I should like to repeat what Senator Mullins has said, and to stress that this Bill is permissive. It empowers a local authority, if, in its opinion, the circumstances of the individual concerned warrant it, to make a charge up to the definite limit of 10/- per day. As Senator Mullins has pointed out, it does not make it mandatory on the local authority to charge 10/- per day in every case. That is the basis of the criticism which has been levelled against this Bill, that it does make it mandatory to charge 10/- a day.
It is inconceivable to me how any responsible Senator reading the relevant sections of the principal Act and the provisions of this Bill could possibly make himself responsible for the statements which I have heard here from Senator Murphy and Senator Sheehy Skeffington. Those statements have been made, not with the desire to debate this Bill in a rational and reasonable way, but merely with the desire to confuse the issue, to make political capital by misrepresentation. No proposal that comes before any legislative assembly can be immune from criticism, but at least when measures are before this House where we are supposed to live in a higher and more rarefied atmosphere than exists in the other House, let us refrain from the lower political tricks. Let us keep away, if we can, from the hustings, and let us, when submitting arguments to the House, base them upon the facts.
The discretion of local authorities in this matter of the charge which they may make to individuals in relation to hospital treatment is wide and open and I do not propose, in reply to the question which was put to me by Senator Murphy, to fetter or to limit that discretion in any way. The responsibility for administering the Health Acts has been placed on the local authorities because they are better placed than the central administration to determine the circumstances of the individuals who come before them asking for free treatment or treatment in hospitals at reduced rates; and the health authorities have to determine these matters with full advertence to their responsibility to provide health services for all those within their jurisdiction who require them at a cost to the patient which will be within his capacity to pay. That was the principle of Section 15 of the principal Act and it is not being departed from in any way in this Bill.
It has been asserted by those who are critical of the Bill that the maximum charge is the general, or almost invariable, charge which local authorities impose for hospital treatment. That allegation is far from the truth. I must refer to Senator Murphy frequently, perhaps, in the course of this brief reply to his statement, because it opened the case against the Bill and everything he said in criticism of the Bill was repeated, perhaps at greater length, by those who supported him in those criticisms. He wondered if I were serious when I stressed that the maximum charge was seldom applied. I should like to assure the Seanad that I was perfectly serious and quite truthful.
It is time to come down from the stratosphere of the fanciful criticisms of Senators Sheehy Skeffington and Murphy to the solid ground of hard facts. It has not been possible for me to investigate the position under every health authority, but a rapid examination has been made of the position in the City of Dublin and I think it is well I should repeat what has already been said, in order that the general body of the Seanad should be aware that there is no justification for the statement which has been so frequently repeated here, that this Bill will in future require every in-patient in a hospital who comes within the provisions of Section 15 of the Act of 1953 to pay 10/- a day so long as he is in that institution.
It has been pointed out—and I want to stress it again; the figures are easily remembered—that out of every 100 eligible persons, that is, persons who qualify for benefits under Section 15 of the Act, 75 in the City of Dublin are not charged anything. That is 75 per cent. of the total. Eleven are asked to pay less than 6/- per day and 14 per cent., taking the general average, are asked to pay 6/- a day. When this Bill passes, I am reasonably certain that, having regard to the humanitarian spirit in which the Act is administered in the City of Dublin and elsewhere, it will be found that the number of persons called upon to pay up to 10/- per day will be very much less than 14 per cent. Of course, the charges which will be made in relation to some small fraction of the total will range from 6/- to 10/- per day, but 10/- per day is the maximum that may be charged, except in relation to what are known as the hardship cases under Section 15 of the Bill. They are, in fact, people who would normally be regarded as being better off than those who are included in what we know, in the parlance of the health code, as the middle income group.
These are the facts. I would ask Senators to consider them and I submit that it cannot be seriously contended, in the light of them, that there is any justification for the statement for which Senator Murphy made himself responsible. Yet, I fear we shall hear that statement repeated ad nauseam and that perhaps he will be echoed by Senators Davidson and Sheehy Skeffington.
Senator Murphy was again incorrect when he said that the people who will be mainly affected by the Bill are the insured workers. I think it will be agreed that the figures I have given are not consistent with that statement. Perhaps some of the insured workers may be affected, but they cannot be more than a fraction of the whole anywhere, nor are they likely, in fact, to be the greater part anywhere.
Moreover it is not correct to say, as Senator Murphy did, that the insured persons got a very raw deal under the 1953 Act. I do not want to enter into a discussion on the merits or defects of the 1953 Act. I have no intention of doing so. It has been accepted by the Oireachtas and the principles which it embodies in general are acceptable to the people. The question as to whether the cost of giving effect to those principles is justifiable, having regard to our existing circumstances, is another matter. As I have said, I do not want to enter into a discussion on the merits and defects of the 1953 Act, any more than I want to enter into a controversy as to the morality or immorality of the means test in relation to this Bill. All these questions have been settled. They are in principle the basis of the original Act.
There is nothing in this Bill which amends the original Act except in relation to a very minor matter. It does not alter the principles on which the Act is based, in any way which would warrant a discussion such as Senator Murphy and Senator Sheehy Skeffington want me to embark upon. Neither do I want to enter into a discussion as to the merits of the additional benefits which were conferred on the insured workers when I happened to be Minister for Local Government and Public Health. Prior to that, may I say in regard to the Senator who has alleged that this is a Tory measure, that I as Minister was responsible for the enlargement of the benefits which insured persons might derive under the national health insurance code? It was, I think, owing to the fact that I happened to be Minister at the time that the insured workers were allowed even the modicum of the free hospitalisation enjoyed before the 1953 Act.
In view of what Senator Murphy has said, I must give the Seanad the facts in relation to insured persons before Section 15 of the Act was brought into operation by my predecessor. Senator Murphy has stated that before that time insured persons were entitled to institutional treatment free of charge. Apparently the Senator did not know that, in the case of insured persons, treatment in hospitals free of charge was for a strictly limited period. It is regrettable that the Senator should have been unaware of this when he spoke; otherwise I do not think he would have made the statement to which I am referring.
The period to which insured persons were entitled to treatment free of charge was limited to six weeks. The position now is that there is no limitation on the period. In addition, not only was the hospital benefit limited to a period of six weeks, but it was confined to the insured person himself. Under the 1953 Act, not only the insured person but his dependents were entitled to hospital treatment under Section 15 of the Act. Whether an insured person was better off prior to that than since depends on the view we take of the proper relationship between an insured person and his dependents.
If we take the view that as long as I, an insured person, am all right and can take this six weeks' free treatment and it does not matter a damn about my wife and children, we can say with conviction that the insured person was better off previously than he is now under the 1953 Act. On the other hand, if we say the family is to be accepted as a unit, to be safeguarded as is provided under the Constitution, so that a man and his wife and children should all be on the same plane in relation to the health services, then I think we would be prepared to say that the position of the insured person and of his wife and children is much better than it was prior to the bringing into operation of Section 15 of the Act by my predecessor.
There is another aspect of this. Under the social welfare national health insurance code not only was the hospital benefit limited to the insured person himself, not only was it limited to a period of six weeks, but he also had to have 156 contributions on his card, of which I think 26 contributions had to be paid or excused in the relevant year. That limitation does not apply under the 1953 Act, so that I think we can say that as far as the insured person is concerned, taking it by and large, weighing up the advantages and disadvantages, we can all be reasonably assured that there has been an improvement, a very appreciable and substantial improvement, in his position since Section 15 of the Act was brought into operation.
A great deal of play was made by Senator Sheehy Skeffington about how we were going to reduce the burden on the rates and on the Exchequer to the extent of £180,000 a year, if there were only 17,000 persons who were affected by the Bill. In that connection, the Senator quoted from a speech which I made in introducing the Bill, but—it was not an act of deliberate omission— he failed to grasp that, when I mentioned that figure of 17,000 people, I was referring only to those patients who would be affected in general hospitals and other hospital institutions, other than mental hospitals, who would be affected by the permission given to local authorities to increase the maximum daily charge from 6/- to 10/-. If he had referred to my closing speech on the Fifth Stage of the Bill, he would have seen there would be 14,000 other in-patients in mental hospitals. That is a total of 31,000 people, not 17,000 as Senator Sheehy Skeffington assumed was the total, when he was considering the matter.
In addition to that, there are other people who are going to be affected. There is the number of people who are going to avail themselves of the outpatient specialist services for which very modest charges are to be made and it is over this rather wide congregation that that burden of £180,000 will be imposed, a burden of contributing towards the cost of their treatment. Perhaps it is not proper to use the word "burden" in that connection, but rather to say the moral obligation of contributing towards the cost of keeping themselves in good health and of restoring themselves to good health, if they should happen to be ill.
If we consider these circumstances, we see there is nothing in the sort of speech Senator O'Donovan made. He may gibe and jeer and make light of the fact that we are saving and that we are relieving the community as a whole. Mark you, the community as a whole is just as important in one sense as every individual in it. We are relieving the community as a whole of the obligation of finding this £180,000 in order to give cheaper services to people who cannot afford to contribute something more towards the cost of them.
Those who are concerned about the social effects, from the economic point of view, of this legislation should consider this. If we do not get it from those who can afford to give it, that £180,000 will have to be found, in the main, by the less well-off elements in the community. The small farmers, the ratepayers, the self-employed persons, small shopkeepers and others who do not share all the benefits of our social welfare legislation are the people who will have to find that £180,000. I for one am convinced that, so far as the principles of social justice are concerned, it is better, fairer and more justifiable to ask the people who can contribute something towards the cost of hospital treatment and specialist services to do so rather than that we should ask those who are not so well off to bear part of that burden.
Senator Fearon asked me some questions as to how I should account for the very substantial increase which has taken place over the past four years in the cost of our general hospital services. Senator Sheehy Skeffington put a similar question to me. I do not think that these questions properly arise on this comparatively minor measure. Perhaps on another occasion, if I am in the Seanad and if I have some notice of such questions, I will have the archives and the accounts examined and may be able to give a specific answer to them, in so far as such an answer could be specific.
A number of other things were said. I heard from one Senator an interjected remark about racing. All I can say is this. One of the reasons for our present precarious position is that we are not exporting enough. The horse-breeding industry has become one of our main industries; not only that, but it is an expanding industry. The only place in which we can display these horses to prospective buyers and the only place they can be seen in action is on our race courses. As far as I am concerned, having regard to the fact that we must increase our exports, I certainly would not be prepared to apologise to anyone for the fact that, instead of trying to kill the horse-breeding industry in this country, we are endeavouring to encourage it.
Senator Sheehy Skeffington asked would it not have been better to have raised this £180,000 in some other way —for instance, instead of spending £150,000—I do not remember the exact figure he mentioned—in converting Irish wheat into pig feed. That is a very nice debating point. It could be answered by asking: Does the Senator want the Irish people to eat wheat which is only fit for conversion into pig food?
