Dáil Éireann díospóireacht -
Thursday, 8 Apr 1937

Vol. 66 No. 4

Committee on Finance. - Vote 44—National Health Insurance.

Minister for Local Government and Public Health (Mr. O Ceallaigh)

I move:—

Go ndeontar suim ná raghaidh thar £196,084 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1938, chun Tuarastail agus Costaisí i dtaobh Riaracháin na nAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1934, agus na nAchtanna um Pinsin do Bhaintreacha agus do Dhílleachtaithe, 1935 agus 1936 agus chun Ilsíntiúisí agus Ildeontaisí, ar a n-áirmhítear Deontaisí áirithe i gCabhair mar gheall ar Chostas Sochar agus Costaisí Riaracháin fé sna hAchtanna um Arachas Sláinte Náisiúnta.

That a sum not exceeding £196,084 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1938, for Salaries and Expenses in connection with the Administration of the National Health Insurance Acts, 1911 to 1934, and the Widows' and Orphans' Pensions Acts, 1935 and 1936, and for sundry Contributions and Grants including certain Grants-in-Aid in respect of the Cost of Benefits and Expenses of Administration under the National Health Insurance Acts.

The sum now asked for is to complete the sum of £294,084 required under the National Health Insurance Vote for 1937-1938. The figure covers the cost of central administration of National Health Insurance, and also the cost incurred for staff of the Department engaged on administration of widows' and orphans' pensions. It also includes the amount required for the statutory Exchequer Grants for National Health Insurance and expenditure in connection with the district medical referee service.

During the year 1936 the Provisional Committee of Management which had organised the new Unified Society and had carried through the transfers of the old Approved Societies handed over their duties to the new committee of management set up under the provisions of the Act of 1936. The transfer of their functions took place on the 14th July last. The new committee consists of a chairman, three trustees and three representatives of employers—all nominated by me— together with eight representatives of insured persons, of whom three are nominated by the Executive Council of the Irish Trades Union Congress and five are elected at an annual meeting of an electorate consisting of insured persons nominated by the councils of county boroughs and county councils. In electing the five latter members of the committee, provision was made for two being representative of the province of Leinster, two for Munster and one for Connaught and Ulster (i.e., Cavan, Donegal and Monaghan). The persons elected were residents of Dublin, Longford, Tralee, Clonmel and Westport, which I think is a satisfactory distribution of representation.

I appointed the Most Reverend Dr. Dignan, Bishop of Clonfert, as chairman and Mrs. Helena Concannon, T.D., Mr. Thomas Foran and Dr. Robert J. Rowlette, T.D., as trustees. The employers' representatives appointed were: Mr. Seán Noonan, manager, Freemount Dairy Society, Charleville; Mr. William O'Meara, Smithwick's Brewery, Kilkenny, and Mr. John O'Neill, President, Dublin Chamber of Commerce. All members of the committee will hold office until the 31st July this year, and thereafter the persons appointed or elected will hold office for one year.

The membership of the society at the end of 1936 was over 500,000 and the number of insured persons in receipt of sickness and disablement benefits at 31st December, 1936, was 24,747, which is about the average throughout the year. It will be seen that the percentage of insured persons in receipt of those benefits is nearly 5 per cent., a figure which is higher than the actuarial expectation. The value of the contributions from employers and employees collected in 1936 was £675,000, an increase over the previous year of £24,000. The expenditure on benefits during the year amounted to £738,549, made up of: ordinary cash benefits £710,103; additional benefits £28,446; showing a decrease from the previous year of £14,750 cash and an increase of £2,040 additional benefits. The decrease in cash benefits is reflected in the number of medical certificates issued in 1936, which was 36,000 less than in 1935.

The accumulated funds forming the assets of National Health Insurance amounted to £3,942,240, showing an increase of £139,390 during the year. The income derived during the year from dividends, interest, etc., was £161,000; and it is evident that the income from other sources, i.e., contributions and State grants is about £22,000 short of expenditure.

It will be necessary to have the whole question of the financial basis of the Acts investigated as soon as statistics, which are at present being prepared, showing the income and expenditure of the Unified Society up to the end of 1936, are available for the actuary. Although the contribution income is still increasing, I think that there is still considerable non-compliance with the provisions of the Acts. During 1936 it was found necessary to protect the interests of insured people by prosecutions of 637 employers. In addition, a sum of £356 was recovered from employers in respect of benefit lost by employees owing to the employers' failure to pay contributions.

Mr. Dillon

That is a very remarkable statement and is a bland announcement by the Minister that the National Health Insurance Society has gone bankrupt—that is what it amounts to. He has announced it in modest terms and with careful circumlocution, but that is true. It is interesting to cast our minds back to the days when some of us here in this House were warning the Minister of the danger of the policy he determined upon when he set his hand to the task of amalgamation. We suggested to him then that he was dealing with a large series of solvent societies. There were one or two which were unsatisfactory—I think the Foresters and one other—but the vast majority were found to be solvent. What the House may now forget, but which they ought to remember, is that the vast majority of these societies were paying extra benefits—some of them dental benefits, some of them oculist benefits—and their members were enjoying special privileges of that kind. I remember in the case of one approved society with which I was associated, that we were ordered not to increase our benefits because it was not thought good to increase benefits when it was the Government's intention very shortly compulsorily to amalgamate us with a new grouping where such increased benefits might not be available. Some of the Protestant societies, where you had a comparatively rich membership, were giving very extensive increased benefits. There were a few societies which were sectarian. Other societies, which were purely craft societies, admitted anybody within certain walks of life and were giving modest extra benefits. Others were simply giving the statutory benefits as fixed by the early National Health Insurance Acts.

When the amalgamation took place, all the extra benefits were swept away, with the exception of one or two small societies where special provision was made for the retention of the rights of existing members. At the time of amalgamation, everybody was put on the lowest common denominator for statutory benefit. In spite of that, after operating for two or three years, the whole shooting match has gone bankrupt after an amalgamation consisting, in the vast majority, of solvent societies. That requires some more explanation than the Minister has been in a position to give us. The Minister points out that contributions are going up and benefits are going down. He finds that an average number of persons was getting benefit—there was no remarkable increase. He finds that contributions have gone up by £24,000 per annum and that benefits represent a decrease as compared with those paid out in the year before, and the funds do not seem to be materially depleted.

What is it that has created this actuarial insolvency? There must be some reason for it. I have been told that there was a disproportionate amount of disablement amongst women employees. That seems to me to be a specious kind of excuse. A society of this character, which collects contributions from every work-person in the country ought to be, actuarially speaking, more solvent than most of the old approved societies were, because in the old days, before this amalgamation, you had the men who never were unemployed and who paid in regularly week after week, mostly segregated in their own approved societies. They gathered themselves into small groups; they had small societies; and they excluded those who had only casual employment so that they themselves might enjoy the extra benefits which the regularity of their contributions would permit. The result of that was that you skimmed the cream off the insured population for these societies, and that the general membership of the other societies was something below the average, because all the cream had been segregated into these few which catered for persons who were constantly employed and in good jobs.

Now we have everybody, those who are permanently employed, who are never out of work and, therefore, whose contributions are never suspended, all lumped together with the casual man and the man in precarious employment, likely to lose his job from time to time.

Instead of the situation getting better, it is getting worse. Why is that? I think the reason is pretty easy to understand. When this Government came into office, there was a pretty general impression all along the front bench that every Minister sitting there could do everybody's job better than that person could do it himself. The Minister for Industry and Commerce was prepared to run every factory and workshop, the Minister for Local Government thought he could run everybody's business better than the people could run it themselves, and the Minister for Agriculture was quite prepared to run every farm. Accordingly, we had amalgamation, centralisation and monopolies. In fact, they were quite unconsciously putting into operation the theorems of socialism. They believed that bureaucracy could run everything. In regard to National Health Insurance business they swept away altogether the system of individual initiative and competition and substituted therefor a socialistic monopoly.

The result, of course, has been that you have an immense bureaucracy in Arachas Sláinte Náisiúnta. Anybody —as far as I could find out—who made himself or herself a nuisance was dumped on Arachas Sláinte Náisiúnta, and given a job on condition that they would keep their tongues within certain limits. I suspect that you have an altogether excessive staff there, overlapping, and that you have all the inefficiency associated with monopoly. Before this each approved society struggled to keep its expenses as low as it could so that new members would be attracted to it, and the officials running the society a better expense ratio, a securer position, and a better public record. You had one society competing with another in efficiency, in economy, in vigilance to see that there were no fraudulent claims and that the funds were not depleted in any way. If they did not do that, a society would go to the wall, some other society would take the membership, and the officials running the collapsed society would lose their jobs. Now it does not matter if Arachas Sláinte Náisiúnta goes burst, because the Government will have to build it up.

The committee of management, as explained by the Minister, was nominated by him. He cannot find fault with them; they are his own nominees. To tell the honest truth, devil a much had the committee of management to do with it. It is run by civil servants. I believe the officials are hard-working and zealous in their own way. While I am at a loss to understand how the present condition came about, I believe they had not the beneficial effect of competition. They have been forced into methods of bureaucracy, and they regard themselves as a semi-Government Department and are allowing the Civil Service mind to dominate their activities. You cannot run anything like a business enterprise on the lines of a Government Department. If you do run it sufficiently long on such lines the end must be what we see to-day, to go to the Treasury and say that it has to make up a deficit.

I find it hard in the existing situation to recommend a solution. It is easy to tear down what you find there, but it is very difficult to re-establish it. I do not see how you could get back to the approved society. We have this baby, the Unified Society, and we have to make the best of a bad job. But the Minister does not discharge his responsibility to this House by merely saying that he does not know what is happening or what is wrong here. He ought to know. This is his baby. He recommended it to the House. Presumably he investigated the whole problem before he came here and took the responsibility of recommending unified legislation. The calculation that he made before he recommended the scheme to the House has gone wrong. He must know that. He ought to be able to tell why it has gone wrong. He told us when he recommended the scheme that it provided an absolute guarantee against bankruptcy. He admitted that it was a hardship to many to do away with the extra benefits that existed, but he was doing it to ensure that there was no danger of insolvency. He told us that he earnestly hoped, when the emigrants started to come back from America to take up the jobs provided by the Minister for Industry and Commerce, that there would be an immense surplus and that we could spend it by embarking on extra benefits to be provided out of the surplus and out of the aid provided by the Government's new policy in the years to come. We are told that there are more people employed, that there are more people in insurable occupation than ever before in the history of the country, yet the fund into which this greater number of insured people is paying has gone burst. How is it, if more people are paying into the fund, and if less benefit is being paid, that it has gone burst?

Remember, it is heresy, it is sabotage, it is trying to destroy the State, if anyone questions the fact that great industrial development has taken place in the last five years. "The March of Time" says that Fianna Fáil has stimulated the demand for Guinness, built Trinity College, and new industries, including Cleeves' Creamery, which was built years before they came into office. All those in these additional factories, all these hundreds of thousands of men and women who were put into permanent employment by Fianna Fáil, are paying into this fund that has gone burst. Emigrants would have to pay into this fund if they came home to take up jobs. They have not landed yet. Probably they will come and they can make their contributions, too. The trouble is: "Live horse and get grass." This horse is going to die before the emigrants get here. The Minister comes here but does not know what happened, except that something has gone wrong. I want to know what has gone wrong. Is it the plan or is it the scheme? If the Fianna Fáil plan has gone wrong, I admit that that has upset the Minister's calculations. It may be that the scheme which he fathered to this House has gone wrong. He must know. If his calculations worked out, this would be a solvent fund, an immense and prosperous undertaking, considering ways and means for the distribution of the surplus that the Minister foresaw three years ago. What has gone wrong? The Minister does not discharge his responsibility to this House until he tells us.

Mr. Anthony

On the last occasion on which this Estimate was before the House I refrained from passing any adverse comment. As one who opposed the unification scheme from its inception, I felt, that having been defeated—if you like to put it that way—it was only right and proper that the scheme should get a fair try-out. I submit that it has got a fair try-out. We were led to believe that when this amalgamation or unification scheme would fructify there would be increased benefits. What do we find now after it has got a fair try-out? We find that there are decreased benefits. There was considerable opposition to the unification measure in this House and throughout the State amongst persons who were insured under the National Health Act, because it was felt—and the impression has now been verified—that a well organised and well managed national health society would be asked to pay for badly managed and inefficient health insurance societies that operated before amalgamation took place. We were told that, with greater numbers, great benefits could be paid. We had some excellent national health institutions in Cork. We had St. Finbarr's Diocesar Society, which paid benefits with which the present payments do not compare. The payments made by the Cork society were infinitely more numerous. The financial benefits were certainly many times higher than the rates paid under the present system. The Minister has promised an investigation, and I hope it will be a fairly exhaustive one. It will take very exhaustive investigation indeed to reveal what are the real or root causes of the doleful account the Minister has given us of the state of the fund.

When one considers that some most important services have been dropped under the unification scheme, one begins to wonder at the patience of the persons who comprised the well-organised and efficiently-managed societies before this unification scheme became operative. I want to say that, so far as the officials of the new organisation are concerned, that is, the National Health Society with its headquarters in Dublin, I have nothing to say. They have been most courteous on any occasion I have had to approach them and I must pay particular tribute to the secretary of that institution. He has always been most courteous and has always gone to a great deal of trouble to explain, or perhaps I should say, to explain away, the causes which operate against deserving people getting the benefits which they believe, and which their medical advisers believe also, they are entitled to. I have come across many cases, which I do not want to recount now, in which applicants for medical benefit were turned down, who received none for a considerable time and who were vouched for by two or three doctors as suffering from certain diseases and complaints which necessitated their remaining away from their work. There have been a good many cases of hardships of that kind and my feeling in the matter, and it is a feeling shared by a large and growing number of citizens in this country, is that it is the loss of the personal contact which the various local societies had which is responsible for most of it.

The Minister must be aware, because he was, I think, told it here when the Bill which gave birth to this central institution in Dublin was going through, that the fact of the head office being situated in Dublin would result in many cases of hardship. These cases of hardship have occurred. A patient leaves the doctor with a certificate; he goes to the local office, and the local office official says that he knows no more about it, that it has gone to Dublin. This delay is a source of complaint to me week in and week out. I do not at all times bother the officials because I know they are efficient and hardworking. It is not their fault; it is the fault of the system. I think it was wrong in its inception and the prophecies of those who said at the time that it would prove a rank failure have now, I am very sorry to say, been fulfilled. We were told then, and I think it is fairly generally accepted, that the larger the organisation numerically, the more benefits it could pay. That was true of Cork City up to the time of the amalgamation, but the members of the St. Finbarr's National Health Society and other societies operating, feel that they have been badly let down by the Government in this scheme.

Everybody knows that these organisations paid maternity, optical and dental, as well as sanatoria benefits. We find now that one most important service which is regarded by medical authorities as being of primary importance to the health of the nation, the care of the teeth, has been dropped. I refer to dental treatment. Up to July, 1936, persons who complained of their teeth were entitled to get certain benefits in the shape of extractions and so on. When these extractions took place, they were entitled to get dental plates, etc., but now all that benefit is gone. In many cases, members of the dental profession state that they frequently have working-class people coming into them to get teeth extracted, and they find, on examining their mouths, that they want several teeth extracted. Some of these people are unable to pay the cost of the extractions and, to my knowledge, there are two or three dentists, personal friends of my own, by the way, who are giving free extractions to persons who cannot afford to pay. That is not a position that should be allowed to continue very long, and I make this appeal to the Minister that, when this investigation takes place, this dental treatment should be extended to the members of the National Health Societies.

I said a moment ago that the medical profession now recognise that the care of the teeth is a very big factor indeed in the health or ill-health of the people, and that this benefit has been taken from the working-class people is something of which, I am sure, the Minister does not approve. I urge upon him the absolute necessity of doing his best in this matter after this investigation, and to scrap this national health institution you have here in Dublin which is out of touch with the people in the country and give us back the old institutions. Deputy Dillon said it was very easy to destroy and very difficult to build up. I agree, and I prefer to be a builder rather than a person who would destroy, but I do not see why this institution should continue, and should take money from working-class people. That is what I want to emphasise. Why should they take money from working-class people and refuse to give them the benefits for which they are paying and have paid? One case will illustrate what I want to put to the Minister. A man who had been paying national health contributions since the Act was introduced had occasion some time ago to go to his local doctor, and, when his teeth were examined, the doctor told him that he should get his teeth extracted and replaced by others. He went to his medical society and was told he could not get any dental benefit after July, 1936. He was a man who had been paying National Health Insurance all his life, and I consider that that is a fraud on the private citizen. I wonder if that private citizen committed fraud on the Department, if, for instance, he drew unemployment money while he was working, or national health benefit when he was only malingering, what the Minister's answer would be. He would be entitled to prosecute him——

Mr. O Ceallaigh

We would if we could.

Mr. Anthony

Certainly, but what position does the private citizen find himself in now—the man who has been contributing for years and years into this fund for certain benefits he was promised and who, when he falls ill and goes to his local office, is told that after July, 1936, he cannot procure any dental benefit or treatment? That is a state of affairs which I consider to be a fraud on the part of the State. If a fraud is committed against the State, the State will take jolly good care to prosecute the offender and to have him in the dock. In this case, the State, as represented by one of its institutions, is in the dock. Again, I say I have no fault to find with the officials who are endeavouring, to the best of their ability, to run this ungainly institution which is out of sympathy and out of touch, and will continue to be out of sympathy and out of touch, with the working-class people throughout the country. So long as you have centralisation of institutions of that kind in Dublin, you are going to have these injustices perpetrated every day.

My last word to the Minister is that he should endeavour to secure that dental treatment should be restored to these people, and, again, I want to register my protest against the way in which the whole affair was managed. It was rushed through this House with a flourish of trumpets, and we were told that it might result in increased benefits because of increased numbers. I do not want to stress Deputy Dillon's points, but I think they should be emphasised. You have increased numbers; you have increased revenue, and you have lesser benefits. What is happening? I hope this investigation will result in clearing the air and will result in the poor man, who is unable to pay high fees to dentists for plates or extractions, getting what is his due and getting treatment for which he contributed and paid over a long period of years.

Mr. Everett

If there is any great loss or expense incurred in this matter it cannot be attributed to the payments made to agents through the country. I think the agents of this society are a very hard-working, conscientious section of the citizens, but with regard to the rates of wages allowed to these agents in the rural areas, there is no consideration taken of the journeys these agents have to travel. They have to travel five or ten miles, perhaps, twice a week to visit a sick person, to collect certificates or to pay benefits. It may be quite different in the city, where a large number of insured persons reside in one street. You may have a larger number in one street in the city than you have within a 20-mile radius in a rural area. The payment allocated to an agent in the City of Dublin should not be put on a par with payment in the country, at so much per head. I know a large number of agents who earn about 30/- per week and who have to provide their own bicycle and travel ten or 12 miles in all classes of weather. In addition, they have to maintain an office and they are not allowed for postage. These men are asked to carry on this responsible work conscientiously on a miserable pittance. Apart from the commission that is to be appointed, I make a special appeal for special consideration for the deserving sections of the Minister's employees.

Mr. O Ceallaigh

They are not my employees. I have nothing to say to their wages.

Mr. Everett

The management has. Probably a suggestion from you would be helpful.

Mr. O Ceallaigh

I have no power to interfere.

Mr. Everett

The State have to make up some deficiencies in connection with the administration of this service.

Mr. O Ceallaigh

I have nothing to say to the employees.

Mr. Everett

The service is costing a considerable amount more than it did when the old insurance committees were in operation. There is more money being spent by the Minister's own Department in dealing with insurance than there is in England and less benefit is being given. That cannot be attributed to the small wages paid to the agents and I protest against payment of 30/- a week to men who must be trustworthy in every way and who have to maintain an office at a cost of about £10 or £15 a year. I was opposed to unification from the start but I do not want to say "I told you so" now. Coming from a rural constituency, I ask the Minister to carry out what was intended by the Insurance Act—that is, to make payment to sick persons during the first week of sickness. A breadwinner who is sick should not have to depend upon charity during the first week of illness, whether that charity comes from the St. Vincent de Paul Society or by way of home assistance. Under the present administration of the Act, a man in the country may be ill for three weeks before he receives the first payment of insurance benefit. The agent sends up his certificates on a particular day at the end of the week. By the time these certificates are examined by the Department in Dublin and the cheque reaches the insured person he is very often back at work after his illness. I think that that is a matter that calls for special consideration. That man should not have to depend on relief from a local authority. The first week's benefit should be sent out so that he would not be dependent on charity. During the present week I had to draw the attention of the Department to the case of a man who had been sick for three weeks and who had not received the benefit to which he was entitled, through the fault of an agent who sent up only one certificate, leaving a couple of certificates due. The local authority must come to the rescue in those cases. The rates in rural areas are not coming in as well as one would wish. There is high expenditure on home assistance and it is hard lines that the local authority should be obliged to come to the assistance of people who are entitled to benefit from the National Health Insurance Society but who do not receive it for a fortnight or three weeks. I protest against undue delay in sending out cheques to sick people in the country.

Mr. O Ceallaigh

No Deputy in this House talks more blatherskite almost every time he gets up than Deputy Dillon, and I think he outshone himself to-day. He claims to know something about the management of national health insurance societies before amalgamation. If he does he should know, and every Deputy who was interested in the debates on the unification Bill should know, that if there was ever any question of bankruptcy, it had arisen when the fourth valuation report by the actuary was submitted. That was long before unification was discussed in this House.

Mr. Anthony

Those were the badly managed societies.

Mr. O Ceallaigh

It was shown by the actuary's fourth valuation that there was a deficiency of £500,000 by the societies as a whole. It showed that National Health Insurance, as a whole——

Mr. Anthony

No, not as a whole.

Mr. O Ceallaigh

Yes, because if it is a national scheme, you must, in fairness, treat all citizens alike. How could you stand for a select little body, or coterie, getting its own members around it, getting them into a society, and keeping out everybody who was likely to have a claim against the society? That was done. Some societies hand-picked their members, and only allowed them in after strict medical examination. Other societies —decent societies—had, unquestionably, strict regulations, but not so strict as those others. County societies, trade union societies, and societies with religious affiliations took in everybody. There were bound to be differences in these circumstances. The select body could have additional benefits for its members. They got good lives, from the insurance point of view, and they accumulated funds. They could allow additional benefits, such as dental, optical and hospital benefits, to their members, but the vast majority of the societies could not afford to allow these benefits.

Mr. Anthony

Surely the Minister must be aware that not alone in this country but in a neighbouring country where they take in all and sundry without medical examination they give three times the benefits that are given here.

Mr. O Ceallaigh

What is the use of comparing societies in England with our society? Look at the relative population. The Deputy is a sensible man, and he knows that the basis of successful insurance is large numbers.

Mr. Anthony

I said so. We have a larger number now, and we are giving fewer benefits.

Mr. O Ceallaigh

The loss of £500,000 has to be made up. Where are we going to get that? That sum was lost.

Mr. Anthony

By badly-managed societies.

Mr. O Ceallaigh

Not altogether, because this fourth valuation showed that the vast majority of the societies were extending at too great a rate. Even with that report, Deputies will see that Deputy Dillon cannot keep out of trying to make politics out of this discussion on National Health Insurance. I could make politics out of this discussion if I wished, taking this report of the valuation from 1929 to the end of 1932. We were not in power four years out of the five during the period of that valuation, but I am not going to make politics out of it. Probably if we were in power the same thing would have happened. I think it is certain that it would have happened; we are not going to discuss the matter from that point of view. Therefore, I say that Deputy Dillon is dishonest in talking blatherskite of that kind. It is not his first time doing so. Every day he is talking blatherskite. I am not going to say that that institution went bankrupt then nor that it is bankrupt now. At least, according to the actuary, it was not bankrupt. Deputy Dillon would probably say that the actuary was appointed by the Fianna Fáil Government. He was an Englishman. I do not know who he was, but I know he was not appointed by me, anyway. He was appointed before my time. His figures show that there was a loss of at least £500,000, and during the last year there was a loss of £45,000.

What we are trying to do is to gather the members into one association, make them stand together, make them strong and have the strong ones paying for the weak. That is what we did. I am not now making this argument for Deputy Dillon. Nobody takes him seriously, but Deputy Anthony and Deputy Everett are two Deputies who are experienced and sensible and I am putting the matter to them. They are not, I am sure, getting up to say: "I told you so." For the time being the Government saved the National Health Insurance from going on the rocks. There was a very stiff rise in expenditure during those five years. If it were worked out in a graph it would be found that that rise was a very rapid one. I do not say that the rise is anybody's fault. I am not blaming anybody, but the fact is that there was a very rapid rise in expenditure and the income was not there to meet it. That rise reached its peak some time in 1934, and it is going down since because of the careful nursing and management by the new committee of management. That is what has happened. The new committee are being strict and they are watching the working expenses and the benefits because of that loss of £500,000. We are not out of the wood yet and it will take some time yet before we are out of the wood. The report showed that in the last year of the period there was a loss of £22,000; in the previous year the loss was £45,000. We are gradually cutting down the loss. It is untrue—I will not use any stronger word than that—for Deputy Dillon to make the statement he has made here. I put it to Deputy Dillon that I am afraid he knows it is untrue to say that the majority of the societies paid additional benefits. They did not.

If it were not for unification being put through and the responsibility taken by the Government and by me for that operation, and the House here adopting it with a considerable amount of opposition from interested parties and from people who had good societies and good membership and who were getting additional benefits, this loss would continue to increase instead of being reduced. These societies did not care a damn about the poor persons who were in the weaker societies, the weaker societies who had to take the sick, the blind and the halt into their membership. These societies were often subject to losses through sickness and so on. The strong societies did not care a snap of their fingers about these weaker societies, but I want to point out to the House that this is National Health Insurance, and the strong and the healthy and the wealthy have to stand in with the weak. Otherwise it would not be a national scheme. I do not say that we are quite out of the wood yet. We are not. We are awaiting the report of the next valuation. It would be disastrous to the future of National Health Insurance if we had not unification, despite what Deputy Anthony and Deputy Everett now say in criticism of it. Unification was the salvation of National Health Insurance. Otherwise, the position would be that you would have people thrown on the wayside without any benefits. Even the small 7/6 benefit would not be available to them. We had to ask the wealthy and the healthy people to stand in with the weaker ones. It is a compulsory scheme as well as a national scheme. The Government and the taxpayers of the country are paying a very considerable sum towards it. They were not going to continue paying these considerable sums to a number of societies for the sake of enabling these special societies to handpick their members. The Government were paying the same for everybody and, consequently, the same benefits should be available for everybody. If we found it necessary to take some benefits from those who had additional benefits, well then we had to do it.

I still hope that National Health Insurance will be saved by unification without asking the State and the taxpayer to put their hands deeper into their pockets. Until we had unification there was no hope for National Health Insurance, but there is hope now. I would advise Deputy Anthony and Deputy Everett to look at the matter in a sensible way. There is no use in offering sound advice to Deputy Dillon, because he would not recognise it if he heard it. I ask Deputies to wait until we have a proper valuation and a certain number of years has elapsed. The usual period in National Health Insurance since it was first established was the five years' period. We hope to get a valuation earlier; at any rate, there is a valuation coming shortly. I ask Deputies to hold their breaths and not to be shouting: "What a great fellow I am; I told you so." I was going to say that it is damned little good to talk like that, only that that would be an unparliamentary expression. I ask Deputies to keep their mouths shut before offering any definite information about National Health Insurance.

Mr. Anthony

Has the Minister any estimate at all as to what it will take to restore dental benefits? The Minister has mentioned National Health Insurance. Now, without going to the Minister for a definition of that term "National," I wish to point out to him that if he were really so national as he pretends in his outlook, it is a wonder he did not make the nation as a whole pay for this loss out of its pockets rather than ask the hard-working, industrial society people to make up this loss by the curtailment of their benefits?

An Ceann Comhairle

That is more like a speech than a question.

Mr. Anthony

It is a question with a parenthesis.

An Ceann Comhairle

But the parenthesis has smothered the question.

Mr. Anthony

I do not want the Minister to give us an estimate right away. What I do ask him is to look into the question and to tell us whether he would, even by way of loans to the National Health Society, do something towards restoring to the persons who paid for these benefits those benefits which are now denied them.

Mr. O Ceallaigh

They paid no more than the people who never got these additional benefits.

Mr. Anthony

But those others went bankrupt because of their own fault. The Minister knows that people go bankrupt, else why is there a Bankruptcy Court in this country? I submit that the Minister should come to the help of the societies and get them out of their bankruptcy, and not compel the solvent societies to do so.

Mr. Everett

Pending some arrangement being made, we would be glad if the Minister did restore the benefits.

Mr. O Ceallaigh

The National Health Society has its own committee of management, and Deputy Everett knows that his own organisation has many members on that committee. I am not in control of the committee of management.

Mr. Everett

It does not at all follow that because Labour is represented on the committee of management that everything done by that committee is perfect.

Mr. O Ceallaigh

I am not in control of the management and I am not in control of the salaries or wages of the staff.

Mr. Everett

But you are interested in sick persons and you should not have them waiting three weeks for their first payment.

Mr. O Ceallaigh

There are plenty of representatives on the committee of management and the Deputy should take it up with them.

Vote put and agreed to.