As a Deputy who has spoken on this subject many times in this House, I should like to welcome the contribution I have just heard from Deputy Desmond. I hope I did not misunderstand him, but I think he repeated on a number of occasions his agreement with the idea of a national health scheme based on insurance. This, indeed, is a welcome expression of view. I should like to state for the record, if not for the benefit of Deputies who have been here through the years, that the Fine Gael Party were the only party to develop and consistently advocate a national insurance scheme based on graduated contributions.
We suggested that scheme as a solution for the difficulties then apparent in the administration of our health services ten years ago. Subsequently, when the select committee on the health services was established we went into that committee to advocate this idea and this scheme. We pointed out that, as long as our health services were based on the old public assistance approach, we were not measuring up to our obligations as a Christian community. Unfortunately, our views found bitter and, I regret to say, absolutely intractable opposition on that committee from the then Minister for Health. It is worth recalling that, while that committee was still in session, set up as it was to consider the feasibility, amongst other things, of the introduction of a health insurance scheme, the then Taoiseach came into this House —the committee was sitting in one of the rooms in this House—and announced that the Government had decided against such a change in the health services, because it would involve—and this is where the phrase came from— a poll-tax on every person in the country.
The committee broke up because their decision was pre-empted by the leader of the Government but, before they broke up, I had submitted on behalf of my party—I was the person responsible at that time—a detailed scheme for the medical services based on graduated insurance payments. At that stage we were dealing only with the general medical service. In the last Dáil we tabled a motion to advocate our point of view again. I regret to say that, at that time, the attitude of the Labour Party left much to be desired because they expressed opposition to an insurance scheme. They agreed with us that the scheme should be comprehensive, but they wanted it to be financed entirely by the State. They did not find that they could agree with our point of view. Therefore, it is a matter for comment and, I think, congratulation that now in this Dáil, Deputy Desmond, obviously speaking on behalf of the Labour Party, can express in such a clear and succinct manner his agreement with the point of view that we have advocated so consistently and for such a long time.
It is now becoming more and more apparent that, if we are to grow up in relation to the provision of adequate health services, we must accept that the approach can be only on the basis of social insurance. We have tried the other way for far too long. We have tried to have a scheme based on cold public charity with the built-in ingredients of means tests of one kind or another. That scheme has not provided the kind of service the people want. Up to this—and, indeed, regrettably continued in this Bill—we had the taxpayer married to the ratepayer in order to finance a limited service for a section of the community. This has led to a variety of standards, depending on the exigencies of the rates in different parts of the country. It has meant that, generally speaking, there has been a consistent criticism of the kind of services our people were getting. Whether that criticism was well-founded or not, it has persisted and continued.
The fact of the matter is—this I regret to have to say but I am going to say it—that successive Fianna Fáil Governments have been guilty of the gravest deception in relation to this entire problem of the health services. In the general election prior to the passing of the Health Act, 1953, the Fianna Fáil Party went out with posters asking for votes with the slogan: "Should health depend on wealth?" In that there was an implied promise that if they got back there would be a new approach to health which would disregard a person's means. The result was the Health Act of 1953. In relation to eligibility for general medical services, for all the other services which our people required, that Act laid down as a test that a person had to be unable by his own industry or other lawful means to provide these services for himself.
These words were taken without change, without altering a comma, from the public assistance code, words which were borrowed from the last century, from the time when in the height of the famine the purse-proud imperial Parliament was forced to do something for the starving, sick people of Ireland. That was Fianna Fáil legislation in 1953, and it was that class of person only who were regarded as requiring the attention of our Government and of our organised community here. That was an appalling bit of legislation; it was retrograde and it was wrong.
Although my party had opposed the passing of that Health Bill as it then was—we had opposed it from these benches and had advocated then the insurance approach—I found myself as Minister for Health with the obligation of bringing that Act into operation, and I made a pledge to this House, which I am glad to say I honoured, that before I left office I would have that Act fully in operation. I am glad to say that that was done, but it did not mean that I in any way subscribed to the mentality behind the Health Act of 1953, and I made that perfectly clear.
My view the whole time was that we had to move away from what Deputy Desmond correctly called this approach of selectivity, that we had to accept that we as an organised community had a responsibility comprehensively to provide against the exigencies, the hazards, of ill-health for all our people and that we had to do that within our own resources and in the best way available to us. My personal judgment at that time, and I think the view is shared now by many others, was that the approach should be on the basis of social insurance.
Here today in this Bill in 1969, the year in which we celebrate the 50th anniversary of the first Dáil of 1919, we are legislating again—using other words but use what words you like— for the same kind of parsimonious approach to the problem of health in our community as the imperial Parliament did over 100 years ago: "Full eligibility will be provided for adult persons unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants"—new words but the same approach. Those words replace the words "persons who are unable by their own industry or other lawful means to provide for themselves."
Where are we going in this country? Twenty-five years ago in part of Ireland it was accepted as the concern of a community that there should be available a comprehensive system of medical services for the people living in that part of Ireland. Twenty-five years ago the British health scheme went into operation in the Six Counties of Northern Ireland. We are now in a session of the Dáil in which each one of us talked sincerely of how best we could achieve a situation in which all people living on this island would accept common responsibility for the future of this island, a situation which all of us agreed could only come about by the wholehearted agreement of a majority of the people living in the North of Ireland. Here we are, in our first measure of social services since the debate on the Northern Ireland situation five or six weeks ago, saying that in the Republic we do not share any universal concern for the ill-health, the difficulties, of the general population.
Who can regard us as being serious about providing an invitation, genuinely and honourably, to those living in the Six Counties of Northern Ireland to join us if we still approach this problem wearing this kind of blinkers, refusing to see anything except the need that so clearly exists among those who can wear their tattered garments and demonstrate without fear of contradiction that they have no means or have to face undue hardship? Here is another example of the kind of political deception that many of us have criticised for so long, a promise made of a great leap forward, whereas it is merely a play upon words.
As Deputy Ryan said, if we want to forget about the North of Ireland, where are we in relation to the rest of Europe? It is well to recall that there is no country in western Europe today, except the Republic of Ireland, which does not recognise its responsibilities to provide a comprehensive medical service for all its citizens. We do not appear to be concerned about this. That, perhaps, is an exaggeration. The majority party do not appear to be concerned about it. They are apparently happy with a promise of change in new health legislation, but in so far as providing for the ordinary people dealing with this social problem, nothing emanates from them.
The Minister said yesterday that they were considering some form of health insurance scheme for people outside section 43. That is marvellous, but what does the Minister mean by it? Does this mean that this kind of throw-away line is going to be a ration for the people to exist on in hope for the next couple of years? I understand that it was the view of the Government that a contributory insurance scheme was out—that it could not be done, and as a result we had this bit of legislation. Apparently the penny has dropped and we are now going to have consideration of a contributory insurance scheme for some undefined section of the community. I do not believe the Government have given any serious consideration over the last 15 years, as to what is the proper approach to social problems in this country and in particular in relation to health.
Alone in Europe we continue to do what ceased to be appropriate in all European countries at the end of the last war. We are the only country in Europe affiliated to the Council of Europe unable to sign the European Social Charter. We cannot sign it, because we cannot subscribe to the aims and ideas of a comprehensive medical service for our citizens which all other countries regard as minimum. I regret to say the reason we cannot do it is because we have a Fianna Fáil Government back in office. The reason that the Government cannot do it is that they are not sufficiently big enough to recognise that they made a profound social mistake when they refused some years ago to accept Fine Gael policy on this issue. Had they been big enough to recognise that we were right and they were wrong substantial progress could have been made. That was not done. We had a series of operations in which heels were dug in and positions were adopted, decisions were made and announced and all this was precursor to the 1969 Health Bill. This Bill, in the end result, means that nothing much has changed. A new shop front has been put up but the goods being sold in the shop are still the same. There is a 50/50 approach to financing the health service, there is the marriage of the ratepayer to the taxpayer and the selection of those entitled to benefit on the basis of their lack of means. It is the same old thing wrapped up in new words, but so far as progress is concerned there is none whatsoever.
I think it is a tragedy at a time when we should be planning and contriving, within our means, to raise social standards in an effort to make this country more attractive to our countrymen living in the North of Ireland that we have in office a party which has been so long there that it is incapable of new thinking on problems of this kind. It is a pity that the unfortunate people should be given a tawdry measure of this kind.
