Certainly; why not? The Deputy made such an extraordinary statement that it was necessary that it should be verified. That, at least, was due to the House, and it was also due to the Deputy that if he were labouring under any misapprehension, that misapprehension should be corrected. The position is that for every 40 patients who went into the hospital in a recent six months, 28 out of the 40 were charged nothing at all for their treatment and maintenance, and 11 were assessed within the hospital for payment for treatment, and paid the amount assessed without demur and before they left the hospital. That accounts for 39 out of 40. In only one case out of the 40 patients treated was it necessary to send the papers outside the hospital to the county council offices and the assistance officer for investigation.
The number of cases left which it was necessary to have dealt with in the way described by Deputy McQuillan on the last evening this motion was debated was 49 over six months. That was an average of eight per month. For local investigation of these cases, these assistance officers are available so that each in his own area had only one or two cases in the month to investigate. This work naturally was dovetailed into his ordinary duties and investigations where applicable, payment of home assistance, disability allowances and so on.
It is very clear, therefore, that the picture which the Deputy painted was greatly, shall I say, over-coloured. I think the Deputy's misunderstanding of the situation arose from the fact that he assumed that for every case that came before the county council, there were a considerable number of others that had to be dealt with in the way he described.
In relation to the speech in which it was moved, the terms of the motion on the Order Paper are, shall I say, at least peculiar. Let me remind the House what they are:
That in view of the fact that the cost of ill health among middle-income families is a serious financial burden and a dangerous impediment to their getting ready access to a first class health service, and since the dispensary medical service does not make available an efficient or equitable service with free choice of doctor to the lower-income group, Dáil Éireann is of opinion that the present blue card medical system, subject to a means test, should be abolished and replaced by a no means test national health service based on the principle underlying the present tuberculosis medical services.
The phraseology of the motion is not the most elegant, but it will suffice.
It will be noted that the motion makes two assertions: first, that the cost of medical attendance is a serious burden on middle-income families, and secondly, than an efficient and equitable medical service is not available to medical card holders, that is, people of the lower-income group. It proceeds on the basis of those premises to demand that persons who enjoy incomes in the top brackets, who may even be in the uppermost branches of the surtax payers, be given a similar medical service, a similar family doctor service, hospital and specialist service, and what else have you, free of charge.
When we consider this, am I not justified in saying that a motion such as this, emanating as it does from a Party composed of two such typical proletarians as Deputy Dr. Noel C. Browne and Deputy Jack McQuillan is very peculiar? It is quite clearly a compromise motion in terms agreed upon by the Right Wing and the Left Wing of the National Progressive Democrat Party. I suppose we should be glad that in these days of turmoil and strife, these two members find themselves able to join in demanding unnecessary, unwanted and unasked boons for plutocracy, all at the expense of the general body of taxpayers and ratepayers throughout the country. For that, as I hope to show if time permits, is what this motion amounts to. The Don Quixote of the National Progressive Democrat Party and his Sancho Panza demand that the State should provide medical care for the better off, the best off, the rich, the very rich and the very richest elements in the community.
The motion, as I have pointed out, advances two reasons for that: first, as I have said earlier, that when a person of the middle-income group requires the services of a family doctor, the cost of it deters him from calling one in. Of course, the reason is not stated in those very clear and simple terms in the motion. Instead, we have a general statement designed to convey a moving picture of oppressed middle classes weighted down by the exactions of a rapacious medical profession. It drips with tears and oozes sympathy. It is calculated to appeal to the bourgeoisie in the residential districts where perhaps the mover of the motion will be canvassing for votes at the next election. Presumably, it is designed to show them that they have a place in his heart, as well as the Congolese. That is the sole reason why the motion opens with that precious bit of claptrap about the conditions of the middle-income families.
If it is not—if I am wrong—if there be any other reason for it, why did not Deputy Dr. Browne set out to justify by evidence these assertions of his—assertions with which I am sorry to see a man of commonsense and with a rational approach like Deputy McQuillan, associate himself. Why did Deputy Dr. Browne not give details of the actual cases—not of just one or two isolated instances but of a sufficient number of cases to show that what he states in the opening phrase of his motion is, in general, true?
I read his speech carefully. I failed to find a scintilla of evidence to back his assertion that the middle-class in general are oppressed by the cost of medical treatment. That speech was if I may say so, a queer sort of speech. It reminded me of nothing so much as a minestrone soup into which the Italian housewife has thrown every scrap, every odd and end of kitchen left overs, to give substance to the thin and watery fluid that is its foundation.
The speech started off ponderously with the words:
I think it is some time since we had a serious debate on health services. We felt that sufficient time has elapsed for us to face the problems which are created by providing State health services and that we are also in a position to judge by the results of different services by Governments over the years. From that judgment we must try to find out what would be the wisest way to progress in future.
When I read so much of the speech, I said to myself: "The Irish de Gaulle has returned from his prolonged meditation in the country, or should it be in the Congo, and has brought with him a solution for the very difficult problem of the Irish medical services. There is now about to be revealed to us"—and I quote Deputy Dr. Browne again—"‘the wisest way to progress in future'."
What, in fact, we were regaled with was, to drop into medical phraseology, the mixture as before. We were told about pauper laws, about the failure of successive Governments, including the one of which Deputy Dr. Browne was such an ornament, about the Infectious Diseases Regulations and so on. Incidentally, we were told that the British have long since discarded the poor law. What, however, really has happened in Great Britain is that they have reached the stage reached in this country long ago when the workhouses and outdoor relief were abolished and home assistance was instituted. In Great Britain, they have for some years past national assistance, based on the same principles as our home assistance, which is that destitution must be relieved.
However, no speech from Deputy Dr. Browne would be complete or characteristic if it did not feature an attack upon the Irish doctors. The Deputy seems to cherish a strange love-hate emotionalism towards them. One day he resigns from the National Health Council because the Minister for Health is not to be intimidated by their association and, a few months later, he rises in this House to rend them tooth and claw. According to Deputy Dr. Browne, the attitude of the doctors under our national health service towards their patients is conditioned by the most mercenary motives. He implies their guiding rule of professional conduct is: No cash no care.
If any Deputy thinks that, in that phrase, I have misrepresented Deputy Dr. Browne's attitude towards his professional colleagues, let him turn to Column 490 of the Official Report of Wednesday, 15th February, 1961, and read Deputy Dr. Browne on the Irish dispensary doctor. There he will read that no matter how many times a doctor sees a dispensary patient, the emoluments he gets do not increase, whereas the more private patients he sees the more money he gets.
Deputy Dr. Browne goes on to argue that doctors tend to neglect the dispensary type of patient and concentrate upon the private and fee-earning patient. The dispensary patient, he tells us later on, must take his place at the end of the queue. Not only that, he alleges, but dispensary doctors deliberately try to operate a system of apartheid, again, and I quote the Deputy with "one type of service for the poor patient, the nonpaying patient, and a superior type of service for the paying patient."
Doctors, he tells us, in the same column, in order to force their impoverished patients to pay fees, will be brusque, short and ill-mannered towards them so that they may understand that if they go to the doctor's house and hand him a fee he will treat them better.
The dispensary doctors, the Deputy is good enough to assure us, are not all bad, brutal, greedy and grasping. Deputy Dr. Browne, with great magnanimity, concedes as much. There are exceptions to that general rule. However, it would appear, in Deputy Dr. Browne's judgment, that the exceptions are extremely few. He will not believe any good of the Irish dispensary doctors, in the main, unless dispensary patients or a substantial number of them come forward and express their satisfaction with the profession. In short, Deputy Dr. Browne, who is so devoted to freedom and justice in Stanleyville, Moscow and Budapest, would try Irish doctors according to the rules of the peoples' democracies and hold them all guilty until everybody proves them to be innocent. So much for the Deputy on the dispensary doctors.
What about the doctors who are not in the public service, who live by private practice? They, too, according to Deputy Dr. Browne, are exploiters of the sick. When depicting the sad plight of the dispensary patient, the Deputy told us how all the dispensary doctor's care and skill are lavished on his private patients and when he comes to treat of the private practitioner, there is conjured up for us an even gloomier picture of the lot of the private patient. "He— according to the Deputy; I am quoting from column 497—"is probably worse off, if it is possible to be worse off, than the dispensary patient."
I would advise Deputies who are interested in this question of the relationship of the medical profession to their Irish compatriots to read the column which I have quoted and am quoting to the effect that, if anything, the private patient is worse off, if that were possible, than the dispensary patient. There, in column 497, they will find that statement embellished and worked up to the grand climax that "this fee for service system leaves the patient at the mercy of his fears and in receipt of an inferior service, except for those who can afford to pay for it, a service inferior even to that which the dispensary patient gets."
Mark that statement from the Deputy who proposed that motion and who on last Wednesday just 15 minutes previously told the House that the dispensary patient must take his place at the end of the queue, that the dispensary doctors had one type of service for the poor patient, the non-paying patient, and a superior type of service for the paying patient. What way is that to treat Dáil Éireann? The Deputy's inconsistencies may be lapped up by the beatniks who lisp his Party catchcries and toe his Party line, but I would suggest that they are an insult to the intelligence of his fellow Deputies and, what is more, they are highly slanderous of an honourable profession. They have been uttered in this House under the cloak of the privilege of this House without a scintilla of evdence to support them.
The Deputy, however, having passed from this attack on the Irish doctors, having painted them in the terms which I have quoted, became highly avuncular. He is prepared always to distribute his largesse—at other peoples' expense, of course—broadcast. He has even something for the doctors. Having beslaved them with spittle, he has now a carrot and a gold brick to offer. They would be wonderfully happy he tells them, if only we had a service such as he proposes, a service on the same lines as the British. They would no longer have to compete for patients; they would no longer be called upon to give patients of their best. They could, in short, drop out of what Deputy Dr. Browne described as this rat-race of the medical profession in Ireland.
Then he gives us at column 948 a tender-hearted picture, all charity and light, of the general practitioners. He tells us that those whom he described as brusque, crude, ill-mannered and mercenary when he was describing their attitude towards the dispensary patient, and cheats and humbugs who, when they were dealing with private patients take fees and give inferior service, are at heart conscientious men, kind men, sensitive men, who worry for their patients and to save them expense will not prescribe costly drugs or call in consultants.
Evidently Deputy Dr. Browne wishes to be all things to all men, even to the doctors. Let me recall to him the words of a great humanitarian who was withal a skilful politician— I hope I quote him correctly. "You may," said Abraham Lincoln, "fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time" and not even Deputy Dr. Browne can fool at one and the same time the dispensary patient, the private patient and the private practitioner.
I have been at odds with the Association which purports to speak for the majority of the medical profession, but I have seldom found in any profession greater devotion and greater desire to serve humanity in general. There are, of course, black sheep among them but they are the rare exceptions—the very rare exceptions.
