COME TO STAY

Rotorua Morning Post, Volume 3, Issue 638, 16 September 1933, Page 6

COME TO STAY

health insurance EXPERIENCES OF BRITAIN AFTER TWENTY YEARS. EARLIER OPPOSITION. The Health Insurance system of Britain came into force twenty-one years ago. It has become so much a part of our social life that it may seem strange to the present generation to be told that it was the subject of one of the bitterest political fights the country has known, writes Dr. Alfred Cox, former secretary of the B.M.A., in the Daily Mail. Introduced in a very friendly atmosphere by Mr. Lloyd George in 1911 as a great measure of social reform, it soon became the subject of fierce suspicion and criticism, though the differenees were never altogether on the then usual clearly cut political lines. It was attacked on many grounds. It was "made in Germany," which country had had a similar system for years, the trade unionists and friendly societies feared that it would undermine their position with the working classes; the doctors, brought for the first time as a body into the political arena, were hostile because they feared it was a step to-. wards a medical bureaucracy. Great Change. Looking back, I think it is very probable that if the Bill had been fathered by any politician other than Mr. Lloyd George it would have had a much easier passage, for he had always been the "stormy petrel" of politics and was the subject of more uncritical adulation on the one hand and suspicion on the other than any politician of that time. And yet, I do not know that any other politician could have provided the necessary driving force for such a great social change. Anyhow, by a process of negotiation and compromise, which more or less satisfied the trade unionists and friendly societies; by considerable changes in the Bill, which went far to satisfy the doctors; and by the help of a strong Liberal majority in the House of Commons, the Bill was passed, and the working man entered into the enjoyment of his "9d for 4d" — the current method of saying that to his own contribution of 4d would be added by the employer and the State another 5d. For this 9d he was to get benefits which had hitherto been beyond his reach. Of the need of some such provision there could be no doubt. Many inquiries and a Royal Commission had proved that a large proportion of the working men and women of this country were unable to obtain, without help from charity or otherwise, the medical attention they all needed. Millions of Patients. I have no figures available to show how| many million working men and women have, during the last twentyone years, received these benefits or how much money they have cost. But it may be said that during this time some 16,000,000 of them have had the right to call in a doctor and to obtain a sickness benefit which compares favourably with what a small number of them were previously getting through voluntary associations. The doctors concerned in carrying out l the provisions of the Act number ; 16,000. The criticisms of the medical benefit made iat the beginnirig still hold. It only provides the services which a general practitioner can give — no specialist services, no hospital treatment. We are all apt to dwell on the things that are still lacking nather than on what we have got; but there can be no doubt that the fact that a doctor is available when necessiary, without any worry about his bill, has been a great boon, not to mention the monetary help. And it has been no less a blessing to the doctor, particularly in the industrial areas. He has the assurance that he will be paid regularly, even for his treatment of those who are not working. It is not too much to say that there are many very hardly hit areas in this country which, but for the insurance system, would have been denuded of doctors, who without it would have been quite unable to carry on. Alternative Measures. It has often been said that the money spent on this gigantic system could have been better applied in other ways for the health of the community. The British Medical Association, in its evidence before the Royal Commission of 1926, said that ; it . was possible that better results might have been got if the money j had been spent on housing, town plan- ' ning, pure milk supply, and smoke prevention. But obviously for such general measures the working classes could not have been iasked to pay directly. Provision for such things would have had to be made out of general taxation. The system is, of course, far from being perfect. I could criticise it myself, but this is not the time. I am glad to have the opportunity of stating my deliberate opinion that Na•tional Health Insurance has been a great boon to the people of this country and has provided a solid foundation for future progress in public health. With a good deal of knowledge of insurance systems in other countries, I can declare that there is none which has worked smoothly as ours. This is due, I think, to our British habit of putting responsibility on the people who are interested in the suecess of such schemes. The Approved Societies, the Insurance Committees, ■the doctors, and the chemists all play a great part in Health Insurance administration, with great benefit botb to it and to them.Permanent Feature. I agree with the Royal Commission which said that "National Health Insurance has established its position as a permanent feature of the social life of this country," and. I would add my word of praise to its originator, who in this matter proved him- 1

self to be a far-sighted statesman and a benefactor to his country. But such a tribute would be ineomplete (as I am sure Mr. Lloyd George would be first to agree) without a reference to the man who took over the heavy burden from the politicians and made the scheme work. The late Sir Robert Morant, the first secretary of the 'National Health Insurance Commission, was a truly great man, and, with the help of the most brilliant galaxy of cfvil servants ever brought together, achieved a task which at one time seemed hopeless. At this time it is fitting that we should honour his memory.