MIONTUAIRISC NA FINNEACHTA
(Minutes of Evidence)
Bille um Arachas Sláinte Náisiúnta, 1933.
National Health Insurance Bill, 1933.
Dé hAoine, 16° Meitheamh, 1933.
Friday, 16th June, 1933.
The Committee sat at 11 a.m.
Mr. Coffey (Assistant Clerk of the Sea nad) attended as Secretary to the Select Committee.
THE LEAS-CHATHAOIRLEACH (MR. M. F. O’HANLON) in the Chair.
Chairman.—The Select Committee met on Wednesday of this week and decided to invite certain witnesses. The invitations have been issued to these witnesses. The first witness whom we asked to appear before us was Sir Joseph Glynn, and we are very glad to have him here this morning. It would be very difficult for us to get any person who might give us more valuable evidence on the matter to which we are directing our attention.
Sir Joseph Glynn called and examined.
1. Chairman.—Sir Joseph, your experience of schemes of National Health Insurance in Ireland goes over a very long period?—It goes back to the start of it.
2. 1911?—Yes, I was the first and the last Chairman, the only one.
3. Of the Irish Insurance Commission? —Yes.
4. There was practically no scheme of National Health Insurance prior to that? —You had a few friendly societies, not many.
5. The Foresters and Hibernians?—Yes, and a few smaller ones, trade societies.
Chairman.—I understand that you have been in contact very much with Senator Farren, and Senator Farren might like to ask you some questions on account of the contact previously established between you. Perhaps Senator Farren would proceed by way of question and answer.
Mr. Farren.—It is very nice of you to say so, Mr. Chairman, but I have not been in touch with Sir Joseph Glynn for a considerable number of years.
Sir Joseph Glynn.—I presume this is in connection with the new Bill?
Sir Joseph Glynn.—I have no objection to helping the Seanad at all now that I am out of the service, but all the information I have to give, I got as a civil servant and I do not know exactly what my position is. At the same time, when the Seanad summoned me to this meeting, I thought I was bound to give all the assistance I could. I do not raise any point in that connection because I consider I am free to give my opinion on the Bill itself and what led up to it if that would help you.
Mr. Farren.—Perhaps if we had a statement from Sir Joiseph it would be the better way to proceed.
6. Chairman.—Would you prefer to make a statement?—Yes, it might be more helpful. In 1911 when we started National Health Insurance in this country we had very few friendly societies in Ireland. The Hibernians and the Foresters were the biggest ones. In addition to them you had a number of what were known as collecting or insurance societies like the Prudential. They did nothing in the shape of what is known as National Health Insurance. Then you had a number of small trade societies, etc. When the Act was started efforts were made to create a number of that type of society. There were friendly and trade societies and sectarian societies of various kinds. The societies were really got up ad hoc and had no connection with any other business. In a short time there were over 100 of these societies. In 1912 we had about 106 or 107, certainly over 100. At that time our entire insured population was certainly under 800,000. We never got the real figures for a long time because it was difficult to count them. The system did not succeed when we tried to count them. We found that we had more societies than we required. The result of having such a number of societies was they could not cover the country. No one society except a society such perhaps as the Hibernians could have covered the whole country. They had not enough members to arrange for sick visitors or matters of that kind. We tried to bring about a friendly agreement between societies to reduce the numbers of these societies. That was not very successful because it meant dispossessing certain officials of their positions and there was nothing to give them when they went away. We, however, had the number reduced to about 80 or 90 at the time of the separation between ourselves and Northern Ireland in 1922. We had then to divide the funds of such societies as the Prudential between Northern Ireland, Great Britain and ourselves. These societies functioned over the entire of the United Kingdom and we had to divide their funds as I say between ourselves, Northern Ireland and Great Britain. These were international societies. That applied to the Hibernians and to the Foresters also. The net result was that these societies for our purposes had to be self-contained within the Free State.
Quite a large number of them had the type of member that was not remunerative at all. There were not enough members who were in good employment. That was the type of society with which we were faced in 1922 and and 1923. At one end you had a society like the Irish Transport Workers’ Union whose members were largely of the casual labourers class and these members very seldom had anything approaching the full number of contributions in the year: that is, 48 contributions. That was the number counted on under the Act. That society never had a surplus on valuation. It was barely able to struggle on and make ends meet. In fact at one valuation it did not make ends meet. Then, at the other end of the scale, you had a society like the Bankers’ Society where you had people in constant employment. The young men in that society when they passed over a certain salary went out of insurance and left the accumulated funds behind them. You had, at the same time, a type of society known as the Union Friendly whose members were in constant employment. These societies—the Union Friendly and the Bankers and so on—had at the valuation so much surplus funds that they were able to give the maximum benefits. At the opposite end of the scale you had the Transport Workers and societies like the Meath Labour Union, which were struggling from day to day to exist. That was not insurance, because the insurance to which we looked would mean an insurance where the burden would be evenly spread over the entire population. The Act of 1911 did not allow them to have a selection—to aggregate them as they wished and make certain selections for their members. The result, from our point of view, was disastrous to National Health Insurance. You could do that kind of thing in England where you have over 10,000,000 insured workers. In one society alone in England you have actually 3,000,000 insured workers, but you could not do it with an insured population of 440,000, for that was what we had here.
7. Mr. Dowdall.—I thought you said you had 800,000 insured workers?—That was for the whole of Ireland, but I do not think that the maximum figure ever reached 800,000 at all. It would be nearer to 600,000. I do not want to bind myself to figures. This is ancient history now, but I know that since 1922 we never had more than 440,000 or 450,000 insured people and these were spread over 65 societies. That, in our opinion, made for inefficiency and injustice, inefficiency because they could not be supervised, and injustice because it was not fair that groups of people who were not in constant employment or in good employment should be herded into one type of society while you had the better paid type of people in another society. Two Committees sat and we brought in a scheme in which we advocated the unification of all these societies.
8. When did these Committees sit?— One was in 1925 or 1926.
9. I thought the first Committee was in 1924?—It would be about that time. In this Committee the whole subject was gone into and we advocated the unification of the societies. We thought that if we had one society centrally controlled we would be able to manage much better for the rural areas. We would be able to have sick visitors appointed and local agents. Having local agents and sick visitors would ensure that we would be able to get better compliance with the Act, because it would be the duty of the local agents to see that the cards were stamped. At present the local agent is so badly paid that he just sends up any cards he gets and does not go to the trouble of getting the employers in his area to stamp cards. He leaves all that work to the Department, to the outdoor staff. That was the sort of thing that influenced us to seek amalgamation. We were also up against the fact that there was a huge increase from year to year in the amount of sickness benefit that was paid. There was an increase also in contributions but there was no comparison or proportion between the increase in contributions and the increase in the case of benefits. That situation was reflected in the last valuation, because the surplus that had been declared on the second valuation had been practically wiped out on the last valuation.
10. The second valuation was in 1923? —There was a valuation in 1918. We had a valuation in 1923 and that valuation was a satisfactory valuation.
11. Chairman.—It was in the valuation in 1928 that you found the surplus had been wiped out?—Yes; of course these results were declared only a year and a half afterwards. There was always some delay like that. After the 1928 valuation and as a result of what we discovered from that valuation we found that the surpluses had been lost by a large number of societies. We expected at the next valuation, which is due to take place this year or next, that what had been a surplus or what had been line-ball cases, would be converted into serious deficits. The result would be that the societies would have to face a reduction in benefits or an increase in the deficits.
12. Mr. Dowdall.—To what do you attribute the deficit?—To the increase—I might say a large increase—in the benefits paid by the societies. The societies were paying a great deal more than was justified.
13. Have you not a sort of temporary actuarial investigations? —We have no temporary actuarial investigations, nothing except the valuation. I may say that the Department watches very closely the expenditure to see if it is kept within what they consider would be the limits. The Valuer reported in the last valuation in 1928 that we should have to do either of two things or both—reduce the benefits or increase the contributions. That was his view if the next valuation was to bring the societies on the right side.
14. Mr. Counihan.—How would they reduce the benefits?—Instead of giving, as at present, 15/- a week to a man and 12/- a week to a woman you would have to cut down the benefits to such figure as would balance your budget.
Sir John Keane.—I think it would be better that the witness finished his evidence in his own way; then we can ask questions.
15. Sir Joseph Glynn.—I do not want to be tied to the figures I am giving now because I came here without consulting anybody at all. I am only giving general evidence and have not got the precise figures with me. In 1928 we were faced with a position which would result not only in the surplus disappearing but in large deficits showing instead of surpluses. Now that is the main fact. That made it still clearer to us that if we were to put our house in order it would be necessary to carry out a scheme of unification and have in the country one society under the direct control of the Minister and try to get compliance through local management, to get better supervision in the case of benefits paid and to see that when doctors issue certificates they would issue them to sick people and not to people who were merely unemployed. That was going on. An unemployed man said to the doctor that he had a pain in his back. The doctor knew that he had not a pain in his back, but the doctor is soft-hearted and gives a certificate that the man is sick. He is soft-hearted at the expense of other people. It was that sort of thing that brought about this Bill, which has been upon the stocks for some time. The idea was to bring about unification of the societies under one Department. That was a principle on which I never wavered and I consider it the first step in the saving of National Health Insurance in this country, so that we would have one strong society in the Free State, which would still be only about the same size as a moderate-sized insurance society in England. We felt then that the new society would probably be able to absorb quite a number of the best officials of the old societies and any official that was not able to get employed by the new society should be reasonably compensated, bearing in mind, of course, that the compensation would have to come out of the funds of the society. Any money that would be paid as compensation to the dispossessed official should have to come out of the administrative and official funds of the society and that meant eventually out of the pockets of the insured people. The scheme that has been put up now in this Bill is a more generous scheme than the scheme in the original draft of the Bill when I was in the saddle. It seems to me to be quite generous.
16. Chairman.—Generous in respect to what?—Compensation. Some people are misled by seeing £2,000,000 or £3,000,000 of accumulated funds. But these millions are there to meet benefits for people who have ceased to contribute. We have had cases of people who were contributing for two years and, then, afterwards, were ten years on the funds. They never made another contribution. These accumulated funds are there to keep people in benefit until they reach 70 years of age. When you come to consider valuations, you find that they are made having regard to part of the unexpired risk. One society has a surplus of say, £5,000 or £10,000. The Valuer comes along and divides that up into two, one portion is apportioned to additional benefits under the Act. The other portion is kept up lest there should be sickness or epidemics or outbreaks of some kind that would upset the balance. At the next valuation, the same thing gones on again.
17. Would you explain the reserve values?—Yes. When the Act was started in 1911, there was a flat rate imposed. That flat rate would apply to any boy or girl at the age of sixteen. That was a different insurable proposition from that of a man or woman of 50. If a person wanted to be insured with an ordinary insurance company, they would have to pay a higher rate of contribution at the age of 50 or a lump sum, which would be the difference between a capital sum and the flat rate. However, it was decided that a flat rate was the only rate possible. When societies started on the new, they had no capital sums and you could not ask a labouring man, coming into insurance at 50, to pay a capital sum; so the Government gave a paper reserve. That is, they guaranteed that this sum would be made up by them. Each society was credited on paper with this reserve sum. Then, out of the contributions, there was taken every week a certain proportion of each contribution which was in time converted into cash and a certain amount of the paper reserve was cancelled and replaced by cash. As the original Act stood, it would take about 19 years to convert the paper into cash, provided always that you had the full contribution paid every year. That did not happen. In the year 1913, there was a bit of a panic in financial matters and things were found not to be quite so sound. The period for redemption of the paper reserves was increased to 35 years. I do not think there has been any change since then. If the whole thing had gone smoothly, all these paper reserves would be converted into cash in the course of 35 or 40 years.
18. Mr. Dowdall.—Out of contributions?—Yes. That necessitated a constant stream of contributions at the full rate. We never had that full rate in Ireland. Our average contributions were about 33 or 37. Therefore, you could not have the money in the societies that was so necessary from time to time to convert some of those paper reserves into cash and to pay the interest on these paper reserves out of contributions. The original idea was that the State should contribute two-ninths so as to make up for the loss of contributions for interest.
19. I was rather at a loss to know how the two-ninths came in. When the Act was being passed originally, of course, we heard a lot about 9d. for 4d., about the employee’s contributions and the Government’s contribution and so on?— The sum of 9d. per week was what the Actuary said was necessary to pay for all.
20. The rate here is 4d., 4d. and 2d.?— Of course, there has been a change since 1911. What the State really does is: it pays two-ninths of the benefits and expenses of administration. You had to get 9d. originally—7d. from the employee, and employer, 2d. from the State and so on. The figures are available. Every society has its own valuation.
21. Where could these figures be got?— The Department has them. The Minister could supply them.
22. They are not issued in any Government publication?—No, we did not issue anything like that at the time. If they were issued, it would make a huge volume, but each society got its own figures.
23. How did the reduction come in the figures? You told me that, by reason of the transfer from the unit of 32 counties to 26, the 106 societies became 80 or 90?— We had ourselves been reducing the numbers, first of all. We found a lot of societies in difficulties and we had transferred and connected them up with stronger societies. We caused societies to be amalgamated. By that means, probably 20 societies were abolished. When we lost Northern Ireland, of course, the northern local societies disappeared off the map for us. International societies set up separate societies for the Free State. The last time, I remember, the societies numbered 65, but we had all along tried to transfer or connect the weaker societies with the stronger.
24. In the 1928 valuation, I think, 55 societies were in surplus and 10 had a deficit?—Yes.
25. Was it not possible to continue the linking up process?—They would not continue it. The stronger societies, with the largest surpluses, would not take over societies that were going down steadily, because they would have to take over their liabilities also, and, in that way, their own surpluses might disappear next time.
26. The figures we got were that there were 55 societies in surplus with a sum of £513,000, that is to say, that the average surplus was £9,338. Ten societies had a deficit of £5,168, so that the average deficit was £5,000. Now it is proposed to unify the societies. Would it not have been possible, if it could not be done voluntarily, to compel them to merge by legislation?—There you are up against the same difficulty again. We asked them in 1925 and in 1926, but they did not do that. They said they could not comply unless compensation was paid to their officials. The only societies that approached one another were the stronger societies— strength to strength; weakness to weakness. What we wanted was the strong societies to take over the weak ones. When it came to a question of amalgamation, the 440,000 insured persons would only make one decent society. We failed to bring about amalgamation. They failed to make any arrangement with one another. Of course, we had power to dissolve any society that was mismanaged.
27. You could not get the weaker societies in 1928 to merge?—No, there was one very prominent society—I do not want to mention any names—that had been in existence long before the National Health Insurance Act. That society was in deficit and we could not get anyone to take it over. They knew it was on the down grade.
28. A deficit is really brought about by the payment of excess benefits?—They had not enough to meet their benefit payments. Of course, others were mismanaged. They could not afford to pay for the proper working of the society. That might be due to mismanagement by the officials or even mismanagement by the Committee, which did not take proper control in the society.
29. When the scheme was organised in the first instance was a limit put to the amount of the expenses of administration? —Yes, the regulations laid down made it 4/5 per member, but a big society ought to be able to work at less.
30. Was the 4/5 exceeded?—Yes, there were a few such cases. If they expended more than 6d. per member over the 4/5 we called upon them to levy or to reduce their expenses at headquarters instead, in such a way as to show that they could make up for the deficit in a few years.
31. And the deficit caused by expenditure in that way was recouped?—In the course of time, from their own funds. What occurred was that it was found on the valuation that the society was in deficit, and when we were satisfied that that arose from things over which the society had no control, they had their own contingency fund to fall back upon. If that was exhausted, there was a separate fund which they could apply to us to use to wipe off that deficit. We paid in all cases where we were satisfied that the deficit was due to excessive benefits. It was out of other people’s money and, of course, there was a limit to that little nest egg.
32. At present it is £130,000?—That is not a lot.
33. Chairman.—There are two contingency funds. There is the society contingency fund and then there is a separate contingency fund?—Yes.
34. Mr. Dowdall.—There has been an increased payment in benefits for years past?—Yes. These figures are all in existence. I think it was very close to £800,000 a year. In 1922, it was £500,000.
35. The figures were £500,000 in 1922? —I remember the figure was £740,000 a couple of years ago. There was a steady increase from 1923 on—a very huge increase.
36. Of course the number of insured persons has increased also?—Yes, moderately; and there was also a moderate increase in contributions.
37. Has the net increase been comparable with the expenses?—Oh, no—nothing comparable to the expenditure.
38. So, the position has really arisen from the payment of more benefit?—No. That is one of the reasons. That is what brought the thing to a head finally—that bankruptcy was facing the societies through excessive payments; but there was also inefficient management because of the scattered numbers of societies and we had no control over the giving of certificates by doctors and very little control over the management of societies.
39. Where can I get the benefit figures and the cost of administration?—I think the Minister can supply all those to you. You will easily get all these figures in detail from the Minister.
40. Mr. Counihan.—I suppose, Sir Joseph, we may take it that you are definitely in favour of unification?—Yes, and have been for years.
41. You mentioned the Meath Labour Union. I take it that most of these people would be agricultural labourers?— Yes.
42. Would not they be less likely to get sick than people in the cities or towns?— They ought to be, but when they are out of work they go to a doctor and say they have a pain somewhere and get a certificate.
43. Is there any law to compel the societies to admit a man of 60 years or more?—Previously they could refuse to do so, but not now.
44. Take insurance societies with a lot of funds such as bankers, railwaymen, drapers and, say, the Dublin tramwaymen and bus drivers—would you be in favour of putting all these classes of people in the one society with the agricultural labourers?—Yes. If the working population of the Saorstát is to be insured, then every working person in the Saorstát ought to bear a portion of the burden.
45. Could you define what is a con tractor for the purpose of this insurance society? Supposing that a farmer let a field of thistles or a hedge for cutting at a specified rate, would he be liable?—Do not ask me that. We have a special section —Section 66 of the Act—which, in our judicial capacity, we use to decide all these points. If you want to find out if A or B is insurably employed by C or D, you have to find out the agreed facts as between employer and employed, and these facts come before us and we have to decide on these facts as to whether or not the person concerned is an employed person.
46. Yes, for the purpose of this Act we want to get a definite wording. Could you not suggest something to us?
Chairman.—You need not answer, if you do not choose, Sir Joseph.
47. Mr. Counihan.—I have a particular case in mind, where a farmer let a hedge for cutting and, in cutting the hedge, the workman or contractor who took over the cutting of the hedge got a thorn in his finger. He developed blood poisoning as a result, but under the Insurance Act he got no compensation. The National Health Insurance Society would not take him.—They would not do it if the employer was liable, because such persons are excluded. That man might have been employed and properly employed under our Act, but the society would refuse benefit because the employer was personally liable.
48. In this particular case it seems that the matter would have to be tested in a court of law. Both the employer and the society denied liability and he had no money to go to law.—You cannot settle that by an Act of Parliament. That is a case of disputed liability, as to whether the employer or the man’s society is liable. On the face of it, would you not say that the employer was liable since the man cut his finger in the course of his employment?
49. Suppose, following the line of that particular case, the man who took over the cutting of the thistles or the hedge took in half a dozen men to assist him?— All that is provided for in the scheme of National Insurance. All that we have to decide is who employed all these extra men and whether they were working for the first man who let the field or the hedge, or for the man who took over the cutting of the thistles or the hedge. If A employs C, D, and E, he has to insure them. If, on the other hand, we find that B is the employer he has to insure them. But all that is provided for in this Act.
50. It seems very complicated, because the man I have in mind got nothing from either the employer or the society?— Well, that was probably because he had nobody to take up his case.
51. He applied to the society and they said they were not liable. He also applied to the farmer and he said he was not liable. Apart from that, have you any suggestion to offer with regard to certification?—I do not think you can cure that by Act of Parliament either. The whole thing is that the doctors are slack because they are kind-hearted.
52. Chairman.—Is it only kind-heartedness?—Well, I am putting it at its best. You have no medical benefit in this country, and when a person gets sick and goes to the doctor all the doctor needs to say is that A or B is suffering from so-and-so. He need not do anything to cure him. That means that every time the man goes it is something in the doctor’s pocket.
53. Do you think that is a proper system?—Well, if there was medical benefit it would be in the doctor’s interest to cure the man and get rid of him as soon as possible. The net effect is that we were paying the doctor for certificates and he was not bound to do anything to cure the person at all. The system is rotten and always has been so, and, in our view, the solution is that there ought to be a system of medical benefit. That would be costly, however. We were never able to carry that because of the medical charities system here.
54. What is the point of the remuneration per case?—Well, take the case of an English doctor. A workman on his panel comes in and the doctor gets a capitation fee for curing him and attending him while he is sick. That man goes to the doctor to be cured and the doctor gives him, as part of his capitation fee, the certificate.
55. Why should we copy that system?— The Irishman gets sick but he goes to the doctor not to be cured but to get a certificate. The doctor says, “What is wrong with you?” He says “Rheumatism,” and the doctor gives him a certificate to that effect. There is a capitation rate allowed for certification and that is pooled in the country districts or dispensary districts.
56. Mr. Counihan.—The people I represent are very interested in having the status of a contractor defined?—I am not here to define such things. I must keep away from definitions entirely.
Nevertheless, I think you should insert something in this Bill to cover it.
57. Sir John Keane.—I am very interested, Sir Joseph, in what you say about the difficulty of certification. Would not a fixed salary be better?—We tried that. We had a big row with the doctors at one time, but the doctors themselves will not have it because, in practice, the dispensary doctor takes whatever is in the pool. We must get the certificates and, while the fixed salary might work out in the rural areas, it will not work out in the cities because there is a very large choice of doctors in the cities. In Dublin, for instance, a man can go to any doctor on our panel and that doctor must give him a certificate.
58. Could not that be got over by changing the law?—The other doctors will not stand for that.
59. According to that, the whole community is at the mercy of the doctors?— Yes, in that respect.
60. It is a most important respect, I think?—Whom would you select? There is a certain number of dispensary doctors and some people will not go. You cannot force them down to a dispensary which is already overcrowded. All we can do is to pool the rate allowed.
61. You have not had the abuse of certification so much in the city?—We have had it everywhere. Doctors will tell you frankly that they have not the time to make the thorough examination that is necessary. A man comes in and says he has a pain in his stomach or somewhere else and the doctor gives him a certificate. If it is a serious illness, of course, it is different.
62. The only solution then is that medical benefit should be added to the existing benefits?—There ought to be a duty imposed on a doctor to cure or try to cure a person when he is sick, and he should be paid for curing him. For the sick poor that is done through the dispensaries. Some of the friendly societies have their own doctor, but the ordinary person has to pay for his treatment out of his own pocket and he gets his certificate free. You cannot blame them.
63. Do you think it is a matter to which the State should give serious attention? —I started in 1913 to try to get the State to do it. A Commission was set up at that time by the British Government, which took a lot of evidence, but they could not get over the difficulties in this country of the Medical Charities Acts. There was another committee later on and we went into that question and produced a big scheme, but it did not materialise. The matter has been considered three or four times by committees or commissions and we were always up against the snag of the medical charities.
64. Sir John Keane.—This certification has contributed in some measure to the financial instability of the whole system?— No doubt the lack of certification has been largely the cause of these huge payments.
65. How will that difficulty be overcome in the case of the Unified Society? —Well, you can have sick visitors appointed who will visit the homes. A man may report that he is affected with rheumatism and that he is unable to go to work. A visitor may be able to ascertain that that man has been able to attend football matches and the like.
66. Chairman.—Have you no sick visitors?—There are a few, not many. The well-to-do societies are able to employ them, but the others cannot.
67. Sir John Keane.—How are we likely to ensure under a Unified Society the integrity of a sick visitor vis-a-vis a doctor?—If the sick visitors are not doing their duty they can be dismissed. I dare say you will have supervising officers who will go around.
68. Are you not liable to get a sick visitor in conflict with the doctor?—No. The doctor very often will welcome a sick visitor. The doctor is human as well as the rest of us. He often is aware that he ought to put a person off, but he does not want to say so. He does not want to get into bad odour. I once visited a dispensary in this city. On one side there was Doctor A, who had ten certificates. I remarked to him that he had not many and he said: “No, I issue them to sick people.” Doctor B had large numbers of certificates and I asked him why that was the case, because ordinarily there would not be much of a difference between the two doctors. He said to me that he had to go down such-and-such a street and he did not want to get a crack of a bottle on the head for refusing a certificate.
69. Possibly it might mean loss of custom and popularity. The whole system is bad?—The whole system is rotten.
70. When you talk of a surplus, what does that mean?—The actuary makes a valuation of all the liabilities of the society for the coming five years and he calculates the membership, the probable number of sick people, and also the probable amount of benefit. He puts all the liabilities on one side and on the other side he takes the assets—the surplus coming in, the reserves and the value of the contributions that are going to come in during the ensuing five years. When he balances these figures if there is, say, £10,000 on the right side, that is regarded as the surplus that will be there at the end of five years, and you can spend so much of that by giving additional benefits.
71. The additional benefits are strictly prescribed on the basis of the previous valuation?—Yes.
72. What seems to me to be rather hard about this is that the members of an existing society, a prosperous society, who are given additional benefits, are now liable to lose those benefits by unification?—They will retain under the valuation all the additional benefits they have, but at the next valuation, if the valuation results in bringing out additional benefit, that will be spread over more of the insured population.
73. Then it is possible that the surplus will be pro tanto reduced?—It is bound to be. In fact, I want it reduced. I do not think it is fair there should be discrimination always between the healthy person and the wretched man who may be employed on the quays as a labourer.
74. Would it not be possible to get over the injustice by an assurance that additional benefits will be continued?—They will be continued until the next valuation.
75. If, in accordance with this undertaking, additional finance is needed, would it not be desirable that the State should assist?—It would be a frightful complication. You could never work it. It would be utterly impossible.
76. But one must regard it from the point of view of members of societies who are getting additional benefit?—You are going to give those particular people, because of their valuation, a guaranteed surplus for the rest of their lives.
77. Chairman.—Additional benefits?— Yes.
78. Sir John Keane.—Do you think that impracticable?—Not only is it impracticable, but I do not think you could justify it.
79. In equity I think you can hardly justify the present proposals?—All we do is to say that the present system is not insurance. We want insurance for the whole country. If you are a member of a society giving additional benefits you must take your chance as well as everybody else. We say to such a person: “You have got the pick of it for the last 20 years and you must take your chance with everyone else.” It is nearly the same as your super tax, Sir John.
80. I do not know that the analogy is quite a good one.—After all, some people have been clipped pretty heavily at the top in order to give the under dog a chance, and by all accounts we are going to get more of it.
81. I would like you to deal with the contention that this big society will lack the personal and human interest in its members?—Big societies never have had either the personal or the human element. There has been no contact at any time in any society, except the very smallest, between the members and their heads. No one knows that better than Senator Farren. Take the biggest of the societies. They put a notice into the papers calling an annual meeting and about seven people turn up and they re-elect a Committee of Management. That is usually the case with a society of 80,000 members. There is no contact at present.
82. Not even locally, through local machinery?—The local machinery is usually the local agent and that local machinery will still exist. I asked a man in Donnybrook to what society he belonged and he said he was in Mr. Darcy’s society. Mr. Darcy was merely the local agent. The man whom I questioned was aware that Mr. Darcy collected his contributions and paid benefit.
83. As regards societies that are in difficulties, is the position such that at any moment they may not be able to continue statutory benefit?—We never stopped statutory benefit. As regards such societies as those to which you refer, we try to check them by sending officials down from the accounting department to find out where any laxity may be and to try to help them in that may. We would still provide them with funds to pay the minimum benefit. Up to the present the minimum benefits have not been stopped.
84. And they have been justified on the valuation?—Except where there was a deficit. In such case we meet deficits out of their contingency funds and in a few cases we did so out of the central fund. Of course that cannot go on.
85. Then the next valuation will reveal a critical position?—There is no question the next valuation is bound to be a very critical one.
86. I gather that unemployment and sickness largely go together. As unemployment increases, sickness benefit mysteriously increases also?—It is the same everywhere. It is our experience more largely than it is the experience in England. Perhaps that is not quite so now, because England is in a very bad way from unemployment.
87. It may be argued that the unemployed man is under-nourished?—That is a fact. Unemployment makes him sick.
88. A question arose about refusing a member. Societies have power, apparently, to refuse members?—We are abolishing that. You cannot have that in the unified society.
89. Where do they go?—They do not refuse members now since we abolished the deposit contributors. We made an arrangement with the societies and we have a panel of societies that will take any members we send them. They take these members without any question. As a matter of fact for the last few years they did not refuse them. One society may, but then we get them into another society.
90. You do not agree with the view expressed to me by certain officials in existing societies that the unified society will be in difficulties in the course of a few years?—I hope not. I would be sorry to think so. There might be a bad valuation, but we cannot avoid that if it comes. Whatever chance the unified society has, I certainly see disaster for a large number of societies if there is not unification.
91. Mr. Farren.—You told us that the insurable population is round about 450,000?—About that—say, 440,000.
92. The reason for the introduction of this Bill for the unification of societies is because of the fact that the insurance scheme has proved unsound as it is at present being administered?—That is the tendency.
93. You stated that up to 1923 the valuation was satisfactory?—Of course in that connection we must consider the war. I did not want to go into details, and it seems a cruel thing to say that the more people who were killed in the war, members of societies, the better for the societies. That is why the valuation was so good.
94. That is not the point that I wanted to bring out. You said that in 1923 the valuation was satisfactory. My opinion is that it was satisfactory because up to that period there was a good deal of employment?—Undoubtedly.
95. And very little unemployment?— Yes. The war again helped that.
96. From 1923 to 1928 there was a considerable amount of unemployment and that was responsible for increased benefit? —Quite.
97. Anyone who has anything to do with societies knows that when unemployment is rife there is an increased cost in insurance?—We are all agreed on that.
98. Your suggestion about the unified society will not, it appears to me, meet the position that you put up. I rather think that smaller societies would meet the position better?—Of course we disagree—that is all I can say.
99. I think you will agree that in small societies, where there was close contact between the membership and the committee, they could be properly administered and were in the best position to stop malingering?—If you could get the ideal friendly society, naturally, but that is not what exists. They would watch one another. For instance, the Hibernians have 85,000 members scattered over the 26 counties. Then you have the Sláinte Society with less than half that number spread over the 26 counties, and there is no personal contact whatever. I am afraid we cannot get to your ideal.
100. It would be the proper solution?— I do not know about that.
101. The cost of administration would be considerably greater?—It would run away with the whole thing.
102. On the question of certification, I think you said that the cure is the introduction of a scheme of medical benefits in this country?—That, and closer supervision of the sick person by sick visitors.
103. You think it would cure this matter of loose certification?—I know it would not cure it altogether but if the doctor has to cure a person he will cure him as quickly as he can.
104. You think the present system is altogether wrong?—Yes, from beginning to end.
105. The society has no check?—No.
106. They cannot afford to pay for a sick visitor and they have no control over the doctor. Even a sick visitor cannot say to a man that he is not sick if the doctor gives a certificate. On the other hand, the society may appoint a sick visitor and may have rules that a sick person should be in by seven or eight o’clock at night, but if a man has a sore arm you cannot compel him to remain at home?—We never did compel him, but if a man has bronchitis he ought not to be out at the pictures at night.
107. At the same time a sick visitor will not cure this. I venture to suggest from my limited experience, that even with the unified society a sick visitor will not cure this question of certification?—I am not saying it is going to cure it, but I say it will be a help.
108. You have a panel of referee doctors?—Yes, the Department has.
109. Supposing a society gets a certificate from a doctor and, on its report from the sick visitor, the society is suspicious that the member is malingering, that society has the right to demand that the person shall go before a referee doctor?— Yes, the Department has four or five such doctors.
110. You have the system still?—Yes.
111. How is it working?—Fairly well because it affords a check. The society gets a hint from the sick visitor that A.B. is not as sick as he pretends and they apply to the Commissioners to have this sick person refereed. Then the referee doctor sees that person. The results are rather curious. My recollection was that about one-third of the people notified to attend before the referee doctor went back to work.
112. Thirty-three per cent?—Yes. Roughly one-third would go back to work or would not turn up to be refereed. Another one-third would be declared unfit for work and the remaining one-third would be declared either fit for full work or for light work. That again is not an ideal system, because the referee does not see that person for a month after the person was supposed to be sick, and he has been drawing benefit for the month.
113. As far as my information goes the societies are dissatisfied with the present system of medical certification?—Naturally.
114. They complain, and I think it is largely true, that in many cases when a person goes to get a medical certificate the certificate is already written and waiting for him in the doctor’s residence —that the doctor does not see the person at all?—We have had complaints to that effect.
115. It appears to me that the only protection for the ordinary insured person, whose contribution goes to pay sick benefit to people who are not entitled to it, is the institution of medical benefits?—That is what they are trying to do here in this Bill.
116. You do not introduce in this Bill what most people who have experience believe will be the proper solution?—That is a matter of policy for the Government and a question of money. We, as National Health Commissioners, put before committees appointed to inquire into the matter our view that medical benefits of some kind or another should be set up—I do not pin myself to the English system.
117. In your opinion would the institution of medical benefits more than compensate for the loss that would accrue to the society through this new method of medical certification?—I think medical benefits for the society would be largely its salvation. If you had one strong society, plus medical benefits, I think you would have a magnificent system. I think it ought to be one society. I am not altogether in sympathy with the little societies.
118. I am not arguing for the small society because I think we have gone beyond that stage. Personally, I think that if it is national insurance it is insurance covering the whole working population?—That is what I want.
119. That there will be no privileged class?—I agree, no privileged class in health insurance.
120. Chairman.—You said that the legislative proposals contained in the Bill were a start to meet the position?—I did not say a start.
121. You stated “we were making a start to meet the position”?—What I meant was that if the Decartment is to face the next valuation with any confidence at all it must face it with one society. It will be then in a position to say whether it will be necessary at the valuation to increase the contributions or reduce the benefits.
122. Do you think there will be sufficient time to operate under the unified society?—I think they will be in a better position to come to a conclusion if they have their house in order with one society operating. The actuary will be in a much better position then to say whether, in his opinion, he can leave things as they are.
123. If some approved societies in existence are not transferred by then the proposal is to take them as if they were transferred?—Whether actually transferred or not at the time of the valuation they will be all put into the one valuation. They will not declare the results for any of these societies. They will be kept in the mind of the Department until they are all brought in together.
124. You said that what you were aiming at is medical benefit?—That is one. We have been at it for twenty years.
125. You are still at it?—I think the system of National Haelth Insurance is incomplete until, side by side with the payment of benefits, you have a system by which a man who gets sick is cured.
126. If a scheme of medical benefits is instituted, how is that going to affect the contribution of the employers?—It will increase both the employers’ and employees’ contributions by a certain amount.
127. In what proportion?—Roughly I think it is 2d. that has to be added on for medical benefits. The English contribution was reduced by 2d. in this country, because, roughly, 2d. was set aside for medical benefits.
128. 2d. on the part of the employer?— No; 1d. each. The English contribution originally was 9d. and ours 7d. There was a difference of 2d.
129. As to non-compliance, do you think any considerable section evade stamping national health insurance cards at present? There seems to be some figures available which might lead to that conclusion, notwithstanding the amount of unemployment. The number in Unemployment Insurance in this country is around 350,000 and those insured under the National Health scheme number about 451,000. Would that not lead one to believe that there is a considerable amount of evasion?—There is some evasion, but it is difficult to get at what the amount is. There used to be a considerable amount of evasion amongst the domestic servants class. Some mistresses objected to the maids bothering about insurance and some maids did not want to be bothered with it. There was evasion also amongst casual workers in rural districts. I think, on the whole, the belief was that compliance was getting more regular. As the people were beginning to understand the benefits of the Act, the men and the women began to look after their rights. There was a certain amount of systematic evasion amongst shopkeepers and people like that. When an inspector went to a district you generally knew that there was evasion by the huge increase in the sale of stamps that resulted from his arrival. They knew we would not prosecute in a hurry if they stamped up. We collected an enormous amount of arrears for the Unemployment Insurance people after 1923, because the outdoor staff of the National Health Commission did the inspection for Unemployment Insurance. It has been more or less regularised now, but a huge amount of the arrears which came into the employment fund was collected by the machinery of our outdoor staff. We set that right for the Unemployment Insurance people, while, at the same time, setting our house in order.
130. Sir John Keane suggested that there might be a clash between the sick visitor and the doctor; is that likely?— What the sick visitor will do does not go to the doctor at all. He visits the person and writes a confidential report to his headquarters saying that he visited so-and-so and that he did not think he was sick.
131. He does not report to the local doctor?—No, he sends a report to his headquarters. The headquarters office would simply apply to have that person refereed and the doctor is notified that he is to be refereed. It often results in the doctor saying to the person concerned: “You had better go back to work.”
132. Is not that system likely to be cumbersome?—I do not think so. I think it will be more expeditious, because now, with the funds they have for administration, they can have one sick visitor in a town where, say, five societies were operating before. None of these societies was able to afford a sick visitor and they would not combine to have one. Now you will have all the funds from these people in that town and you can pay a sick visitor. The doctors, on the whole, will welcome that because to give them their due they do not want to issue certificates if they can help it. They do it partly through good nature and partly because they do not want to quarrel with these people.
133. Mr. Farren.—You pay per certificate?—In the final result it is per certificate, but you cannot exceed the pool. If one doctor is issuing too many, he is graded down to the average for the particular pool.
134. Chairman.—One of the main purposes of the Bill is to lessen the cost of administration, but in respect of the sick visitor you are likely to have an increase in the cost?—No; within the allowance for administration for the society you will be able to get very much more efficient administration. I do not expect there is going to be a reduction in the amount of money allowed for administration.
135. I am not saying that.—You will be able to spend that money to much greater advantage.
136. In that item there will be an extension of the expenditure?—Yes; because you will be able to employ more sick visitors.
137. You referred to the question of compensation in passing, but you did not express any views on that?—The scheme in this Bill seems to be more generous than in the original draft when I was responsible. My successor seems to be more generous than I was.
138. What is your attitude towards these part-time sub-agents in respect to compensation; they are to get no compensation under this?—You have to recollect that a part-time man has only a part-time job. Many of these men have lost these jobs over and over again. A man gets £25 or £30 a year for a part-time job. It would be a hardship on the societies if they had to compensate him on the scale laid down in the Bill.
139. But you need not compensate him on that scale. He might be compensated on a lesser scale?—Where is the money to come from? You are saddling the scheme of National Health Insurance with repayment of the compensation in the Bill for the next generation.
140. Will the repayment last for the next generation?—It will be 20 years or 25 years before the amount is repaid, with interest.
141. The amount is estimated at £140,000?—That is an enormous sum to put on the administration fund of these societies for the next generation.
142. You think it will go on for a generation?—When we were discussing this matter originally I understood that, in order to lighten the payment, it would have to be spread over a considerable number of years and carried on from valuation to valuation.
143. It is estimated that any scheme of compensation for part-time agents would cost about £30,000?—I do not know what it would cost. Most of the agents are agents for collecting societies. These men have a book and they are going around collecting contributions for ordinary life insurance. They took on this job as a side line for the purpose of bolstering up the other business. Therefore, you would compensate a man who is not really losing anything because what he is getting for this particular job he probably ought to have got on the other side.
144. In a case where the business is not a side-line and where the agent is not using the job to bolster up any other occupation, could not a case be made for compensation?—You could make a case for compensation for any man who is dispossessed but the answer is that no business man will compensate a man to whom he has paid only a trifling amount. Why should an insured person be saddled with that responsibility if the ordinary private person does not accept it himself?
145. Is the insured person saddled with it?—It is the insured person who has to pay. That £140,000 compensation is coming out of the pockets of insured persons, with the exception of two-ninths which is contributed by the State.
146. Sir John Keane.—Would it be possible to consider compensation on the merits of the individual cases? There may be cases in which hardship will occur.— How are you to get the facts? An arbitrator may be appointed but the arbitrator will be human. The human element will enter into it in some way.
147. Could you not deal with the matter by way of compassionate allowances? All private persons do that. Pensions and allowances are not given by individuals indiscriminately. They are given on the merits of each case.—I do not see why a part-time agent should be compensated in respect of a very small side-line.
148. Chairman.—His compensation would be relatively small. You are considering the demands upon the fund and not the equity of justice of the cases?— You can make a case to compensate anybody.
149. If an officer in an approved society derives the greater portion of his remuneration from the society as an agent, he is entitled to compensation under the Bill?—It must be his principal means of livelihood.
150. That has to be determined— whether or not it is his principal means of livelihood?—You usually had a police pensioner or a person of that type doing this work. He got a few pounds a year for handing out the cards at the end of the half year and sending them back. If benefits were paid through him, he handed out the benefits. That was the amount of work these part-time agents had to do.
151. Your views are very interesting. This is a very difficult question and was debated at great length. Could you give us any assistance by way of explaining why different results have been produced by societies of the same composite character, not based upon religious or political tendencies? How is it that these societies have produced results which differ so much?—It is not easy to get a picture of that position. I do not know what sort of society you have in mind, but take, by way of example, the biggest society—the Hibernian Society. They started out de novo and they took in every type of member who wished to come, making no selection. They got a large number of very bad lives and they have always suffered from that. That was a composite society and included good and bad lives, but, through tip-top management, they have kept that society floating. Another society, equally composite in character, had not one-third of the membership of the Hibernians and had not sufficient good lives to balance the bad ones.
152. Mr. Dowdall.—I cannot understand that?—That is what did occur.
153. Chairman.—I gather from your statement that the two elements as regards results are numbers and management. The results are mainly based on these two factors?—Not only does the question of fewness of numbers enter into it but a society may have too many of the bad type of life and too many unemployed. The society to which I have referred had too many of the casual type of labourer. The Hibernian Society—I may refer to it by name because it is an excellently managed society—had the casual labourer type, but they had a good class of life besides and were able to carry on. The good and bad lives balanced fairly well, although they have never had a large surplus. In the other society, you had mixed lives, but the membership was only one-third of the Hibernians and the management was by no means as good. The employment of their members was poor and their lives did not seem to be up to the mark. They went down very rapidly.
154. The question of management is not the sole question on which results depend? —No. You have the sheltered society, with its members in constant employment, which has got magnificent results. You had then the little Labour Union, with casual labourers, which did everything possible to get on and did not get on. Between these two types, you had all sorts of types, including railway societies with men in constant employment.
155. Mr. Counihan.—You think unemployment was the greatest source of loss to the societies?—I think that where you had full contributions paid—48 per year— they offset the strain of lax certification, to a great extent.
156. Mr. Dowdall.—The unified society can only be made economic by reduced benefit. Is that your view?—I did not say that at all. I said that the unified society is the first step in the salvation of National Health Insurance in this country. When you get your unified society, you will get good management. You will probably be able to get better stamping because your local agent will be made to do his work. Then there will be closer supervision of the sick claims by the sick visitors. Greater care will be taken by agents locally and there will be a smaller amount of sick benefit because of the closer supervision of the sick person.
157. Closer supervision of the sick person will, in your opinion, mean that the sick person will automatically go off benefit more quickly than he does now?—I think so.
158. Is that not reducing the amount payable to the sick person?—I admit that. What I was disagreeing with was your adjectives. That is not the only effect.
159. The net result of the economy in administration will be that there will be a lesser amount paid to the insured person? —There will be a lesser amount wasted. I am surprised at you, Senator.
160. I am rather surprised at you.—Let us have no misunderstanding. Neither the societies nor the Commission ever sought to prevent a sick person getting sick benefit. What they were out against was malingering. That was what we wanted to stop. That was due largely to lax certification and lax supervision.
161. You said that unemployment makes societies sink?—I think that that came from Senator Farren. If a person is unemployed, he does not get enough food. The doctor says “This poor person must get food” and he gets sickness benefit.
162. It is suggested that there will be closer supervision and visiting of an unfortunate man in that position, that a man possibly suffering from malnutrition is to be spied upon.—I did not say any such thing and I do not think it is fair to make that statement.
163. Chairman.—The Senator is dealing with the Bill and not with your evidence? —The Bill was mine originally.
164. You referred to the machinery. The Minister, in introducing the Bill in the Dáil, said the small part-time agency system would be reorganised so as to allow of a large number of whole-time agents, permitting better supervision of and closer and earlier attention to members. You hope to have closer and earlier attention to members under the new scheme?—We hope so.
165. On the question of attention to members, will the case of a woman who is to receive maternity benefit be dealt with as expeditiously in the future as it was in the past?—No woman ought to be without maternity benefit for a day after eight or ten days. That means that when a child is born, if the certificate is filled that day, she ought to get benefit in about a week.
166. Why a week?—Suppose the birth takes place in Kerry. The nurse or doctor has to write to the society for a form. They have to fill that form and send it back. At headquarters, they must be satisfied that a birth did actually take place. We had a famous case once arising out of a birth which was certified. In these matters, you must be sure. I came across one of the biggest frauds under the insurance system by inquiry in Clare, where officials were deliberately defrauding the society by filling fraudulent claims and sending them on.
167. In going too far one way, might you not be causing hardship?—In nine out of ten societies I do not think that there is any genuine complaint about maternity benefit. The societies are very prompt in paying maternity benefit.
168. I am not thinking so much about what happened in the past. There is to be earlier and closer attention in the future. How are you going to get that?—You will have a paid agent whose job will be to visit these people. The very moment that a claim comes in, he must attend to it and send it on. He will not be attending to this particular job and to nine or ten other things as well. His will be a whole-time job. He will have nothing else to do than the work under this Bill.
169. He ought to attend to it at once? —Yes, and, if he is not prompt in dealing with it, it will be dealt with from headquarters.
170. Has it not happened in the past and is it not quite a usual thing that a poor woman is given the money right away when the child is born?—It may be, but I do not know how a society could have done that unless the headquarters of the society were on the spot, because the agent has no power to pay any money.
171. But he has the money?—He should not have.
172. In this respect, the system will not be more expeditious?—So far as maternity benefit is concerned, I have never heard any complaints worth listening to of real delay in the payment of the benefit. After all, delay, if it were there, could easily be proved.
173. What I am coming to is really not the question of what happened in the past. It is your belief that attention will be earlier and better in the future?—I think so.
174. Under the scheme you have brought into being?—If a woman is going to get benefit in a week, it will be very difficult unless she is living in Dublin or Cork, where most of these women are either in hospital or attended from hospitals. As a matter of fact, maternity hospitals have a lot of trouble, because women do not look for a certificate until they have gone home, and then they complain when they do apply because they cannot get paid on the spot. They are frightfully negligent of their own interests.
175. Mr. Farren.—As a general rule, on the question of maternity benefit, I agree with Sir Joseph Glynn. My experience is, at least, in Dublin, that societies paid instantly. In later years, in the case of the Coombe and Holles Street Hospitals, a system was inaugurated whereby a certificate would be given and benefit paid next day.
Sir Joseph Glynn.—And the society paid the hospital for the certificate.
176. Mr. Counihan.—But I think you mentioned Kerry?—The wilds of Donegal will do me. I merely took Kerry because it was a long way off.
177. Chairman.—It would take eight or ten days for the woman to get it?—That would be the maximum.
178. Could there not be some system whereby it would be sent more expeditiously?—I think there will be. If a woman has a baby, the nurse has to write for a certificate and it takes two or three days to get it back and it then has to go back to the woman and come back again. It would take a week, surely. I would be entirely opposed to giving any agent power to pay money for maternity benefit because I can see any quantity of fraud arising from it.
Chairman.—You are, of course, referring to the human element.
179. Sir John Keane.—I have only one general question to ask. If you had maternity benefit as part of the insurance system, it would have reactions on the operation of the dispensary system?—Yes.
180. You would have to consider the whole thing together?—Yes.
181. It is a subject which the Government might well inquire into if it has not done so already?—The late Government inquired into it, as did the British Government, but nothing was done.
182. This question will show my ignorance. How long does sick benefit continue for?—The full sick benefit will continue for 26 weeks. It drops from 15/- to 7/6, which is disablement benefit, and it is possible for that to continue up to the age of 70, so long as the person is disabled by the illness.
183. Chairman.—You call it disability? It is called disablement benefit after six months.
184. Sir John Keane.—You never considered any system analogous to unemployment benefit where, after a certain time, stamps run out and the person goes on the dispensary system?—The system is that where a person is sick he or she may continue in benefit until the age of 70 after two years’ insurance. Will all this be in the newspapers?
185. Sir John Keane.—Only the spicy bits. Probably the only bits that will appear will be your encounter with Senator Dowdall.
Chairman.—You have been with us for one hour and 35 minutes and you have given us very valuable evidence. We are very indebted to you.
Sir Joseph Glynn.—Thank you. I am glad to have been of assistance.
The witness withdrew.
186. Chairman.—This communication which I have received is addressed to the chairman. I got it this morning and it comes from the Lord Mayor of Dublin. It is intended for the Committee and I had better read it. It says:—
Now that a Seanad Select Committee has been appointed to fully investigate the position in respect of National Health Insurance in the Irish Free State, I take the opportunity, through you, of asking your Committee to give special regard to the position of part-time officials of approved societies whose services will be dispensed with under the Bill which is at present before the Oireachtas. Great hardships will be inflicted on the agents referred to as there is no compensation for loss of remuneration provided for in the Bill—
Mr. Farren.—With all respect, I suggest that that letter ought to be read at a private meeting of the Committee. I object to anybody using the Committee for advertising purposes.
Mr. Counihan.—I have no objection.
Mr. Farren.—I certainly object to anybody making use of a Select Committee appointed by the House for the purpose of advertising. I think it is altogether wrong and should not be tolerated.
Sir John Keane.—The Lord Mayor can be asked to give evidence.
Mr. Farren.—He is entitled to do so but he is not entitled to get a letter read at a sitting of the Committee and published in the newspapers. I strongly object to that.
Mr. Dowdall.—I do not know anything about it but, in view of Senator Farren’s statement, I think it would be better to ask the Lord Mayor if he cares to come and give evidence.
Mr. Counihan.—That would be after having read the letter at a private sitting and we could decide whether he should be asked or not.
Mr. Farren.—The gentleman concerned had every opportunity when the Bill was going through the Dáil of airing his views without looking for public advertisement.
Sir John Keane.—I do not quite take the view that he was looking for public advertisement—
Mr. Farren.—I am not suggesting that he is but he had ample opportunity to air his views when the Bill was going through the other House and I think it is unfair to send a letter to be read publicly here.
Sir John Keane.—I do not think he is seeking public advertisement, as the Senator suggests. That is the only comment I want to make.
Mr. Farren.—I do not see any necessity to have the letter read at a public sitting.
Chairman.—I will read another communication now. It is addressed from the Minister for Local Government and Public Health to the Chairman of the Select Committee.
Mr. Counihan.—Are they looking for public advertisement?
187. Chairman.—The letter states:—
I am informed that the Select Committee set up by the Seanad have invited Messrs. J. A. McCarron and J. A. Duffy of the National Health Insurance Section of my Department to appear before them at their meeting to-day to be examined in relation to the National Health Insurance Bill now before the Seanad. As I do not think it proper that Messrs. McCarron and Duffy or any other official of my Department should be subject to examination in the manner suggested, I have instructed them not to attend the Committee’s meeting. If the Select Committee desire further information on the National Health Insurance Bill I will be prepared to attend and give the Committee whatever information is necessary.
Mise le meas,
SEAN T. O CEALLAIGH.
Mr. Dowdall.—I propose that we ask the Minister to come and give us particulars.
Sir John Keane.—I suppose the Mininster is within his rights in saying that, but I think that, in view of his own statement—and I am saying it in the presence of the Press—in the Senate that he himself knew very little about this Bill, it is only right and proper that we should hear directly the evidence of the people who do know. I think the Minister is not treating the Committee as it should be treated in sending us that communication.
Chairman.—And, further, it has to be added that the first intimation we got that Messrs. McCarron and Duffy were not to be here was on the telephone a quarter of an hour before the Committee was due to sit. The letter was handed to me at two minutes past 11.
Mr. Dowdall.—We only asked for them the day before yesterday. I do not think it is very vital.
Chairman.—It must be said that the Minister knew all about it. He was present in the Seanad when the motion was proposed and carried.
Sir John Keane.—Perhaps he did not know whom we wanted.
Chairman.—He did and he knew from last Friday morning.
Mr. Farren.—I think that, in view of the Minister’s letter, we ought to adjourn consideration of the matter for the moment. It would be unfair to the officials to ask them to give evidence and we could not dare ask them.
Sir John Keane.—We are not asking them.
Mr. Farren.—I want to say publicly that, from my experience and knowledge of national health insurance, we have asked people here who thoroughly understand the whole position and who, in my opinion, are most competent to assist and to give the evidence we require. That is my personal view and I have no hesitation in publicly stating it.
Sir John Keane.—I do not think that we are being treated at all in the manner a representative body like this should be treated.
Mr. Dowdall.—I am perfectly satisfied. It is immaterial to me where we get the information from so long as we get it, but, as a matter of choice, I should prefer to be cranky with the Minister rather than with Messrs McCarron and Duffy.
Chairman.—You could have had the opportunity of doing that in the Seanad. You had the Minister there but you could not question the officials.
Sir John Keane.—I should like to ask Mr. Coffey if he knows of any cases in which officials have appeared before a Committee.
Mr. Coffey.—This is the first case of the kind we have had.
Chairman.—There was the case of the Moneylenders’ Bill, but it was not possible to get any information of any value.
Mr. Counihan.—We have come here at a good deal of inconvenience to ourselves and I think the attitude taken up by the Minister is very unfair. Our only object in setting up the Committee was to try to improve the Bill and there were no political ideas in our heads at all. It is very unfair that we should not have the assistance of experts in this particular Department to give us the information we are looking for.
Chairman.—May I state, with regard to the question Sir John Keane asked, that, at the sittings of the Select Committee on the Moneylenders’ Bill, 1929, General Eoin O’Duffy attended and gave evidence.
Sir John Keane.—That is a comparable case.
Chairman.—I think we might leave the matter as it is at the moment. There is a suggestion by Senator Dowdall that we invite the Minister to attend and give evidence before the Committee.
Mr. Farren.—I would suggest that the proper procedure would be to declare the public sitting at an end and hold a private sitting.
Mr. Counihan.—With regard to the question of inviting the Minister, I think we have all the information from the Minister that it is possible for him to give.
Mr. Dowdall.—There are quite a lot of figures and I think we had better have him here.
Chairman.—Senator Dowdall suggests that we should hear the Minister. I do not want that matter delayed until a private sitting because I think it is a matter we should decide on.
The Committee went into private sitting.