I welcome the fact that we have here in this particular session of the Dáil a wonderful mad scramble by the Government and the main Opposition Parties to put down proposals and amendments towards the betterment of our health services. That is a great achievement and one which I welcome. I do not mind who improves our health services so long as someone does.
I have had the opportunity of reading Deputy O'Higgins's contribution concerning the provision of an insurance scheme. I may be wrong, but my feeling, from what I read of it, is that it does not substantially or appreciably advance the health services which we at present enjoy. It strikes me as being an ill-thought out, scrappy patchwork of ill-digested social objectives, held together by the dictates of political expediency. I think it is ill-thought out because if the proposer of the motion were anxious to give our people the same standards of health services, then without looking beyond the four corners of our own country, he would not find better examples than there are within our own service, that is, that our health services should be extended on the free, no means test principle on which our tuberculosis services, our fever hospital services, and our ante-natal services are founded.
I do not think he made any case for the suggestion that we should abandon that principle. He had no justification for the abandonment of that principle and, in fact, no matter what Minister is in office in the Department of Health, the wonderful achievements of those services cannot be clouded. If they wanted to achieve what they profess they want to achieve, that is, an equitable standard of health services for everyone, they would have got rid, once and for all, of the two-tiered service we have had in the country since the late 19th century, with only minor ameliorations and changes here and there.
Why has no case been made on ethical grounds, on administrative grounds, on medical grounds, or on any other plausible grounds, for the abandonment of a free, no-means test principle and the installation of this absurd proposal concerning the use of insurance? Deputy O'Higgins gave voice to a number of the war cries which one hears from Tory and Conservative politicians, in this and every other country, concerning the attitude of our people to paternalism and the rejection of State interference with self-reliance and the dangers of undermining that self-reliance, if we give too much protection and too many social services.
This is certainly an advance. Even if it is step by step and taken at ten yearly intervals, it is still an advance on the war cries of about ten years ago when the proposition of free health services was anathematised in this House and outside it. At least we have succeeded in dragging them so much further forward into the 20th century that they now accept that free medical general health services are essential in a properly organised modern society.
Deputy O'Higgins strikes me as being a very confused man on this question of paternalism and State interference. Deputy Ryan talked about the principle of people putting by for the rainy day, providing for ill-health when it turned up. Every citizen in this State is putting by for the rainy day when he pays taxation; a very high percentage of our people pay direct taxation and every man, woman and child in the country pays indirect taxation. Every man and woman in this State pays indirect taxation in respect of bread, butter, tea, sugar, intoxicating liquor, tobacco, cigarettes and in numerous other ways.
An increasing amount of money in the form of indirect taxation is paid by the mass of the people. They pay for the rainy day. A very high percentage of the people also pay for the rainy day in the form of rates, for old age, for the education of their children for the time when they may fall ill. These are all insurance contributions, insurance payments. They are taking no charity from anyone for any services. Any services provided by any Minister, whether social welfare, health, education or any other, are paid for out of money taken out of the ordinary people's pockets.
On the one hand, you have this conservative approach, that we do not like State paternalism, that the people like to pay for these things. When you say it is a free service, they say everybody pays, but then when they want to talk about State paternalism, they say there is no Father Christmas State which can provide money for everything. You know well the difference between the two and you know quite well that that is the type of insurance produced by conservative politicians at a time when they are under pressure to make some advance in the provision of social services to meet modern needs. That is the only reason, a reason of political expediency, that has brought Fine Gael into this House to-day with this proposal because they know quite well, and the Minister knows, too, that probably the greatest issue in Irish public life at the present time is the improvement and betterment of our health services.
When I hear this kind of confused mumbling by these politicians, I do not know whether to put it down to foolishness, ignorance or to a deliberate attempt to confuse the electorate on these points, telling them they do not like these free services. All right. I have done this before and I shall now do it again. Why did Fine Gael not fight the last election on the proposition that the free services we have here at the moment should be scrapped because the Irish people do not want these services? Fine Gael believe the Irish people do not want a free tuberculosis service so we shall scrap that and establish it on an insurance basis. Fine Gael do not believe in free children's allowances so we shall scrap those and establish an inane or idiotic form of insurance. The Irish people do not like free primary education so in order to restore our self-respect from the advanced stage of erosion it has suffered because of these free services over the years, we shall introduce some kind of insurance contribution so that we can get that free primary education for our children.
In that way, we have put the stiff poker into the backs of the Irish people and made them stand up and hold their heads high. What arrant rubbish is this! Fine Gael know quite well that the Irish people are very proud of and pleased with their free services. If anybody dared to lay their hands on them, he would not last for 24 hours in public life. They know that our people here have free services, that our people in the Six Counties, who are also Irish men and women, have free services. See how many of them opt out of the free health services in the North of Ireland because they are afraid it will undermine their independence, their individuality or their moral fibre. Show me a dozen people in the whole of the North of Ireland who are not availing of their health services because of an alleged threat to their independence, and I will certify them.
Deputies know quite well that this applies to every one of our people in Great Britain enjoying the free national health services there. How many of them opt out of the services? There is this extraordinary chauvinistic attitude that we are rather different from the English, the Scots, the Welsh, the Scandinavians, the Swiss, the New Zealanders and the Australians. There is this idea that we are superior to these other people, that we are a kind of herrenvolk living here in Ireland who have nothing but contempt for these free services.
Is it not time to stop foisting this absurd rubbish on the Irish people, trying to suggest to them that there is something noble about paying 1/9d. for penicillin or some other drug when it costs 3/6d., that in so doing, you have done a great job for Ireland, that you have established your manhood, your right to be the father of a family. Our people are not as easily fooled as they used to be about these things. They see their friends and relations coming back from Britain; they see the wonderful success of the free services here at home and in Great Britain and they will not thank the Fine Gael Brains Trust for sitting down and worrying itself. The mountain laboured and brought forth a mouse. If ever there was a mouse, it is this scheme brought here today by Deputy O'Higgins and the Fine Gael Party.
We heard during the election of the anathematising of the means test, this vexatious means test. If a means test is vexatious, get rid of it. Why talk about the vexatious means test and then bring in a scheme in which there is still retained a means test for quite a proportion of the people? I do not care whether it is 75 per cent. or 7 per cent. of the people who have to undergo the means test. I do not think they should have to undergo it. I am not concerned with a proportion of our people; I am concerned with social justice for all our people. That is what has been wrong with our health services over the years. They satisfied themselves that a minority were well cared for and the rest could fend for themselves.
In spite of the condemnation of the dispensary principle by Deputy O'Higgins, in spite of his condemnation of all the admitted faults, serious faults, of the old poor law system, he made no serious or substantial attempt to ameliorate or improve or better the position. I believe that the simplest form of insurance collection—and I am heartened by the thought that the Minister for Health subscribes to the same view and I hope it will help the Committee, if it is established, to know that they will have his goodwill on this particular point—is income tax, through the Revenue Commissioners or through the rates. Because of that, it is the ideal way to base any of these services, particularly a health service.
If you have an insurance scheme, you have the position where, first of all, you have to establish a separate bureaucracy in order to try to organise and run the scheme and see to the collection of the insurance contributions. The Minister dealt with the difficulty of collecting these contributions. No detailed attempt was made by Deputy O'Higgins to say how it was to be done, how many new rate collectors were to be provided to go around counting the chickens, the turkeys, the cocks of hay and the cattle in the byre in order to decide whether a valuation was £15, £15 1s. 6d., £15 2s. 6d. or £15 5s. Is that not the great difficulty of the present position and the means test? Is that not the thing Fine Gael at the election promised to see to?
I think the Minister was right. If Fine Gael had given detailed information about this scheme at the time of the election, they would have been wiped out completely. There is the thought that the country would be flooded with supernumerary rate collectors and investigations of one kind or another in order to try to make this scheme work, to decide who was a small farmer and who was not a small farmer. I do not know what arrangements were to be made for the collection of the insurance contribution from the self-employed person. I do not know how the village blacksmith, and so on, would go about making available his 6/6d. or his 5/6d. or whatever it might be a week that he would have to find for insurance.
I think it is wrong and inequitable in an insurance scheme that the wealthiest person in the State pays 6/- or 7/- and the poor person pays the same. Take the person in the upper income group. I do not know what ceiling was mentioned by Deputy O'Higgins. I did not see it referred to in his speech. However, the person at the upper peak of the income level included in his compulsory insurance scheme pays the same contribution as the person at the lowest level. I think that is wrong and inequitable. I favour the taxation system because the individual pays only what he can afford to pay and that is assessed by detached individuals in the Revenue Commissioners' offices who have a certain code on which they act. We all know about it and we are all reasonably sure it acts reasonably fairly. That cannot be said for the insurance contribution.
It seems absurd that a person with £1,000 a year should get a service for the same weekly contribution as a person, say, on £300 a year. Again, it must be a scheme based on the parents and a family, with contributions in respect of each member of the family. That would seem to mean that the bigger the family, the greater the contribution and the greater the hardship on the big family. That is wrong. The big family should be helped and not penalised. If you are to have an actuarially sound insurance scheme, it is very difficult to organise it so that the person who has a large family will be helped by the operation of the scheme.
The other point raised by the Minister is a valid point—the question of the number of stamps on a card. At what stage is a person eligible for the service? How is an individual to know when he joins a service like this that he will not have to get his appendix out or that he will not get an attack of pneumonia or something else, before he has a certain number of stamps on his card? If he has not enough stamps, as many of us find in our dealings with our constituents concerning pensions, and so on, what will happen? Suppose the requisite number of stamps is 136, if he has only 135 stamps, he does not get the service. If a person has two stamps less than the number laid down in the scheme, what will happen to him? Does he get a less efficient service? Does he get cheaper drugs? Does he have a fifth-class surgeon?
If there is not discrimination of that kind, then it does not matter a damn how many contributions he has paid or if he has none at all. If you give him the same standard of service, out of mercy or human consideration or whatever it is, no matter how many stamps he has, then there is no virtue in having the optimum number of stamps. How are you to decide it?
One of the most sinister aspects of this scheme is the overnight acclamation from the I.M.A. for the propositions. They will back these schemes and these propositions for insurance schemes of one kind or another: of course, they will. This proposition emanated from the I.M.A. many years ago. Anybody who knows their record of obscurantist obstruction over the years against the efforts for an improvement in our health services must view with the greatest suspicion any approval by the Medical Association. As soon as any such proposition is put forward by a Deputy he should look over his shoulder to see where he has gone wrong in his decision on how to operate the health services.
The scheme has this wonderful quality from the point of view of the Medical Association. It excludes the plutocrat—the "bloody plutocrat", as Deputy O'Higgins curiously described him: I would not think that he would feel like that about him. Fifteen per cent. of them are excluded from the scheme. They are told they can have the Voluntary Health Insurance Scheme. I do not understand the mentality that divides our society into those who are compelled to insure themselves and those who are left to graze in the paddock by themselves without any dictation at all. However, Deputy O'Higgins says the plutocrats can avail of the Voluntary Health Insurance Scheme. The great virtue for the Medical Association in that proposition is that the 15 per cent. can buy their medicine. I am not worried that they are not included in the compulsory scheme. It is not a matter of principle with me at all.
I am concerned with the ordinary worker and the ordinary man in the street whom we are trying to help. What will happen when you leave out 15 per cent. of the plutocrats, as Deputy O'Higgins describes them, is that you will get, like honey bees around a hive, anybody whose work is sought at all in medicine and in surgery congregating around these 15 per cent., all spending all their time, technical skill and knowledge working on these people because they will be paid well to do it, because they will get fee for service. The sky is the limit; they can ask anything they want. I do not mind that. They are welcome to what they can get out of these people. However, I mind the fact that they will be spending their time, energy and skill taking out an ingrowing toe-nail or some of these varicose ulcers, and so on, when they should be using their great skill and energy in working on our people who are in the insurance scheme.
I believe that will be one of the side effects of leaving out even a minority—but a wealthy minority—in any proposed scheme as suggested here by Deputy O'Higgins.
