"HARMFUL & UNNECESSARY"

Hawke's Bay Herald-Tribune, Issue 172, 7 August 1937, Page 7

"HARMFUL & UNNECESSARY"

Government Health Scheme

MONEY BETTER SPENT Hastings Doctor Voices Opposition ONLY THE BEGINNING Tbougb the medicaft profession , favoured a health insurance scheme covering some sections of the community, it did not approve oi^the system now proposed by the Government and it saw no reason for taxing every member of tfie commimity to pay for sucb a scheme, Dr. E. Cashmore, chairman of the Hastings branch of the British Medical Association, told the Hastings Rotary Cluh at-its luncheon yesterday. Most "doctors were against the proposed scheme, he said, and many would leave the coUntry rather than work undcr it, although they would get more money from it than they were now receiving. It was not any finaneial consideration wbich was iniluencing tbem. They wore actiug in tbe interests of tbe health of tbe country. Under tbe scheme doctors would become too busy to give individual patients tbe attention they deserved, and tbe elimination of competitiou would remove tbe iucentivo to study anu undertalie constaut researcb. 0 Tbe Government was niaking a beginning by socialising doctors because they were tbe emallest body in tbe country and tbeir votes therefore eounted for notbing. "Tbe medical profession feels that tbe publie bas no coneeption of tbo magmtude of tbis scheme, nor of tbe eli'ects it wijl bave," began Dr. Cashmore. "W e are moro or less in favour of nationai health imsuranee, but we advocate a dill'eretlt scheme from tbat proposed by tbo Government, and wc are tbo ones wbo should know bettcr than tbe politicians wbat is best." Dr. Cashnloro outlined tbe pauel scheme in force in England, under vvbicb people obtained free medical attention for 9/- a year, wbicb was paid to tb'e doctors tbfbugh a fund. fcjimilar scbemes were'in forco in most other Europea countfies. Tbo Englisb scheme did not cover a man's dependeuts, but tbe otber scbemes gtenerally did and tbe medical profession thougbt that tbe dependents Sbould be included in tbe eckeme. Tbe wage-earner was usually a fit man; it was bis wife and children wbo bad more need of tbe benefits of sucb a scheme. Tbe Farmers' Union and tbe hospitai boards bad approved of a nationai health insurance scheme some years ago and the last Government, just before tbe elections, had decidcd to do sometbing in tbe matter. "Doctors Object On Principle." The scheme now proposed by the Government would impoee a tax on all, entitling everybody to free medicai attention. The scheme was outlined to the doctors at first under a "gentleman's agreements npt to divulge the details of it, but tbe ban bad now been lifted. It was not from any finaneial considerations tbat tbe doctors did not favour tbe scheme. Dr. Gasbmore stresses tnis point .many times during bis address. Doctors bad been offered under tbe scheme more than they were getting at tbe present time. They would get .£1 a head per annum on tbe wkole population of New Zealand, wbicb would mean a total amount of sometbing like £1,500,000. But tbe doctors would not accept it. They objeeted on principle. Tbe whole population, Dr. Cashmore contended, sbould not be taxed. Thero were, bowever, tbree groups wbicb sbould be cover ecL They were: (1) Old-age pensioners, tbe unemployed ar.d tbe unemployables, and people witb an' income of not more than the amount of tbe old-age pension. Tbese people, Dr. Cashmore pointed out, already received free medical attention^ pimply because they could not pay for it, but there was no acceptation of tbis fact. They bad to suffer a loss of dignity. Hospitals billed all people alike. Tbe result was that tbe people in fhis group fell into two classes — tkose wbo would call tbe doctor up at all bours and take advaDtage of bim, and tkose wbo would not call a doctor until it was to late. t (2) Single men and women witb an income of not more than £3 a week and m'arried couples without children receiving not more than £4 a week, with an allowanco of an additional 10/- a week for oach child under 16 years old. (3) People with an income of £500 a year or under, not included in groups 1 or 2. People in this group were usually able to pay tbeir doctor 's bills, but protracted illnesses. frequently ran up hospital bills wbich took away as mueh as a quarter of a man's annuai income. Tbese people, therefore needed kelp for hospital and uuraing expenscs. Those Able to Look A^ter Themsellves. Tbe group witb annuai incomeB in excess Of £500 (and tbero were not so many of tbese people) were able to look after themselves, Dr. Cashmore said. If they so desired, of eourse, they j sliould be allowed to link up witb tbe sclieme ■ voliintarily. A universal scheme of health insurance like tbat now proposed bad never been tried in any other- country. It was going to eost New Zealand an immense sum. The Government had saggested it would cost £3,500,000 a year, but, it bad been estimated by ihe hospital boards that gross medical services amounted to four times the

amount necessary for payang tbe doctors, so tbat, if tbe doctors were to be paid tbe amount now offered tbem, the total cost of tbe scheme would be £6,000,000. If tbis were raised by a tax on income, as tbe Government iutended tbat it sbould, it would mean seven pence off tbe weokly wages in addition to present taxea. Tbe medical profession was sincere wben it opposed tbe scheme, Dr. Cashmore emphasised. Tbe doctors bad been offered more • than, they were getting now, but they wanted- to preserve tbo health of tbe Dominion. Visitors, and world-renowned medical men aniong tbem, repeatedly said tbat in Australia and in New Zealand a type of medical practitioner and of hospital servico not found. anywbere else in tbe world had been evolved. "I am speaking of tbe hospital service," added tbe speaker, "not of tbe system of control by. hospital boards, wbicb is bad." 'Tbe medical practitioner in England attended only uinall cases. For anytking out of tbo ordinary a specialist bad to be called in. In New Zealand one doctor could do everytbing, and generally did it well. Money Could Be Spent on Prevention. Under £Se panel system people attended tbe doctor frequently— somelimes niore than 30 Qv 40 times a year. In New Zealand tbe usual figure was about nine or ten times. In' a day a busy doctor now saw 20 to 25 people. If tbis number increased to 50 or 60 it was going to -result in eacb getting less attention than now. Wben a doctor was rushed a number of tbings would be sure to be missed. Tbe element of competitiou was valuable. It made a doctor strive to fiud out what was wrong witb a pdtient wbose case was somewhat baffliug^ for be knew tbat if ko did not find out wbat was wrong some otber doctor would. The panel system encouraged a doctor to be less tborougk. "Wo believe tbe scheme is barmful and unnecessary, and we feel tbe money to be spent on it could be better spent on discase-preveufcion and public-bealtb work. Tbe number of lives saved every tirne a srnall epidemic was 'nipped in tbe bud' must run into hundreds. We are now spcnding far more on saving fruit and trces than on disease provontion. Wo object to the proposed experimont, and we tbink that a universal scheme is dctrimcntal to the health of tbo country." In reply to questions asked at tbe conclusion of tbe address, Dr. Caskmoro said that at present a doctor bad to spend a great deal of money all tbo time on researck and study but, under the new scheme, it would not pay bim to do so and it would be of no advantage. Tha Government would not worry about sending doctors to England for training, or anytbing like that. Many doctors, be said, would get out of tbe country; they would not work under the Government 's system. Most of tbe doctors were against it. A small minority,' wbom be eharacterised as "tbe needy and the greedy" would fall for tbe system. Tbat would be all. "Chemists and La-wyers Next." Asked wbat would kappen if tho doctors refuscd to work uiider tbe scheme, Dr. Cashmore replied tbat tlie Government 'fe alternative would be to import men from outside. Tkere were plcnty of Jewish doctors now being turned out of Germany, and some of tho Englisb doctors might be willing to come out to work for a fixed wage. Higker-trained nurses might also be procured to belp witb tbe work. It was certain that for recruits sucb a high standard of training would not be required, and free scbolarships yould probably be offered as an inducement in tbe New Zealand universities. In British Columbia, wben a similar scheme bad been mooted, 293 doctors had vo.ted against it; seven for it. "Wbat is going to happen to tbe chemists? Will they be assUred of their money?" afcked a questioner. Dr. Cashmore said be was not sure that they would. "Tbe point is," be said, '/tbat tbe doctors are tho smallest body in the country. The Government is starting witb us, and later it will socialise tbe chemists and lawyers. Our votes aro wortb nothing, tjiere are so few of us." There could not be a free choice of doctors under tbe scheme. Tbis was a form of individualism, wbich the Government was against.- It keld that tbe State, and not the patient, shofild cboose tho doctor. A voluntary systfem already existcd in friendlv societies and lodges, Dr. Cashmore concluded.