§ Regulations made by the Insurance Commissioners under Sub-section (4) of Section 4 of the principal Act shall provide for applying the contributions paid in respect of persons who hold certificates of exemption in providing medical benefit and sanatorium benefit for such persons and the cost of the administration of such benefits, and such persons shall, if they fulfil such conditions as may be imposed by those regulations, become entitled to medical benefit and sanatorium benefit as if they ware members of approved societies, and the provisions of the principal Act and this Act with respect to the payment and administration of those benefits (including those relating to the application of moneys provided by Parliament towards the cost of those benefits and the expenses of the administration thereof) shall, subject to any modifications, adaptations, and exceptions contained in the regulations, apply accordingly.
§ Mr. ALDENI beg to move, after the word "persons" ["applying the contributions paid in respect of persons"], to insert the words "resident in Great Britain."
This is just a slip in drafting. There should, after the word "persons," be inserted the words "resident in Great Britain," because medical benefit is not at present paid in Ireland.
§ Mr. MASTERMANThe Amendment will require a consequential Amendment. It is quite true that there is no medical benefit in Ireland at present, and therefore, at present, we cannot offer exempted persons medical benefit in Ireland. Their money will have to go to a special fund, and we shall have to give them such benefits as we can out of that fund, with the addition of the two-ninths which otherwise we give to medical benefit. We accept the Amendment.
Mr. WORTHINGTON-EVANSI would suggest that this Amendment should not be accepted until we have dealt with the ether Amendments, because if the Amendment which stands in the name of my hon. Friend the Member for Salisbury (Mr. G. Locker-Lampson) were, for example, 2937 accepted, making alternative benefits possible, then we should not need to limit this Clause to those resident in Great Britain.
§ Mr. MASTERMANIt can quite easily be put as a separate Sub-section in connection with the later Amendment which, I understand, the hon. Gentleman intends to move, and in order to preserve that right I would ask my hon. Friend to withdraw.
§ Amendment, by leave, withdrawn.
§ Mr. GWYNNEI beg to move after the word "benefit" ["certificates of exemption in providing medical benefit"] to insert the words "maternity benefit." The right hon. Gentleman has so often spoken in favour of, and enlarged on the advantages of, maternity benefit, that I feel sure that he will accept this Amendment, seeing that there is sufficient money to meet it.
§ Mr. GWYNNEI should like the right hon. Gentleman who is going to reply to prove to me that there is not sufficient money. If there is not sufficient money, I think that even then it should be inserted and something else taken out.
§ Dr. MACNAMARAWe propose to give exempted persons medical and sanatorium benefit, and the proposal now is to add maternity benefit. The benefits which we do propose are substantial, remembering that all we have on their account is the employers' contribution, and I am afraid that we cannot possible add maternity benefit. I would point out further that probably the average age of these people is high. I know that there are a number of pensioners among them. Take sickness benefit. If their age is high the contributions on their behalf would stop at seventy, and they would have a life right to medical benefit. A very small number of contributions might be paid on their behalf, whereas they would have a life claim on the particular benefit we are offering. We do give substantial benefits on account of the contributions paid for them, and we cannot possibly add the maternity benefit.
Mr. WORTHINGTON-EVANSI think that we are entitled to some more explanation from the Government. The right hon. Gentleman has opened up the most terrible vista that for one or two pay- 2938 ments an exempted person is to have a life-right to medical benefit. Surely that cannot be intended. Is there no limitation?
§ Dr. MACNAMARAI referred to the case of a person over seventy years of age.
Mr. WORTHINGTON-EVANSThen it is very necessary to consider the finance of this Clause. The first quarter, so far as I know, shows an average of 2s. 10d. on the card of each exempted person. Multiplying that by four to get the whole year, there will be an average of 11s. 4d. contributed by the employer of each exempted person. The proposal in the Bill, as drawn, is to give medical benefit and sanatorium benefit, and seven-ninths of the cost of those benefits will be 5s. 9d. a year. That leaves a balance of 5s. 7d. a year to meet the prolongation of medical benefit beyond seventy years of age, if that is intended, though I do not know where it is provided, and also the cost of administration. It cannot be necessary to preserve fifty per cent. of the contributions for the purposes of paying the cost of administration, and, if my hon. Friend wants to give maternity benefit in addition, there is plenty of margin for it, if the figures I am quoting are correct, and I got them from the Blue Book which has just recently been issued. I think that the Committee ought to have some further guidance from the Government on this point. There are other Amendments on this Clause, and I am not sure that would not be wise to have a general discussion now, and then limit the discussion on the separate Amendments, because at present the Committee is quite in the dark as far as any guidance from the Government is concerned, as to what the effect of this Clause will be. If we are to have a general discussion, then I would like to deal with the question whether medical benefit is the right benefit. Perhaps, Sir, you will rule on that point.
§ The CHAIRMANI think, if it is desired, the Committee might be able to take these two Amendments together on the understanding that the questions were simply submitted, and that afterwards there would be no repetition of debate.
§ Mr. G. LOCKER-LAMPSONI reserve the right of moving my Amendment.
§ The CHAIRMANOf formally moving it.
Mr. WORTHINGTON-EVANSI am not sure whether the Government would wish now to make a general statement on the Clause.
§ Mr. MASTERMANI am grateful to the hon. Gentleman for suggesting that I should do so. This Clause deals with the fund which is being created from the contributions of the employers of exempted persons. Under Section 3 all these persons were entitled to obtain exemption, and they obtained it if they had £26 a year or more, and were mainly supported by other persons. In all those cases, as the Committee knows, the employed person pays nothing, and the employer has to pay 3d. in respect of him, using a special card, and the money is sent into a special fund, altogether apart from the fund of the approved society. The instruction in Sub-section (4) of Section 4 of the principal Act, was, "such contributions shall be carried to such account and dealt with in such manner as may be prescribed by regulations made by the Insurance Commissioners and those regulations may provide for applying the sums standing to the credit of the account, or any part thereof, for the benefit of any persons in respect of whom contributions have been so paid, in the event of such persons subsequently becoming employed contributors." In other words, the charge on the fund made by the original Act is for the provision of a sufficient amount of money to enable those persons, at any time, to come into Insurance at the ordinary rates. It is because we have been quite unable to make an estimate up to now, in the six months during which the scheme has been in operation, of how much that reserved value fund will be, and because we are now getting an understanding of what the age of the persons will be. The cost to the fund will depend entirely on the age of the persons who are exempted. If they were all young, it would be a small sum, but if they are old, it would be a large sum. The money is waiting for them to be used. Our actuaries now tell us that they have sufficient information at their disposal, as they think, during the first year's payments to this account, to enable us to give certain benefits from this fund with the assistance of the State. These benefits, mentioned in the Clause, are the benefits which we propose to give under the Insurance scheme—medical benefit and sanatorium benefit. As this is a general discussion I may tell the Committee why it is that we chose these two special 2940 benefits. It was for this reason; This fund is mainly contributed to by two classes of persons. A number of persons who began contributing to the fund have now a clearer knowledge of Insurance, and they have dropped out of the fund and become insured persons during the past year. There are always persons transferring from being exempted persons to being insured persons. I think we will find that there are only two classes of persons, in the main, who will be exempted persons. The one will be persons of a certain age—pensioners and others—who are getting £26 a year, or a little more. These are persons of a certain age to whom such a thing as maternity benefit would be little benefit at all, but they would greatly appreciate medical benefit if it can be given to them, and given for the rest of their lives. The other class of persons have been specially pressed upon us by the Women's Trade Union, speaking in the interest of girls not entirely dependent on their own work, because they are living at home, but who have obtained exemption because they cannot afford the 4d. or 3d., and whose condition of life is such that they are, of all others, persons who ought to receive medical benefit—under-worked, underpaid, anæmic girls. It was largely the pressure of representations made by men's and women's trade unions that led us to select the medical benefit as the best benefit which could be used for these persons. It may be asked why not give them other benefits in addition. But we have no money to do that, and until we see how this money works out we cannot do more. Whatever money they have got will be banked in their interest for these two purposes—the medical and the sanatorium benefit—and anything over will go into the Insurance Reserve Fund. If hon. Members think they should also be given the maternity, sickness, and other benefits, then I say the scheme is useless. We are not only giving them two-ninths for medical benefits, but also the 2s. 6d. required from the State. If this Committee is in sympathy with this class of persons it should be remembered they are getting more from the State in medical benefit than any other people. If they had the maternity or sickness benefit instead they would not get this 2s. 6d. I agree that the regulations must limit the number of contributions which have to be paid before they can come into benefit. The regulations may prescribe that, but 2941 if the Committee would rather that that was not made a matter of regulation but was made a matter of statutory limitation we are quite willing to put into the Bill what we consider would be necessary under the regulation, viz., the ordinary twenty-six weeks waiting period, which we put in yesterday in connection with the old men, on an Amendment accepted by the hon. Gentleman the Member for Worcester (Mr. Goulding). It would limit the obligation which may fall on other members of this fund by saying that no one shall come into medical benefit until twenty-six contributions have been paid. The great majority of those at present in the fund—70,000 or 80,000—will have paid that number of contributions, and will become immediately entitled to medical benefit, and we cannot allow a man to pay one contribution as an accepted person and have the medical benefit for the rest of his life. I submit that we have chosen the really best course in the interests of this particular class of person.
§ Mr. G. LOCKER-LAMPSONI do not feel that the right hon. Gentleman has really made out a good case for this Clause. In the first place I do not see why we should restrict it merely to medical and sanatorium benefits. Why should we not give exempted persons their choice of benefit? After all, if you give them a choice it will not in the least add to the cost to the State. In fact it may tend to diminish that cost because if the exempted person chooses some other benefit and not the medical benefit the State will get off having to pay the 2s. 6d. in regard to those persons. I do not see that there is any reason whatsoever why you should not give exempted persons this choice.
§ Mr. MASTERMANDoes the hon. Gentleman mean that they should have a ballot and all agree to it, or that each individual should choose? If each individual is to choose we cannot get mutual insurance for medical benefit.
§ Mr. G. LOCKER-LAMPSONI am not prepared to meet that point at the present moment. I think very likely there may be a difficulty if every individual member has a choice, but I should have thought that possibly the societies might have agreed to give certain benefits. May I pass to another point? The medical benefit costs 1.51d. per week, the sanatorium benefit 2942 costs.32d. per week, and if you add the two together it gives 1.83d. per week. Then the cost of administration amounts to.92d. per week, making a total of 2.75d., and that is what you are going to give exempted persons in respect of these benefits, medical and sanatorium. The employers' contribution is 3d., therefore you have a considerable margin which it seems to me ought to be used for the benefit of the exempted persons. You have a fairly big Margin to play with, and it was on that account that I suggested exempted persons should have a choice. It they have to take these two benefits only, they will not be getting the full benefit of the employers' contribution. I see the difficulty which has been suggested by the right hon. Gentleman; but I do not think the exempted persons ought to have the benefit of that margin. I do not understand where it is going to. The benefit's you are offering them are not going to cost the amount of the employers' contribution. Although it possibly may be actuarially very difficult, to allow every individual exempted person to have his choice, something ought to be done to enable exempted persons to get the benefit of the whole of the employers' contribution.
§ Mr. MASTERMANSo they will. I said there was a necessity for a margin in order to preserve the right which is given them in the Act to go into the ordinary insurance. Reserve value has to be paid out, and if there is any balance over it will remain for the advantage of those persons. If after experience we find that other benefits can be given, of course we shall suggest other benefits to the House.
§ Mr. MASTERMANThat is the difficulty. As I stated in my introductory remarks, the difficulty of calculating that has been the reason why we have been unable to propose any scheme under this Act. It depends entirely on getting the average ages of the men exempted.
§ Sir P. MAGNUSAs we are discussing the whole of Clause 4 of the Amending Act I think I ought to give some reason for the Amendment which I propose to introduce into the Clause.
§ The CHAIRMANI think it is understood that we are only discussing the two 2943 next Amendments on the paper. The hon. Member will have his opportunity later on.
§ Sir RANDOLF BAKERMight I suggest that possibly it would be better to allow people, whilst taking the medical benefit, to have a choice between the sanatorium benefit and the maternity benefit? That might meet the right hon. Gentleman's difficulty that it would not be possible to have a concerted scheme with regard to the medical benefit. Let them, however, have an alternative choice between the sanatorium and the maternity benefit.
§ Dr. ADDISONThe hon. Member has quite overlooked the very important consideration that a large number of these people are very old, so that their time of contribution will cover a short number of years, while the medical benefit will last throughout their lives. Therefore the liability of the society is much greater in a large number of cases than the number of years for which they will make contributions to the society. You must have a margin on account of the extra risks of the society itself. I think the right hon. Gentleman says that that margin is provided for in the reserve value which is not known. It would be unwise to take more out of this fund at the present time.
Mr. FREDERICK HALLMay I draw the attention of the Committee to the statement made by the last speaker, as well as to the statement of the right hon. Gentleman? The hon. Member who last spoke drew particular attention to the fact that a majority of these persons would be very old persons, whereas the Financial Secretary to the Treasury stated that in going into this matter they had carefully considered the question of over-worked, under-paid and anæmic girls. I cannot help thinking therefore that there is a discrepancy of opinion even on the other side of the Committee. May I ask the right hon. Gentleman this question? It seems to me, as far as we are concerned, that it will help us a great deal in coming to a decision if we know when the extra benefits are likely to be dealt with. The right hon. Gentleman stated that the figures would be considered after they had got the actuarial calculations. I quite agree that at this moment there May be difficulty with regard to saying exactly what may be the actual result, especially when we have to consider that 9–10ths of 1d. 2944 goes in management expenses. Can the right hon. Gentleman inform the Committee within any reasonable period when the surplus is likely to be dealt with? Is it a question of dealing with it within a period of twelve months or of leaving it in abeyance for four or five years. Can he give us some information on this point—as to when he will get an intimation as to the excess amount that will be in hand?
§ Mr. NEWMANLooking down the Amendment paper, I am surprised that there is no Amendment to omit Clause 4 so far as Ireland is concerned, and I am astonished that hon. Members below Me did not get up to speak. We want from the Secretary to the Treasury some explanation of what happens with this money with regard to Ireland. [An HON. MEMBER: "Ireland comes on later."] When does Ireland come on?
§ Mr. MASTERMANPerhaps the hon. Member was not present when the matter was explained. A Motion was made to omit Ireland from this Clause by an hon. Friend behind me. An hon. Gentleman opposite made an appeal that that should be postponed until we had discussed Clause 4, and thereupon my hon. Friend withdrew his Motion, and is going to present a new Clause dealing with Ireland.
Mr. MacCALLUM SCOTTThe hon. Member for Colchester (Mr. Worthington-Evans) omitted one important factor from the figures he gave. He told us that in regard to persons who are now exempted, but whose employers are paying, the average amount paid was 11s. 4d. He and the hon. Member for Salisbury (Mr. G. Locker-Lampson) based their calculations on the fact that 11s. 4d. would be paid for each of these exempted persons. That is only during the first year. During that year he will have some employer paying for him, but in future years many of these persons will have dropped out, and will be entitled to medical benefit for life. The number who drop out will increase every year until they probably equal the number of those employed and having employers paying for them. That would diminish the average by about one half. The figures given by the hon. Member are liable to considerable reduction in future years if this scheme is carried out.
Mr. WORTHINGTON-EVANSI do not know whether the rest of the Committee have the same feeling as I have. I want to do whatever is right for the exempted people. I do not think there is any certainty that we are going to do the best for them under this Clause. An hon. Gentleman opposite just now said it was intended to give medical benefit to those who drop out. Can that be so?
§ Mr. MASTERMANindicated dissent.
§ Mr. MASTERMANThe hon. Member will see, by looking at the Clause, that the Arrears Clause applies to these persons as much as to others.
Mr. WORTHINGTON-EVANSI supposed that it did so, because it is obvious you cannot by receiving twenty-six threepences provide for the rest of a child's or young person's life. I cannot understand why the Clause is in the Bill at all, having regard to the present position. Under the original Act full power was given to the Commissioners in Clause 4, Sub-section (4), to prescribe by regulation how the moneys paid on behalf of exempted persons should be applied for their benefit. They were to bring in a scheme. It seems to me that they have complete power without this Bill at all. If they brought in a scheme which did give medical benefit to some and sanatorium benefit perhaps, to all, then the ordinary Treasury Grant of 2s. 9d. would apply.
§ Mr. MASTERMANNo.
Mr. WORTHINGTON-EVANSI should have thought it would apply, and that as you have now got the 2s. 6d. provided for in this Bill, that 2s. 6d. also would apply. With regard to medical benefit, it seems to me that as to some of these people it is the very last benefit they want. There is quite a number of people exempt who are sons of parents in business and who, for the time being, are earning low salaries and learning their work, but who, in time, will become partners, perhaps, in their parents' businesses, and who, at any rate, will get far above the income limit of £160. For them their employers are making contributions now. Now you are suggesting that they ought to have medical benefit. That seems to be the very benefit of which they will not make use if they are of the class to which I am referring.
Mr. WORTHINGTON-EVANSI have not the slightest desire to give anything to the medical profession for work they do not perform, although I think they ought to be paid for the work they do. In the cases I am suggesting, the boys who will be included in this scheme for medical benefit would not go to a panel doctor, but to the doctor who is looking after their father's household. There is a want of elasticity in thus forcing medical benefit on a large number who do not require it. It is far wiser that some optional rights should be given to exempted persons. Dealing with the question whether you can give a personal option, I think you can, because medical benefit and sanatorium require little or no reserve values. Sanatorium benefit does not want any reserve value, and medical benefit can only want the reserve value attributable to severity and upwards, and it never exceeds £1. Therefore it is a very small thing. The provision of that reserve value certainly does not destroy the validity of the claim that everybody who is supposed to benefit here ought to have the benefits which are suitable to them. They ought not to have forced upon them benefits of which we brow in advance they will not take advantage in a great many cases.
§ Mr. COOPERAs my name is associated with some of the Amendments with regard to this matter I desire to make a few remarks upon the attitude the Government have taken up. The hon. Member for Hoxton (Dr. Addison) is one of the members of this Committee whose opinion on this matter ought to be of very great value. I understood from his remarks that these exempted persons for the larger part would be old people. If that is so, the Government are going to give away precious little if they are going to give maternity benefit to exempted persons.
§ Dr. ADDISONThat is not proposed.
§ Mr. COOPERTurning from the hon. Member for Hoxton to the Secretary to the Treasury, we understood from him that among these people are a number of young women to whom he specially referred. I am going to be quite frank with the Committee, and say that when we come to the minute claims and inquire whether they can be met or not, I am not going to express a dogmatic view, and, if they cannot be met except by upsetting 2947 the whole scheme, I will not say a word for them. But I think there is an argument for including maternity benefit in these cases. It is in the spirit of the Act itself to do so, as hon. Members will see if they refer to Section 8, Sub-section (4), which says that a person temporarily resident out of the United Kingdom shall not be disentitled to maternity benefit in respect of the confinement of his wife. If it is done in that case, and we all admit the great advantage of maternity benefit—it is the one thing in this Act in regard to which the majority of the people in this country are united in agreeing is most beneficial—my point is that we should carry this beneficial part of the Act as far as we possibly can and cover all necessitous cases.
§ Mr. BOOTHHon. Members opposite divide exempted persons into two classes, those who are very old, and those who the hon. Member for Colchester (Mr. Worthington-Evans) says are living at home in very excellent circumstances, and who are going to manage their parent's businesses later on. I do not think either of those classes, deserve maternity benefit.
§ Mr. RAMSAY MACDONALDIf we are to put in maternity benefit we ought to consider how it is going to apply to the exempted people. We have been told that these people form two classes, the very young and very old. I think that is a mistake. There is also the married woman and outworker whose husband is an employed contributor.
§ Mr. RAMSAY MACDONALDI know several. I happen to pay for one under this Act myself. Consequently maternity benefit is already provided for a very substantial proportion of the people who are exempt under Clause 4. I doubt very much if it would be any material benefit to these people if you included maternity benefit, and the Clause is a compulsory Clause. It says: "Regulations made by the Insurance Commissioners under Sub-section (4) of Section 4 of the principal Act" shall apply to medical benefit and sanatorium benefit. Therefore I do not want exactly to vote against it. We might be misunderstood by voting against it. It might appear as though we were opposed to the inclusion of maternity benefit on its own merits. If I voted against this Amendment, if it is 2948 pushed to a Division, that would not be my reason at all. It would simply be because I think the statement made by the Secretary to the Treasury is quite convincing, that the two pressing things that ought to be dealt with now are medical benefit and sanatorium benefit, and then if there is still a margin which may be used for maternity benefit let us have it. But at the moment our experience shows that medical benefit and sanatorium benefit will be welcomed, and let us stick to that as the Clause is a compulsory Clause.
§ Sir PHILIP MAGNUSI find myself among that small class, I suppose, of Members present who do not see the necessity of this Amending Clause 4 at all. I cannot help thinking that Clause 4 in the Bill itself gives all the necessary powers to the Commissioners to make regulations for the benefits which are referred to in Section 4 of the Act. It seems to me that on the one hand we give great powers to the Commissioners, and on the other hand we lay down regulations which will restrict the powers which we have conferred upon them. I shall be glad, certainly, before called upon to vote for the Clause, to hear from the Financial Secretary why the insertion of this Clause in the Amending Bill has become absolutely necessary. According to the Section in the original Act it is provided that the Insurance Commissioners may make regulations
for applying the sums standing to the credit of the account, or any part thereof, for the benefit of any persons in respect of whom contributions have been so paid, in the event of such persons subsequently becoming employed contributors.It seems to me that these exempted persons can be dealt with by the Commissioners without the necessity of this particular Clause. I shall be very glad to know whether I have ascribed sufficient importance or too much importance to the amending Clause suggested.
§ Mr. MASTERMANI appeal to the Committee to come to a decision now on the Clause, all the more so because there is really no disagreement between us. What disagreement there is is due to misunderstanding, and not to any fundamental difference of opinion. Take, for example, the particular question that has just been put. It is perfectly true that we could have made a scheme for dealing with these exempted persons purely out of their own contributions. If money would have carried it, we could have made a scheme for giving them, purely out of their own contributions, Maternity Benefit, but in that case they 2949 would have lost the two-ninths which is given by the State, and the extra half-crown. That is to say, the Clause was necessary in order to give these persons £19,000 a year more. If the Committee does not want to give that, I as a Treasury man, would he very glad because we could have the £19,000 for other purposes, but it is because medical benefit requires that money, if it is to be given efficiently to these people, that we give it. As to the point raised by the hon. Member (Mr. Ramsay Macdonald) in answer to the hon. Member (Mr. Cooper), of course, if this fund is able to carry more than it does carry, we can give fresh benefits more than it can carry under this Clause, and we can give it without coming to Parliament. If it will carry insurance for Maternity Benefit, we can give it, and we should give it, but at present the figures given by the hon. Member (Mr. G. Locker-Lampson) show convincingly that we cannot put any greater compulsion on the fund, allowing for the reserve value, than medical benefit, and we can only put it on the fund for medical benefit by giving an extra £19,000 a year to these people.
§ Mr. HARRY LAWSONThe speech of the hon. Member (Mr. Ramsay Macdonald), as well as the speech of the Secretary to the Treasury, convinces me that this is a thoroughly undigested Clause, and I think, so far as anything but the Sanatorium Benefit is concerned, it will be far better to reserve the treatment of exempted persons until the Amending Bill of next year. What you are doing is to apply inappropriate benefit—medical benefit—and using the money, which is the greater part of that which you have to play with, for what a large proportion of the class dealt with do not require. But we are earmarking it for that purpose, and we are taking it for all time and making certain that you will not have any large sum to devote to other benefits which are more appropriate to a large number of these people. This is the employer's money, and they have a right to a special say, and I am quite certain they know the medical benefit to be the last which really ought to be given. With regard to sanatorium benefit, it is a different matter. I think we should all be agreed that sanatorium benefit is one which should be given, but you are dealing with this prematurely, and without consideration, and you are taking a large part of that which would be available for a more elastic and a more beneficial scheme for those who are concerned.
§ Mr. ALDENMy experience is quite contrary to that of the hon. Member. I have seen a large number of employers on this question. I happen to employ one or two naval pensioners myself, and they are all in favour of medical benefit. I wanted maternity benefit as well, but after the discussion that has gone on, I should ay that it was unfair to ask for it. But I am convinced that a very large number of exempted persons are persons who are rather old and are liable to sickness, and I am sure medical benefit is the very best benefit you could give to them. So far as my experience goes, it is that employers and employed are agreed that this medical benefit would be an advantage, and if you could take a referendum on this question amongst employers you would find they would agree with me in this matter.
Mr. GEORGE HAMILTONIt appears to me that the people who are exempted are exempted because they are better off than other people in the State. Very few of the exempted persons, I understand, are people who have not got pensions or some private means which enable them to be exempt. It appears to me, therefore, that the people in this country who are better off under this Clause are going to get a present from the State of £19,000 and they are not contributing anything themselves. Only the employer's contribution is going into this fund. I feel disposed to vote against the whole Clause and leave it to regulations to find some better method which would not cost the State £19,000 a year.
§ Mr. GLYN-JONESWhilst the interest of exempted persons, of course, must be considered, it must be remembered that they find not one farthing of this money but that it comes entirely from the employer and the State, and I think we have to consider what in the interest of the employers and the State is the best use to put this money to. I, personally, have no hesitation in saying that in the interest of the employer and in the interest of the State the best possible use which could be made of this money is to ensure the best treatment for the insured person. I do not at all take the view of the last hon. Member that the majority of these people will be people who are well off. My experience is that a very large number of them are of the poorest of the community, and it certainly is to the interest of the employer and the State that adequate medical treatment and sanatorium benefit should be found. I can conceive of no better benefit that employers could wish for.
§ Mr. GWYNNEI do not wish to press this Amendment if it is really definitely stated that the money is not there to give this extra benefit; but the point which I took was this, that there is a surplus, though only a sm111 one, and that the cheapest extra benefit we could give would be maternity benefit, and it seems to me that it would about balance it. I think that if the right hon. Gentleman had inserted in his Clause a proviso that people should not get medical benefit until they had made twenty-six contributions at least it might have given a little extra money which might have just made up the balance.
§ Mr. MASTERMANThere is really no money for it, and if we insert it it would really be no use.
§ Mr. GWYNNEIf the right hon. Gentleman gives me a definite assurance that the money is not there to do it, and that it would be an extra State grant, I shall not press it. But I would like to ask what would be the position of one of these exempted persons who happens to have over £160 a year?
§ The CHAIRMANThere is an Amendment down on that point.
§ Amendment, by leave, withdrawn.
§ Sir PHILIP MAGNUSI beg to move to leave out the words "members of approved societies," and to insert instead thereof the words "employed contributors whose total income from all sources exceeds £160 a year."
I think it has been generally admitted that these exempted persons are persons in a better position than many of those who come under insurance, and certainly all exempted persons must have some income of their own, in order that they may be exempted. It will be admitted that a great many of these exempted persons would very much prefer to be able to make their own arrangement with the doctors than that they should come upon the panel and be compelled to accept the doctors who are on the panel, and by subsequent Amendment, to which I shall refer later on, it will be suggested that persons whose income is certainly over £160 a year shall be able to make their own arrangements, and that it shall not be necessary therefore to come upon the panel of doctors. If we insert these words which I suggest, we shall certainly exclude all those from partaking necessarily of the benefits which this Clause confers who themselves have an income which would enable them 2952 to do as they probably would desire to make their own arrangements with the doctor. It is for the purpose of excluding those persons who have an income of this kind that I move this Amendment.
§ Mr. BOOTHOn the point of Order. Are we to have a general rule about luncheon? Some Members are going out.
§ The CHAIRMANPerhaps it would be convenient to adjourn now.
§ Mr. MASTERMANI beg to move, "That the Committee do continue to sit this day, notwithstanding the Sitting of the House."
§ Question put, and agreed to.
§ At twenty-five minutes before two o'clock the Committee adjourned for lunch, till 2.15 p.m., when the proceedings were resumed.
§ Mr. MASTERMANI think the principle embodied in this Amendment is a reasonable one. I do not think it will refer to many persons; not more than 100 or 200 will be influenced by it. If a person is an exempted person and his private income exceeds £160 a year, in addition to what he is earning—
§ Sir PHILIP MAGNUSNo, his "total income from all sources."
§ Mr. MASTERMANI think it ought to be "in addition," but leave it at that. If the person's total income from all sources exceeds £100, and he is an exempted person, it shall only apply to those who do not pay a penny themselves for the. purpose of insurance—he shall be required to make his own arrangements; a certain sum of money shall be given for medical expenses and he shall not come under the ordinary arrangement of the capitation fee. I cannot accept the Amendment in the form proposed, but I will move a proviso in the following form:
Provided that if the total income from all sources of any such person exceeds £160 a year, he shall be required to make his own arrangements for medical benefit and treatment, and Sub-section (3), Section 5 of the principal Act shall not apply to him.
§ Sir PHILIP MAGNUSI accept that, and am prepared to move those words instead of my own Amendment.
§ Amendment, by leave, withdrawn.
2953§ Mr. RUPERT GWYNNEI beg to move to leave out the words "subject to an modifications, adaptations, and exceptions contained in the regulations."
My object in doing so is to ask for information from the Financial Secretary to the Treasury as to what really these words mean. As I read them the Commissioners may, in their wisdom, make modifications, adaptations and exceptions, which would render the Act quite inoperative fur whole classes of people. Would he kindly say what these words really mean in this Clause, as we have nothing more to guide us than what we have already got in the Act, and what can be done if the Commissioners so desire? If that is the case, what is the object of putting them in the Bill at all? Perhaps the right hon. Gentleman can again give me an undertaking that so long as he is able to get the Commissioners to do what he wants, they shall do nothing unreasonable. I should like some explanation as to the object of putting in those words.
§ Mr. MASTERMANThere must be some elasticity in connection with these matters. I think I can meet the point of the hon. Gentleman by inserting in the Bill what is his main point, that is the limitation of the twenty-six contributions which 1 have already agreed to insert. That is one of the points that would have been laid down in the regulations under the Bill. If it would meet his point 1 propose to move at the end of the Clause, if the Committee agrees, "if the conditions imposed require the payment of a number of weekly contributions before a person becomes entitled to such benefits, that number shall not exceed twenty-six."
§ Mr. GWYNNEI would accept that Amendment.
§ Mr. CASSELI should like to ask why these words are inserted, because we have, earlier in the Clause, the words "if they fulfil such conditions as may be imposed by those regulations." What is the necessity for these other words, which seem to give the Commissioners power to legislate and to make exemptions for large classes of persons? These words "if they fulfil such conditions as may be imposed by those regulations" appear to me to be quite sufficient. If you put in those other words, they may be construed as giving the Commissioners power to legislate in matters over which Parliament ought to have control, and to 2954 exempt whole classes of persons whom Parliament may wish to have in the Bill. I should like some explanation of the purpose of those additional words.
§ Mr. MASTERMANIt is the application of the provisions of the principal Act with respect to the payment and administration of these benefits, and all these matters involve a certain number of minor modifications and adaptations to fit them into the scheme as in the case of married women. These words are only put in with a view to making these modifications. I have offered to the hon. Gentleman to insert words which I think will meet his point. I hope the Committee will see that sonic such words are necessary if this scheme is going through.
§ Mr. CASSELYou have already got the words which I have pointed out. I do not think the right hon. Gentleman has really dealt with the point. Are not those words "if they fulfil such conditions as may be imposed by those regulations" sufficient?
§ Mr. MASTERMANThe first set of words deals with general regulations and the second set of words with modifications and adaptations to the principal Act.
§ Mr. GWYNNEThe Clause as it stands already ought to cover the point and the other words are not necessary. The right hon. Gentleman goes so far as to emphasise the weakness or rather the strength which he is putting into the hands of the Commissioners. I object to his proposal to keep in the general words and to insert in the Clause words which will deal with one specific exception. This morning he objected to one of my Amendments which provided for one thing specifically on the ground that it might limit the application to the particular point which was specified. He is willing to deal with the question of the twenty-six contributions, but he wishes still to get the other general words. I think that instead of putting in this particular exemption of the twenty-six weeks, he should accept my Amendment and omit the words altogether.
§ Question put, "That the words proposed to be left out stand part of the Clause."
§ The Committee divided: Ayes, 21; Noes, 12.
| Division No. 3.] | AYES. | |
| Addison, Dr. | Harvey, Mr. Edmund | Masterman, Mr. |
| Alden, Mr. | Jones, Mr. Glyn- | Pearce, Mr. William |
| Booth, Mr. | Lardner, Mr. | Roberts, Mr. Charles |
| Boyle, Mr. Daniel | Lynch, Mr. | Roberts, Mr. George |
| Dawes, Mr. | Macdonald, Mr. Ramsay | Samuel, Mr. Jonathan |
| Falconer, Mr. | M'Laren, Mr. Henry | Scott, Mr. MacCallum |
| Harcourt, Mr. Robert | Macnamara, Dr. | Thomas, Mr. |
| NOES. | ||
| Baker, Sir Randolf | Goulding, Mr. | Locker-Lampson, Mr. Godfrey |
| Cassel, Mr. | Gwynne, Mr. Rupert | Newman, Mr. |
| Craik, Sir Henry | Hamilton, Mr. | Remnant, Mr. |
| Forster, Mr. | Lawson, Mr. Harry | Worthington-Evans, Mr. |
§ The next Amendment standing on the Paper in the name of Sir P. Magnus was to add at the end of the Clause the words, "Medical benefit shall not include any right to medical treatment or attendance in respect of miscarriage, or any condition arising from and within twenty-eight days after miscarriage or abortion, and Sub-section (6) of Section 8 of the principal Act shall be amended accordingly."
§ The CHAIRMANThis Amendment, with regard to medical benefit, is out of order.
§ Sir P. MAGNUSIs my Amendment out of order?
§ The CHAIRMANYes.
§ Sir P. MAGNUSWhere will it come in?
§ The CHAIRMANIt is not for me at the moment to say.
§ Sir P. MAGNUSMay I ask why it is out of order?
§ The CHAIRMANThis Clause deals with exempted persons, and the Amendment, as far as I read it, treats of medical benefit.
§ Sir P. MAGNUSShould I be able to move it as a new Clause?
§ The CHAIRMANPerhaps the hon. Member will consult others afterwards with regard to where to put it. I can see that it does not come in here.
§ Mr. MASTERMANI beg to move, at the end of the Clause, to insert the words, "Provided that (a) if the conditions imposed require payment of a number of weekly contributions before the person becomes entitled to such benefits that number shall not exceed twenty-six.
§ Question, "That those words be there inserted," put, and agreed to.
§ Sir P. MAGNUSMay my Amendment, as moved by the Financial Secretary to the Treasury, come in now?
§ The CHAIRMANYes.
§ Sir P. MAGNUSThen I beg to move, after the words last inserted, to add the words, "(b) Provided that where the total income from all sources of any such person exceeds £160 a year, he shall be required to make his own arrangements for receiving medical attendance and treatment., and Sub-section (3) of Section 15 of the principal Act shall apply accordingly."
§ Question put, and agreed to.
§ Mr. ALDENI beg to move, after the words last inserted, to add the words, "This Section shall apply to persons resident in Ireland, with this modification, that the benefits to be provided shall be such as can be specified in a scheme framed by the Irish Commissioners, and that the sum to be contributed by Parliament towards the cost of these benefits, and the administration thereof, shall be the same as if the benefits were benefits to insured persons."
The object of this Amendment is to put Ireland into a fair position as regards the rest of the United Kingdom. Ireland, at present, has no medical benefit, and therefore it is impossible to insert medical benefit in this Clause. I understand that the new Clause to be moved by the Labour party does deal with this question. As the Irish Medical Benefit Committee is sitting to consider the question of medical benefits for Ireland, it is impossible for us to come to a decision this afternoon. Exactly the same argument would apply to disablement benefit. At any rate, it would have been impossible for us to have decided this afternoon in either case. Therefore, in order that Ireland may keep the benefits of the State two-ninths, which otherwise she would fail to get, I move the Amendment. It seems to me that the representatives of Ireland would be satisfied with this. It is true it places the scheme in the hands of the Insurance Commissioners, but it gives them all the benefits to which they are strictly 2957 entitled, and all the exempted persons in Ireland will get just such benefits as insured persons will get. Under these circumstances, I hope the Committee will see its way to accept this Amendment, and I hope it will be satisfactory to the representatives from Ireland.
§ Mr. RAMSAY MACDONALDMay I draw attention to a new Clause in the name of two hon. Friends of mine, which purposes to extend the medical benefits to Ireland? The point of Order I should like to ask you now is, supposing this Amendment, which you have just put from the Chair, is moved and voted upon, would that Clause, which my two Friends have put down be, in your opinion, out of order?
§ The CHAIRMANNo, I think that Clause refers to the general question. This is simply to exempted persons.
§ Mr. RAMSAY MACDONALDOur Clause is wider than this Amendment, but I wondered if, having settled the minor question, which is really essential to the larger question, you would rule the larger one out of order.
§ The CHAIRMANI should rule that this particular Section has reference to exempted persons, and does not at all prejudice the Amendments referred to by the hon. Member for Leicester (Mr. Ramsay Macdonald).
§ Mr. LARDNERI am sorry we had not an opportunity of seeing this new Sub-section on the Paper, and of considering it in detail, but having heard it read, I think it is an Amendment which I can see my way to advise those interested in Ireland to accept, for this reason. In Ireland we have had nothing but the greatest praise for the sympathetic administration of the Insurance Act in that country, and I am perfectly sure that any scheme devised by the Irish Commissioners will be one that will meet with general approval. I wish to know from the Government what the effect of this new Sub-section will be in regard to Irish migratory labourers who come to England for employment under the twenty-six weeks period. With reference to the point raised by the hon. Member for Leicester (Mr. Ramsay Macdonald), the proposal of the new Clause is to extend medical benefit to all Ireland, and even if that Clause was subsequently carried, the Sub-section now before the Committee would not prevent that being done. I think the Amendment is one which might be accepted.
§ Mr. MASTERMANI think the hon. Gentleman is quite right to accept the Subsection. It makes the Irish Fund perfectly independent, and it is rather important that they should have the right to the extra two-ninths in Committee, for it cannot be given on the Report stage of the Bill. The two-ninths would be ensured for them and it would not be an extra charge. The migratory labourers would be exempted persons, and I think any arrangements made by the Commissioners would be for benefiting them as in the case of other exempted persons.
§ Mr. BOOTHI wish to ask whether this will be one of the schemes which must lie on the Table of the House for a number of days? As members of the Government know, they occasionally put Papers on the Table, and there is a right to move an Address to the Crown and discuss them. I wish to know whether this comes within that category, or whether the House will have no opportunity of looking at the scheme?
§ Mr. HARRY LAWSONI wish to say that I have no objection to benefit with respect to exempted persons being given to Ireland, but I would point out to the Committee that this gives Ireland what was asked for, and asked in vain, in respect of the rest of the United Kingdom. The whole point of the argument in opposition to that was that medical benefit was inappropriate to the classes of people to be dealt with. Here, according to the manuscript. Amendment, there is to be elasticity which we did not get in the case of the rest of the United Kingdom. The regulations made by the Insurance Commissioners in this regard will, I suppose, be submitted to Parliament for confirmation. Why should that be done in this case and not in others? It points the moral that this is a half-baked Clause all through, and that you are earmarking money in an inappropriate and rigid way for Great Britain and allowing this latitude to Ireland. I think this shows that Ireland is making a much better bargain than we have been able to do.
§ Question, "That those words be there added," put, and agreed to.
§ Question proposed, "That the Clause, as amended, stand part of the Bill."
Mr. WORTHINGTON-EVANSI do not propose at the present time to divide the Committee against this Clause. The Clause is a most unsatisfactory one. I do not think the Government have taken enough trouble to produce a Clause which is suitable, 2959 nor have they treated the Committee fairly, because they have withheld from the Committee information winch is necessary to enable them to say whether or not the Clause ought to be added to the Bill. I do not say they have withheld the information wilfully, because I do not believe they know themselves. We have had from the other side all sorts of descriptions of the various beneficiaries who are supposed to be benefited by this Clause. Sometimes it has been a pale anemic young woman, at other times old men, and in addition to those we know there is a large class of children living with their parents who are only temporarily under its provisions. The result is we are giving these unknown beneficiaries unsuitable benefits, which are stereotyped, when it would have been possible for us to make the scheme sufficiently elastic to benefit those who ought to come within it, and to give the nature and quality of the benefits required by these people. Within the last few minutes we have had the usual example that Ireland's importunities are more listened to by this Government than any that may be thought of for England. I do not propose to divide the Committee, because I am not going to take the responsibility of cutting out of the Government Grant even the few who may benefit by this Clause. As it stands there is certainly a large sum of money being wasted, or, at any rate, being speculated, in this matter, because no one can say whether the benefits given by it are really suitable.
§ Mr. BOOTHI do not think the statement of the bon. Member should be made without challenge. It does not represent the view of the majority of the Committee, and it is certainly not the view of those who are administering the Act. It is particularly ungracious, in view of the fact that the Government take up the matter of dealing with exempted persons, about whom the hon. Member himself made a great deal of noise, and when the Government do the best thing possible in the circumstances for these people it is ungracious for the hon. Member to speak in this grudging way. The Clause is a great gain. The hon. Gentleman has not been able to suggest anything that is practical in regard to it, but simply gets up and murmurs against the Clause.
§ Mr. CHIOZZA MONEYI am very reluctant to intervene in this matter, but after what has been said by the hon. Member for Colchester (Mr. Worthington-Evans), it cannot be allowed to pass without protest from this side. May I remind the Committee 2960 that this particular point was to a large extent discussed when we were discussing Section 13 of the principal Act? We were then discussing the question of allowing persons to elect, from the additional benefits, a different scheme of insurance. The House, which was then sitting as a Committee, decided that, above all, there must be no contracting out of medical benefits. That, above all, was the first purpose of the Act. Surely the arguments which held good in the House, hold good here! The hon. Member for Colchester has been quite unable to make any suggestion to take the place of what the Government propose. I utter these few words of protest against such an ungracious speech being made with regard to this particular proposal.
§ Mr. RONALD M'NEILLI should not have risen but for the two speeches to which we have just listened. I do not think the two hon. Members should have got up in this angry spirit to denounce my hon. Friend the Member for Colchester for the perfectly legitimate and moderate observations he addressed to the Committee upon this Clause. The bon. Member for Pontefract (Mr. Booth) rather angrily protested against the remarks of my hon. Friend on the ground that the majority of the Committee did not agree with him. There is nothing surprising in that. I am certain there is no one on this side of the Committee who does not agree entirely with the moderate remarks of my hon. Friend. We feel that my hon. Friend has made an exceedingly strong case for the Amendment of this particular Clause, and we should not have been at all surprised or have disagreed with him if he had gone to the more extreme length and asked the Committee to divide against it. My hon. Friend has shown conclusively that although the provision of this Clause is an Amendment in the right direction, I think very much better provision might have been made for the beneficiaries intended to gain under this Clause if a more elastic system had been adopted by the Government. Therefore, I do think before we pass this Clause we ought to be allowed on this side to protest most strongly against the spirit in which the observations have been made by the last two hon. Members against the exceedingly moderate and conciliatory speech of my hon. Friend.
§ Question put, and agreed to.