their position to be in respect of this Bill: Can they continue as voluntary contributors? Will they be compelled to continue as voluntary contributors, or will the voluntary character of their membership of the National Health Insurance Society cease and will they become compulsory contributors for the purpose of this Bill? It is a matter which affects quite a number of voluntary contributors, and I would like the Minister to clarify that position.

There is one other matter, and that is the position of the staff of the National Health Insurance Society. Some time ago, and again as late as yesterday, claims by the staff for an increase in remuneration have been before the Labour Court. The plea put up by the society is that the staff in question can only be paid out of what is known as the administration fund and the society contends that the administration fund is not sufficient to enable it to grant to the staff the reasonable increase in wages which the staff are seeking. It is quite clear, therefore, that unless the staff of the National Health Insurance Society are to be compelled to accept wage increases which bear no reasonable comparison to the ratio of increases granted to outside workers, something will have to be done with the administration fund; in other words, the State will have to come to the assistance of the society by stepping up its proportion of the grant which it makes for the administration of the National Health Insurance Acts.

The Minister cannot contemplate with any complacency a situation in which the staff of the society are compelled to work for rates of wages which are abnormally low compared with the ratio of increases granted to other workers in recent months. I should like to hear from the Minister that he proposes to put the society in a position in which it will have at its disposal an administration fund capable of granting to the staff the reasonable wage increases which they are seeking.

Mr. Cafferky

I should like to know why it is that a Bill of this kind could not be distributed to members of the Dáil before this morning, or at least when they came into the House this afternoon. It is impossible to expect any Deputy to make a proper contribution to the debate if he does not get a copy of the Bill up to an hour before the House assembles.

An Ceann Comhairle

This Bill was in the hands of Deputies last week.

Mr. Cafferky

We got it this morning That is the position in which we are.

Mr. Commons

Two of us were under lock and key last week.

Mr. Cafferky

It is not that our address was not well known to the Government Departments. I am rather surprised that the new Minister for Health and for Social Welfare is following in the steps of his predecessor, the Minister for Local Government and Public Health—that is, in bits and scraps. One would have expected that he would scrap the whole insurance scheme and start off on a fresh foundation by introducing something worthwhile, something that we could understand. We did think when the new Department was separated from the old Department of Local Government and Public Health that something worthwhile would be started, that something of a practical nature would be done as far as public health is concerned.

I have not been the recipient of health insurance benefit in this country, but I was on one occasion in Great Britain after I came out of hospital, where I spent a considerable time. The system there then was reasonably good in comparison with the system that operated here. For instance, an unemployed man who went to the labour exchange to register for employment was unable to have his card stamped because of the fact that he was unemployed. But he brought his health insurance card and had it franked; he was not losing any ground through being unemployed; he was keeping his health insurance card up to scratch. If he became sick and was unable to accept work if it was available, he was disqualified automatically as an unemployed recipient and, therefore, he would have to fall back on health assistance. Having to do that, and being unemployed, he would find his health insurance card was not stamped to date. In Great Britain they had a system of presenting the health insurance card and having it franked, and it was always stamped to date. I understand that does not apply here and it is not included even in this Bill. I see no provision whereby a man who becomes unemployed will be able to keep his health card stamped to date unless he does it out of his own pocket, and not many of them can do that.

I do not regard as adequate the amount of benefit which a person will receive, even under the increases the Minister is prepared to give. The Minister must recognise that a man who is unemployed may have the responsibility of maintaining a wife and family and a man in that position was unable to do so under the meagre allowance granted up to this. That is one thing we expected from the Minister, that he would take care that the allowances granted would be sufficient to provide for the maintenance of a man and his dependent wife and family. I think the Minister will have to admit that he could not expect that any man will derive much benefit even under this Bill. I think he will admit that the amount allowed will not be sufficient to maintain even the man himself, not to mind his dependents.

This Bill makes no allowance for free medical treatment. If I am correct in that assumption, a sick person will have to pay for medical advice and medical attendance. How could the poor people be expected to do it? The Minister's Department must be well aware that in Great Britain for at least 15 years they have had a free medical service for men and women. That system was not everything it should be, but at least it was a help. The amount allowed for a doctor and for medicine was insufficient. The medicine was not everything it should be, because the doctor was not allowed enough remuneration to permit him to give the best type of medicine for whatever disease or ailment the patient might be suffering from. Here we have no allowances at all. This is a country which is divided between two Governments, and if the health services in one part of the State, that part which is cut off from our Government, are so much in advance of those here, I do not think it is any encouragement to the people who are living in that other part of the country to come in under our Government.

An Ceann Comhairle

The question of the settlement of the Border is a long way from this Bill.

Mr. Cafferky

It is a very long way, but one hears so many statements that are obviously insincere on this question that they force one to refer to it even though it is irrelevant. The fact remains that we were all looking forward to what was going to come out of the new Minister's hat. If this is the beginning—and you always expect the beginning to be good, however you end up—I am afraid that there will be many disappointed people. Deputy Norton's remarks, of course, have been curtailed within the limits of the Bill, but the Labour Party in particular, who represent industrial workers and the largest percentage of insured persons, should, I think, request the Minister to withdraw the Bill and introduce a new Bill, starting from scratch. Let him go about it decently and introduce something more in keeping with the reforms advocated by Dr. Dignan in relation to social services and public health.

Deputy Morrissey spoke about malingering but I think that is a matter that is hardly worth consideration, when one thinks of the many other aspects which should be considered. I think the number of men and women who, for the purpose of getting a few miserable shillings from the National Health Insurance Society, pretend that they are ill when they are not ill are very small and represent a very small percentage of the total number of insured persons. I think we should be more concerned about the small allowances which insured persons will receive and also about the fact that these allowances will be insufficient to enable married men to maintain themselves and their families. There is also the fact that no provision has been made to assist men to keep their cards stamped for national health insurance purposes during the periods of unemployment. We expected a good deal more from the man who is taking over the responsibility for this Department and who has himself some medical knowledge. I think I can safely say that we are disappointed as a whole with this Bill.

General Mulcahy

I regret that I missed a small portion of the Minister's statement on the Bill but I think I am right in saying that it is proposed to increase the amount of sickness benefit by 50 per cent. and to withdraw food vouchers.

Dr. Ryan

Yes, but of course people drawing sickness benefit do not get food vouchers.

General Mulcahy

It has been suggested that the Minister should have introduced a comprehensive Bill at the present time. I must say that I would be rather afraid in that event to see the type of Bill that the Minister might introduce, when we consider the type of Health Bill which we had before us a short time ago, a Bill which must necessarily impinge on the whole situation in regard to national health insurance. When we consider that we are waiting now for a new Health Bill, I feel that the Government should give a greater amount of consideration to the views put forward in regard to the Health Bill before they embark on any comprehensive measure in relation to national health insurance. The Minister is doing just one simple thing by this Bill—he is increasing the amount of benefits that are being paid under the National Health Insurance Acts and under the widows' and orphans' pension scheme. He is doing that without increasing contributions and is providing for these increases by a State grant. I think that these are the lines upon which we should like the Minister to act at the present time because in the first place it is urgent that these payments should be increased. We could afford to wait to see a more comprehensive scheme, if we were sure that the real distress that exists at present is being relieved but the real distress is not being relieved by the Minister's proposal. At the present time a man who is ill and who may have a family gets 15/- a week. Under this Bill he will get 22/6 a week. In these circumstances, a man who has a wife and family will be dependent on home assistance to supply the balance necessary for the maintenance of himself and his wife and family. I feel that considerably more consideration should have been given to the circumstances of married people. I suggest to the Minister that the increase to be given in the case of a person who is married, as this is an emergency measure, should be greater than the increase given to an unmarried person. I would also suggest that the benefits in the case of a married insured person should at least be doubled. The Minister is providing an increase of 50 per cent. for an unmarried person and seeing that a married person has considerably more responsibility I think that the benefit in his case should be doubled.

This Bill maintains the national health insurance scheme as a contributory scheme and for that reason I do not think that any scheme such as that suggested by Dr. Dignan is prejudiced in any way by the passage of this Bill. I do say of course that the whole national health insurance scheme is still left in the ugly atmosphere of the poor law system in which it has been for a long time. It is a very tragic thing that our national health insurance scheme should continue to lie for so long in the shadow of the poor law. This Bill will still leave it in the shadow of the poor law but we are not prejudicing our attitude with regard to the future by accepting the provisions of this measure.

Deputy Norton suggests that the limit of £400, as the insurable ceiling should be raised to £500. I saw—I think it was in the Irish Press—a statement that this measure will bring 61,000 more people under the national health insurance scheme. I do not know whether that refers to people who slipped out of it because of the £250 ceiling, but I read it to mean that it would bring in under the scheme 61,000 people who had not been bound by the scheme before. If that is so, while for some reasons one might welcome a raising of the ceiling from £400 to £500, I do not think it ought to be raised £500. My first reaction is that it ought, but my second is that is ought not, because I do not think that, until we know the general line of approach of the Minister to a comprehensive national health insurance scheme, we ought to drag more people into insurability at present. This Bill will give a considerable amount of extra work to the national health insurance staff, and I think it would be complicating the work for the National Health Insurance Society and bringing into a scheme, which we might perhaps afterwards consider to be unsatisfactory, a number of new people. I think the Bill goes far enough in raising the ceiling to £400.

Deputy Norton raised the matter of the staff and the Minister, particularly when we consider his two Departments, should take a fairly wide view of the greater part of our social problems connected with health and all that arises from lack of health, whether on the economic or the social side. He must know that nothing has been more conducive to a serious health problem here than the lack of wages. Deputy Norton referred to the position of the staff in their appearance before the Labour Court, and I ask the Minister to take special notice of the fact that the Labour Court, in recommending the staff to accept the proposals the society have put before them for an increase in pay, had to make a declaration to this effect:—

"If the new scales for the lower grades of the society's staff are compared with the salaries at present paid to the two lowest general grades in the Civil Service, it will be seen that the society's proposed rates are substantially lower than the Civil Service standard."

The lower grades in the Civil Service are the more numerous and the lower grades in the National Health Insurance Society are the more numerous, too, but when one hears of any class of wages being substantially lower than the lowest Civil Service standard, one would think that any Minister ought to sit up and see what exactly is involved. The court went on to declare that the society is not in a position to deal with the matter directly, that is, by reducing benefits. They have not sufficient funds in hands to pay their staff, the ordinary clerical staff, even an amount as high as the lowest grades in the Civil Service. The court stated further:—

"The court believes that a reduction of additional benefits would be generally regarded as undesirable."

I think we would all regard it as undesirable.

"The alternative of an increase in contributions was a matter beyond the competence of the court and the society, but it appeared to the court to be one which should not be omitted from consideration by the responsible authorities."

I do not think any increase in contributions should be considered at the moment—again until a general scheme is involved—but I do consider that, if the condition of people who are contributors to the national health insurance scheme have to be taken into consideration and additional moneys granted because of the lowering of the purchasing power of money to-day, the same should apply to staffs whose payment is substantially lower than the lowest grades of the Civil Service.

The maximum wage of one of the lowest grades, the most numerous, in the national health insurance staff was £2 12s. od. per week before the war. A bonus of 15/- was given during the war, and now the Labour Court advise them to accept an additional 2/-. I do not know where the National Health Insurance Society management got the idea of an increase of 2/- per week, unless they got it from people who are offering increases to turf workers, but an increase of 15/-, plus 2/- over the 1939 standard on a wage of 52/- is an increase of about 33 per cent. on a total remuneration pre-war which was lower than the lowest Civil Service wage. A wage of 52/- per week is £135 per year. In the case of the Civil Service, where civil servants on the 1939 scale had a total remuneration of £135 per year, they got, in the recent increases, an increase of 53 per cent. Those in the Civil Service who got an increase of 33 per cent. were persons whose total remuneration in 1939 was approximately £684 per year. The society are offering their staff to-day a percentage increase on a very low rate, which is the percentage increase given to civil servants who were in receipt of £684 per year.

I submit to the Minister that when one takes into account the very low total remuneration the staff were receiving in 1939, they would be receiving less than justice if they got the percentage increase which the better paid civil servants got when, on their particular scale, they got an increase of 53 per cent. The Minister is only building up a national health insurance scheme on a staff which can scarcely keep them in health if their wages are substantially lower, over a large number of them, than those of the lowest grades in the Civil Service. A considerable amount of work will be thrown on the society as a result of this Bill and I do not think that, in present circumstances, the Minister can ask the staff to take on a considerable amount of new work without treating them, in relation to increases in wages, at least as well as the Civil Service has been treated. The original basis on which national health insurance benefit payments were made, I think, was related to the agricultural labourers' wages at that particular time and it was suggested that if the insurance scheme planned for any more it would mean that certain people would get as much under national health insurance as they would get if they were working in agriculture. As strong as has been the pressure of the Department of Local Government in keeping down road workers' wages in order to keep down agricultural labourers' wages, they have risen substantially above the benefits that are being paid under the national health insurance scheme now, and I consider that, particularly in the case of married people, the Minister should make a definite increase in his proposals.

Mr. M. O'Sullivan

In so far as I understand the Bill, having read the excellent explanatory memorandum— the first of its kind coming from the particular Department—the purpose is to raise the limit of remuneration for insurance purposes and to make the necessary provision for interim supplementary payments. On all sides of the House, disappointment will be expressed that this form of approach has been found necessary at this stage to a very important social question, that is, that the Minister has found it necessary to introduce it here in a piecemeal fashion. His answer to that will naturally be that so far as his Department are concerned they did not have the necessary time to examine the position as a whole. I can recall a debate in this House 12 months ago on this very subject and the various systems and schemes of social insurance that were referred to and, in particular, the scheme outlined by Most Reverend Dr. Dignan. There was an indication at that time by representatives of the Government that the problem as a whole was being seriously examined. I do not think the two positions are reconcilable. If the Minister and his Department now claim that they need time to examine this important matter, the question arises, what has been done during the last 12 months? It is only fair to the Minister personally to say that probably he would be justified in claiming the indulgence of the House on the plea that he has not had the necessary time. This piecemeal approach is entirely unsatisfactory and the House would be glad to get a picture of the scheme as a whole at the earliest opportunity.

I want to join in the appeal that has been made by Deputy Norton, particularly in relation to the section of employees that are now limited by a ceiling of £400, that is, those who are termed non-manual workers. On the introduction of the Bill in 1911, the figure fixed was £160. That was altered in 1918 to £250 and there has been no change up to the present. The Minister will appreciate that there is an upward trend so far as clerical workers are concerned and that the figure of £400 does not represent the position accurately. It would appear as if the intention of the Minister may be defeated if he retains an arbitrary figure of £400. A range of workers, clerical workers particularly, will be found outside the £400 limit, and in order to have a comprehensive scheme that will be attractive, I strongly urge that the figure should be altered to £500.

The only other criticism of the Bill I have to offer is in relation to Section 17. I suggest that Section 17 contains a complete departure from Parliamentary practice. The framework of the scheme has been very clearly defined in relation to its upkeep by contributions from insured persons and by a State grant. That has been on the basis of seven-ninths to two-ninths. In Section 17 the Minister introduces a completely new departure so far as the House is concerned. The words "in the opinion of the Minister" govern that particular section. That is entirely unsatisfactory. Granting that the Minister finds it necessary at the present time to get some form of adjustment to enable him to make his interim supplementary payment, I suggest that the House would not be wise in giving the Minister permission to alter the provision in the way he seeks. The society at any and every stage should be in a position to say on what basis its finances will be constructed in the future. They will not be able to do it under Section 17 as at present drafted.

Dr. Ryan

I agree with the Deputies who submitted that it would be very much better if we had a comprehensive scheme dealing with all these social services. I think Deputy Mulcahy was the only one who had some doubt about that. But, I explained here last week that I do not think it is possible to have a comprehensive scheme dealing with all these social services within 12 months. I thought it would be unfair not to bring in this temporary relief to certain people and to wait until the 12 months are up. What I had in mind in regard to a comprehensive scheme is that we should try to insure people against sickness, unemployment, old age, perhaps insure widows in the same scheme and perhaps also in the same scheme to insure them against the burden of a large family. I mean by a comprehensive scheme that we should have if possible one stamp to deal with all these things, one inspector or agent dealing with the insured person, one card at head office giving all the information that is necessary about the insured person and, in that way, to have a unified scheme administered by the same people. That will take a long time to prepare. In regard to the point put forward by Deputy O'Sullivan, it is true that certain officers of the Department have been examining this, off and on, for a long time past but it will take a long time to get a scheme like that into proper order, to get, first of all, a White Paper for examination by Deputies, followed by the necessary legislation.

General Mulcahy

Does the Minister definitely exclude a health service?

Dr. Ryan

I was going to mention that. That would be the comprehensive scheme as far as social services are concerned. I think health would have to be separate because in the social services scheme we are dealing with people who are on a certain income and it is a contributory scheme we have in mind when we talk of insurance but health must be applied to everybody who cannot afford to pay for the services themselves, that is, it must be applied to people who are not insurable because they are not earning money as well as to people who are insurable, who are earning money. Therefore, I think the health service must be taken as a separate thing and that any health service must apply all round.

I am just giving those views. I should not like to be tied too rigidly to them because, as we examine this matter, we may have to change our minds somewhat. I am just trying to give the Dáil some idea of the magnitude of the job. Even in other countries where they did this thing they took some time to prepare the scheme and they took a very long time to put the scheme into operation. We hope we may be at least as quick as other countries in having our scheme in operation from the time we start out to prepare it.

There were a few minor points raised. At least they were not stressed. Deputy Morrissey talked of the malingering that is going on. Of course, there is no doubt that if we had a scheme that could be worked honestly by everybody, the contributions could be lower or the benefits could be higher than when you have a scheme where there is a certain amount of malingering. These are matters that we must deal with as far as we possibly can in preparing the scheme. Deputy Norton asked whether a person who had been a voluntary contributor, his income for some time past having been over £250, would become a com- pulsory contributor now. Any non-manual worker whose remuneration at the moment is between £250 and £400 will become a compulsory contributor if this Bill is passed as it stands.

Mr. Norton

Suppose he elected to remain a voluntary contributor.

Dr. Ryan

He cannot elect to remain voluntary. If he remains under the scheme he must become compulsory.

Mr. Norton

There are people who are in what are known as "excepted employments".

Dr. Ryan

Yes?

Mr. Norton

Take the case of a person who is in an "excepted employment". If that person is a voluntary contributor at present because he has over £250 a year and if you raise the ceiling to £400 a year does that person become a compulsory contributor?

Dr. Ryan

Of course, an excepted person would not become a compulsory contributor under any circumstances. There are certain employments where people are excepted: he will not be compulsorily insured under any circumstances.

Mr. Norton

There is just one point not covered by the Minister. Because he was in excepted employment he became a voluntary contributor under the National Health Act. He may now after 12 to 18 months—after perhaps three or four years—be a voluntary contributor for national health insurance purposes. When you pass this Bill can he remain a voluntary contributor for national health insurance purposes even though employed in an excepted occupation?

Dr. Ryan

It does not alter his position.

Mr. Norton

Is it clear he remains a voluntary contributor even though he remains in excepted employment?

Dr. Ryan

I would like to get notice of the circumstances there, because I am not sure about certain excepted employment—whether a person could be a voluntary contributor or not. But if he was a voluntary contributor in the past he could remain so.

Mr. Norton

Take the case of a State servant.

Dr. Ryan

No, they would not be insurable but they come under the widows and orphans scheme.

Mr. Norton

But some of them have acquired the status of voluntary contributors. Will they keep that when you pass this Bill? What section of the Bill would prevent them?

Dr. Ryan

So far as I know State servants are not insurable under the National Health Act in any circumstance.

Mr. Norton

The Minister in not right in that. A person who was in excepted employment in the past for the purpose of the National Health Insurance Act was, therefore, insured under the Widows' and Orphans' Pensions Act. But when he earned more than £250 a year, to keep his widows' and orphans' pensions' contributions alive he would have to become a voluntary contributor under the National Health Insurance.

Dr. Ryan

That is right.

Mr. Norton

And he now has the status of voluntary contributor that he may have had over the past three or four years. What I want to know is can he continue as a voluntary contributor and, if not, what section of the Bill will prevent his doing so?

Dr. Ryan

As far as I know he will become a compulsory contributor under the widows' and orphans' pensions scheme and he may remain a voluntary contributor under the national health. That is my view. I would like to go further into it.

Mr. Norton

May I take it, in any case, that that is the Minister's view in the matter at this stage?

Dr. Ryan

Yes. As I said, under this Bill, which brings him up to £400, he contributes under the Widows' and Orphans' Pensions Act, but he can remain a voluntary contributor under the national health. That is the position.

Mr. Norton

He can?

Dr. Ryan

Yes. There are a few other points. Section 17 was raised by Deputy O'Sullivan. I explained it already but perhaps Deputy O'Sullivan did not follow me. First of all, if we had given the supplementary benefit, it would have to be raised by contributions, and in the proportion as laid down in the original Act—so much from the employer, so much from the employee and so much from the State. We do not want to do that at the moment. We prefer to wait for a comprehensive Act before changing contributions and so on. I was very much in favour of letting the Exchequer pay the total amount of the supplementary grant pending the comprehensive scheme. We could, of course, give the necessary assurances legally by bringing in a very long Act, but we mean to work this clause in the following way: the State will continue to contribute the two-ninths that they would have contributed to the ordinary benefits that were there already, and, in addition, the State will contribute all the supplementary amount, whatever it may be, so that the fund will not be a penny worse off at the end of this coming financial year as a result of the supplementary allowances being paid.

Mr. O'Sullivan

The State will bear the full supplementary amount?

Dr. Ryan

Yes.

Mr. Norton

You will follow the same mathematical procedure as in the past?

Dr. Ryan

Yes, that is the position. Some Deputies have referred to the question of staff. I have not gone into the question of staff. I suppose I will have to go into it naturally before long. Deputy Cafferky made a remark that the allowance was not sufficient to maintain a man and his wife and his family. I know it does not and I do not think we will ever be able to provide an allowance for sickness and unemployment that will be sufficient to keep a man and his wife and family. These social services were designed, in the first place, to help a man in time of difficulty, when he is sick or unemployed, but I do not think that in any country they have ever attempted to give a person as much as he would earn if he was in good health. We may, as I said here before, try to improve those benefits, but I have no hope that we will ever improve them to the extent that Dáil Deputies will generally agree that they are sufficient to keep a man and his wife and family.

With regard to the number that is brought in, it is estimated—we must admit that we are not too sure of the number—that it will bring in about 30,000 people, not 60,000 as Deputy Mulcahy mentioned.

General Mulcahy

30,000 new people?

Dr. Ryan

Yes. Some will be brought back. They were there already.

General Mulcahy

When the Minister says "brought back" does he mean brought back after having been forced out as a result of increased wages under the emergency conditions?

Dr. Ryan

As a result of increased wages. One other point was mentioned by Deputy Cafferky. He talked about the superiority of the English scheme as compared with ours. That superiority is more apparent than real. I have often noticed that we are very much inclined here to take the good points of a scheme we hear of in another country and take the bad points of a scheme we know of in our own country and compare the good points of the scheme we hear about with the bad points of the scheme we know about. I suppose if we were fundamentally patriotic we should take it the other way round. It is true that if a person is drawing unemployment insurance in England he gets his national health cards franked. He gets some credit for them but, in order to revive his national health insurance, he must pay practically all the arrears when he goes back to work again. Now, the same principle applies here but in the reverse direction. What we do here is, when a man is unemployed we do not frank his card but we accept from him a contribution in lieu of arrears and we revive his national health insurance when he goes back to work. We do not ask for the full amount of the arrears from such a person going back into work but the system works out much the same in this country as in England except that we do it in the opposite way.

The only other point that was raised was this matter of the ceiling of £400. Some of the Deputies would like to see that raised. On the Second Reading of the Bill I made a calculation as to what the average increase in a man's wage would be during the last six or seven years in relation to a salary of £5 a week in an office. Taking the average I found that it would not bring him exactly to £400 a year, but it would be something very close to that and so I took the round figure of £400. What I am really trying to do under this Bill is to re-establish the position that existed in 1939 as far as possible. It is quite understandable that some Deputies may say that in 1939 the position was not what it should be and that we should take this opportunity of making a change now. The Dáil, of course, can do what it likes but I would prefer myself not to make any unnecessary change in contributions or in the age governing insurability until we are ready to bring in a comprehensive scheme.

Mr. Norton

Has the Minister any real difficulty in making the £400 ceiling £500?

Dr. Ryan

There is, of course, no difficulty at all but I am merely giving the House my reason for taking £400.

General Mulcahy

Has the Minister any idea how many new people that would bring in?

Dr. Ryan

Again, the calculation is not reliable but it might perhaps be something in the region of 15,000.

Mr. Norton

Does the Minister appreciate the very considerable benefit it would be to the non-manual worker earning up to £500 a year if he was able to insure for widows' and orphans' pension purposes and thus make provision for widows and orphans for whom he is not able to make any adequate provision at the moment out of his existing salary? Is it right that we, when we have an opportunity such as this, should neglect to make provision for that class? I think Deputy Morrissey on the Fine Gael benches advocated an extension of the limit beyond £400. A similar advocacy has been advanced from these benches. Some of the Government Party have shown the same preference for raising it to £500. As ordinary Deputies are in a difficulty in moving a precise amendment of this kind because of its relation to a charge on public funds would the Minister accept responsibility at this stage and introduce an amendment on the Committee Stage raising the level from £400 to £500?

Dr. Ryan

I must admit it did not strike me that the Deputy would be prohibited from moving an amendment of this kind.

Mr. Norton

I did not think I would and I was a bit shocked when I was told I would.

Dr. Ryan

I would not resist the amendment if all Parties in the House thought it was advisable. I would like to put this to the Deputy: I think there is a distinct advantage, and possibly an inducement, to a person in receipt of £400 to £500 from the pensions point of view, but I am not so sure as to the sickness benefit. I do not think the person in receipt of £9 a week is going to be attracted by a sickness benefit of 22/6 a week.

Mr. Norton

I can see the point of view of the person who can see very clearly but cannot see very far and I am afraid there are a lot of people in that category in this particular salary earning group. I am equally sure that if their wives and children were consulted this would be carried by an overwhelming majority. It is a choice between the wisdom of the man and the wisdom of his unprovided for wife and children. I take the side of the wife and children. It is easy for the man to say the prospect does not attract him. Whilst he is earning he can manage to pay but once he is dead his widow and children have to depend on anyone on whom they can depend for help. I want the Minister to come in on the side of the widow and the potential orphans even though he may appear to be in some difficulty in doing that.

An Leas-Cheann Comhairle

This could be taken on the Committee Stage.

Mr. M. O'Sullivan

Is the Minister in a position to indicate when he hopes to have the comprehensive insurance scheme ready?

Dr. Ryan

Not before 12 months, I think. I am very anxious to get all stages of the Bill to-day because I want to take it to the Seanad to-morrow. We want to bring this into operation on the 1st April since it would be very convenient from an accountancy point of view if we could do that.

Mr. Norton

If you move the amendment for me I will be satisfied. Will you accept that now?

Dr. Ryan

If every Party is in favour of it I will move it.

Mr. M. O'Sullivan

There is no objection to it.

Agreed to take the remaining stages to-day.