Vol. 50 No. 4
Before we take up consideration of the Committee Stage of this Bill, I should like to indicate that I consider amendments Nos. 1 and 2 standing in the name of Senator O'Quigley out of order as they are outside the scope of the Bill as read a Second Time. The Senator has been notified accordingly.
SECTION 1.
On Section 1 we had some information from the Minister on the Second Reading in relation to the number of people to be readmitted to the scheme under this section. The effect, we were told by the Minister, of raising the remuneration limit from £600 to £800 and of allowing certain concessions in relation to the earnings of the family would be to bring into the scheme some 80,000 people. The Minister also told us that practically all—I think he said "all"—of these 80,000 were previously in the scheme but had gone out of the scheme, and were now being brought back in once more.
I should like to hear from the Minister some further explanation. I am not quite satisfied that that is wholly in accordance with the facts. I should like to hear from him the basis of his calculation when he says that the raising of the remuneration limit by 33? per cent., from £600 to £800, is merely bringing back in people who, owing to the rising cost of living, had gone out of the scheme by reason of their having their salaries increased. In the first place, I do not think the cost of living has gone up by that amount, though sometimes one might be forgiven for thinking that it has, and the Minister may be under the impression that the cost of living has gone up more than it actually has. I do not think it has gone up by 33? per cent. since 1953.
In the second place, I should like him to advert to the fact that there appears to be a new principle involved here in the allowing of the first £100 of the wages or salary of a child not to be counted, so that, in certain circumstances, the remuneration limit would not be £800 but £1,100. The Minister contends that he is merely bringing back into the scheme people who were originally in it in 1953. In relation to this second provision, I think it is even more open to question. I should like him to justify, if he can, his contention that all these 80,000 people now being brought in under the scheme were originally in it, even the people whose family income could be calculated now at a shade under £1,100 instead of a shade under £600. I personally would like the scheme extended far more and the means test abolished altogether.
Another day.
In relation to the view that this constitutes no change whatever, I should like to hear the Minister's justification for it.
I am in rather a difficulty here because what is involved is largely a question of finance, a matter in which the Seanad, if I may say so with all respect, is in a rather circumscribed position. Constitutionally, it is not allowed to raise any money and, when the Finance Bill comes before it, its powers are limited to making recommendations.
I do not want to make myself in any way responsible to the Seanad for the finances of any public measure. Neither am I going to create the precedent, and I shall justify it to the Seanad, of explaining the basis of the calculations and the manner in which I formed the estimate that 80,000 persons would be brought within the scheme. I can say, however, that the 80,000 covers not only the insured persons but their dependents and, on that basis, according to the best information available to us, that is a reasonably accurate figure. It is no more than a general estimate, but we will stand or fall by it. It is an inclusive estimate; it is a comprehensive estimate. It does not err on the side of understating the liabilities imposed upon the Central Fund and upon the local authorities by reason of the increase in the incomes of persons who may qualify under the Bill.
I should like to say also that I do not think it is quite fair for the Senator to say that, when the Bill was before the House on the Second Reading, I stated there would be no increase whatsoever in the number of persons who would fall within the scope of this Bill. I did not say that. I could not possibly have said no increase whatsoever. I did say the main purpose of the Bill was to try to restore the status quo and to bring back again within the ambit of the scheme persons who had been excluded from the scheme by reason of the fact that there had been a considerable increase in monetary incomes arising out of employment.
Another aspect to this matter, which I tried to make clear in reply to a question put to me by Senator Hayes, was that we are dealing in this Bill, in relation to sub-section (4) of Section 1, not with personal remuneration but with family income, with household income. It is not correct to say, therefore, that the remuneration limit has been raised from £600 to £1,100 per annum—not the remuneration limit of any individual. The maximum limit of remuneration which can be enjoyed by any individual to come within the scope of this scheme is £800. If he should happen to be the head of a household, whose children are earning their own separate incomes, the total of the children's incomes will not be aggregated in toto with his in order to determine the family income, because that would exclude them from the scheme. The aggregation will be made subject to the deduction of £100 per child or step-child who is earning, with the overriding limit that the deduction cannot exceed £300.
I do not know what purpose the Senator had in mind when he made that case but I hope it was not merely with the object of confusing the issue and making it appear that we are providing, at the expense of the State services for people who would normally be expected to provide these services at their own expense. If one goes on and says, of course, a person with an income of £1,100 per year ought to be in a reasonable position to provide for his own medical expenses, I suppose most people would be inclined to agree with that, but that is not the position. The position under the Bill is that if the head of the household earns more than £800 per year, he is out. If the head of the household does not earn more than £800, but at the same time has a number of earning members in his household, children or step-children, then he will be out also, if the total of their incomes, as abated up to a maximum of £300, should exceed £800 a year. That is putting it in another way but it comes to the same thing in the end.
Would the Minister allow me to ask a question? Was the previous £600 an individual income or a family income?
A family income.
Therefore, the family income is being raised from £600 to £1,100?
In certain circumstances, yes. That is the point.
There is nothing wrong with that.
There is another matter. It has nothing to do with the section. I did not follow the Minister in the beginning but I thought the Minister said in the beginning that he was under no responsibility to explain to the Seanad how he arrived at the figure of 80,000 or what the financial basis of this Bill was. Am I right in that?
Well, wait now.
I am not sure that I got the Minister right. I would just like to be clear on it.
What I did say was—I pointed out that this was a case in which I was being asked to justify to the Seanad a financial matter and I say that I am not bound to do that, but I am quite prepared to explain in an ordinary way, as a matter of courtesy to the Seanad, how I arrived at those figures, but not otherwise.
May I say that that is a new constitutional point which I never heard before? I am prepared to agree that the Minister is courteous and that, indeed, all the Ministers that have been here have explained things to us, but it is a completely new thing to me, when a Minister brings a Bill to the Seanad, that he is not under any obligation to explain to the Seanad how the financial provisions of the Bill were arrived at. I know that Senators are not allowed to move amendments which will increase the public charge and there were amendments ruled out of order to-day on that basis. But it seems to me, Sir, with all due deference to the Minister and with all admiration for the Minister's courtesy, that we depend on something much more important than the casual courtesy of the Minister for information on Bills which he brings here. If the Minister brings Bills here, I think he must explain them, whether they are financial or not. The Minister for Finance, for example, explains Bills which are Money Bills and which are Finance Bills.
I was going to raise that point, also. I entirely agree with Senator Hayes. The Minister, when I asked him to justify his figures, in the politest possible terms, replied that Senators, on financial matters, might mind their own business. He did mention that we have the right to make recommendations, but he seemed to imply that nobody ever pays any attention to those recommendations. I do not think that is wholly true. It may be true in many cases, but, since we have the right to make recommendations on financial matters, no matter how unimportant any Minister may consider our recommendations, nevertheless, since it is possible, it is conceivable that our recommendations might be sane and wise recommendations. It is therefore quite obvious that it is the Minister's duty to inform us, as far as he can, of the basis of his own financial calculations in order to help us to make our recommendations as wise as possible.
The Minister did go on then to give us some of the facts which made him make his statement about the 80,000 people being brought in by this Bill and about the calculation of the family income, and so on, but he said that this was merely a general estimate and he hotly denied that he had ever said or suggested that there would be no increase whatsoever in the numbers of people brought in because I had said he had told us that this was merely a bringing back in of people who had gone out.
The Minister to-day told us he never made any suggestion that there would be no increase in numbers whatsoever. I should like to refresh his memory by quoting what, in fact, he did say on the last occasion. It is in Volume 50 of the Official Debate, column 140. He says, in the first place:—
"All we are doing in this Bill is to give renewed entitlement to benefit to persons who were excluded from the scope of the Act by reason of the increases which have taken place from time to time in their money incomes."
He went on, in case that was not sufficiently clear, to say:—
"We are merely restoring the status quo as it existed in 1953.”
I think that entitles me to say that the Minister said there would be no increase whatsoever, but, in case it does not, I would remind him that, in reply to another question of mine, at column 141, he said:—
"The question was put to me by Senator Sheehy Skeffington, and repeated by a number of others: ‘Have the doctors been consulted?' The doctors have not been consulted because we are merely restoring the position as it was understood to be at the time when the introduction of the services concerned was being considered."
In case that was not sufficiently clear, he goes on to say:—
"We are merely bringing back into eligibility the persons who it was anticipated would be eligible in the first instance."
Therefore, I feel I was entitled and, in fact, am still entitled, to say that the Minister claims that there is no increase whatsoever over what was anticipated in 1953 now proposed. This is merely a bringing back of 80,000 people into eligibility who were anticipated in the first place to have been eligible.
That brings me to the question, again, as to whether, in calculating the family income, the aggregation of a certain proportion of the children's income with the head of the family's income, under this Bill, a new basis of calculation is not being introduced. I think it is a good basis. The Minister wonders why I am raising this question at all but I think it is a good basis of calculation. Nevertheless I do not think we should be afraid to recognise that it is a new basis, if the truth is that it is a new basis. I do not think we should run away from the facts and, in relation to consideration of the effect of this Bill on voluntary health insurance schemes, upon the compliance and the co-operation of the doctors, the co-operation of the hospitals, the co-operation of the local authorities, I think it would be unfair to ask for acceptance of this Bill by all these interested bodies without telling them the full truth.
I did not intend to intervene in this debate but I should like to rise on the general constitutional point that has been thrown into this discussion by the Minister's refusal even to allow the Seanad to discuss the financial repercussions of Bills of this kind. On the last occasion, this day week, I spoke on behalf of the medical profession and I tried to put the point of view that the medical profession were not entirely fairly treated under this Bill. As far as I can understand the situation now, it seems that any change in the treatment of the medical profession under this Bill and any increase in their remuneration might conceivably involve a further charge on public funds.
We are then told that any debate on any subject that may conceivably have the effect of increasing the charge on public funds is outside the scope of discussion in the Seanad. It seems to me we are limited to an extremely narrow scope. Surely I am entitled to discuss the effects of the measure on the medical profession without being told that I cannot do it and that the Seanad has no right to discuss public finance? As a House, we should protest against that attitude.
There is no such rule.
I should like to reply to what Senator Sheehy Skeffington said. I do not want to prolong the debate. I did not say— the Senator alleged I said—that there was no change whatever in the general classes who were brought back within the scope of the Health Act, 1953. The Senator quoted one or two extracts from my statement on the last occasion, but he does not produce, and has not been able to find, one word to justify his contention. "Whatever" is an exclusive term which rules out everything else.
I was talking in general terms. The Senator is well aware of that. I was not discussing particular cases. I was dealing with general categories. There was no substance whatever in the Senator's point. I was dealing with general categories. I said—and I stand over it—that, by and large, there is not any change being made in the classes who are now to be covered by the Health Act. There is a minor mitigation in respect of the manner in which the family income will be calculated, but it is only a minor one. It is not a sweeping change which will bring within the scope of the Health Act a large number of persons.
I cannot say precisely how many it will bring in. We can only proceed in a matter of this sort on the basis of the position as it existed in 1953 and as it exists to-day. There are about 20,000 persons, including their dependents, who were in the scheme in 1954 and who will now be brought back. We calculated that, concomitant with that, there will be a more or less proportionate number of persons who were not insured persons. When I say 20,000 persons, I mean 20,000 insured persons including their dependents. I have to be very careful in discussing this matter with Senator Sheehy Skeffington. We anticipate that about 20,000 persons whose right to services was based on the insured status of the head of the household, who were pushed out by reason of the fact that they were gradually pushed above the income limit will be brought back. Concomitantly, a number of self-employed persons will now again come back inside the scheme.
There have been no radical changes. It is on that basis we arrived at the figure. It is a general figure. Had I been asked a question in relation to people formerly covered by the Act and who are at the present moment not covered by the Act but will be covered by it when this Bill becomes law, I should have to say we had not got the figure. We had to work on the statistical information available to us. The figures which I have given to the Seanad are, I think, comprehensive and will be found not to understate— and that is really what Senators in the House are concerned with—the cost of the scheme to the Exchequer and the local authorities.
A point was made in regard to the statement I made in relation to the right of the Seanad to demand information from me. If the Senator who raised this matter in the first instance had made a rather different approach, my response might have been different. I thought I was being called to account —and that is what I demur against— by the Seanad in relation to the figures which I had given to the House on the Second Reading of the Bill.
Why not?
I explained why. I do not want to raise another constitutional issue. If the Senator takes the trouble to study the Constitution, he will see that members of the Government are responsible to Dáil Éireann. That is the House to which they are responsible. As I say, the voice and the tone in which the Senator put this to me implied that I was being called to account here in the House. Ministers are not responsible to the Seanad. Senators might like to have it that way, but that does not happen to be the case under the Constitution. I am very jealous, not about my personal position —I do not care two hoots about that —but about the provisions of the Constitution. I do not want to see them weakened in any way.
I do not want to weaken the Minister's constitutional position and I do not want to set out to improve anybody's manners or make any animadversions upon the way in which anybody puts anything, but the Minister was certainly not right when he said that he is not under any obligation when he comes to the House to tell the House how the financial provisions of a Bill have been arrived at. The Minister knows that and that is why he slipped off on this question of courtesy and manners.
He is responsible to the Dáil, but once a Bill is brought in, the Minister who brings the Bill here is under the same obligation as he is in the Dáil to tell this House the provisions of the Bill. I do not think the Minister means to depart from that. I am trying to save the Minister from himself.
We will leave that matter. We will not pursue that aspect any further.
I am entirely satisfied with the Minister's statement.
It does not satisfy me at all.
I have now established that it is not a question merely of bringing back those who were eligible before but also bringing in some other numbers unnamed.
At this stage, I want to make some observations upon the position in which we now find ourselves under this Bill. There may be varying views on the extent to which the State should engage in social welfare legislation, but I think it will be generally agreed that the State and local authorities ought not to subsidise negligence. That is precisely the position in which we now find ourselves, and which I unsuccessfully attempted to correct, in the amendment which I submitted to this Bill. The point was raised on the Second Reading, by Senator Lenihan and myself, but was not adverted to by the Minister, in his reply. I should like to ask the Minister whether it is intended that that position will continue, or whether he proposes to introduce legislation to rectify it.
I do not want to hold Senator Lenihan up, but we have got the Bill and we cannot deal with anything that is not in the Bill. However, if the Senator wants to ask a question——
I merely want to support Senator O'Quigley in what he said. An early decision on this matter would be desirable, because it represents the shifting from the insurance companies to the local authorities of a burden which was usually borne by the insurance companies. I just want to mention that while the Minister is here.
I should like to say I am not sure this matter is appropriate to this Bill at all.
It is not.
After all, it relates to compensation for injuries sustained, and would more properly arise on the Road Traffic Act or the Workmen's Compensation Act than under this Bill and it is outside the scope of the principles of the Health Act to introduce that provision by a sidewind in a measure of this sort.
At this stage, if you will permit me, Sir, I should like to refer to a point which was raised by Senator Cole on the last occasion. He mentioned the matter of the provisions of Section 230 of the Mental Treatment Act, and suggested that there was some inconsistency between the Mental Treatment Act and the Health Act. I have had that matter further examined, and I find what I did say on the Second Reading of the Bill is substantially correct. Section 27 of the Public Assistance Act does cover those who come within the scope of the Health Act, but so far as the Mental Treatment Act is concerned, the position is dealt with by a separate section but the principle is the same. I shall let the Senator have a fuller note on that in due course. I should just like to close this constitutional battle by saying——
I thought we had closed it.
If you allow me, I should like to say that I did say a little more than I had intended to. I quite realise that when a Minister comes to the Seanad, the Seanad must be treated with the same courtesy as the Minister would give to the House to which he is responsible. I regret that I did not give precisely the treatment I should have liked to have given it in regard to the information asked for by Senator Sheehy Skeffington. In so far as I am concerned, I shall always endeavour to keep the Seanad informed to the best of my ability about the implications of any measure before the House.
