Committee Reports > List of Committees > Seanad > 1933 > Select Committee on National Health Insurance Bill, 1933 > Report - National Health Insurance Bill, 1933

MIONTUAIRISC NA FINNEACHTA

(Minutes of Evidence)

Dé Céadaoin, 21° Meitheamh, 1933.

Wednesday, 21st June, 1933.

The Committee sat at 11.15 a.m.

THE LEAS-CHATHAOIRLEACH (Mr. F. O’HANLON) in the Chair.

Mr. Sean T. O’Kelly, Minister for Local Government and Public Health, examined.

561. Chairman.—Do you wish to make any statement, Mr. O’Kelly?—With regard to a formal statement, anything I have to say on the Bill was said on the Second Reading Stage in the Seanad; but if you will allow me, there are one or two matters that I would like to mention before you begin to ask me questions. The first is to say that it was not my desire, in any way, to interfere with the fullest inquiry by this Committee into the subject matter of the Bill when I indicated that I considered it improper for the officials of the Department to come here to participate in this procedure. So far as I am concerned I considered it is the privilege of the Minister to give any information that might be desired by the Committee and that I should be the person to give it and to judge what information might properly be given to the Seanad with reference to this, or any other Bill that I might be introducing. It might place the officials in a very difficult position if they were obliged to come here. On a question of principle I thought it was not proper that the officials should come here. I view it that I should be responsible for giving information. I would like it to be understood that so far as the Committee are concerned any information they ask for we will be only too happy to give. In connection with the other matters, I wrote to Senator Sir John Keane but I have not had any reply from him. He stated before the Committee, that the Minister had made a statement in the Seanad. I want to be careful. You have a copy of the Official Report. I do not want to misrepresent what the Senator said in the fashion that he misrepresented me. Sir John Keane was reported here as saying, in the presence of members of the Press, that the Minister himself knew very little about the Bill. That is a gross misrepresentation and it is a statement that a gentleman occupying the responsible position of Sir John Keane should not make. He had the Report of the Seanad to quote from, and I look upon it as an unworthy misrepresentation of my words. I wrote to Sir John Keane to see him on the matter so that I might, perhaps, give him an opportunity to realise the mistake he had made in misquoting and misrepresenting me and to see what action could be taken. However, he has not got my letter. I wrote to him on Saturday. It is the first opportunity that was given me and I think it right and proper to raise the matter now.

562. Sir John Keane.—I am very sorry. It certainly was not my intention to do so and I am prepared to make such representation and apology as will meet the case. I was speaking from recollection and I have not yet got the Official Report. If I have misrepresented the Minister I make a full apology in any form he wishes.

563. Chairman.—You did not get Mr. O’Kelly’s letter?

Sir John Keane.—No, and if the Minister will suggest what form the apology should take, I shall be glad to give it.

564. Mr. O’Kelly.—Here is what I said: “I frankly admit that I have not had very considerable experience of national health insurance myself, but anyone in my position has to take the advice of those who are, and have been from the beginning, closely associated with national health insurance work.”

565. Sir John Keane.—I shall be glad to make any explanation or apology desired by the Minister in view of what I now see the Minister actually did say. I was relying on my recollection and I was, to a certain extent, at fault. The impression left in my mind was that the officials would be more informed on the matter than the Minister. Will the Minister suggest what he would like me to do in the circumstances?

Mr. O’Kelly.—If Senator Sir John Keane wishes to withdraw, I am perfectly contented.

566. Sir John Keane.—Will it satisfy the Minister if I put it in the Report of the Committee and present it to the House?

Mr. O’Kelly.—It will.

Sir John Keane.—I am very sorry it occurred.

Mr. O’Kelly.—It was given some prominence in the Press.

Sir John Keane.—It was said in the heat of the moment and I would not have said it after more mature thought.

567. Mr. Counihan.—What the Committee had in mind was that the Minister might not be so very conversant with statistics in relation to insurance as his officials. That was the only complaint.

Mr. O’Kelly.—Well, I am not aware, beyond the statement of Sir John Keane, what the feeling of the Committee was.

568. Chairman.—Sir John is prepared to make ample amends. Is the Minister satisfied?

Mr. Kelly.—Oh, yes.

Chairman.—Then the matter is ended. Senator Dowdall has expressed himself as very much concerned with this Bill, and he requires an amount of information.

569. Mr. Dowdall.—I intend to ask the Minister a number of questions in reference to the statement made on the Second Reading in the Seanad. In column 1737, in reference to the National Health Insurance Central Fund we are told, at the bottom of the page, that it actually stands with accumulated interest at about £120,000, and no additional contributions have been made to it in recent years. Why have no contributions been made to it?—No contributions have been made because of the very heavy demands on the accounts of insurance in general, since 1928. I know, fairly well, that the demand has been increasing, we might use the words at an alarming rate.

570. When did the contributions to that fund cease?—In 1921.

571. I suggest that as the demands on the fund began to creep up, these contributions should have been resumed?—You think they ought to have been resumed. If there is money available they are supposed to provide for those things.

572. When a fund is formed to meet a certain contingency, and continuing experience shows that the fund may be heavily raided, I submit it would be only the merest prudence to resume contributions to the fund?—There is this much to be said about it, that the moneys put up into that fund came from the contingency fund and would, therefore, reduce that fund.

573. Chairman.—It did not seem wise policy to reduce that fund?—That was the decision responsible for operating the fund; that was at the foundation of it.

574. Mr. Dowdall.—That is not the information we got in the speech. The speech delivered by the Parliamentary Secretary to the Minister contained the following. “If on the other hand the society shows a deficiency, the position is more complicated.” I am reading the second paragraph of column 1737. “It has in the first instance a reserve fund to fall back on, known as its contingencies fund. Each society has a contingencies fund which has been accumulating during the five years covered by the valuation from a small fraction of each contribution paid in respect of its members. The society’s contingencies fund is used as a first reserve to meet the deficiency. If this is not sufficient there is a second reserve known as the National Health Insurance Central Fund. This fund has been derived partly from State grants and partly from a fraction of each contribution paid in respect of members of all societies . . .”?—According to that, the fund is made up partly from State grants and partly from a fraction of each contribution. What has not been taken is available for the contingencies fund, and is available for the insurance societies in any case. The money is there for the society. It has been in their own contingencies fund, and if it was not put into that, a peculiar position would arise.

575. But no part of the State grant has been put in since 1921?—The State grant was a small sum of £5,000 a year, and as a result of what happened it did not seem to be so necessary at that time in 1921. In recent times, because of the great change, the £5,000 would not be very serious.

576. It would not be very serious?—No.

577. I am quoting from the speech of the Minister’s Parliamentary Secretary, who was dealing with the financing of the Bill generally. In the portion of the Parliamentary Secretary’s speech dealing with the valuations, he makes some interesting statements. Of course, we recognise that the 1919 valuation was not of particular value for the purpose of comparison. We had two valuations, one in 1923 and the other in 1928. In 1923 a surplus was shown of £613,648, minus £370,000 brought forward, which left an accumulated increase during the period of £243,648. Now, Dr. Ward told us that that amount was by some means reduced from the total of £243,648 to £50,000. It would appear on paper, at least, that it was £243,648. There is a very considerable amount to be explained away there, something like £193,000?—There was an effort to explain that.

578. I followed it closely, and I confess it conveyed very little to me?—Dr. Ward pointed out that there was a sum of £613,648, but in fact a sum of £370,000 had been carried forward. Making allowance for these items, the actual surplus earned in the five years from 1919 to 1923 was only £50,000. That division brought about a radical change in the societies and a radical change in their financial condition. There was a split up, first of all, from Great Britain and then Northern Ireland. When the whole thirty-two counties were together we had a very big industrial population in the North and many thousands of their members were members of the national insurance societies, the biggest ones we had here. We were not so industrially developed and it meant a very material loss. From the purely financial point of view the loss of the insured elements in the six counties, by the taking away of members from the societies that remained in the Free State, altered the situation very materially. Taking away a large amount of finance and giving over to the six counties what they claimed, meant a very material alteration of the finances.

579. Am I right in saying that with a nominal surplus of £243,648 the sum of £193,000 was transferred to Northern Ireland? — The sickness benefits in Northern Ireland were more than in the Free State. The difference was such that they had a much more favourable balance, taking their members as a whole, than we had in the Free State.

580. Did we retain the £243,000, or had we to pay over the £193,000?—We retained it.

581. It really is in the fund?—It is.

582. As a contingency, by reason of the bad sickness record of the Free State, it was thought advisable to make an allocation which really was more or less in anticipation? — The amount actually earned in that period was £50,000.

583. At the bottom of column 1738 “At the 1923 valuation” appears. That should read 1928 instead of 1923. The Parliamentary Secretary is reported as saying “55 societies showed a surplus of £513,626 and ten societies were in deficiency to the extent of £51,268. The net surplus was, therefore, £462,358 . . .”? —Yes.

584. I am particularly anxious to get at one figure. The Parliamentary Secretary said further on “as there had been a carry forward from the previous valuation which with interest amounted to £510,000 it followed that there was a loss on the five year period 1923-1928 of £50,000.” Does that valuation carry forward £510,000? You will have to have regard to the figures of the previous valuation. I think it is a case for paper, a case for calculation?—The actuary has to decide how much he has to carry forward. We have here the details and if the Senator wishes to see them he can do so. In the valuation of the 31st December, 1923, the amount released and the amount reserved are two separate items. The Senator does not want the figures for every society?

585. If I got the total figures they would do?—The amount released was £248,309 on 31st December, 1923, and the amount reserved was £215,128.

586. At the winding up, or the breaking up, of a society both these sums would be available?—Yes.

587. Now I come to 1928. I want the reserved and the released funds?—I will try to make them up for you.

588. It is rather important to have them. I want the figures. I think I can go on with the speech. “The net surplus was, therefore, £462,358 and as there had been a carry forward from the previous valuation which with interest amounted to £510,000 . . .” How does that carry forward of £248,000 with interest become £510,000?—That is the £248,000 from 1923.

589. Yes. By no conceivable form of mathematics that I know of can £248,000 be made into £510,000 in five years?—We will get you the figures. At the valuation made on the 31st December, 1928, there were 83 societies with a membership of 408,000 odd. There were 73 societies containing a membership of 291,160, with a surplus of £513,626, and ten societies with a membership of 117,152 were in deficiency to the amount of £51,268. The net surplus amounted to £243,268. The sum carried forward and transferred to the benefit fund of the society was £440,000. What we give you there is the reserve value. This sum would have accumulated with interest to £510,000 at the date of the valuation. The operation of the societies would appear to have resulted in a loss of £50,000.

590. What is the sum, apart from interest?—It does not give the amount of interest. The sum carried forward from the second valuation, including the contingencies fund transferred to the benefit fund of the society, was £440,000. This sum would have accumulated, with interest, to £510,000.

591. It does not tell you how much was transferred to swell that figure from the contingencies fund?—No.

592. Then it is not on the same basis as the 1923 allocation?—The valuation was done by the same man and the same principles operated in this valuation exactly.

593. The sum brought forward, apart from interest, was £440,000, and that interest is available. The £440,000 which I treat apart from added interest would leave a surplus of £22,358. The Parliamentary Secretary said that the net surplus was £462,358. The figure we get now, which includes the sum brought forward, plus something from the contingencies fund, was £440,000 which treating it part from interest, would leave a surplus of £22,358. There was interest available also which, by some method, I confess I cannot follow, was reconciled or deducted from the surplus instead of being added to it?—It is shown here that the interest included by the actuary would amount to £70, 000.

594. It says about £70,000?—Yes, about £70,000. This sum would have accumulated with interest to about £510,000 at the date of the valuation. It takes into credit £70,000 interest accumulated—I suppose compound interest.

595. £70,000 on £440,000 is something very different from £510,000 on £263,000. That interest is understandable, at all events. I confess I do not follow the book-keeper because, taking what is done in any trading firm, a profit is made which is allocated partly to reserve and partly to carry forward and in the subsequent account you get the carry forward exactly as it was and any interest that has been earned on the investment of the reserve or carry forward goes into the general account and adds to the general surplus?—Have you not got that here?

596. It seems to have been deducted? —Oh, no. We have to take what you bring forward. The Senator realises that profit and loss are entirely different things from surplus.

597. In insurance—I may be quite wrong; I am not an actuary and still less am I a chartered accountant. I have read a good deal of trading accounts and balance sheets in my time?—I am sure you have. I cannot say that the actuary here in making out this valuation for us followed the same lines as an actual balance sheet. Nevertheless, he shows us here clearly, to my mind at any rate, what the actual position was at the end of 1923 and 1928.

598. The figures show there was a loss on the period 1923 and taking only these figures to which I cannot give the full assent of my will, that period shows a loss of approximately £50,000. With the surplus that came in of £50,000 that would show a loss of £100,000. I am putting it at the worst now. I am taking it that I have lost the £50,000 I brought in and I am £50,000 out. But putting it at its worst Dr. Ward in his speech goes on to say: “The expenditure on benefits had also been increasing to a somewhat alarming extent; it had risen from £439,000 in 1923 to £686,000 in 1928.” That is taking only those two years. It continued to progress until it reached £686,000. The difference between those two figures paid in benefits is £247,000, which shows that in one year alone the insured persons got an increased benefit of £247,000 and there was only the loss on the whole five years of £200,000. I say that is a good scheme for the persons who organised it and the insured persons. If I can get, by any means, £247,000 for £100,000 I am doing remarkably well?—Well, this does not show that the £247,000 was got for £100,000, taking the Senator’s figure of £100,000.

599. For the work of five years?—There was a loss of £100,000.

600. There was a loss during that period of £100,000. What were the total benefits during the period 1923 to 1928? It does not show it in the Parliamentary Secretary’s speech. Would it be in the statistics? I think we have to tot it. I have the total benefits on page 101 of the statistictl abstract. I will pass these over to you in a moment?—It may be we are at cross purposes all the time, Senator. You are dealing with all the figures as against the valuation and there are two different sets of figures. There is the speech on the Second Reading based upon the valuation by the actuary and the figures there are not comparable with the balance sheet figure.

601. I think I am right in saying that the actuary brought out that there was a diminution in the available funds of the whole organisation of £100,000 during the period?—In the valuation he has to take into account the liability for every insured person up to the time that insured person reaches 70 years of age. In making his valuation he has to look forward.

602. Chairman.—That is an estimate? —It is an estimate based by a person whose profession it is to do this work.

603. Mr. Dowdall.—And, of course, he has his professional experience to guide him?—He has, in our own national health insurance societies. So that in judging the position the figures given by the Parliamentary Secretary in the Second Reading speech are a forecast of what the position is likely to be at the end of this valuation period.

604. I have not come to that yet. Have you the actuary’s report here?—I have.

605. What does the actuary give as the diminution in the fund, having regard to what he allocates for unexpired risks? The fund is increasing, not diminishing,

606. I quite see that, but I know he has to allocate a certain amount?—He has to make a valuation on the basis of the present demands. If economic conditions remain as they are, or grow worse, he has to make a valuation of what they are likely to be at the end of the next valuation period. As long as there are people paying certain reserves are accumulating all the time.

607. This statistical abstract shows it is a very healthy organisation?—The fund is in a healthy position. Suppose the present economic conditions continued for a number of years it might be altered very much. As long as this is a national institution we have to secure, for the people who are paying in, that the money is there.

608. Of course, I accept that but it seems to me in view of the criticism of the great number of societies and the lax certification that the evils which have been represented to us are not borne out by the accumulated figures. Of course, we have the actuary’s report or forecast. Hitherto it has dealt with accomplished and finished periods, but in this paragraph of Dr. Ward’s speech it has more or less to go into the realms of prophecy?—It has.

609. Not to a large extent?—But this is our position with regard to the present and the future. We have experienced men, the chief officials in the Department. Up to a few months ago we had the insurance commissioners and we had all their experience added to the valuable experience based on the scientific examination of the actuary as to what is behind this. It is based on their knowledge and experience. What I mean is that the provision we must make for the future is based on that accumulated experience. I read over carefully the evidence that was given before this Committee and various matters were dealt with by a number of witnesses. They dealt with national health insurance generally and they brought forward suggestions as to how it may be improved. We were told that there was about to be a crisis.

610. Chairman.—And you are setting yourself out to deal with that situation?—Exactly. It must be dealt with now.

611. Mr. Dowdall.—I pass from that with this parting shot, that unification was advocated in 1924 when there was no such crisis impending?—For my part since I have examined this situation I would have said that unification ought to have been the policy since national health insurance was inaugurated.

612. I agree with that. I lived in England at the time, and I recollect the passing of this Act very well?—I took considerable interest in the matter at the time.

613. I would be prepared to agree that possibly there could be something said for unification in the first instance, although I could say something of the competitive element too?—We cannot compare national health insurance in a country like ours, with a country like England, highly industrialised and with a huge population. If the Oireachtas were to set about establishing a national health insurance scheme it might do it on an entirely different basis, and it might be a very good thing for the Oireachtas to set about enquiring now when we get over this crisis. If the Bill is passed I think we will have safeguarded the position of national health insurance. As represented by witnesses during the past few days, it might be a wise thing to have an investigation covering the whole question of insurance, workmen’s compensation, medical benefits and infant mortality. These are things we have not attempted to deal with in the Bill. The position as I found it, when I came in as a Minister was this. It was represented that this matter was urgent. We did not have time last year to deal with it, and we were advised to deal with this aspect of the matter first, because of what might, according to the actuary’s report, occur in the 1933 period. The danger was that if we did not tackle it we might have to have reduced benefits, and if there was to be any reduction in benefits we thought it would be more equitable to bring all the insured persons into one society and share the credits and losses of each, and make it a really national organisation.

614. I am afraid I do not agree with my friend, Sir John Keane. I agree it would be the better system?—We met a number of the societies, some individually, and we met a delegation of the approved societies and had long discussions with them. Even those witnesses who appeared before your Committee were not able to demonstrate that this problem could be solved in any better manner than by unification.

615. There is a general concensus of opinion that unemployment causes a greater strain on the benefits?—That seems to be the point of view.

616. It has been suggested that this is due to lax certification. It has been suggested that unemployment brings on a number of border-line cases, and the medical officers give the certificates. I suggest to you that the medical officer is right to give a certificate in border-line cases?—That matter rests with the medical officer as to whether a person is entitled to a certificate or not. Most of the medical men are, I would say, humanitarians.

617. As between the fund and the individual he should give the individual the benefit of the doubt?—I agree.

618. We are not dealing with benefits purely for their own sake. We are dealing with them as collateral to health?—If these people are unemployed certain sections would be entitled to unemployment benefit. Others of them not entitled to unemployment benefit should apply for home help. They do not like to do that. We are dealing with an insurance fund and our aim, as heads of the national health insurance, is to see that it is dealt with very strictly, no matter how our hearts may prompt us.

619. At the moment you are the vigilant custodian of the fund, and not the Minister for Public Health?—That is so.

620. I think, with all respect, this being a national health insurance fund, at some risk of an inroad into the fund it would be better to give an unemployed man the benefit of the doubt?—If that question were put to me, I would strictly have to examine the laws under which I am working. If they allow me to have discretion in the matter, my own inclination would be to be generous. But on examination from an insurance point of view, I would only give what that man would be entitled to.

621. Chairman.—And if the Fund was limited you inflict a hardship on another section?—As insurance people we would have to examine that and deal with it from a strictly insurance point of view. As an insurance department we object to the doctors dealing too generously with our insurance fund and, it is a strong word to use, robbing other insurance people of what is their due.

622. Mr. Dowdall.—I see the point?—As I mentioned in the Dáll, it was represented to me that a doctor left his book of certificates on the hall table with instructions to the servant that if so-and-so would call for a certificate, to tear one out. I reported the case at the time. The doctor has since retired.

623. You had not an opportunity of reading Dr. Rowlette’s evidence with respect to that. It was the only evidence that dealt with the matter. From the public health point of view, while he agreed there was some abuse he did not assent that the abuses were as widespread as we are led to believe?—We are not allowed to deal with it from the public health point of view.

624. I suggest that unification will not do away with lax certification?—We think the chances are the other way, when we will have a person in an area whose whole-time job it will be to safeguard the interests of national health insurance and when we will have visitors whose duty it will be to see that the cases of people about whom there is a doubt as to their qualifications for certification will be investigated, and that generally there will be a tighetening up of the amounts now paid.

625. It means reduced benefits being paid?—Yes, certainly, out of the insurance fund.

626. I suggest, and I feel this very strongly, that this may introduce the iron heel of officialdom and that these health visitors will be disposed to press people to go back to work when they are not physically fit?—I think there has been a considerable amount of laxity heretofore and it is admitted that when individuals drawing relief were asked by those charged with the work of supervising to present themselves for examination to the referee, at least one-third of them, without going to the referee, went back to work. If we can stop one-third from drawing benefit unjustly it would be a big achievement. I am sure the Senator would not stand for people who were not sick, making a claim.

627. I would not. In the business concern I am dealing with we could not dismiss hands and get on, so I cannot speak from experience?—The Senator is, no doubt, aware that people in the butter and creamery business are generally the longest lived. They do not draw much out of national health insurance benefits.

628. With regard to the one-third who do not present themselves for examination to a referee. I have considerable experience of working people and there is a great deal of difference and shyness and rather the fear of going before a referee?—I do not doubt that that is so.

629. That might account for some of the one-third?—Possibly.

630. It has been told to us that the insured person is not in close association with the society. Sir Joseph Glynn said he met a man in Donnybrook and he asked him what society he was in and he said Mr. Darcy’s. I suggest that is the closest association some of the insured have with the society?—They would not be any less closely associated with the new society.

631. Mr. Counihan.—Do you agree with Sir Joseph Glynn’s statement that unification is the only salvation for national health insurance as otherwise there will be complete bankruptcy of a good many of the societies?—Complete bankruptcy might be a strong word to use. Certainly there is grave danger of a number of societies having to reduce their benefits and a grave injury being done to national health insurance as a whole if we do not take unified action. The steps we have decided on, after long consideration, is unification.

632. Mr. Counihan.—Senator Dowdall suggests that certification is all wrong. In his view it is too strict.

Mr. Dowdall.—Oh, no.

633. Mr. Counihan.—I think the Minister properly answered when he stated that he must administer the Act. You must draw the line somewhere. With regard to certification, you mentioned some cases. Could there be anything put into this Bill so that people who are sick for three or four days would get benefit covering that period? As it is they get no benefit for three or four days’ sickness and I think that leads to a good deal of malingering. When people get no benefit they will be three or four days sick and they will then go to the doctor and make it seven days, in order to get the benefit. If they got benefit only for the time they were sick they would get back to work sooner. Would it be possible to arrange that?—That was a matter that was debated ad nauseam by our own department and the Commission and undoubtedly there is something that might be done there. We have not attempted, in this Bill, to interfere at all with the finances of national health. We have only attempted in this Bill to meet the suggestion that is being put up to us.

634. We have more experience now than at the introduction of the Bill. I have seen men who could go back to work but they stay out for the week because they get nothing for three days?—I do not doubt it.

635. That is where the health visitors would come in and I think the health visitors would be the only cure for malingering. There is another point a good many farmers are interested in and that is having some words in the Insurance Act to define what is a contractor. At the last sitting of the Committee I explained clearly what I meant??—I read what the Senator said, but I think any definition of that kind would be outside the scope of the Bill. We do not intend to deal in this Bill with any matters except the difficulties we are up against. Those are matters that will rightly and properly be dealt with on another occasion.

636. Sir John Keane.—I am not quite clear about this reserve fund. Was there a statutory obligation to contribute to that reserve fund?—Yes, I cannot quote you the section, but there is a section.

637. How did it come that that contribution ceased?—That is the £5,000 a year.

638. Was there a statutory obligation on the part of the State to contribute to the reserve fund? The Parliamentary Secretary says: “This fund has been derived partly from State grants”?—There were deductions made from contributions but in 1921 they were discontinued.

639. They were discontinued by the 1921 Act which was a British Act. Up to that there was a statutory obligation?—There was.

640. With regard to the 1923 valuation, that was made ignoring for the time being the political situation?—The actuary had started some time before that.

641. Was the actuary in a position to differentiate lives in the Six and the Twenty-Six Counties?—The actuary did make provision for that.

642. The Society at that time covered the whole geographical island?—Yes, and a number of societies in England as well. Here is what the Parliamentary Secretary said: “After the Treaty, however, a clear cut as regards funds and membership was effected and the valuations in 1923 and 1928 show the results as they affected all Free State insured persons. In 1923 there were 79 societies and 20 branches.” The actuary did investigate the whole situation as to the incidence of demand and benefit with respect to insured persons in the Free State.

643. At a certain stage in his work he had to call a halt and begin to differentiate?—Yes, as regards his valuation. I do not know how long it takes an actuary to make his calculations.

644. Mr. Dowdall.—It must take a long time?—Probably it does.

645. Sir John Keane.—He brings out a surplus of £613,648 and proceeds to water that down and very much reduces it later?—Yes.

646. Can you tell me on what basis the actuary, in his 1928 valuation, views the future? Does he state that he views it rather in the light of depression and that the recent heavy demands will continue, or does he discount that and allow something for improvement?—He cannot tell what the economic conditions are likely to be. He is basing his calculations on the last two or three years and therefore his valuation is not very hopeful. He is in constant touch with us.

647. He made the 1928 valuation after 1928?—Yes.

648. Are these health visitors in existence?—Some societies have them—the larger societies.

649. In future they will be whole-time?— I would not say that they will be whole-time. There are societies who have them as part of their work.

650. Does the ordinary agent combine his other duties with visiting?—The ordinary agent’s desire is to get all the members he can.

651. I would like to know whether anything can be done to recognise the position of better-off societies continuing the benefits to members that those members already enjoy?—Of course, the benefits will continue up to the end of the present valuation period, the end of this year, although the unified society actually comes into existence before then.

652. According to the Bill numbers of approved societies shall, as regards additional benefits, have the same facilities as they had before the transfer?—They are all right under present conditions.

653. That section hangs on another section. Would it not be possible to continue their present privileges?—With one central society it would be absolutely impossible to have one section having special benefits and another section drawing much less.

654. It does seem hard that these people who built up certain assets should lose them by being obliged to pool them?—It had the objection, at the same time, of taking in all classes of people. Let us take an insurance society representing a certain section of the community. That society is excellently managed. I doubt if, under present conditions, they would be able to continue to pay additional benefits although excellently managed. It is not a question of managing alone. It is a question of particular classes of individuals. In our opinion in the matter of national health insurance everybody should be on the same basis. I agree with Senator Dowdall that we must look at it from the national point of view.

655. On the general question, what rather puzzles me is that this position does not obtain in England and I am interested in that point?—They have 12 or 14 millions insured in England, and their insurance revenue is much larger than ours.

656. What I contemplate happened there was that there was a segregation of bad lives from good lives. Have they not some societies there which have shown bad results?—Certainly.

657. What has been done with these societies?—Some of these societies have been amalgamated with other societies.

658. Chairman.—Have they been absorbed?—Yes, and they have much bigger reserves. Insurance societies, perhaps badly managed, had a long period in which they worked up reserves.

659. Sir John Keane.—Sir Joseph Glynn said there was no solution of the certification difficulty except by bringing medical men within the purview of insurance?—That is a big problem. What are we to do with our Medical Act?

Mr. Farren.—Scrap it.

Mr. Dowdall.—I would not agree with scrapping it.

Mr. Farren.—If you had to go to the Dublin dispensaries you would be in favour of scrapping it.

660. Sir John Keane.—Has there been an inquiry into the whole range of dispensary work as against medical benefits? —The matter was discussed in 1924 and 1927. It was gone into fairly fully. The terms of reference of the Committee were as follows:—(1) To inquire into and report on the advisability of the continued maintenance of the system of national health insurance in its present form, and to make any recommendations which the Committee consider proper in that connection; (2) to consider whether it is desirable to institute a system of medical treatment, on a contributory basis and, if so, to advise as to the form which such treatment should take; (3) to examine into and report on the question whether the medical services at present assisted or maintained out of State or local funds can be improved as respects efficiency and economy and, if so, in what manner, due regard being had to any recommendations made in the preceding paragraph. The Committee consisted of Professor Magennis, Sir James Craig, Sir Joseph Glynn, the Minister for Finance, Dr. Maguire and Dr. Rowlette.

661. It seems to have reached a deadlock?—It does seem that there is duplication of effort. You have the same people in national health insurance. You have people who give them certificates, and they go to the dispensary doctor for treatment.

662. If it is proved that the doctors are lax is there any way of dealing with them?—The doctors are struck off, and lose certain revenue.

663. Mr. Dowdall.—I do not think there has been much abuse in the rural areas?—The one case I heard of was from a rural area.

664. Mr. Farren.—The contingency and central fund was set up after 1918, and the moneys that went to build it up were moneys that were formerly allocated to the redemption of reserve values?—That is so.

665. After the second valuation it was decided on the actuary’s recommendation that the fund had amounted to such a considerable sum that it was thought it was sufficient to cover all risks, and then it was decided to cease to make these deductions from the amounts that went for the redemption of the reserve values?—Yes.

666. The actuary contended that there was sufficient to meet all contingencies, and this money was released to enable societies to pay additional benefits?—Yes.

667. The contributions to the contingency fund and central fund were stopped?—They were stopped only in the case of the central fund.

668. I think it was a great mistake that after the second valuation these deductions that were going to build up the reserve fund were stopped?—The contingency fund contributions were not stopped.

669. With regard to the additional benefits the whole scheme of national insurance has broken down because of the introduction of additional benefits?—I would not say that the whole scheme of national insurance has broken down.

670. As at present constituted, it has?—In the case of some societies.

671. Some of the very best societies have been paying additional benefits?—They have. They tried to compete with other societies and got themselves into difficulties.

672. The lack of success of the scheme is because it is not national insurance at all?—That is it.

673. In the case of some societies the contributions were less than anticipated, with the result that the funds were never adequate to meet the demands made upon them?—Quite so.

674. Mr. Farren.—A question has been raised about the sick visitor. I was the Secretary of one of the first trade union societies set up. My view is that the visitor will not stop malingering. Ultimately it is the doctor who must decide that question. It will never be a success without a system of medical benefits. I have a considerable experience of certification under different schemes. At the outset there was no panel of doctors. They had to appoint doctors in different areas for the purpose of certification, but that did not work successfully. We got every doctor in the country who was prepared to issue certificates put on the panel. That has not proved successful. The introduction of medical benefits is another day’s work. Have the Department any figures available with regard to the average amount of sickness benefit paid to agricultural workers and domestic servants? Industrial workers and shop workers are insured but domestic servants and agricultural workers are not insured for unemployment benefit.

675. Chairman.—When the Commission was sitting, representations were made on behalf of the agricultural industry to the effect that agricultural labourers were not getting any adequate return for their contributions. Farmers’ representatives made that contention and when figures were submitted to them they expressed themselves as being well satisfied with conditions.

676. Mr. Farren.—Unemployed people who do not get sufficient to sustain them become sick and put an unfair drain upon an insurance scheme. Every man and woman has a God-given right to be maintained and to get sufficient food. Senator Counihan referred to the advisability of having benefit paid from the first day of sickness. It is only in the case of sickness occurring during the first 12 months that the period of three days does not count for benefit. No man or woman has to do three days a second time without receiving benefit.

The Committee adjourned until 11 a.m. on Thursday, 22nd June.