I wonder did the thought cross Deputies' minds as to the kind of reception that might have been given to this Bill, were it introduced eight or nine weeks ago by me as Minister for Health? I have no doubt I would have been told that this Bill was aimed at destroying the Health Act and was a Bill designed to tax the sick. It is pertinent to note that this Bill is introduced by a Fianna Fáil Minister for Health and a former Fianna Fáil Minister for Finance. It is a Bill in which, for the first time in this State, money is sought from those who are sick. It is a Bill in respect of which, for the first time, the health services are called upon to contribute towards the budgetary position of the State. It is, therefore, a very significant step, and, in examining whether it is a good step or not, it is necessary for us to clarify our minds.
Some years ago, members of the present Government Party sought electoral support from the people with the slogan that health should not depend on wealth. They assured the people of this country that under the Act it is now proposed to amend—the health Act of 1953—for large sections of our people absolutely free health services would be provided. The family doctor, we were told, would have been available, free of all charge, the services of the finest specialists in the country, and the slogan "free specialist services" became a principle of Fianna Fáil. They left office, of course, without providing these services and it became necessary for me and my colleagues in the previous Government to take such steps as were necessary to make these services actually available to the people.
This was no easy task and my task was made more difficult by the suggestions I had to encounter from the Fianna Fáil Party, suggestions that I was out to destroy the Health Act and out to deprive the people of services that Fianna Fáil would provide for them. My task was not made easier when the Minister for Lands, Deputy Childers at that time, was able to go around the country in the year 1955 saying that the Government's attitude to the Health Act was a crooked one and that Fianna Fáil did not believe in any cheese-paring on health services. My task was not made any easier when the present Minister for Finance, Deputy Dr. Ryan, in the same year, 1955, told the people that I in a short space of a couple of months had done everything possible to strangle the Health Act.
Despite these suggestions, the country knows now that I left office with the Health Act services actually in operation and not just something promised on election posters. I left office with free specialist services provided for those designated under the Health Act, with a maternity service working fully and availed of by a growing number of expectant mothers, and supported in peace and understanding by the medical profession.
Despite all these suggestions, the Health Act services had been introduced. Health was removed from controversial politics and solid achievements had been gained. Here, to-day, there is an end to a very sordid story. Health is no longer a matter of political significance to the Fianna Fáil Party. No longer is it possible to seek electoral support because of spurious claims made in relation to health services. Health can now go on the upper shelf and, if necessary, the sick may be taxed to provide the necessary revenue.
I wonder what all the pother was about over the years. I wonder how the Fianna Fáil Party can square their consciences in this regard. Do Deputies remember the Committee Stage of the Health Bill, 1952, now the Health Act of 1953? Do Deputies remember the then Minister for Health pointing a finger of scorn at these benches, describing the Fine Gael Party as frauds and hypocrites? Who were the frauds? Where are the hypocrites? What Party and what men have, in fact, contributed consistently and honourably towards improving health services? Who now finds it necessary to come into this House with a Bill to tax the sick?
I have no doubt that the people will judge this issue fairly and squarely. I have no doubt that the people will regard the action of the Fianna Fáil Party over the years in relation to health services as something despicable. Only 12 months ago the Fianna Fáil Party were asking for two things, mutually contradictory. One member of their national executive was demanding that I should initiate here State medicine and that we should provide free services for all, irrespective of means. That member of the Fianna Fáil Executive is now a Deputy of this House. He is no longer a member of Fianna Fáil, but, so long as he remained on the Fianna Fáil National Executive, he was permitted to make demands of that kind. There are others in the Fianna Fáil Party who apparently think that the actions taken in providing health services in recent years were so radical that they must now be retarded.
I cannot guess what judgment the people may pass on those who have, with utter disregard, made health the plaything of politics. Thanks be to God, my Party have been consistent in this matter all down the years. My Party have provided solid achievement and we have not sought to seek passing political advantage in doing so.
This Bill is a Bill designed to destroy the principle of free specialist services contained in the Health Act. It is a Bill designed, too, to impose a considerable increase in the charges that sick people in hospital may have to pay. The Minister said that the increase from 6/- to 10/- was a moderate increase. It is an increase of more than 50 per cent. and it is an increase in a charge that has not yet been even 12 months in operation.
Do Deputies realise that prior to the enactment of the Health Act, 1953, every insured person—800,000 in all— was entitled to go into the leading teaching hospitals in this State and receive there absolutely free hospital treatment for a period not in excess of, I think, six weeks? Every insured person had that benefit prior to the enactment of the Health Act, 1953. When the Health Act was brought into operation a maximum charge of 6/- per day was provided, a charge which could be imposed on such insured persons.
It was my responsibility to try to bring some order into the chaotic health conditions which I found in 1954 and I sought approval from the Dáil to delay the imposition of that charge, until it was possible to provide all the services. Accordingly, on 1st April of last year, when the full services under the Health Act were introduced, this charge of 6/- per day became payable under the Health Act of 1953. That is slightly over 12 months ago. Do Deputies recall the storm of criticism that arose when last year persons in the middle income group, particularly insured persons, found that in respect of their own treatment or the treatment of their children or dependents in hospital, they had to pay two guineas per week? Indeed, the suggestion was made that it was some charge that I had imposed upon them; people were so charitable with regard to health matters while I was Minister for Health. Nevertheless, we find now that this charge of two guineas per week which was recently imposed and which has aroused some disquiet and dissension, particularly amongst the trade union movement, is now to be increased by more than 50 per cent. and rises to 10/- per day.
The Minister says what is perfectly accurate: "Of course, this is a maximum charge". He points very properly to the provisions in the Health Act which entitle health authorities to refrain from imposing any charge, if they so wish. That is a section which does not operate. I hope the Minister is not so foolish as to think that health authorities anywhere in the country refrain from charging the full 6/- per day because, once they decide to impose a charge, it is all or nothing. One object, I understood, of the Health Act was to get away from the system whereby public representatives were asked to make representations, to pull the county manager's cost and try to get something off a hospital bill. Indeed I remember Deputy Burke, who is here listening, making that point when I was being accused in this House of destroying the Health Act. Now it is suggested, when the charge is increased from 6/- to 10/- a day, when a person may be charged £3 10s. per week, that that should not cause any trouble because, after all, the charge is not mandatory. I assume that county councillors again will be encouraged to go around with a hospital bill and try to become popular on the shillings they can get off it.
This increase will represent a very serious burden to many people. I know well that the charge of 10/- per day does not represent a third of the cost of treating a patient in our teaching hospitals. I well accept what the Minister says when he says that the cost in a Dublin hospital now runs over 30/- per day. But is that an argument? Is it not the object of health legislation to provide assistance to classes whom this Parliament regard as needing assistance in the provision of health services for themselves? It is because the cost in hospital is so high that health legislation is necessary; it is because it costs over 30/- in a Dublin hospital bed that it is necessary to have a Health Act. If the cost of treating and maintaining a patient in a Dublin hospital was only a matter of a few shillings, there would be no need for health legislation because it would not have political significance. It is when the charges increase that this kind of legislation is necessary.
Long before the Health Act, the State always recognised the fact that many sections of our people cannot afford to pay the full cost of their hospitalisation. For many years before the Health Act, the principle of paying the deficits of the voluntary hospitals was fully recognised and to-day every hospital authority knows well that the difference between its revenue from patients and the sum of its expenses will be met sooner or later by deficit payments from the Hospitals' Trust Fund. I know that efforts are made to prevent that being an assurance to each hospital authority, but the plain fact, of course, is that they know well that sooner or later the Minister for Health must come to their assistance.
Accordingly, the argument advanced by the Minister with regard to the actual cost of treating an in-patient in the Dublin hospitals or elsewhere is, in my opinion, not an argument at all. What we have to remember is that every worker in this city, in this county and in this country who has not a medical card—and if he is in insurable employment, it is unlikely that he has a medical card—must, in respect of the illness of his wife, himself or his children, face a charge of £3 10/- per week. If two children get sick, it is double the amount. If the insured worker himself gets sick, his own wage may cease to be earned, but nevertheless he will have to pay £3 10/- per week. That is a serious increase and it is no good suggesting that it is something so small as, perhaps, to be disregarded.
May I say to the Minister that if he proposed to impose this charge on a certain section of the agricultural community—and I represent them—I would not oppose that in any way? I believe there is a certain section of the farming community—I will not mention a particular valuation limit because valuations change in different parts of the country—who are entitled to benefits under Sections 15 and 16 of the Health Act and who could afford to pay more. I do not believe that section is very large. I believe there are many farmers with valuations of £20, £25 and £30 who at the moment find it very difficult to carry on. To them, this increase will be quite a serious imposition.
The Minister—and, may I say, I have some sympathy for the rôle the Minister has to play in this final chapter of the Health Act story—pointed out that many services still remain free, small-pox vaccination, B.C.G., mass radiography and all these public health services. May I say to the Minister: thank you for nothing? The public health service in this country was developed and built up long before the Fianna Fáil Party came into office. It was developed as a State service.
This State and every other State, I think—certainly, in Europe—recognise that, in relation to infectious diseases, free services must be provided because the State itself and society has a very definite interest in the provision of immunity. It is for that reason, on sound national grounds, that the provision in relation to infectious diseases of free vaccination and immunisation was, and has always been recognised here, and when the Minister comes in with his little taxing Bill and says: "I am not interfering with those free services," I say to him: "Thank you for nothing".
The Minister goes on to say that also excluded from these increases is the maternity service, that is, the general practitioner service. That is a service in respect of which I had considerable difficulty in providing something that would work and be accepted by all. I am glad that service is now in operation and working successfully, but it is a general practitioner service, service based on the family doctor. If specialist assistance is needed, then, under this Act, a charge must be imposed, and I want to remind Deputies that whatever discretion is given to health authorities in respect of a charge for persons going into hospital, under this Bill, if it is not amended, it is mandatory on them to charge for specialist services. They have no discretion, in that respect; they must impose the charge nominated by the Minister.
The Minister has told us he intends to fix a charge of 7/6 for X-rays, 3/- for the first visit to the specialist and 2/- for each return visit. That may mean in the one example the Minister has given, merely a payment of 12/6. 12/6 to a £50 farmer in, perhaps, one of our north-eastern counties, might be something that he would regard so lightly as not to affect him, but 12/6 to an insured worker who is worried about some pain he may have and who has to go to see a physician or surgeon and be X-rayed, can be quite a considerable charge. In any event, whether it is small or big, they will have to pay now because this is a mandatory charge.
The Minister also said that free specialist services and free hospital service would still be continued for the lower income group. That comprises persons who were formerly described as the public assistance class, persons who formerly benefited under the Public Assistance Act of 1939. In addition, the Minister told us that free services would continue to be provided for school children in respect of defects discovered at a school health examination. Again, I would say to the Minister: thank you for nothing. Those free services were there long before the Health Act. For many years, although people apparently do not know this, and it was not desirable they should know it, one third of our population, 30 per cent., were entitled to and received absolutely free hospital services and free specialist services. These are the people who were entitled to benefit under the Public Assistance Act, 1939. They are now the people described in the Health Act as persons in the lower income group, evidenced by the possession of, or entitlement to, a medical card.
The Minister says they will continue to have free hospital treatment and free specialist services. They always had those things and in fact many of them had them more easily prior to the Health Act than they have had them since. Again, in the case of school children, it should be known that the school medical service did not originate under the Health Act of 1953. It was there, I think, since 1919. Certainly, it was there for many years before the Health Act. Every school child in the national school was for many years entitled to free hospital treatment and free specialist services in respect of defects discovered at a school health examination. The Minister says that will not be interfered with. That is no concession on the Minister's part.
I do not want to prolong the debate on this Bill. It is introduced by a Fianna Fáil Minister. Had I introduced it, as I have said, bedlam would have been let loose. Had I in any way suggested that some charges could be imposed on some sections under the Health Act, I would have been told that it was my antipathy to the Health Act which was governing my motives. I did not introduce it; it is introduced by the Party which made slogans out of health a few years ago, which told us that health should in no way depend upon wealth, which made a principle out of free specialist services. It is introduced by the Party which at one time found health legislation to be popular.
I may say, and I make no concealment of it, that when I was Minister for Health, I always anticipated a case might arise in which an increase in some contributions should be made, but I proposed to consider such an increase when a scheme of voluntary health insurance was available to the people. If an attractive scheme of health insurance at a reasonable premium were available to the people of the country, then I could see a case being made, for instance, for increasing the charge on certain categories of farmers under the Health Act. We may have—I hope we will have, in the near future—such a scheme. To the extent that these increases will encourage people to insure, it is welcome. However, these charges are being imposed now on all sections who benefit under Section 15, on all insured workers, on all farmers, on all persons whose income is less than £600, the self employed. Each such section now has to face an increase.
May I just say this in conclusion? There has been certainly, in my experience, considerable criticism of the manner in which persons under Section 14 of the Health Act of 1953 became entitled to free medical treatment. This Bill will result in a considerable increase in the applications for medical cards. In certain parts of the country at the moment, very nearly half the population, half the county population, is regarded as being so poor as to be unable to provide for themselves. The effect of these increases will be to increase the number of people seeking medical cards and therefore entitled to free hospital services.
I do not know whether the amount of money involved in this Bill justifies this departure. It would seem to me that in order to justify a Bill of this kind on purely material grounds, the gain to the Exchequer would have to be considerable. If the amount expected to be raised by these charges on sick people is nothing of any considerable significance, then it baffles me why the obvious administrative and other difficulties should be faced in order to get the sum of money which, in relation to the sum spent on health, is not a significant saving. In any event, I feel that in so far as these increases arise from a Budget and are budgetary increases, they therefore represent part of the taxation imposed by the Budget. They are, therefore, a tax imposed on the sick people of this country. They are imposed when no alternative means of providing health services is available to those people. For those reasons, I feel this Bill should be opposed.