Yes, malicious. How can anybody say that the doctor-patient relationship is gone because the family doctor says to his patient: "It will not cost you very much to have your operation?"
Let us go further. The patient goes in to have his operation. I will be told that at the moment, for the pleasure, if you like, of paying his £100, he can choose his own surgeon. Of course, we know how that happened in the past. A person went in to his family doctor. He did not know the surgeons very well and as a rule he said to the family doctor: "What surgeon would you advise?" The family doctor in the past advised a certain surgeon, everything was fixed up and when it was all over the bill was paid. Now the doctor says: "If you go to the county hospital, the surgeon there is a good man." He cannot say anything else. There is no conscientious doctor in this country who can say anything but that the county surgeon is a good man because these surgeons are selected on a certain basis as a result of which only the best man is appointed. Therefore he must say that he is a good man.
We know from experience what the result has been. It is because people know that, that we have all this talk about want of beds. Every county hospital is clamouring to have more beds supplied because of the additional demands on the county surgeon and his staff. The family doctor then says: "If you go to the county surgeon, everything will be free but if you prefer to go to Dublin, perhaps it can be managed." I say, perhaps it can be managed. The family doctor sends this man, if he agrees to go, to the county surgeon and everything is free. If he wants to go to another hospital it may be arranged; I do not know. If it cannot be arranged, all you can say is that he can go to the hospital of his own choice but at least he gets accommodation in that hospital by paying the difference between the figure for maintenance and that in the county hospital —say two guineas weekly. If he takes the advice of the family doctor he will be better off and he will get good treatment. Suppose he does go to the county surgeon, what is the difference— I want to get this answered—between the doctor-patient relationship in the case of a man who goes to the county surgeon and the doctor-patient relationship between a Dublin surgeon and a man who comes from the country? Is it that the county surgeon is an inferior type who is not capable of having a proper doctor-patient relationship? Where does the difference come in and at what stage? That is what I want to know.
We could deal with all these other generalities just as well if we had time to take them seriatim. On this stage we are discussing the Bill as it appears in its final form and, therefore, we are not discussing any change that might be advisable or that could be suggested.
Senator Cunningham, I think, gave a fair enough analysis of the provisions of this Bill, now that it is about to pass through this House. He said that the lower income group were in much the same position as heretofore, except that a young woman had now a choice of doctor which was a considerable improvement. He did mention, however, that an insured person would not be as well off because he might be charged £2 2s. a week. He mentioned, also, that his dependents would get services which they are not entitled to from the fact that he is insured at the moment. That is fair enough, except that, of course, at the present time the insured man is entitled only to six weeks' benefit. If his term in hospital runs over that he has to pay for the treatment somehow or other. Under this Bill there will be no limit of that kind. Otherwise the case was fairly well stated.
Senator Cunningham, however, has an objection to the Bill in a general way—that it does not apply equally all round. Well, of course, there are many Bills that do not apply equally all round. It is not always possible to introduce a Bill that will apply to everybody in the same way. We have had many Bills with means tests and tests of other kinds. I think we need not delay too long on that aspect at this moment.
Senator Cunningham also said— maybe not to-day but on other stages —that this Bill was likely to cost 10/- in the £ on the poor law valuation. He said that, I think, on the Report Stage. I do not say that he said it very definitely but at least he indicated that it was put to him that it might cost 10/- in the £. Senator Cunningham said to-day, speaking from his long experience in a voluntary hospital in Dublin, that any person in the middle income group, that is, a person with an income under £600, always got treatment in these hospitals, if it was needed, and was never turned away from the hospital because he would not pay. I am not disputing what Senator Cunningham says; I am sure he is giving his own experience, but if that is true, that most of those in the middle income group are getting free service now, does it not mean that this Bill is not going to cost very much? It is surely not going to cost 10/- in the £, because 10/- in the £. when it is covered £ for £ by the Minister for Health, would mean between £7,000,000 or £8,000,000. That would be as much as all our health services are costing at the moment. It is not possible, however, to hold both viewpoints. It would be possible, of course, for the Senator to say it will cost a lot more, or that it may cost a lot more, but if it is going to cost a lot more it means that there is a big number in the middle income group who are not getting free services or subsidised services at the moment.
It is true that the Taoiseach said at the Ard-Fheis that the farmers are fairly well off, taking them all round, but yet there may be many farmers who could not stand the shock of a surgeon's bill. I mentioned some cases here on the early stages, which I just quoted at random from letters which I received when the White Paper on this Bill was first published and when the Bill came up for discussion in the Dáil. I said I had received many letters written by people from all over the country pointing out to me how necessary a Bill of this kind was. I quoted one particular case of a widow with a valuation of £15, who had a family and who had just received a bill for £115. That widow, on ordinary standards, might be considered to be fairly well off. She has enough to eat for herself and her children and she is able to clothe them fairly satisfactorily, but there is no doubt whatever that a bill for £115 was a bit of a shock to her. Even though farmers may be well off, I still think a Bill of this kind is necessary.
Senator Cunniningham stated that he thought it was wrong to have this provision for the higher income group which would enable them to plead hardship and therefore to claim either free or subsidised treatment in hospital and make their case to the local authority for that help. It may be wrong to tempt people of that kind, but we must put in some provision like that. If we did not put in that provision and suppose a person who had an income over £600—it does not matter for my present argument whether he was deserving or undeserving of help—wants hospital treatment and is not able to pay, am I to say to the county manager: "There is the Act; do not let him in; somebody else must provide for his funeral?" What can we do? We cannot let a man die. We cannot refuse a man treatment in a hospital because for some reason his income is too high or his valuation is too high, whatever it may be.
Even at the present time, a man who had, up to this anyway, an income of £2,000 or £3,000 a year, if he is absolutely derelict and if he approaches the county manager and says: "I am unable to pay for medical treatment," he must get it free. So that the people who passed the Public Assistance Acts 100 years ago were more enlightened than some of our Senators here to-day because they did foresee that even a very well-off man may need treatment and that he must get it if he cannot pay. Therefore that wording was put in the Public Assistance Acts, and as I say, they were passed about 100 years ago. We, if you like, tried to cover the contingency of a man who is not able to pay for hospital treatment even though his income may be higher than that laid down for the middle income group.
Senator Cunningham says that the whole scheme means a levelling down. I have heard that criticism before and, as Senator Cunningham put it, I have heard that it would be better if we could level up. What is meant by that, I understand, is that the general tendency of this Bill will be that people will go into the public wards and that we could, on the other hand, have given these people a sum of money, as mentioned by Senator Cunningham on the Committee Stage, and said: "Go where you like; this will help you." In that way, as Senator Cunningham said, we could have a tendency to level up, by which is meant that they would go into private wards and private homes.
Now I am not concerned with social distinctions of that kind. If, as Minister for Health, I am careful that I will not compel people to do a thing that is bad from the medical point of view, I think that I can be quite satisfied and have a clear conscience. I am quite satisfied that if a person is concerned only with his health, he is as well off in a public ward as in any private home. Senator Cunningham, who has followed a certain speciality in medicine, I am sure will admit that the lady who goes in for a confinement is as well off medically in the public ward as she would be in any of our private homes. If I am satisfied—and, of course, when I say I am satisfied I want Senators to understand that I am satisfied by advice, because I do not know anything about these things or I do not know very much anyway— that people will be treated as well in the public ward as in the private home, then, as far as this legislation goes, if I provide for them in the public ward I am doing my duty as Minister for Health.
I know that we should have respect, if you like, for people's feelings beyond that. If, as mentioned by Senator Cunningham, a person is diffident about going into a public ward and would prefer to be in a private room or a private home, I am afraid we cannot legislate for that. The best we can do is what we have offered here. If the patient wants to choose his or her hospital, all we can do is to give a subvention and let the patient pay the difference. We are going a good way to meet them. After all, they are not getting anything at present. We are going a good way to meet them by giving this subvention to help them out in such a contingency.
Senator McGuire talked about private enterprise and nationalisation. I must say that I agree with him. I do not think that nationalisation is a good thing. But I do not see any indication of nationalisation in this Bill. That is another instance of these vague generalisations and criticisms of the Bill. They talk about destroying private enterprise, encouraging nationalisation and so on.
It was rather interesting, I must say, to hear the Senator say that we are over-taxed in this country and then add: "We are not saying that; it is the Government who are saying that." It is news to me that the Fine Gael Party think we are not over-taxed in this country. Senator McGuire also stated that this Bill was going against vocational organisation. I admit, of course, that it is not 100 per cent. vocational organisation or perhaps 50 per cent. either. I do not know what percentage it may be, but I never claimed that the scheme was brought in on a vocational organisation basis. I do not know if it would be possible to do that.
