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Seanad Éireann debate -
Wednesday, 30 Jan 1957

Vol. 47 No. 3

Voluntary Health Insurance Bill, 1956—Report and Final Stages.

Before we take up consideration of the amendments tabled for this Bill, it would be well if I indicated that there are certain amendments which I consider out of order. These amendments are Nos. 1 and 2.

I consider Nos. 1 and 2 out of order because they did not arise out of proceedings in Committee as laid down in Standing Order No. 83. The Senator has been notified accordingly.

I should also like to add that the Government amendments which have been circulated have been withdrawn.

I move amendment No. 3:—

In page 3, line 10, to delete "four" and substitute "six".

This is the question we discussed on the Committee Stage as to whether it would be desirable to increase the maximum number the Minister proposed to appoint to the board to what I consider a more appropriate figure. The arguments have been covered on the Committee Stage as to the desirability of having, instead of a small executive type of board, a larger, more representative board. Whilst I was not in any sense advocating a representative type of board, I thought it might be desirable that the Minister should have power at a later date may be to increase the number on the board in order to encourage another group or large section of the community to come under the Bill. The Minister promised to consider the matter between the Committee and Report Stages and the amendment is now down for this stage of the Bill.

There is not very much I can add to what Senator Murphy has said. I do think the Minister was very fair in promising us on the Committee Stage that he would give this matter full consideration. Let me stress that I do not think any of us were envisaging a very large, unwieldy type of board, but we do think the representation permitted in this section of the Bill seems very limited. I hope, therefore, the Minister will at least give the House the benefit of his views as to why he does not consider it possible to extend it to the small extent we propose in the amendment.

As I undertook, I have considered this matter carefully and have come to the conclusion that the board as proposed in the Bill should remain a board of five and not be a purely representative board. It seems clear that the issue that arises in this matter leads to two quite diverse conclusions. If it were decided to make the board a representative board, there would be no end to the interests that should be represented in the membership of the board and that would lead inevitably to a board of such size that, apart from its cost, it would be unwieldy and perhaps unmanageable.

I feel that a smaller type of board is the better one in the circumstances. It will consist of a chairman and four ordinary members who will have the responsibility of putting this scheme into operation. I feel that the consumer interests will be fully protected by the members of the board themselves and in addition by the Minister for Health, who will have a large responsibility in ensuring that the benefits under this scheme are in accordance with the directions he gives. Accordingly, having examined the matter very carefully, I feel that the balance of argument is in favour of leaving the board as suggested in the Bill and accordingly I cannot accept the amendment.

Amendment, by leave, withdrawn.
Amendment No. 4 not moved.

I move amendment No. 5:—

In page 7, line 29, before "which" to insert "or agreement with a provident association".

I should like to remind the House of what lies behind this amendment. The 1936 Insurance Act prevented all citizens of this country from taking out insurance against illness or accident with any other than a licensed company. In fact, between 1936 and the present time there was only a single licensed company for two years only. For the remaining 18 years it was impossible for a citizen of this State legally to insure against accident or illness—an extraordinary situation. The Minister told us on the Committee Stage that the Minister for Industry and Commerce, and I would agree, turned the "Nelson eye" to breaches of the law, realising that it was impossible for a citizen to insure legally, and did not prosecute.

As I mentioned to the House at the last sitting, there was another solution before conscientious citizens of this country who wished to insure themselves and their families against illness and accidents. May I emphasise that moral and spiritual leaders of this country have been urging the necessity and the duty of entering into such insurance? As a result of such urging and as a result of natural prudence, some citizens adopted a course which they did not consider to be illegal. They entered into membership of a provident association. As a result, from 1936 on, some citizens of this State have been reaping very considerable benefits.

The point at issue is this—was membership of a provident association prohibited under the 1936 Act? I know that several lawyers take the view that it was not prohibited since only insurance companies were mentioned in that Act. I know that in England a legal distinction is made between insurance companies and provident associations. At any rate, certain citizens of this country, I think a good number of them, became members of provident associations subsequent to the Insurance Act of 1936. Now, under this Bill, that will clearly become illegal. It was dubious whether or not it was legal before this, but under this Bill it will clearly become illegal. I have suggested to the Minister that that will place considerable, and I think unjust, hardship on many citizens.

Let me give one example. I know of one father who, although he is a lawyer, entered into membership of one of these provident associations when he and his family were in good health. He paid a subscription of 13 guineas a year. Subsequently both he and his family fell into bad health and they received most remarkable benefits from the association amounting, as far as I can remember, to about £400. When this Bill is passed it will be illegal, unless the House accepts this amendment, for that person or for any other person like him to continue enjoying those benefits. The Minister may reply that it is open to him to enjoy the benefits under the new Act but may I insist that it is not, for this very good reason? In his case neither he nor his family can be classed as good lives now. I am sorry to say they are dubious lives as they are in bad health. The Minister told us last day that there will be some sort of medical test. I am fairly sure that under any medical test this man or his family would not be accepted under anything but the most expensive terms. Under this new Bill, he will be prohibited from continuing his present membership of the provident association and he will be simply left high and dry as far as insurance against sickness and accident is concerned.

That is one case and I believe there are several others of this kind. By adopting this amendment the Minister could remove that anomaly; he could allow those who entered into membership of provident associations before the passing of this Bill to remain members. He may argue that he would be condoning a misdemeanour by doing so but he has told us that another Minister has turned the "Nelson eye" for the last 20 years in this regard. I do not think it is asking too much.

I think I should meet one other possible argument. The Minister, who is naturally anxious to make a success of this scheme, will say that, if this provision is put in, much fewer people may become members of this new insurance company. I do not think that in fact that is true. I think that the people who are members of provident associations will not consider the terms of the new company sufficiently attractive for them to enter it. That is a highly controversial topic but I think that it can be argued, and I would suggest to the Minister that if he accepts the amendment he will not be depriving the new company of any possible members. I suggest to Senators, in whose hands this amendment lies, that they will be doing an act of justice to several conscientious citizens if they accept the amendment. If they do not accept, certain citizens will not, I think, be insured in the future against accident or illness. I do hope that even at the eleventh hour the Minister may consider this amendment favourably and that the House will accept it.

I rise to support this amendment and I do so in the conviction that if the Minister finds it possible to accept this amendment he will be doing what is only justice for the people concerned, who are not big in number. I should like to add to what Senator Stanford has said, the consideration that it is possible that, in such a case as the one he has mentioned, a person having been seriously ill, and having benefited under such a scheme might, by reason of health, be rejected by the new scheme under the new board and, consequently, would find himself precluded from continuing insurance with the provident society across the water, and likewise precluded from taking out insurance with the new voluntary health insurance scheme. I feel sure that the Minister will see that point, and realise that a large measure of hardship might fall on such a man.

I also notice in sub-section (1) of this section that reference is made to a person providing "by means of insurance or otherwise". Senator Stanford's amendment is to put in after "a contract of insurance" the words "or agreement with a provident association". I should like to ask the Minister whether it is intended by this fourth paragraph of his simply to allow a contract of insurance already entered into to continue to the end of the year and then to lapse, or is it intended that a person already having such a contract of insurance may continue to pay in subsequent years? The reference here is to the question of "benefits", and not to the question of continuing to have the right to pay in subsequent years a premium for a contract of insurance.

I am not quite clear as to what is the full import of paragraph 4— whether it is intended that such a contract made before the passing of this Act will continue to the end of the financial year, and cannot then be renewed, or may continue for as long as the beneficiary may wish it. I should like to support this amendment.

I have the utmost sympathy with the case made by Senator Stanford in regard to the hard case he talked about. I would certainly support the amendment if the amendment simply dealt with that hard case, but it seems to me that the amendment goes much further. It means to cover all the people, whether hard cases or otherwise, who have up to now been insured by those provident associations. It is all very well to say that the Minister for Industry and Commerce turned the "Nelson eye" to such transactions during the past decade or so, but surely the reason for turning the blind eye was the fact that we had not a scheme as we are now setting up?

Really, it does seem to me that the amendment is going much too far. I suppose it was not possible to put down an appropriate amendment to deal with the particular hard case, but there is an old adage which says that hard cases make bad law. That certainly seems to be proved here now, because not alone would you be dealing with the individual hard case, but you would be allowing out all the people who have up to now been insured with these provident societies and insured only because we had not an Irish scheme yet set up. The blind eye was turned on them in the interval until we came to have a scheme which is now before this House. For those reasons, I very reluctantly have to oppose the amendment. It seems to me to go too far.

I think Senator Murphy stated the case very adequately and very well. I have considerable sympathy with Senator Stanford's case and with the difficulty which he sees confronting him, but that sympathy should not lead one into an error which, I believe, might be created in trying to deal with the case he has in mind.

May I put it this way? Whatever the need may have been, the fact is that any person who insured with these provident associations in the past years or so was, on the advice available to me, offending against the provisions of the law. If, in fact, that advice is incorrect, if in fact the people who hold such insurance contracts with provident societies are not offending the provisions of the Insurance Act of 1936, then under this Bill those contracts can continue. That is the position. If Senator Stanford has been advised that they are correct, then existing contracts of insurance continue.

Could I ask whether it is not very carefully sealed off by sub-section (1) of Section 23, because in the Insurance Act of 1936 there was not the phrase "by means of insurance or otherwise"? By adding those words "or otherwise," it seems to seal it off completely now.

That is in relation to future contracts.

An existing contract which is a lawful contract and which is validly taken out will continue. As an aside on that Senator Sheehy Skeffington asked how long those contracts would continue in accordance with the terms of the contract. Most insurance contracts relating to health, providing against ill-health and so on, are yearly contracts, so that existing contracts of insurance in the vast majority of cases would continue merely for the existing year. There may be—I do not know—contracts of health insurance with a longer period. If so, they will continue for whatever the contract period may be, but in any event the object of the licensing provisions in this Bill is to reserve the Irish market for the voluntary health insurance board on the grounds that more than one organisation would mean lack of business for both.

That is the policy behind the licensing provisions. If it is agreed that policy is correct, as the House has agreed, then it seems unwise in any way to weaken that position. You cannot provide licensing provisions and, in effect, protection for the new insurance board, and at the same time open a back door and allow in through that back door a whole lot of competing interests. I feel that is what would take place if Senator Stanford's amendment were allowed.

The Senator has with some justice— I would not accuse him of arguing from the particular to the general—taken the particular case of a person who for many years has been accustomed to insuring against ill-health and is now no longer a good risk and who may find himself unable to get cover under this new scheme. That is a hard case undoubtedly, but I think it would be a hard case anyway. I am told that the practice of all the provident associations is not only to screen new subscribers, but also to exclude from benefit in succeeding years conditions which have given rise to claims in a particular subscription year. The practice of the provident association is to screen the new, intending subscribers and, in relation to existing subscribers, to exclude in the new insurance year any particular condition that has given rise to claims in the year under review.

That might mean, for example, that a person holding an insurance contract with the provident association for a number of years who may be unfortunate enough to get a coronary thrombosis, would be told by the provident association: "We will carry you on in the new year for everything, except claims that might arise from that condition." That is the universal practice, I am informed, with these provident associations. Therefore, I am saying to the Senator that the person he has in mind is, in fact, in no worse position, because he would get cover here under the new arrangement for all conditions, except those from which he is at present suffering and, in fact, he would get the same type of cover as would be available to him in the provident associations.

He will have to pay more for it because the premiums here will be higher, as I explained on the last occasion, than those commonly charged by existing provident associations in Britain. As I explained to the House, there are reasons for that and the premiums that will be charged here will be the premiums which need to be charged, and no more. They will not contain any element of profit; they will be merely designed to ensure that the board from its premium revenue meets its expenditure. I think that is the least we could expect in running a scheme of this kind.

For these reasons, I feel I cannot accept the Senator's amendment. I agree there may be difficulties, but I feel the amendment, if accepted, would weaken what I believe to be an important part of the Bill—necessary protection to the insurance body to operate. I feel that, in the particular case the Senator has mentioned, no real injustice, in fact, is done because the person he has in mind should be able to obtain here the same kind of cover as he will be able to obtain from the provident associations.

Is Senator Stanford withdrawing his amendment?

I should like to press it.

The debate is closed on the amendment?


Amendment put and declared negatived.

Will those in favour of a division please rise?

Senators Stanford, Sheehy Skeffington and Fearon rose.

The Senators will be recorded as dissenting.

I move amendment No. 6:—

In page 7, between lines 30 and 31, to insert a new paragraph as follows:—

(v) a medical benefit scheme confined solely to the employees of a particular company or group of associated companies.

This is a matter which I mentioned on Committee Stage. I am aware that in a number of companies with which I am associated medical or benevolent schemes have existed for a considerable time for the benefit of the workers and to which they contribute. These do a great deal of good work and in some cases have accumulated a certain amount of funds. I am aware that under the Act the Minister has licensing powers, but I think it might very well be argued that such societies might be excluded from the operation of the Act. I do not think the fact that a person was a member of such a scheme would be likely in any way to deter him from the wider scope of insuring himself as is proposed under the Bill.

Again, I think I can understand the Senator's concern as evidenced by the amendment he has put down. This is a difficulty that I have been aware of. Perhaps if I give the House some information, it might be possible to see some of the difficulties that are present to my mind. I should like to make it clear that there would be no intention whatever of refusing licences for the type of scheme that Senator Cox has in mind in the amendment. The Senator is probably aware that a number of schemes confined solely to the employees of a particular company are at present administered by friendly societies and would be outside the provisions of the Bill under sub-section (3) of Section 23.

There are, in addition to schemes such as those operated by friendly societies—some, but not many—other schemes of the same kind operated by bodies which are not registered as friendly societies or organised as trade unions; for instance, the C.I.E. Clerical Staff Hospital Fund and the L.M.S. Hospital Fund, and a few other schemes of that kind operated by bodies which are not registered as friendly societies and are not run by trade unions and therefore not excluded under any of the convenient headings in the Bill.

It would be the clear intention to license all such organisations and the licensing provision with regard to those would come into operation. I did consider carefully whether any more general formula could be adopted such as Senator Cox had in mind, but there were difficulties with regard to it. If one tries to describe people with a common interest, by such a phrase as "salaried workers", in fact, that includes everyone, and it is very difficult to devise a general formula for these schemes. I think the wisest thing is not to attempt to do it, but to let the licensing provision come into operation and it is the intention that all such schemes would be licensed. Under those circumstances, I hope the Senator will feel that the provisions of the Bill should remain, on the understanding that it is the intention to allow all these existing schemes, whether already provided for under exclusions in the Bill or whether they arise as particular cases, to continue.

I will accept what the Minister says and withdraw the amendment.

Amendment, by leave, withdrawn.
Amendment No. 7 not moved.
Bill reported without amendment.
Agreed to take remaining stages now.
Bill received for final consideration.
Question proposed: "That the Bill do now pass".

When I spoke on the Second Stage of this Bill, I gave a number of reasons as to why I felt the Bill would not prove to be workable, when it became an Act, and the careful consideration which the Seanad has subsequently given to the Bill has not caused me to change my mind in any way. I think the more consideration we give the Bill, the more many of us wonder how this Bill, if it becomes an Act, is going to work out.

As we have considered the Bill in Committee rather in detail, there are certain other aspects which we did not deal with on the Second Stage which I think should now be mentioned. The first of these is the question of the board itself. I really think the term Voluntary Health Board is very much a misnomer, because I do not believe a board has ever been sponsored by any Government in this country which had in fact less power than this board. The members of the board are appointed by the Minister; the board is incapable of taking any decision of importance without the Minister's consent; the board is not even permitted to publish an annual report without first ascertaining if the Minister wishes to have anything included in the report. I fail to see why the Minister should have taken the trouble to create this Voluntary Health Board at all, because, in fact, the board has no more independent power than a number of the Minister's officials would have sitting in a room in the Minister's Department.

There is no Voluntary Health Board in this Voluntary Health Bill that could not be run from start to finish by the Minister for Health, so that while many of us feel that the idea of a Voluntary Health Board is a good one, I think the particular board will be a board of nominees appointed by the Minister who will have no independent power or authority whatever.

There is one other thing: I feel there is a very serious departure here so far as health legislation is concerned. When we had health legislation here before the Oireachtas, there were always references either to existing or previous Health Acts. When we discussed the Health Act, 1953, that measure proposed amendments in the Act of 1947 and it referred to the Act of 1939 and to other Health Acts, so that we were enabled while studying that legislation to get a very fair idea of what lines the scheme which would be drawn up under these Health Acts would follow. In this case, we are giving a completely blank cheque to a few members of the board and the Minister for Health. We have absolutely no idea what sort of health scheme will be drawn up under this Voluntary Health Act. The position is that the terms of it are vague. It is mandatory on the board to operate whatever scheme the Minister directs and the Minister under the wide terms of this Bill may choose to present any scheme he thinks fit to the Voluntary Health Board.

I think it is quite wrong that the Oireachtas should not have some opportunity to consider and amend— if it wishes to do so—whatever schemes or scheme is to be drawn up under the Voluntary Health Act. I realise we cannot see the details of the scheme. That has not been the practice; and the same applies to all legislation of that type. The scheme is drawn up after the Act becomes law, but again, in the case of previous legislation, it was usually the local authority which was carrying out the scheme and often it was the local authority which was making the scheme under regulations laid down by the Minister, so that it was being carried out by democratically-elected representatives of the people who were in touch with the public every day. They had power to alter and amend the scheme they carried out in their own areas. I feel it is a principle which the Minister has often opposed on other occasions when it was suggested that we, in the Oireachtas, should delegate such wide powers to a very small group such as is envisaged in this Voluntary Health Board.

I am very sorry indeed to hear Senator ffrench O'Carroll speak against the principle of the Bill at this stage. I had hoped that after discussing the measure and having a few votes on the details of it we could then agree to say: "Now, here is a measure with which we may not agree in detail but with which we agree in principle and we wish it all success." Apparently Senator ffrench O'Carroll does not believe in the principles of the voluntary health insurance scheme personally——

I have not opposed the principle at all at any time.

I certainly got the impression from the Senator's speech that he was opposed to and did not believe in this scheme of voluntary health insurance. I should like to say for my part that I am a very strong believer in it and I think it deplorable that up to the moment we have left a section of the community, those with over £600 per annum income, without any cover whatever in regard to health except the cover that if they can plead they are in very straitened circumstances, they can go to the local authority, cap in hand.

I do not know what Senator ffrench O'Carroll wishes to do for that section, whether he wishes to leave them as they are at present without cover, or whether, on the other hand, he expects or would like them to be covered by payment from the rates—in other words, under an extension of the 1953 Act. I think this is the better approach to the problem and I would hope, now that we are about to launch the scheme, that we could get co-operation from all sections of the community. I know Senator ffrench O'Carroll speaks on behalf of a large and influential body in the country and I hope, even though he may not be quite pleased with the measure, that if we do launch it, we will all co-operate in making it a success. This is only my own view, but, to my mind, it is only by making a success of the scheme that we can provide any cover for the people who, in my view, are definitely not very well off, the people with salaries over £600 a year.

I should like to support what Senator ffrench O'Carroll has said and to suggest on this Final Stage of the Bill that the Bill represents in fact an heroic attempt on the part of the Minister to do the impossible for the sake of giving health insurance cover to those who are at present uncovered by the national health services, by reason of the fact that they have an income of more than £600 per year or landed property of valuation of more than £50. Whatever the position has been up to now, such people are specifically, by the terms of this Bill—this one-fifth of the population-that was, I think, the proportion mentioned by the Minister-is now specifically precluded from enjoying the benefits of joining one of the British provident associations. Yet, this Bill, by its present terms, prevents, in my submission, any alternative scheme from working.

I realise fully that the Minister is sincere in believing that the scheme envisaged and made possible by this Bill will provide a workable alternative, but I would deny it does so. There is no Government aid embodied in this scheme at all, except the two sums of £25,000, each of which has to be paid back with full interest. I would say there is no effective Government aid at all for the purpose of helping this scheme in a realistic way. The expenses ratio is to be enormous—it is to be up as high as 30 per cent.—and yet we are told the scheme must be entirely self-supporting. Were the Government to have decided to pay half the premiums, or were some such subsidy to be incorporated, there might have been a chance of such a scheme succeeding. The result, however, of the present unrealistic framing of this scheme, as it has now reached final form, will be that the premiums envisaged under the scheme will have to be so high for the scheme to be self-supporting that the subscribers will be exceedingly few. I shall be very surprised if they even reach the necessary minimum total of 25,000 contemplated by the Minister. I shall be surprised, in any event, if 25,000 will prove to be anything like enough.

I believe the subscribers will prove to be so few in number that after the first year the premiums will have to be raised higher still, and the subscribers will become even fewer in number and the scheme will founder. What will come then? I would enjoin the Minister, arising out of this Bill, to set about thinking now of what he will do then for this one-fifth of the community, if and when this scheme fails to produce the goods, as I think it will. He will then, I consider, be forced— and perhaps it is just as well that he should be so forced at a fairly early date—to extend the present national health scheme to the whole community, without distinction of class or wealth, which will lead to an immense simplification and a consequent demonstrable benefit to the whole community.

I gather that Senator ffrench O'Carroll's criticism has largely been that this scheme is to be administered through a quasi-independent board and not directly by a Government Department. I rather think that one of the successes of administration in this country has been the invention—which I think is rather peculiar to this country—of boards such as the E.S.B., Bord na Móna, and so on, which have undoubtedly, I think, been very successful and have enabled a sort of combination of quasi-private initiative with Government control and under Government legislation. I feel that, if this scheme has any chance of success, a build-up of that kind is probably the wisest type of thing. I consider, therefore, that the scheme should be approved of by this House and that it should, so to speak, be tried out.

First of all, I should like to thank the Senators who contributed to the discussion on the Bill in this House and who undoubtedly helped me in regard to some of the difficulties raised. I rather resent the suggestion by Senator ffrench O'Carroll to the effect that the public generally were not given information as to the kinds of benefits the insurance scheme envisaged under this Bill would be designed to cover. I do not think that is either accurate or fair. I believe that not for many years has a piece of legislation been more carefully considered by an Advisory Body established for that purpose.

The Advisory Body, which was representatives of many sections of the community, considered this matter very carefully and fully. They reported to me some time last June. Their report was published fully in the newspapers and sent to each member of the Seanad and Dáil. In that report, the fullest possible information is given as to the kind of scheme intended and the type of cover desired. I think it is inaccurate and unfair for a Senator now, on the passing of the Bill, to suggest that no one knows what the scheme is intended to achieve. In case there be any doubt, the benefits set out on page 13 of the Advisory Body's report pretty well contain the benefits this scheme is intended to deal with.

Senator ffrench O'Carroll also said that, unlike other health legislation, there was no reference in this Bill to previous Health Acts. Of course, there is not. This is not in any way similar to the Health Act of 1947, or the Health Act of 1953, or to any other health legislation, and it is not intended to be. It is a new proposal and a completely new idea. Senator Sheehy Skeffington says it will not succeed. I believe it will because I believe our people will desire it to succeed. It is very easy to deal with this problem by amending the provisions of the 1953 Health Act and providing for rich and poor alike free or partially-free health services: it is simple, but I do not believe it is Irish. I do not believe it is the kind of approach our people would desire.

I would regard this health insurance proposal as something in the nature of a challenge to our people, and I believe that challenge will be accepted. The alternative to health insurance is State medicine and everything that it connotes.

Senator Sheehy Skeffington also said that under this Bill there is no Government aid for the new health insurance board. He rather "tut-tutted" about that. In our Houses of the Oireachtas, I am afraid we are so used now to thinking that the Government must do everything and that people are not capable of doing anything themselves that we regard it as strange—in fact, in some way suspicious or dangerous—that this Bill does not indent upon the taxpayers. It does not, and it is not intended to do it. It is the first health scheme that does not largely indent upon the taxpayers of the community. It will not cost the Irish taxpayer or ratepayer a farthing. I think that is something that we should regard with favour. All of us should take some satisfaction from that fact. Instead, Senator Sheehy Skeffington sees in that fact something sinister, something dangerous and something that has to be commented upon.

On a point of personal explanation——

The Minister is in possession.

I did not, in fact, say that there was anything sinister about it.

On a point of explanation.

I said that there was no effective Government aid, and, on that account, that the scheme would not work—not that it was sinister.

Perhaps I misunderstood the Senator. It is implicit in this scheme and proposal that it stands on its own feet.

If it falls, then our people have not the kind of breeding I think they have. The scheme stands on its own feet. The State helps in order to organise it and only to organise it. Once it has been organised, it proceeds itself. I think that is something notable and something desirable. In my view the proposal will succeed.

Question put and agreed to.