I was just wondering whether, as the Bill stands, this section might not be open to an ambiguous interpretation. It might be that the board would be taken to be a voluntary board like a voluntary hospital board. I am just wondering whether the section really does indicate that it is a voluntary board. If it is intended to pay the board, then the wording is a bit ambiguous.
Voluntary Health Insurance Bill, 1956—Committee Stage.
I am also worried about this matter. The only thing I can find voluntary in connection with this Bill is the question of subscriptions. Almost every other section of the Bill will go into operation with the Minister's consent. Like Senator Sheehy Skeffington, I, too, am wondering if "Voluntary Health Board" is a correct description.
I must confess I do not understand exactly the point made by the Senators. Surely the whole proposal contained in this Bill and the consideration of this matter over an extended period have had to do with voluntary health insurance. The board which will offer to the people such voluntary health insurance will be a board set up for that specific purpose and, in my opinion, it is therefore correctly described as the voluntary health insurance board.
I wonder would the Minister consider the phrase "to such extent as the Minister may from time to time specify". The board will defray the cost to that extent. I take it that the extent the Minister could specify would have to be specified before the contracts were entered into. Otherwise, this phrase might imply that the Minister might suddenly alter the benefits without notice to subscribers. I would like to draw attention to that point.
There is then a further point I would like to raise in relation to sub-section (4) of this section. The board is to fix the subscriptions so that they will be sufficient to do certain things. I have had some experience with other insurance schemes in connection with the operations of the Revenue Commissioners. It seems to me that a scheme of this kind, run in any kind of sensible way, will at times have reserves of profits accumulated. As the Bill stands, these profits might be subject to tax— I know that is a subject which should not be mentioned here—and, if that were to happen, it might have a very serious effect on any fund built up under the scheme. These are two points which should be considered in relation to this section.
Under sub-section (1), it is mandatory on the board, as Senator Cox has pointed out, to put into operation whatever health services are specified by the Minister. That raises a very important issue because it puts the board in the position in which they can formulate, as we will see in a later section, health legislation. If the Minister directs the board to bring into operation health services, of which so far we have had no details in the Bill, the board under this section will have to put those services into operation. That means that the Oireachtas will be by-passed, as far as consideration of these proposed services is concerned.
Again, in sub-section (3) it says:
"A scheme under this section may be amended by a subsequent scheme made by the board...."
In other words, to take an example, when the board receive this Act, they can amend it by a scheme of their own and, provided they obtain the Minister's consent to this scheme, that scheme as amended by the board can become law. This is a board of a small number of people, a board with a quorum of three. While I accept that State-sponsored companies or bodies may have power to make regulations under a section, it is an entirely different matter that a very experimental company such as this, sponsored by a State Department, should have the power to make an amending scheme without coming to the Oireachtas.
There is another matter. Under sub-section (4), it is mandatory on the board to put the Voluntary Health Insurance Act on a paying basis. I referred to this question on Second Stage. I should like to know from the Minister what will happen if the board fails to put it on a paying basis? They cannot continue to raise the premium year after year until they strike a balance. I am not quite clear as to what the Minister has in mind.
There is one other point to which I wish to refer. Sub-section (1) speaks of medical, surgical and other services as the Minister may from time to time specify. Where are the services to be made available under this Bill to be obtained? Is this Voluntary Health Insurance Bill confined, as far as benefits are concerned, to private hospitals, nursing homes and private accommodation in the public hospitals or—and this is a rather important point—could the Minister tell me can persons who are entitled to benefits under this Bill obtain such benefits in the public wards of our hospitals?
I am sorry to put so many questions and to cross one section over another but there are some points there which, perhaps, the Minister would clear up for us.
There are some points I wish to make on this section with special reference to sub-section (3), which indicates that a scheme may be amended in future under certain circumstances and sub-section (4), which says that the subscriptions "shall be sufficient, but only sufficient", and so on. I asked the Minister a question on the Second Stage which he did not answer at the time. If he is prepared to give it now, I should like him to indicate to us, if he would, within certain limits, necessarily, with what number of subscribers he thinks it is conceivable the scheme will work reasonably well and below what figures it will prove very difficult; in other words, in general terms, what kind of general target he has thought essential as a number of subscribers.
Senator Cox made a point on sub-section (4), that the board shall fix the subscriptions so as to be sufficient, but only sufficient, and he wonders whether, if they made a profit, that profit would be taxed. I think the answer to that is that the words in the sub-section are that the amount "shall be sufficient, but only sufficient (as nearly as may be)," that is to say, the Bill avoids a mathematical arrangement. The board is to do its best to see that no profit is made. I think we would all be in agreement with that. With regard to a point that a Minister for Finance at some point might make the board pay income-tax on a profit which it had—a small profit over a short period—I think Senator Cox, who is so interested in law, would have to take our word for it that that would not be practical politics. I do not see the Minister for Finance now or in the future who would take any such action.
With regard to Senator ffrench O'Carroll, he thinks that the board should not have power, under sub-section (3), to amend the scheme in the Bill, but, as I read the Bill, there is no scheme in the Bill. Is that not correct? I do not know how Senator ffrench O'Carroll comes to the conclusion that they have power to amend the scheme in the Bill because there is not any scheme in the Bill.
The idea of the Bill is that the Voluntary Health Board set up will make a scheme and that they may from time to time amend it. If you once accept the idea that there must be a board, that they can make a scheme, you surely must accept the further idea that they can amend the scheme when they have made it. Therefore, it seems to me that there is no by-passing of the Oireachtas anywhere in the Bill. The idea is that you set up the board and, under Section 4, they make a scheme, subject to certain powers of the Minister and having made the scheme, they can submit amendments to the scheme to the Minister, but I think that the Senator is misinforming himself when he suggests that there is a scheme in the Bill and that the board can amend the Bill. The board can make a scheme and then, naturally, they can amend the scheme in the light of their own experience.
I quite accept that I was incorrect in saying that the board can amend this Bill when it becomes an Act because, of course, we have not got the details here. The reply which Senator Hayes has given to the point that I raised, in a way, does make my question all the more important. We are passing health legislation here which gives far fewer details as to what it proposes to do than any other Health Bill I have ever read and I would submit through you, Sir, to Senator Hayes that that, in fact, makes it all the more important, as it is a very vague Bill and as we here have no idea what the scheme will be. It makes it all the more important that when a scheme is drawn up under a Bill like this, with rather wide powers, that the Oireachtas should have an opportunity at least to see what is proposed or that there should be an opportunity for the Oireachtas to consider amendments before they become law.
I merely want to point out to Senator ffrench O'Carroll that the Health Bills of which he speaks were Bills which were compulsory upon certain classes of people. They were Bills dealing with health services which were available for certain people and the subscriptions towards which were compulsory on certain people. Is that not correct? Therefore, of course, they were public legislation and the scheme was in the Bill. This is a Bill of a completely different character. In this case, what you do is to set up a board which offers certain benefits which people may or may not accept and that is in quite a different category, therefore, from the other Health Bills of which the Senator has spoken.
The only thing you can do with a Bill of this kind, once you accept the principle of it, is to set up a board and let the board do the best it possibly can. The vital point about it is that it is not compulsory. I am not compelled and nobody is compelled to join the scheme. The scheme is a voluntary one. That is the essence of the whole thing. It is not for the Oireachtas to frame a scheme; it is for the Oireachtas to set up a board which will itself frame a scheme and which must have power to amend it. That is not by-passing the Oireachtas in any sense of the word.
I consider that the points put forward from this side of the House by Senators Sheehy Skeffington and ffrench O'Carroll and the point put forward by Senator Cox are worthy of consideration. As Senator Hayes has mentioned, this is a voluntary scheme. We must, at the same time, consider the fact that this board is being given a monopoly of this kind of insurance under Section 23. As far as my reading of the Bill enables me to come to any conclusion, the conclusion I have come to is that no other insurance body in this country will be given the opportunity to carry out any such health insurance as is envisaged in this measure.
Accordingly, I think it right and proper that we should have some machinery whereby the Oireachtas would have the opportunity of becoming acquainted with what the board is doing. I think the best way to meet the point would be to ensure that when a scheme such as is envisaged in this measure is being carried out, it would be done by ministerial Order and that the details of that Order would be made available to the Oireachtas—that copies of the Order would be laid on the Table of the House, that the two Houses of the Oireachtas would be given an opportunity of discussing the method by which the scheme would be carried out, as well as the details of the scheme.
As regards the other point which arises from sub-section (4) of this section, I must say I am not entirely satisfied with the explanation given by Senator Hayes. He said it could not possibly arise that the reserves of this board would be subject to income-tax. After all, all bodies subject to company law are liable for income-tax— friendly societies and so on. Any reserves they have out of profits are subject to tax. I would like at this stage to ascertain from the Minister whether he can say now in fact whether the reserves, if there be any, will be liable for income-tax, because that, in the end, would have an effect on the premiums payable by voluntary subscribers.
A number of matters have been raised on this section and perhaps if I deal with the matter lastly referred to by Senator Kissane, and earlier raised by Senator Cox, at the beginning, it would be best. I refer to the point about the liability of the board, from its business of insurance, to pay income-tax on any profits it makes. It is, I am told, correct to say that, under the present state of the law, income-tax would be payable. Whether the law in that respect will continue as it is at the moment is a matter to be considered. I am not the appropriate Minister to consider that, but I agree it certainly is a matter that will have to be considered later. However, it is not appropriate to a Bill of this kind.
Senators have mentioned as a criticism the power the board would have to alter benefits under their health insurance scheme. I should like to put it this way to Senators: this Bill is a machinery Bill, designed to set up the machinery which is regarded as appropriate to provide this form of health insurance for the people of the country. It is designed to fill a void which exists and to provide some method whereby this form of insurance can be made available to those who require it. If it were decided to provide in this legislation the precise benefits that should be contained in the insurance offered to the public, then it can be readily appreciated that this kind of legislation would have to be amended from time to time.
If costs and expenses vary, if new medical techniques and new specialties become available, that would indeed be a very wrong way to provide for this need. Senators can just think of the trouble that would be involved if this Bill contained a section setting out the benefits suggested in the Advisory Body's report. At page 13 of that report, the benefits are set out. If those benefits were inserted in the Bill, it might be found in a few months that the £7 a week payment suggested in respect of hospital expenses was, in fact, inadequate. It might be found that various specialist services set out in the report did not provide an adequate cover, that some new specialties and techniques had become known and that the insurance scheme thus proposed in the Bill would not cover them. If such benefits were inserted in an Act of Parliament, it would be necessary for the Minister for Health to come back to the Oireachtas and amend the provisions by adding to or altering the benefits.
For that reason, it was proposed here that the board set up would itself draw up a scheme of insurance, power being retained by the Minister for Health to ensure that the scheme the board draws up is adequate to meet the need. That is why the provision which Senator Cox mentioned is contained in sub-section (1)—"to such extent as the Minister may from time to time specify". That is not intended to be a delimiting power. It is intended to be a power to ensure that the cover will be adequate and that it will meet the public need so far as insurance is concerned.
It will be appreciated that each contract of health insurance, whether made with the board or otherwise, is a yearly contract and that it must be renewed every year by the individual insuring and by the insurers. From time to time, it may be found by the board, in the light of their experience, that they have to alter the policy which they offer, and provision is made that in order to alter the insurance scheme, they must secure the consent of the Minister for Health, so as to ensure that at all times the insurance cover is adequate to meet the needs of the people. No alteration of any kind could affect the contract which is then in operation—the yearly contract of insurance. It can affect each individual insuring only at the end of the contract period—at the end of the current year of insurance.
Senator ffrench O'Carroll asked whether this scheme was intended to provide cover only in respect of private and semi-private wards in the general hospitals, nursing homes and so on. There is no restriction in that connection contemplated or intended. A person who insures under this scheme may go to any hospital and any part of any hospital he wishes. He can go into the public ward of the hospital if that is his preference, and, wherever he goes, he will get precisely the cover set out in the scheme. Indeed, I anticipate that—I will not say a large number—but certainly some people may prefer to go to the public ward of one of the general hospitals with this insurance cover, because, of course, the charge falling uncovered under the insurance would be very much less than it might be in a nursing home or in the private wards.
Senator Sheehy Skeffington asked whether I could give an opinion as to the minimum number of persons necessary to provide a reasonable chance for the scheme to succeed. It is not easy to be precise on a matter of that kind, but I am advised that it is felt that 25,000 persons at least will be necessary to enable the scheme to develop properly. As I indicated on Second Reading, I hope there will be a great many more than that availing of health insurance, but it is felt that that would be the minimum to enable the scheme to operate satisfactorily. I hope I have covered the different points made by Senators on the section and the various sub-sections, but if I have overlooked anything, I shall be glad to give any other information required.
In connection with sub-section (3) of Section 4, is the Minister's consent necessary only in so far as the scope of the benefits is concerned or is it necessary in relation to any modification of any scheme?
That is really a matter arising on interpretation, but certainly the idea is that there should not be any serious alteration in the benefits, without the consent of the Minister. As regards going down to trivial details, I would imagine that that would not be desirable administratively, and probably it will be operated in that sense. I should have mentioned earlier that, under sub-section (2) of the section in question, it is envisaged that the board may have on offer to the public not only the minimum scheme, that is, the scheme drawn up in accordance with ministerial specifications, but other schemes of a more expensive kind and perhaps providing greater benefits. The provision of such a scheme is also subject to ministerial consent in order to ensure that, by offering such a scheme to the public, the board will not lose money. They will be encouraged to offer a choice of schemes, provided the return is satisfactory and does not lead to loss of revenue, or in any way militate against the main concern of the board, that is, to provide the minimum scheme that will be detailed.
I am very interested in this statement by the Minister that beneficiaries under this Voluntary Health Insurance Bill will occupy the wards of our public hospitals. Might I remind the Minister that one of the reasons he gave us for postponing the Health Act of 1953 was that he himself felt he had only sufficient accommodation for the lower income group and that he had to postpone the operation of benefits for the middle income group until more accommodation facilities were available? I do not think there is anything wrong with providing for all income groups and giving everybody an opportunity to become a patient in any of our hospitals, but I do assume that the Minister is aware that there is often a shortage of beds in our hospitals from time to time, and that we want to see that as far as the lower income group is concerned that shortage of bed accommodation will not in any way be accentuated by throwing the hospitals open to yet another group which formerly did not use the wards of our public hospitals.
I would not worry very much about the delegated powers which this Bill proposes to give to the Voluntary Health Insurance Board if the position were as Senator Hayes suggests, that this was catering for a group of persons outside the present health legislation, but I think I established on Second Reading, and the Minister acknowledged it in his reply, that there would be an interchange between many sections of this Voluntary Health Bill and the existing Health Act. In view of that, I feel that the Oireachtas should have an opportunity to consider whatever schemes are made under this Bill, particularly in so far as they will affect existing health legislation in the country and certainly anything which the Voluntary Health Board itself seeks to amend.
There is one other point on which I should like the Minister to comment. Sub-section (4) refers to the necessity for this scheme to meet the charges, whatever they may be, "properly chargeable to revenue". In paragraph 34 of the report of the Advisory Body, we are told that information was made available to them in respect of certain existing voluntary health insurance organisations and that information indicated that the administrative costs varied—they are talking about Britain and abroad—"from 15 per cent. to 30 per cent. of premium income". They go on to suggest at the end of the same paragraph, on page 16, that it is probable that an expense ratio of 30 per cent. of the premium income will be necessary, at any rate in the initial stages of the scheme here. The administrative expense ratio will be as high as 30 per cent., which is the highest figure that has been charged elsewhere.
I should like to hear the Minister's comment on that in the light of the fact that the Advisory Body's information on this matter does not seem to me to be complete. They say that administrative costs elsewhere "vary from 15 to 30 per cent." As I indicated on the Second Stage, the expense ratio of at least one British company, the British United Provident Association, is 10 per cent. Therefore, it is not true to say that elsewhere it varies from 15 per cent. to 30 per cent. It varies, if you like, from 10 per cent. to 30 per cent. We are here being told already, therefore, that it looks as if the Irish scheme will be, from the administrative expenses point of view, comparable with the dearest of schemes elsewhere, and I should like to know why the expense ratio is anticipated to be so high.
Might I, first of all, reply to what Senator ffrench O'Carroll has said? It is, strictly speaking, irrelevant to this discussion, but, since he has raised it, I think perhaps I should deal with it. Senator ffrench O'Carroll reminded the House that one of the reasons why I sought the postponement of the operation of the Health Act, 1953, was a shortage of hospital beds. That is true. I would remind the House, however, that, in the past two and a half years, a great number of additional beds has become available and the position in that regard has much improved. It was for that reason that I found it possible to implement the postponed sections of the Health Act and I take some satisfaction in the fact that the advice which I had to give to the House two and a half years ago was, in fact, proved to have been sound.
In addition, nowadays as a result of arrangements which I made, not only all the local authority hospitals but all the voluntary hospitals, who have entered into appropriate agreements, are bound to take into their beds all Health Act patients, all health authority patients. That is a safeguard which now exists and which did not exist before. Again, I feel I am entitled to take some satisfaction for that state of affairs. It means that any person availing of health insurance who desires to go to the public wards of either the local authority hospitals or the different voluntary hospitals will be enabled to do so, provided that a bed is available for him. If a bed is not available, he cannot do so. The beds that are available must be provided, in the first instance, for those who are entitled to avail of the Health Act services because they are regarded as being in need of assistance in that regard.
Senator Sheehy Skeffington mentioned the question of administrative expenses. We do not know what the experience will be with regard to the administrative costs of this scheme. The Advisory Body, in considering this matter, were, I think, quite correctly, concerned to ensure that the factor in the premium to cover administrative costs would be on the cautious side and they approached it from that point of view. I am told that at the time of the Advisory Body's investigations the administrative costs of one of the English associations was around 15 per cent. It has since, I am told, been reduced to around 10 per cent., but it would be foolish to rely completely on English experiences in these matters. The circumstances here are quite different, and were a scheme to be offered based entirely on experience in England, or elsewhere, it might be found to be very faulty. Accordingly, it is wiser to take the outside limit—I think it is an outside limit—of 30 per cent. and then base the initial premiums on that figure, in the belief and hope that experience will show the administrative costs to be very much less and, accordingly, a more realistic premium can be arrived at later on.
There are two points arising out of this matter on which we are not quite clear. Firstly, with reference to this matter of taxation, I may say that we on this side of the House, as the Minister knows, have certain misgivings, as well as on the Bill as a whole. We appreciate that the Bill is in the nature of an experiment and we are perfectly willing to treat it as such and to give the board full scope to carry out its experiment; but are we to take it that the Minister appreciates the importance of this matter of taxing and non-taxing of reserves? Insurance companies, like banks and various financial institutions, must in the public interest, build up very considerable reserves. Normally, the reserves come out of what are called profits and normally, I take it, reserves are taxed. The taxation at present rates runs to about 40 per cent. of the profits involved and the Minister can see what a heavy burden that could be on the members of this organisation, whenever it is set up.
Are we to take it that the Minister appreciates the importance of that and is the fact that he has not made provision that these reserves will be nontaxable due to the fact that the Minister for Finance has the final say? If it is true that the Minister would have power to provide that these reserves be free of tax, then I think he should do it. We had an idea that an amendment might be put down on this matter, but we were conscious of the fact that it might be ruled out of order as involving a charge on the State. We were prepared to let it go and to hear what the Minister had to say about it.
The other point is in regard to the submitting of schemes to the Minister and their publication by means of Order. It is one on which we should get some more clarification. It seems that the board will be charged with the duty of developing a scheme and that that scheme will have to be submitted to the Minister. I take it that the board will have to submit the scheme to the Minister for approval, and, if that is so, what is the objection to providing that the scheme, having been submitted, will be made a matter of ministerial Order and that the Order will then be laid on the Table of the House? The Minister may say: "But changes may have to be made from time to time." That is true of all schemes; changes have to be made from time to time, Orders are altered and new Orders made, and I do not see why in this instance the scheme, when prepared by the board and submitted to the Minister, should not then come before the Oireachtas by way of Order.
May I say on this question of the board and profits and taxation that what I said before was that I thought that if the board was to make a profit, the Minister for Finance would not tax it. Perhaps I could extend that somewhat. I agree entirely with Senator Ó Buachalla. I think that this board will not be a success, unless it can prove that it can make a profit on a certain scheme and should build up reserves. I express the opinion freely that such profits should not be taxed. The board will not be a profit-making concern, and, if it makes profits, it will use them for the purpose of showing that the scheme can be carried out on lower subscriptions from the members. That is the position, I take it. Most certainly, they should not be taxed. As that is not clear from our present legislation, as I think at present it is not, then most emphatically the law should be altered so that such profits made by a board such as this should not be taxed.
Might I ask Senator Hayes whether he believes that the Minister for Finance has power to relieve any particular reserves from taxation?
I am told he has not. That is why I am making myself clear now. I think he should have that power. I think Senator Ó Buachalla will agree that it is not in this Bill but rather in a Finance Bill that that power should be taken by the Minister for Finance. There can be very little doubt that anybody in the position of a Minister for Finance whose colleague was bringing in a Bill of this kind would be bound to put himself in the position in which he would exempt such profits as might be made by such a board as this from taxation. There can be hardly any doubt of that. I suggest, not because it would impose a charge but rather because it would be irrelevant on this particular type of Bill, that provision cannot be made here. I think it certainly should be made elsewhere, presumably in the Finance Bill.
With regard to the members of the Oireachtas seeing the scheme, there is not much difficulty involved, I suppose, in making regulations that such schemes shall be laid on the Table. I take it that when the schemes are laid, copies will be circulated to all the members. It will not be a Civil Service document coming under any form of official secrecy or not available to the public. I am not a skilled person in this matter, but I presume that, when a scheme is made and an amendment proposed and finally agreed upon, after consultation with the Minister, as is provided for under Section 4, it will become for all practical purposes a public document. If there are 25,000 subscribers, as is anticipated, or more, there will surely be plenty of copies of it. In that way, members of the Oireachtas would find no difficulty whatever in getting a copy.
I think Senators may be under a misapprehension. Senator Hayes has just touched on it. Remember that the concern of this board is to sell something—that they are out to sell insurance, to sell an insurance scheme. They are not going to sell it by locking it up in their own office and not letting people know what is in it. I look forward, indeed, to every member of this House entering into this health insurance scheme and buying this policy and having full knowledge of the extent of the benefits and, of course, being an insured person, being also aware of any alterations that may be made.
The House will appreciate that the proposal is that the Health Insurance Board will run the health insurance scheme. If it were felt better to run it by the Department of Health, then I can see the need for publishing regulations and laying them on the Table of the Houses of the Oireachtas and all the rest of that, but that is not the proposal here. This is a Bill to enable a board to run a health insurance and in that regard they should be as free as it is possible to allow in running the business it is set up to run, just as Bord na Móna are charged with the duty of developing our turf resources. The schemes they decide upon are matters entirely for them. Their schemes of development have not to receive the sanction or approbation of either House of the Oireachtas, but if, in fact, Bord na Móna or any other semi-State body does not carry out its duties, the Minister responsible is held to account in the Oireachtas for that failure. Here, too, if the Health Insurance Board does not provide an adequate insurance cover or alters it in some way harmful to persons availing of insurance, then the Minister for Health, who must give his consent to any such alterations, is responsible and answerable to the Oireachtas.
I would ask Senators to remember in this connection that in the Oireachtas we are not completely cut off from the outside world. Everybody will know the extent of these benefits and it will be the concern of the board to make them as widely known as possible because they are out to interest people in buying this insurance. If, as I say, alterations are made of a harmful kind, then, very quickly, the Minister for Health will have it drawn to his attention in the Oireachtas itself. I do not think it is proper to go any further than that. The board is set up to provide a scheme and I think they should be as free as possible to carry out the statutory obligation in that regard.
Under this section, we are keeping an eye on two things: one being the board and the other the scheme. The scheme is going to get away after this section. We can pursue the board through several more sections. I should like to ask the Minister one fundamental question about this scheme. I can see that he will not be inclined to tie the board down in any way in drawing up the scheme, but if he possibly can answer my question, I think it will help our debate. Will it be fundamental in this scheme that there will be no medical test? In other words, will this scheme guarantee both good lives and bad lives? Could the Minister answer that question? I should be grateful if he could because some queries I want to make on the subsequent section depend on that.
Oh, no. There will be a medical test and a very strict one. The concern of this insurance scheme is not to end in insolvency but to end in providing, on reasonable businesslike grounds, health insurance cover. There is no insurance concern that I know of that will only take on bad risks.
With regard to the first matter I mentioned a few minutes ago, the taxation of reserves, I am quite satisfied to leave that matter as it is. I accept that the position is as Senator Hayes has indicated and I am willing to wait and see what will happen in regard to it.
With regard to the laying of the scheme before the Oireachtas, I am not satisfied, to be quite frank. It is true that there will be publicity and very wide publicity for the scheme that will be worked out by the board. The difference between that and what we have in mind is that the schemes, while they will be made public, will not come before us. We will have no say in regard to them. The Minister may say: "Why should you do that?" One of the main reasons which influenced me in asking that the schemes be laid before both Houses of the Oireachtas is that we are about to give to this body what amounts to monopoly of this type of insurance. There are other monopolies. There is a good deal of publicity for the arrangements and the schemes devised, for instance, by the E.S.B. They can come along any time they like and raise their rates and we have no say in regard to these matters. I think this matter of insurance is much closer to us than even the affairs of the E.S.B. or Bord na Móna. It is for that reason we should keep a very close eye on the activities of this board.
I am not satisfied. If the Minister says he is not willing to do it or that it cannot be done, that is all there is to it, but I still think—and my final words on this are—that it is possible to have these schemes, as they are developed by the board, laid before the Houses of the Oireachtas and that they ought to be so laid.
I wanted to say what Senator Ó Buachalla has said and put very much better than I could. The Minister says it is quite clear that this company will be selling commercial insurance. That is their job. The Minister has acknowledged that there will be a certain amount of interchange and competition between various sections of the Health Act and this Act. In all reasonableness we are entitled, therefore—those of us here in this House who are responsible for this legislation—to have an opportunity to see the scheme, so that we, who are responsible not only to the buyers of voluntary health insurance but to the whole public, the whole electorate, should be able to see that everybody's position is covered in any scheme which is brought in by this board.
Would the Senator permit me to say this? Does the Senator think that any of these schemes will not be available to the Senator and everybody else?
The Senator appreciates they will be available, but they will not be available to us to amend or alter as we think fit in this House. That is my point.
At no stage is it suggested that that should be the position. I thought it was common to everyone who spoke on this matter that the board itself should draw up the schemes, that it was right and proper that they should draw up a minimum scheme in accordance with the specifications which the Minister for Health might make and that it was right and proper that they could amend any scheme that they had, provided they got ministerial consent for so doing. I understand the suggestion was made then that any scheme, either the original one drawn up or an altered one, should be made available to members of the Oireachtas and, of course, the public in general. In fact, that will be so. There will be, and could be, no concealment regarding the scheme that would be offered. Full information will be available. If the board is not doing its duty, through the action or inaction of the Minister for Health, he will be responsible to the people to whom he has to account, that is, the Oireachtas.
It seems to me that there is a great deal to be said for this kind of board or body which the Minister suggests. Reference has been made to the E.S.B. and Board na Móna. I think that in the kind of way in which they were set up—that is to say, as semi-independent bodies and yet controlled by the State—a rather valuable innovation was made. I doubt very much if as good progress could have been made with our electrical development or turf development, if a way had not been found to entrust to a board of experts, free from daily governmental control, the business of developing the task assigned to them.
It seems to me that what the Minister is trying to do under this Bill is in effect to set up an insurance body which will be able to operate to some extent on its own and make decisions from day to day, while at the same time the Bill provides that the Minister must approve of all the schemes. A set up of that kind combines the advantages of a certain amount of independence with the control through the Oireachtas. After all, the Minister is responsible to the Oireachtas. In some of this debate that side of the matter seems to have been overlooked. A scheme like this presents the double advantage of keeping control and of giving a certain measure of independence to experts. If they do not produce results, the Oireachtas can step in again.
Arising out of the Minister's reply to the question put to him by Senator Stanford, I must say I was surprised, and a little perturbed, by his ready assumption that of course there will be a medical examination and that bad risks will be fairly ruthlessly removed. I should like to quote the relevant portion of the prospectus of the Western Provident Association of Bristol, which is one of the big British provident associations engaged in the same type of work. They say:—
"No medical examination is required, but a short medical history is asked for on the application form."
It will probably be the same in this case.
I should just like to finish the paragraph, because it appears necessary in certain instances, but only in exceptional circumstances would there be necessity for a medical examination. They say:—
"The Board of Governors reserve the right to call for medical evidence from the applicant's private doctor, or otherwise, at the applicant's expense, to reject applications for initial membership or for renewal, or to require special terms of acceptance or renewal;"
—and this is what seems important to me—
"but normally it is to be understood that once you are accepted into membership of the association you may remain a member for life. These conditions are necessary in the general interest of members but refusal to renew would only be exercised for the most exceptional reasons."
I should like to feel that the Minister could assure us that under this scheme any rejections would be only in the most exceptional circumstances, and not rejections of those generally regarded as a poor risk or not a very good risk.
I think that is so. I may have misunderstood the way in which Senator Stanford put it. I understood Senator Stanford to pose the question: "Is the insurance scheme to be available without regard to the state of the health of the individual?" In other words, is it to cover a person in chronic bad health? Of course it is not intended that that should be so, but the mode of approach would be very much along the lines which Senator Sheehy Skeffington has read out from the Western Provident Association scheme. A person offering to avail himself of this insurance would presumably be asked to give particulars of his medical history. If the board felt that further particulars should be given, arising out of a medical examination or otherwise, they would reserve the right to get them. Generally, I imagine the approach would be very much along the lines of the common practice with this kind of insurance throughout Britain.
I move amendment No. 1:—
In sub-section (1), line 10, to delete "four" and substitute "six".
Section 5 provides for the constitution of the board and I would ask the Seanad to bear in mind that what is being done here is laying down a maximum number for the composition of the board. I feel that the Minister is tying himself a bit too tightly in this respect. His approach, I think, and the approach of the board would be to get the widest possible membership of the insurance scheme, and I envisage there will be different group in the country whom the board would be anxious to bring in, such as the white collar workers, the farmers, and the self-employed people, and I think it would be desirable that all such groups should, as far as possible, have representation on the board. I think this would be desirable because it would help to get the group into the insurance. I also think it might be necessary and advisable to have other people on the board. It might be desirable to have a member of the medical profession; it might be desirable to have somebody connected with the voluntary hospitals—various people like that.
I notice that the commission which drew up the report had, I think, 20 members. I am not suggesting a board to run an insurance scheme should have 20 members but I think that the Minister is, as I said, tying himself too tightly in laying down a maximum of four with the chairman. I am suggesting that might be six and if the amendment is accepted it would not necessarily mean that the Minister would be obliged to appoint six. Indeed, if the amendment were accepted he could probably appoint whatever number he has already in mind to be members of this board, but I am suggesting it might be in the interests of the scheme itself that he should leave himself a certain amount of room.
It might be that after appointing a board he might find it possible to get another group of the community to come into the insurance scheme and if there was place on the board that could be filled from among the group, that would be helpful in the particular situation. That is why I put in this amendment and I hope the Minister will find it possible to accept it.
In supporting this and some of the following amendments, I may say my sole concern is to ensure that the board which is envisaged in the Bill should, at least as Senator Murphy rightly said, be representative. Frankly, I think that, for a scheme of this kind especially, it is very difficult to see how a board constituted as proposed under the Bill could be said to be in any sense representative.
We ought to bear in mind, in considering this section also, the fact that has been stressed throughout the whole course of the last stage of the Bill here and in the other House, that the scheme is intended to be, and that in fact, it must be, self-supporting. The Minister and the Department quite clearly would be against any suggestion of a subvention or anything else to help the scheme along. It has been stressed throughout the whole course of these debates that the scheme must, in fact, carry itself. That being so, we ought to bear in mind the fact that the people who will have to carry it will be the people contributing to the scheme and it seems to me at any rate only fair and just to suggest that the interests of the people contributing to the scheme and making it a success, if it is to be a success, should at least be adequately represented.
Frankly, I do not like the type of provision that appears to be made under this and some of the following sections. I want to point out that it would appear that, right from the very beginning, nobody but the Minister has any right to say who is going to sit on that board. How can we justifiably support that principle if at the same time we are saying to those people for whom the scheme is intended: "You will have to pay for it"?
I said on the previous stage of the Bill here that I did not think the Minister had any right, in fact, to go that far and I believe that in confining representation on the board to the very small number laid down in this section he is going a step further. I think the board will not be representative and cannot, and, in fact will not, be put in a position to do its job properly.
I should like to remind the Minister for a moment that, under the old National Health Insurance Scheme, there was a board which did a remarkably fine job under very difficult conditions but above everything else that board could be said to be representative. I took the trouble of looking back to know how the committee of management of the old National Health Scheme was contrived and I found it was comprised of a chairman, three trustees and three members' representatives all of whom were nominated yearly by the Minister. In addition, it carried three trade union representatives, again nominated yearly by the Trade Union Congress, and in addition to those, it carried five representatives of the insured persons elected annually from a panel of seven persons nominated triennially by local authorities.
In all, the board worked out on that basis at something like 15. I do not suggest that for the purpose of the new scheme such a large committee of management would be necessary. In fact I think I might make my criticism a little more in the other direction, that there might be a cutting down for two reasons; first, there will not be anything like the same wide representation of interests required for this scheme as for the old national health scheme: secondly, because it is also vitally necessary to try to keep the expenses of administration to the minimum in the case of the new scheme.
To me the Minister appears to be taking a tremendous amount of authority to himself under this Bill. I submit even at this stage he should reconsider precisely what is involved in the type of representation he has envisaged in this Bill. I would make a very strong appeal to him even now to reconsider the representation he intends to put on that board and to give at least some type of reasonable representation to the people who are expected to support the scheme itself.
I may say I have no very strong views one way or the other with regard to this amendment, but the problem that poses itself to me is this: should the board be representative of the different sections likely to avail of, or be interested in, health insurance? If it should be representative, then obviously there are a number of matters to be considered. Instead of being representative, the board might consist of four or five people who are regarded, on their merits, as best able to carry out this form of insurance. Those are the two methods of approach. The board, as proposed in the Bill as it stands, is not intended to be representative, as such, and for that reason the membership is suggested as a total of five.
If Senators think it is wiser to try to have a board more representative of the interests likely to be affected, then it seems clear to me that the membership would have to be increased, certainly by one or two. However, I am very concerned to ensure that the overheads—the costs of running this scheme—should be as low as possible. That consideration must be balanced, in considering this matter. If there is any general feeling in this House that there should be another examination of this matter, I will certainly do it.
As I say, I have no very definite view one way or the other in regard to this matter. I am anxious that health insurance will be a success. If it will make success easier to have a representative board, I will certainly make it representative. If, on the other hand, it is more likely to be successful by the appointment of five people whom I regard as being more likely to make the scheme a success, then I will do it in that way. However, I will certainly consider the matter very carefully if there is any general view in the House that it should be reconsidered.
Personally, I feel that this whole Voluntary Health Insurance Bill would have a much better chance of success with a small board. They are catering for a certain limited section of the community. I feel they would be much better fitted to make a success of it if they were people with a specialised knowledge in one aspect or another of the subject they are going to deal with, if the board is not representative. I do not think the insurance can successfully cover a large section of the community and I do not think large community representation is necessary for its administration.
As a result of any experience I have had of boards or boards of directors, I think a comparatively small board of more or less expert people is a very much more valuable and efficient working instrument than a rather large unwieldy board. I remember that the late Tom Kettle always said that in Ireland any gathering of more than three persons should be deemed to be a public meeting.
The Minister has made some very good points. In the first place, he said the board should be composed of those who are best able to carry out this insurance scheme. The amendment stands or falls on how one judges that qualification. Senator Cox's approach to it is, I think, that the people best able to carry out the scheme should be a small body of experts. I take the contrary view completely. I think the best qualifications these people could have would be the ability, by their position, to contact groups of the community and sell insurance.
I do not think they will need to be experts in insurance to be members of this board. I think, in fact, that that would be somewhat of a liability. I do not see how a small body of three or four experts, remote maybe from the groups of the community which should be members of this scheme, could possibly be the best people to run this insurance scheme. I do not want to press my viewpoint too strongly on the Seanad, but I should like to hear some other Senators make their views known on this matter.
My approach is that it would be better for the scheme that there should be people from various groups there, because, by being members of the Board of Management, they could have some effect in bringing in groups and in selling the insurance to the individuals in the groups.
The Minister made a second point, concerning the overheads. Here, again, I am in through agreement with him. I should hate to press on the Minister a larger board if, by doing that, we were to add to the cost of the premiums which would have to be paid.
The other amendments have not yet been moved but Senators will notice that there is a provision to eliminate remuneration for the members of the board. That is all I should like to say on the amendment. However, I would ask the Minister to give further consideration between now and the Report Stage to my viewpoint and also to the views expressed by other Senators. I hope he will agree with me that it would be safer for him to lift his maximum—not to tie himself too tightly. He may appoint six members at any time, but I think it would be safer not to tie himself down to a maximum of four.
Under Section 5, sub-section (3), the Minister has taken power to appoint a managing director of this Voluntary Health Insurance Board. I feel that one of the first essentials of the success of any State-sponsored body——
The board appoints the managing director.
Does the Minister not have to sanction the appointment?
Yes, but the board makes the appointment.
Will the appointment be, for example, by public advertisement?
I should imagine so, but that will be a matter for the board.
I feel it is absolutely essential for any State-sponsored company that they should have a first-class managing director or administrative officer.
On what section is Senator ffrench O'Carroll raising this point?
Section 5, sub-section (3).
I am afraid the Senator has the wrong copy of the Bill before him. There is no such thing in the Bill before the House.
He is not the only person to make that mistake.
The Bill was amended in the Dáil.
I have the Bill "as amended in Committee."
Is Senator Murphy withdrawing this amendment with the intention of setting it down on the Report Stage?
Perhaps there are some other Senators who would like to express their viewpoint.
I think an executive board would be far more likely to function effectively, as was said by Senator ffrench O'Carroll and Senator Cox, if the number is small. I think Senator Murphy's argument would be more feasible if he were speaking about a consultative committee of some kind.
I think Senator Murphy's amendment would not make much difference one way or the other. I agree entirely that this board should be a representative board. I think this board should be a business board —a body that would draw up a scheme which it would then be the duty of the board to see to it that it would be presented to the public.
Senator Crowley referred to the old National Health Committee and said it was a representative committee. I was a member of that committee for a short time, but I did not represent anybody on it. The people whom I would be entitled to represent had nothing to do with national health insurance at all. That was a representative board. The people who were represented had to pay, both the employers and the insured people—the people who paid and who were bound to pay.
I think Senator Crowley said something about the people whom we are talking about now having to pay. Nobody has got to pay under this scheme. I do think it would not be right to make the board completely representative because you will have to increase the board very considerably in order to give representation to all the different sections demanding it.
When referring to the representative capacity of the old National Health Board I thought I made it clear I was not suggesting that anything like that should be set up for the administration of this scheme. Whether I succeeded in conveying that to the House or not I do not know.
One or two aspects of this matter should be stressed. The first is that the people we expect to support this scheme should be entitled to and should be given some say in its management. I cannot see how they will have that if the power of appointment to this board is to be vested completely in the Minister. The principle is wrong and bad. I agree entirely with those Senators who say that the best type of board would be a small board consisting of people who would know something about the subject of voluntary health insurance.
In conclusion, I want to say if the amendment moved by Senator Murphy and myself is accepted I do not think it will depart from that principle in any way. There will still be a very small board. My only misgiving is that we are leaving the board too small. The amendment merely asks for an extension of the number of persons from five to seven and not any more than that.
Is it not the case that the amendment does not even ask for that? It does not ask to have it extended to seven. It asks that the Minister shall have power to appoint seven. It does not compel him to appoint seven.
If Senators think it worth while, I shall have the matter considered. I would have sympathy with the idea that, if it were possible to segregate consumer interests, they should be represented; but it is not a good analogy because members of the board will, of course, be subscribers. It would be very odd if they were not. I am sure they will represent the interests of consumers, too. I shall have the matter considered and see if anything further can be done about it.
I move amendment No. 3:—
In sub-section (1), line 17, before "to" to insert "of whom at least one shall be a woman".
It seemed to me, in setting up such a board as this to arrange a scheme for a large section of the public, that it was not too much to ask that one of these five people should be a woman. I do not think it would be a good thing to say that there should be an exact or large proportion of the places reserved for either sex, but I think it would be a mistake to allow a board of five men to be set up. There is a tendency in this country to remember women only in the appointment of boards which are fully voluntary. They get plenty of voluntary work to do, on committees of all kinds, not merely minor ones but some major ones, too, but when it comes to paid positions somehow the women members of the community are forgotten.
I notice in the Advisory Body itself the Minister appointed one woman out of 20. That seems to me to be too small a proportion and it was lest the Minister might overlook altogether the claims of women to some representation upon this board that I thought it worth while putting down this amendment. I think it is true that women might have a special attitude towards such a voluntary health scheme. Apart entirely from the question, which presumably will be debated by the new board, as to whether there shall be a maternity benefit or not, women would have perhaps a more special view of the benefits to be allowed for dependents in general, whether they be children, the wife and so on. Therefore, it seems to me not unreasonable to ask that at least one of these five members shall be a woman.
I should like to support Senator Sheehy Skeffington in asking that at least one woman be appointed to the board. I think a board of this kind would be singularly incomplete if it did not include a woman member. I rather thought indeed it was in the Minister's mind that a woman would be selected for the board but perhaps it would be wiser to be assured on that point by having it included in the Bill if that is possible.
May I express the hope that anything I say on this matter may not be interpreted as being in any sense anti-feminist? It is not intended to be so. I would, however, draw Senators' attention to certain aspects of this matter. I cannot see, in relation to health insurance, that there is either a masculine approach or a feminine approach. There is a human approach. The concern is to provide under insurance a cover in relation to ill-health of a varying kind which affects all of us. It appears to me to be a little bit odd to provide that in a board of that kind at least one shall be a woman. One might as well say that at least one shall be a man; it is equally logical. If it were provided in that section that one member of this board should be a woman, then the Minister for Health is asked to consider should that woman be single or married.
A single woman might have an interest in certain aspects of the health services. She might not have any familiarity with other matters arising in relation to health services. If a single woman were appointed, it might be suggested that the appointment of such a single woman was wrong and that what was really needed was the appointment of a mother of a family. We all know that the mother of a family has, in common with her husband, a wide knowledge of the ordinary vicissitudes that affect a family. I do not think, as such, she would add any particular knowledge to the deliberations of the board. Indeed, one is driven to the conclusion that if one has to appoint a woman, as such, one can only expect that woman to contribute her own views, her own experience and her own interests as an individual to the deliberations of the board as a whole. She cannot bring to it any particular feminine or feminist approach because I do not believe such an approach exists in relation to health services.
The need is, after all, a common one. Illness affects all of us, irrespective of sex. It is the concern of all of us to see that health services are improved, both for men and for women. For the life of me, I cannot see what particular approach a woman could bring to the deliberations of the board. I think the section should be left as it is and, in considering membership of the board, if there is a woman in relation to whom it is felt that she can contribute to the operation of the scheme, then by all means let her be appointed. But she must be appointed because she can contribute as an individual and not because she is a woman and not because she is either married or single. Indeed, I do not believe that is a worthwhile avenue to travel on. While I consider this amendment is not a good amendment and I must, therefore, be against it, I am against it not because I am in any way anti-feminist —I am not—but because I think it is inappropriate to consider such a matter in relation to a board of this kind.
The Minister advises us to look at this from a human point of view rather than from a merely male or female point of view. While I admit the logic of his remarks up to a certain point, it must be remembered that there is a whole range of illness peculiar to women and a whole range of problems connected with motherhood, for example, which are mainly of interest to women. For that reason, he might perhaps depart a little from his rather too rigid logic in this respect and accept the amendment.
Then, surely, if one travels along the line suggested by Senator McHugh, one will have to amend the amendment to read that "at least one shall be a married woman."
I will leave it to the good sense of the Minister if there is anything at issue in that.
One would very quickly find areductio ad absurdum entering into our deliberations then.
The Minister has made an intelligent case, but he has not made an unanswerable case. I am always a little suspicious when I hear someone beginning with such a phrase as "I am not anti-feminist but", and the Minister has told us that he does not believe that there could possibly be a masculine or a feminine point of view in a matter like health or health insurance. The Minister says we are all human beings and that one might just as well have an amendment saying that "at least one shall be a man". My contention is that in Ireland to-day there is no need for such a phrase as "at least one shall be a man" because this is an essentially masculine society in which the man is never forgotten but, when it comes to paid appointments, there is a very serious danger indeed that woman, however expert, will be quite forgotten. I shall observe with interest the names of the four or five people who will be appointed by the Minister to see whether or not in practice woman, however expert, has been forgotten.
It was for the purpose of reminding the Minister, shall we say, that there is this other half of our society that I put down this amendment. It is not an unreasonable amendment. It does not preclude the Minister from appointing a single woman, a married woman and a widow. There is no reason why all five should not be women, under my amendment, if the Minister considers them to be of sufficient merit. The purpose of the amendment is to prevent him forgetting women altogether, and I suggest that that is precisely what he will do unless we pass this amendment now, for all his public declaration that there is nothing anti-feminist in his views. He has said—and this is of course a principle to which we would all subscribe—that these members will be appointed because of the contribution they can bring and not because they are either men or women. I suggest that the women, many of them, could bring a very important contribution to the deliberations of the board. I suggest they will nevertheless, in fact, be forgotten simply because they are women. It is for that reason that I should like to see this amendment passed.
I note incidentally that the one reservation in the report is on maternity services. It is a reservation made by two men! I should like to feel that when that particular aspect is being discussed by the new board in relation to the new scheme, there would be at least one woman present on the board. I must press this amendment for that reason.
I should like to remind the Senator that, in relation to maternity benefit, which is designed to cover expenses contingent upon maternity, the male has a very deep and vital interest because he has to pay the bill.
I have not suggested he should be excluded.
Might I ask Senator Sheehy Skeffington to take one problem at a time? We have a Voluntary Health Insurance Bill here, a Bill of which it will be very difficult to make a success. The criterion for election to the board should be who is the most competent. I do not mind whether the board is constituted of men or women or men and women. I appreciate the problem in relation to women in the country as a whole, but I think we can put that right in another way rather than by merely putting a woman on this board simply because she is a woman and irrespective of whether or not she is suitable.
I do not agree that the entire and sole interest in relation to maternity should be regarded as a masculine interest. The Minister has spoken as if he knows all about maternity, because he pays the bill. I do not think that is true, but I am afraid that it is essentially the masculine point of view.
No, but the pain in this case is the paying, and that is the pain with which we are concerned.
- Bergin, Patrick.
- Carton, Victor.
- Crosbie, James.
- Davidson, Mary F.
- Hickey, James.
- Kelly, Liam.
- McHugh, Roger J.
- Murphy, Dominick F.
- O'Donnell, Frank H.
- O'Sullivan, John L.
- Sheehy Skeffington, Owen L.
- Tierney, Patrick.
- Tunney, James.
- Barniville, Henry L.
- Burke, Denis.
- Butler, John.
- Cogan, Patrick.
- Commons, Bernard.
- Cox, Arthur.
- Crowley, Patrick.
- ffrench O'Carroll, Michael.
- McCrea, James J.
- Mannion, John.
- Meighan, John J.
- O'Brien, George.
- O'Connell, Thomas J.
- O'Gorman, Patrick J.
- O'Keeffe, James J.
- O'Reilly, Patrick
- Guinness, Henry E.
- Hartney, Seán.
- Hayes, Michael.
- Hayes, Seán.
- Kissane, Éamon.
- L'Estrange, Gerald.
- Lynch, John.
- Lynch, Peter T.
- O'Sullivan, Ted.
- Ruane, Seán T.
- Ruane, Thomas.
- Sheridan, Joseph M.
- Stanford, William B.
- Teehan, Patrick J.
- Walsh, Louis.
- Woods, William.
Perhaps the Seanad would agree to discuss amendments No. 4 and No. 5 together.
I move amendment No. 4:—
In sub-section (5), line 32, to delete "remuneration" and substitute "fees for attendances".
When I spoke on the Second Reading of this Bill I criticised to some degree the fact that here we were setting up a board to conduct voluntary health insurance, that we were providing remuneration for the members of that board, the fixing of allowances for them, and that we were in fact providing no finances whatever to meet those costs. I suggested that the scheme, if it were to be successful, should have as low premiums as possible.
The purpose of this amendment is directed towards that end—to reduce to some degree the administrative cost of the scheme. I suggested it would be quite possible to get a board to run a voluntary health insurance scheme, the members of which would be prepared to do the work without remuneration. I suggest that, instead of remuneration, there should be fees for attendances at meetings of the board, those fees to be set out by the Minister, together with any other allowances for expenses that might be incurred. I am not suggesting that the board should be one whose members would do this work and be out of pocket at the same time. I am suggesting that you could get a board who would do this work competently and who would not require a fixed salary in order to do that work. For that reason I put down this amendment which, I hope, will be accepted.
I should like to oppose the amendment in so far as it seeks to substitute the word "fee" for "remuneration". It seems to me that in any body of this kind members really do their work not perhaps at meetings but over a period of time. I believe the idea that people who are being paid just because they attended meetings is wholly wrong. In all boards of this kind a great deal of the work may have to be done outside meetings, and I think it is quite a silly thing to suggest that because a person went to meetings, and possibly took no part in the discussion or did no real work, he should be paid a fee for attendance. I quite agree there is a lot to be said for people acting without remuneration, but, if there is to be remuneration, it should be in respect of the work done and not in respect of attendance at meetings.
Since I understand that we are taking amendments Nos. 4 and 5 together, I suppose I am in order in discussing my amendment, No. 5, at this stage. My amendment goes a little further than Senator Murphy's because I am asking that the members of the new board, though they be paid expenses, shall not be paid remuneration. I have a consequential amendment, No. 8, which could also be discussed here. I shall speak on all these amendments now. First of all, I feel very strongly— and I think Senator Cox has indicated his sympathy with that view—that the board should be a voluntary board.
In this country we have a large number of public-spirited people with expert knowledge who are anxious to see such a scheme as this work and work in the best possible way. I believe they would be quite proud, and consider themselves privileged, to work on the board in a voluntary capacity. It would be unjust, of course, to expect them to be out of pocket; therefore it is, I think, legitimate to suggest that their expenses be covered to a moderate extent. To suggest that they should be remunerated is, I feel, wrong and against the whole spirit of the scheme.
When speaking on the Second Stage of the Bill, the Minister spoke a lot about self-reliance and the necessity for the scheme running itself. He is very anxious that the scheme will succeed. By imposing this comparatively small burden, but none the less burden, he is militating against the hopes of the scheme succeeding, and I feel that he is rather changing the character of what could be a striking example of voluntary effort. After all, we have in this country a long record of voluntary service in relation to health matters. Our voluntary hospitals yield pride of place to the hospitals of no other country. The medical staffs in all cases and the voluntary boards for long years have been acting in a purely voluntary capacity.
I believe the Minister would, at least in principle, agree with me that it is one of the good things in our society, that we can get such committees to give long hours of service to the public good for no fee or reward whatever. I am disappointed therefore at the fact that he contemplates in the Bill having remunerative posts on this board. The work and record of the voluntary hospital boards, including, I may say, a large number of women, are such that one can affirm the work of this board would be extremely efficient though unpaid. I am tempted to suggest that perhaps the object of my previous amendment might indeed be brought about if this amendment were accepted, because, if the posts were to become voluntary, perhaps the masculine prerogative of sitting on the board would not be so exclusively exercised; we might find a larger proportion of women on the board.
In relation to amendment No. 4, its object is that fees for attendances would be paid. I personally would prefer my amendment; I feel it goes further, though I should say that I prefer Senator Murphy's amendment to the Bill as it stands at present. I am a little doubtful, though, whether it would be wise to accept this principle of fees for attendances. If we in the Seanad were to be paid, say, 20 guineas a sitting I do not know what kind of effect it would have. Perhaps it would save the State a lot of money, though it might well result on the other hand in an unusually crowded House. I may say that the two Senators associated with amendment No. 4 have very good attendance records. I cannot think of a meeting at which Senator Murphy has not been present. Senator Crowley is also a strong attender. But look around the Seanad and see at the present moment about 22 Senators. Admittedly, just now we had 45 Senators present for a division, but they vanished away after the hurly-burly of the vote, and so we have the usual 20 Senators present out of 59. In the public eye, perhaps, we might look a little odd if we were to insist upon the principle of "fees for attendance" on certain committees when perhaps we would not like to accept it for ourselves. Related to that is the point made by Senator Cox that much of the hard work of any committee or deliberative assembly such as this House is done outside of the committee or Parliament itself. Consequently we might be applying a principle here which we would not like to see, as it were, senatorially applied. Therefore, I would press rather my own amendment, that the principle of remuneration be removed altogether from this Bill. That is the purpose of the fifth and eighth amendments here. If that is rejected, however, I should feel nevertheless that "fees for attendance" would be better than just "remuneration".
I should also like to ask the Minister a question which I had asked him on the Second Stage, but to which he did not find time to give an answer, that is, what order of magnitude has he in mind for the remuneration of the members of the board? Will they be considered as full-time or part-time? It is quite obvious their work will be considerable in the opening months, and that after that it will be, relatively speaking, routine work. Would the Minister tell us what order of magnitude he has in mind, when he speaks in the Bill of remuneration as well as the payment of expenses to members of the board?
I do not think the first amendment would be entirely acceptable for the reason that has already been given by Senator Cox. In many of these cases, as we know from experience, a lot of good work could be done by a member of a board who would not be present at all the meetings, and it could also happen that a member of a board of the kind envisaged here could be present at all the meetings and do nothing more. That is why I am not entirely in favour of amendment No. 4.
The substitution of the words "fees for attendance" for "remuneration" might give rise to other consequences, say, as regards income-tax. I do not know how fees for attendance would be calculated for income-tax purposes. They might be regarded as travelling expenses in the end. In any case, I for one would not be in favour of the substitution of the words "fees for attendance" for "remuneration" for the reasons that have been given.
As regards amendment No. 5, standing in the name of Senator Sheehy Skeffington, that is a different proposition altogether, and I must say it is an amendment that is deserving of consideration. If it is a fact that there are public-spirited people in this country who can be got to do this work, the work of the board, without fee or reward, I do not see why they should not be got. I believe there are such people here. The mover of the amendment has referred to hospital boards, and there are many boards and committees operating in the country without any remuneration. All over the country, for instance, you have vocational education committees, and so on, doing very important work, attending frequent meetings, without a single penny of remuneration.
That is a different principle. We shall come to that later on. What we are dealing with here is the question of remuneration. I would suggest to the Minister that this is an experimental measure. There has never before been a voluntary health insurance service in this country and we are bound to look at every side of the picture. If public-spirited individuals, men or women, or men and women together, can be got to be members of this board and carry out the policy the Minister has in mind, I do not see why we should not try it.
I find myself in agreement with Senator Cox, Senator Sheehy Skeffington and Senator Kissane when they say we ought to consider the question of having this done on a voluntary basis. It is possible that the Minister envisages an executive board which will have a considerable amount of work to do, but it would be a pity if we were to lose sight of the voluntary principle. There was reference made to the Seanad. Sometimes I think the Seanad might be even more effective if it were run as a voluntary system but that is another matter. Voluntary service is by no means a thing of the past in Ireland and if it could be extended in connection with this Bill it would be a very desirable provision. On the other hand, I suppose if you do ask a man to come say, from Cork or Kerry, and he spends several days of the week away from his profession, business or occupation, and you tender him no remuneration, not alone is he giving voluntary service but he is at a loss.
He would get his travelling expenses. Furthermore, all the meetings need not be held in Dublin.
The only people then who would get the opportunity of doing voluntary service without incurring too much loss to themselves would be people who reside in Dublin. That is the rather peculiar slant that it takes. I can envisage a man who might reside in Kerry spending a day travelling to Dublin and another day travelling back and spending two or three days here, so that the best part of the week would be gone. However, if the Minister would consider bringing the principle of voluntary service into this Bill, I think it would be a great advance and I agree with the Senators who spoke about it.
Does a great deal not depend on just what this board is going to do? If the insurance company or insurance society is going to have a managing director who can really run the whole thing himself with an adequate staff and if this board is to be an advisory and consultative board, I think it would be very wrong to pay them any considerable salary. However, if the members of this board are to be the equivalent of a really good managing director then they deserve a good salary and I do not think we will get good service at the managerial level unless we pay good salaries. Perhaps the Minister would give his opinion on that. Does he want four really hard-working managing directors or a consultative board? If he gave us his opinion, then perhaps we would be clear about how we should view this amendment.
I presume the job of the chairman, who will be a member of the board, will be nearly whole-time, and if you are to say that the board is not to receive remuneration, then the chairman cannot receive remuneration, either. I imagine the board will consist of experts in insurance and it seems rather unfair to ask those to give their time without paying them. I know that one can get people to act in an unpaid capacity on hospital boards and I myself have been a member of a hospital board for some years, but that is a totally different thing. I think it would be a mistake if the board were not remunerated.
I am supporting the amendment and I am rather surprised at some of the statements to the effect that we could not get people to serve on this board. Senator Murphy referred to fees and allowances. A man might lose a day's wages and I think he should be recouped that loss in wages and his rail fare. You are killing the spirit of voluntary insurance if you start off by paying the board a yearly salary. I have in mind the service that was given by the board which dealt with national health. There are several other boards and I am not entirely in agreement with Senator Kissane that one could not get the type of people in insurance companies to come——
I did not say that.
I am sorry; I thought you did. I would like to hear what the Minister has in mind when he talks about remuneration. Are the members going to be experts in insurance? Then, I am afraid we are going to build up an insurance system very far removed from a voluntary system. I know it is experimental and I am not very optimistic about this voluntary system of insurance, but I am prepared to give it support. I do think, however, that we should not pay a salary to those on the board.
There are two different proposals suggested in the two amendments. Perhaps I should say, first of all, in order to make things clear to the Senators, that my idea with regard to the board is that it should consist of a chairman and four members, who are ordinary members at the moment. The board, having been constituted, will appoint a general manager who will be the executive officer of the board and who will require to be a very skilled and experienced person, possibly having considerable managerial experience elsewhere. The chairman and the members of the board will ordinarily be part-time members, but a case might be made in the initial stages that the chairman might be full-time for a period. That is a matter that would depend on what initial work would have to be done. In normal circumstances, all members would be part-time members.
It is suggested by Senator Murphy that such members be paid fees for attendances and I assume the Senator has in mind attendances at meetings of the board. Obvious difficulties arise straightaway. One has to ask oneself the question: "What constitutes a meeting of the board?" For instance, as might arise, is a visit to the Department of Health to discuss matters of concern to the board, to be regarded as a meeting of the board? If a member of the board is asked, as members may be asked, to conduct a particular inquiry in the interests of the board's functions, could that be regarded as a meeting? If not, is such a member prepared to do that work without any remuneration at all? It will be appreciated that to remunerate members merely because they attended a meeting is to remunerate them without due regard to the contribution they are supposed to give to the success of the scheme. A member may attend a meeting, he may "clock in" and sit there like a bump on a rock without opening his mouth or saying a thing and he will draw his fees because he is given thequid pro quo——
I take it there will be more regard to the selection of members than that.
I am just giving an example. Members of the board will have to study very carefully the problem of health insurance and the manner in which it can be operated and they will have to do a considerable amount of work, apart altogether from meetings. Meetings generally may represent the result rather than the occassion for the result, of the efforts of the members of the board and I feel that to consider remunerating them merely for their attendance at meetings is not a realistic approach. In that regard, I would endorse what Senator Cox has said. In my opinion, members should be paid, as remuneration, some fixed sum. Senator Sheehy Skeffington feels that it should not exceed £50 per annum in respect of each member.
On a point of personal explanation, my point was that there should be no remuneration but that expenses should be allowed to a maximum of £50.
Some Senators have mentioned this already, and I think we must bear in mind that it would be a grand thing if everything was perfect in our society, if members of boards such as this gave their services out of a sense of duty to the people, but, in fact, many people are not free or able to do so. A great number of people find it hard enough to discharge their ordinary duties and to make ends meet, without taking on additional responsibilities which, in time, would involve them in considerable personal expense. If this board were to be a board on which no payment was made, or merely a token payment made in relation to expenses, I feel that inevitably the selection of members would be confined to those who could afford to go on it. It is that precise consideration which in other days led to the remuneration in the way of expenses of members of the Oireachtas. I do not think it is desirable, however fine the motives, that we should, in effect, provide that membership of boards such as this should be open only to those who can afford such responsibility.
I would remind Senator Sheehy Skeffington that if two or three members of the board living in one of our provinces—I might say straight away that I believe meetings of the board must be held normally in Dublin—had to come from the west, the south or the north, they might find themselves involved in an expenditure of something like £5 or £6 per attendance at meetings of the board. It will be appreciated that at the initiation of the scheme very frequent meetings will be necessary in order to get the scheme going.
I think Senators will appreciate that in proposing to the Oireachtas this legislation, I am doing so in the hope and conviction that it will be a success. I will not do or encourage the doing of anything which would militate against the success of the scheme. For that reason, in relation to remuneration, I will be as concerned as any member of this House to ensure that whatever remuneration is paid will in no sense affect the success of the scheme. At the same time, I want to feel there will be available to the board the services of people who could contribute to the success of the scheme.
I feel that either of the suggestions made here would confine, in practice, the membership of the board and that would not be desirable. I think the Bill should be left as it is, on the understanding which, I think, can be fairly accepted that neither I nor any other Minister for Health will fix remuneration at such a point that the effect would be to interfere with or injure the scheme itself. At the same time, I think the remuneration should be such as to make it possible for any person whose services I feel are needed to give those services and thereby contribute towards the success of the scheme.
I did not like to interrupt the Minister a second time. I feel, however, that what the Minister said about the expenses of members coming to a meeting was related to amentment No. 6 which has not yet been looked at, my own amendment about restricting expenses to £50 a year, rather than to amendments Nos. 4 and 5, because my amendment, No. 5, asks for the deletion of "remuneration", but it does not ask for any limit on the expenses. When the Minister speaks of a member of a board incurring expenses to the sum of £5 or £6 in order to attend an individual meeting, I feel that is not relevant to our suggestion that there should be no remuneration or that remuneration should be for attendance at meetings.
I understood that we were discussing all the amendments together.
We are discussing amendments Nos. 4 and 5 together. Amendments Nos. 7 and 8 are consequential.
That is what I understood. I think amendment No. 6 is of a separate type, if you like. Therefore, if the Minister were to persuade me that, at the beginning, the amount of expenses necessary for a member might be more than £50 in a year, I would be inclined to drop amendment No. 6, but I do not think that has anything to do with my contention that they should get expenses and not remuneration. I do not think that point has been met by talking about expenses.
The Minister tried to meet it by suggesting that some people might be kept out of such service to the community because they could not afford to do it. I am not convinced by that argument because, as several Senators said, various committees, councils and boards throughout the country have got precisely that kind of voluntary service from admirable people. You have the corporations, county councils and vocational education committees.
They are all elected bodies.
They are all elected bodies, but the service is voluntary. It is very considerable and, although travelling expenses are allowed in certain cases, they are not allowed in all. They are, in fact, minimal. There is quite a bit of out-of-pocket expense.
I was a little perturbed by the fact that the Minister omitted once more to take us into his confidence as to what order of magnitude of remuneration he has in mind, because, if it is to be a nominal sum, I should not feel so strongly about it. If this is going to be "a fat job," then I feel very strongly that we should insist on the voluntary principle being observed. The Minister has not really taken us into his confidence at all. He said he is not going to pay too little, but he did not even give us an idea of the order of magnitude involved, though he has said that he regards these people as working part-time.
It is obvious that there will be a big difference between the early months, in which they will have to work very hard, and the subsequent months and years, during which the scheme will more or less run itself, if it runs at all. I have my own doubts about that, but it is obvious that the amount of work required of these members will be considerably more in the opening months than ever again in relation to this scheme, once it is established. I should feel most uneasy at a rate of remuneration being calculated on the kind of work demanded of those men and women in the first few months of the existence of the board. I should be inclined, therefore, to press amendment No. 5.
I had hoped that at least the Minister would have converted Senator Sheehy Skeffington towards my amendment, because he made the point that if the member of the board was paid only expenses, only those who could afford to take the responsibility would be members. The idea behind my attempt to provide for fees for attendance is simply that one may have on this board salaried workers. They may be people who, because of attending meetings, would lose a day's pay. Surely it would be quite wrong that such people should be asked to take the responsibility and lose their salary for the days they would attend the meetings. They could not afford to take responsibility on that basis.
That is why I said that, as well as the expenses involved in travelling from one end of the country to the other, they should be paid fees for attendances. The Minister was rather critical of that. He said there would be difficulty in defining what exactly attendances were. I cannot claim to be an expert on that matter, but I am strengthened by the fact that, as Senator Hickey reminded us, the old National Health Management Board were paid some fees for attendances. Some of those were ordinary workers who came to a meeting and lost a day's pay. There were some fees for attendance. There should not be any great difficulty in deciding what exactly a meeting is and in what circumstances fees should be paid. That is why I had hoped that Senator Sheehy Skeffington would come behind me and say that it is quite fair that people who take the responsibility of membership of this board should be paid a fee for attendance.
I do not want to enter into a discussion on the big principle as to whether or not people appointed to boards and bodies should be paid remuneration. What I am concerned with here is that this is to be a voluntary health insurance body and that there is an attempt to lay down in legislation that they should be paid remuneration but at the same time we are not providing that remuneration, as it will have to be paid for by the contributors in premiums. That is why I say we should see how we can make the premiums as low as possible, without doing an injustice to the people we are asking to come on the board to manage the concern. Therefore, I hope that even if the Minister will not agree with me, at least Senator Sheehy Skeffington will agree that my amendment is the better one.
There are three types of payment referred to in this debate— remuneration, fees and expenses. In objecting to remuneration, Senator Sheehy Skeffington thought out a rather novel method—to pay them expenses but make the expenses so substantial as to be equivalent to remuneration. In my experience, expenses are something which are pretty well known definitely. A person gets first-class travelling expenses or a motor-car allowance and a subsistence allowance per day. If one were to suggest that the travelling expenses should be increased above the normal and that a man be paid £10 or £20 subsistence allowance for the day, surely that would be a ridiculous suggestion. If they are to be expenses, they will be just the ordinary expenses which a higher civil servant would get if travelling on the same kind of business. Therefore, that would not be a remedy for this problem.
There are very many public-spirited people in the country who are prepared to do public work, I agree, but the kind of work they do is philanthropic or social work. This is not a philanthropic association and, although it is making arrangements for a voluntary scheme, one must remember that the "voluntary" part refers to the people who will be paying and joining in the insurance scheme, but it is not a voluntary board. I do not think we will get the type of people the Minister has in mind he should appoint to this board, purely because they are public-spirited people who are ready to do this work.
I want to stress this especially. It was mentioned, I think by Senator Sheehy Skeffington, that, as this is an experimental business, we should try it out on a voluntary principle. Because it is experimental, that is the very reason we cannot afford to take any risks. If it is tried on the voluntary principle suggested here by him and if it is a failure—as it might well be a failure just because of that—then we may bid good-bye to the possibility of ever having a voluntary scheme again. Therefore, what is in the Bill is preferable to the other schemes mentioned and I would be prepared to support it.
Are the amendments being pressed?
I wonder if I might press the Minister, before I press the amendment, to tell us the order of magnitude of remuneration he has in mind.
I could not say that because, frankly, I have not considered it. I know it was raised here on the Second Reading and may have been raised in the Dáil. Deliberately, I have not considered that and will not until the legislation is through. Indeed, even at the moment it is not clear what would be the eventual size of the board. I assured Senator Murphy on another amendment that I would have to consider that again. I have not any views, except that whatever sum will be paid will be as small as possible, paying due regard to the need there will be to enable persons to act on the board. I could not mention the size of the remuneration.
In view of what the Minister has said as to his intention to give us an idea—I presume between this and the Report Stage—as to what the constitution of the board will be, would it not be reasonable also to request him to consider the advisability of making up his mind, in conjunction with arranging the personnel of the board, as to what the remuneration of the members will be? Could he not do that between now and the Report Stage?
No, I will not be in a position to do it.
Therefore, we are being asked here this evening to sign a blank cheque, as it were?
Certainly. The Oireachtas has been asked to do that many times.
What we are being asked to do is to agree that the remuneration be fixed by the Minister, in consultation with the Minister for Finance. Those of us who have had experience of the Department of Finance are aware that, whatever they do, they will not fix remuneration too high. Senator Sheehy Skeffington can be assured that if he were dealing with it as a Minister, his figure would be higher than that to which the Minister for Finance eventually would agree. He can be sure of that.
This is a different point altogether which has been brought in by Senator Hayes. No doubt, if there is to be consultation with the Minister for Finance as to the expenditure of any money out of the Treasury——
Any money anywhere.
——there will be slowness or hesitation on the part of the Minister for Finance; but remember that this money will not come out of the Treasury. It will come out of the pockets of the people who will be insured.
The Minister for Finance has a very deep interest, as he is making two loans to this board and has to be concerned to see that he will get the money back.
Surely Senator Kissane's own administrative experience has taught him that the Minister for Finance is interested in all kinds of payments and is particularly interested that no precedents be made which could be used against him for the remuneration of Government servants. Even though that money does not come out of the public Treasury, there is no doubt in my mind—we regard it as a rather melancholy fact, but it is a fact anyhow—that the Minister for Finance will keep this figure to the lowest possible amount, consistent with getting the kind of service which he wants, and which, as Senator O'Connell points out, is not service in a philanthropic way, but service of a specialist character.
Arising out of what Senator Hayes says, I wonder —although we have not succeeded in getting an opinion from the Minister— could we get some opinion from Senator Hayes on whether this "lowest possible amount" is to be £200 or £1,000?
This is all very childish. Senator Hayes is not employing the people and he would not know what kind of people they will be, but I would like to express my complete faith in the Minister for Finance who is in charge of it, to keep the figure as low as possible and lower than Senator Sheehy Skeffington would keep it if he were in power.
The Chair intends to put this matter to the House now.
Might I just suggest that we have the power in this House to make the sum nought by passing my amendment?
It is now proposed to put the matter to the House and I want to draw the attention of the Seanad to the procedure. There are two amendments, Nos. 4 and 5. They have been discussed together and it is now proposed to put the question in this form: "That the word proposed to be deleted stand part of the Bill". Is Senator Murphy asking for a division?
I take it we will divide separately on 4 and 5?
Should the occasion arise, yes.
The occasion will not arise.
- Bergin, Patrick.
- Butler, John.
- Cox, Arthur.
- Crosbie, James.
- Douglas, John Harold.
- Guinness, Henry E.
- Hayes, Michael.
- L'Estrange, Gerald.
- Lynch, John.
- McCrea, James J.
- Mannion, John.
- Meighan, John J.
- O'Brien, George.
- O'Connell, Thomas J.
- O'Gorman, Patrick J.
- O'Keeffe, James J.
- O'Sullivan, John L.
- Ruane, Seán T.
- Tierney, Patrick.
- Woods, William.
- Burke, Denis.
- Carton, Victor.
- Cogan, Patrick.
- Davidson, Mary F.
- Dowdall, Jane.
- Hartney, Seán.
- Hayes, Seán.
- Hickey, James.
- Kelly, Liam.
- Kissane, Éamon.
- McHugh, Roger J.
- Murphy, Dominick F.
- O'Reilly, Patrick.
- O'Sullivan, Ted.
- Ruane, Thomas.
- Sheehy Skeffington, Owen L.
- Teehan, Patrick J.
- Tunney, James.
- Walsh, Louis.
Amendments Nos. 7 and 8 are consequential and will not be moved.
The Minister for Health is in the position that he has a very important public appointment to-night. Therefore, he is desirous of having the further consideration of the Committee Stage of this Bill adjourned until the next sitting day. That would mean that at 7 o'clock we would take the other Bills, that is, beginning with the Statute of Limitations Bill and going on to No. 3.
I do not know what Senator Hayes is proposing.
The Minister for Health has a public engagement for this evening. It is desirable, therefore, to adjourn the further consideration of the Committee Stage of this Bill until the next meeting of the House. I accordingly move that the further consideration of the Committee Stage of this Bill be adjourned until the next sitting day and that, on resuming at 7 o'clock to-day, we consider the Statute of Limitations Bill, when the Minister for Justice will be present.
On a point of order. Am I correct in thinking that amendment No. 6 has still to be dealt with?
What is meant by the next sitting day? Is it to-morrow?
If we sit to-morrow, yes, and if we do not sit to-morrow, the next sitting day.
Business suspended at 6.5 p.m. and resumed at 7 p.m.