Health-Plan Cost Raises Fears

Hawke's Bay Herald-Tribune, Volume 81, Issue 29, 28 October 1937, Page 4

Health-Plan Cost Raises Fears

Oiil Own Correspondent.)

LABOUR'S ANXIETY Will Added Burden Hazard Popular Approval? DIVIDED 0P1NI0NS

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WELLINGTON, This Day. From the cloud of discussion and dissensioii which haa surrounded . the Scheme for health insuranbe tbe Goveriinient is laboriously framing certnin things begin to emerge. Ihe fifst is thac the plan will not be oil anytliffig like • the scale wltiek tiie adiiiinistiation wotlld like it to be} the second is that the ittexorable pressufe of flnan.ce ia bding strohgly' felt. Atiyonfe Who hks endeaVoiired to fdlloW tho platt's groWth has had a difficult task. First of all, there were 86 many authorities, The Prime Ministei', the Mihistef of Health, the chairman of the Government CommittCe On Health Insurance, it was eatly appatent, were thinking on diiferent linfis. There hae been quite a contest, behind the scenes betwSen Dr. D. G. McMiila,n and the Hon. Peter Fraser. The formcr would like to socialise the xnedxcai profession and makes no seeret of the fact; the latter appehrs to hanker after soeialisation of the hospitais. Being a veterail politiCian and the aetiilg-Rriine Minister, Mr Fraser did not take the w«ly of Sir Josefth Ward oUce followCd Witli aU infexperieUCed colleague and pnblicly ddfiate Dr. MdMillan's ciaims, but piivately the Ministfef of Health made it clear that the new reCfiiit tO the Labour Party had no call to epeak With Gabinet authority.

Not Actiiarially So'ind.

What has held the wliole matter up has beeh the simple qiiestion of cost, The financial straitt of launChing a new health scheme is terfible. Tlie British plan, which by New ZSaland (stahdafds dohs riot corifer vety geneiotis benefits. reached a payirig basis only three years ago after 23 years of operation. It can be said defmitely that tho Government is already abandoUing hope of the acheme ever being actuarially sound. If the age of 16 were selected aS a startihg-point, for instance, and the contribiitlonS based on the fiat-rate of 2/S I per Week pi'ovided by the English schgihe for that age, tVith the retiro; ment agq lixed at 64 (a lower figfi wOuld increase the scald), the plan Wotild star't With the enorniolis' capital dsficiency of £17U.0UU,U0U, about 50 pef Ceht, of Ihe publie debt. The aiinual cost wOuld be abb'Jt £7,000,000. Aiid fOr this the contributofs Wohld receive medical service, sickneSs allowance of £2 a week for the iirst eix tiionths, invaiidity alloWanCe of £l 10/- a week thereafter, with death benefit of £20, a pension of £1 10/- a week at the age Of 65, and £1 a Week to the wiuows of dienibers of tho scheme. These figuros Will help, to expluin, alsu, why the Government has now separated the two sChenics for' health iUSurance and iiatidiiai pensions. The dioney needcd Was frigutehing in its quaiitity. And the figtires giveii above by no means represent the worst of the schenie. A non-cOntriblitofy plan, sUch as some members of tho Government would like to sdOj WOuld riin the capital cost up lo well ovef £200,000,000 aiid the annual deficiency to approachiiig £9,000,000.

Limited Renefits. v

Froto what can be learned here from Well-infOfnied cireles it is evident that if the cost of these modest beueiits is higli the sCheme propoxinded by the National Health Insurance Cominittee of the B.M.Ai iS fcohsidered beahtiful but Utopian. The general idea UoW ia that there will be a sCheme With father limited benefits, With an income liniit of £400 a year and- with employedj employer and Stat? all bearing a portion Of the charges. What benefits are available depend entirely on just how fhr the Government can screw up ita courage iu the matter of demands from the contributofs. These benefits Will, quite defmitely, not be as great as Uiany people expcet. The gfeat disadvantage of the SCheme is that it is going to prove So costiy to adminiStef. The scattered areae of this Cbuiitry, So diffefent from more thickly-popiilated Britain. h&ndiehp the henlth plan severely, Slowly it beginS to emerge into the political conseionsiioss, too, that whea the Health. Insurance Committee of the B.M.A, said that tbere was npUiing in tho health condition of the eountr.y to suggest tho necessity fof a nniverSal pfactitioner service, at a cost of £3,500,000 a yeaf, it Whs uttering a little-fealised truth. For in large part the existing hospital service is a forin of health insurance service, with the only difltefeUce that there is no expensive governmedtal machinery fof collecting taxes and administefing the consequent fund, aiid that tho feCS of those who eannot afford to pay are nist in part from direct local tltxation.

The Best for Everyman.

This does not make the existing serviCe apy mofo desii-ablo in tho eycs of the Government, which is coUVinCo'I that everyman sliould have not only hospital sei'Viee, but tho best hospital service aiid medical atteiltion, aud is vaguely of opinion that this will increase chanees of fedovGry, in spite of the doctofs having bluutly pointed Out that 90 per cent. of patients fecover whether they receive any speeial treatment or n0t» But it does Crcate a situation iu which the. Government as not quite sure that it is going to get value for the extra milliohs which are going to be spent. The health scheme is gbing to be very cOstly and impose a burden on the Oohimunity, and' Labour lOaders WonJef if it Will toake it an obvious suecess td excuso that burden. .. It is this and not the position of the dentists, of the unlicensed pfactitiOnefs, .the private nursing hom0s2 the frifindly

societies, tho hundred aud ouo uspucls of tho scheme that ull have their ifi'itating probleuis, which now is eugaging the attentiou of tho Goveniiuent. The Government has had iuanj> things bfought clcarly under their uotiee: tlie pfobablo decline iu honorary work in tho hospitals as a result of tho scheme And the effect on the standard of ! medical practice in consequence of this lost experience, the likeliliood that the general practitioner inay l>e reluctanl to call iil a specialist^ the general levelling down oi rmdical incomes and of status, And the drsadvantages of any UUversal paiiel system. The Government has, at Ifeast, to plan to counter thAsO things if the snheme is to win popular appfoVal. And the Labeuf Batty is troubled by tliO fact tliat this SOliemo will be its final big gestufo (aside froia the repOal df the salOs tax Which is expected next year) before the electioti. Naturally the partv wants the gcsture to b.e a swOeping One*