§ (1) No voluntary contributor whose total income from all sources exceeds one hundred and sixty pounds a year shall be 2961 entitled to receive medical benefit, but in that case the weekly contribution which would otherwise be payable by him shall be reduced by one penny.
§ (2) Paragraph (e) of Sub-section (2) of Section 15 of the principal Act shall extend to members of societies other than such friendly societies as are mentioned in that paragraph who were at the date of the passing of the principal Act entitled as such members to medical attendance and treatment in like manner and subject to the like conditions as it applies to members of such friendly societies.
§ Mr. GOULDINGI beg to move, in Sub-section (1), after the word "contributor," to insert the words "becoming insured after the passing of this Act."
I understand that this Clause has been put on the Paper to give effect to an agreement come to between the Government and the medical authorities. I am perfectly certain that the right hon. Gentleman will see that whatever agreement is come to should not be retrospective. If it is so, it may involve on certain people, more especially among the clerk class, great injustice. For instance, if the employed contributor who within five years becomes a voluntary contributor by reason of his salary being raised to £160 per year, is to be excluded from medical benefit in this way, it is subjecting him to a breach of contract that would not be tolerated against any insurance company. Any insurance company having entered into an agreement with the individual insured is bound by law to carry it out. It seems to me a monstrous proposal that the Government has proposed this change, making a great inroad into the agreement come to with those clerks and depriving them of benefits that they have contracted for. If it is necessary to give effect to an understanding come to between the Government and the medical authorities, let it be done by inserting the words which are in the name of the hon. Member for Wilton (Mr. C. Bathurst) and myself, "becoming insured after the passing of this Act," so that no injustice can be done to those who are already employed contributors and who may, by reason solely of the fact that their salary is raised to £160, become voluntary contributors within that period. I do not know whether now is the time to raise the point as to why the Government are going to allow only a penny for Medical Benefit, while, according to their own actuary, it should be more. The present Amendment, however, deals with another matter, and 2962 I should like the right hon. Gentleman to state the grounds of this injustice.
§ Mr. MASTERMANThis is the one Clause, and I am glad it is the only Clause in the Bill in which I cannot, in the name of the Government, accept any Amendment at all, because it was on a definite promise and pledge made that the Government would use whatever influence the Government had that this Clause should be at the earliest possible moment embodied in an Insurance Act Amending Bill. It may be said that, although we make our pledges, all the doctors who negotiated with us have not kept their pledges. That may be true, but that seems to be an even stronger reason for us keeping ours as a Government, and so showing that, at least, we are prepared to maintain our part of the bargain, and we have the knowledge that some 18,000 doctors have come on the panels on account of the fact, among other elements, that they understood that the Government would pass this Clause. It does not really affect very many people; it does not begin to operate for three years from now, and it may be that in three years' time the condition of medical service may be changed by general arrangement, so that it may never come into operation at all. But, as far as the Clause which stands now on the Paper is concerned, all I can say to the Committee is that it definitely embodies a definite Government pledge under which a very large number of doctors have taken service, and that certainly the Government could not accept any Amendment to the carrying out of that pledge.
§ Sir H. CRAIKI am very glad that the right hon. Gentleman has adhered to what is a distinct pledge to the medical profession, and I shall certainly give him my support if the question goes to a Division. I do not think he need have mentioned about the pledges of doctors, and I am not aware of any broken pledges the doctors have made, but in this case the pledge was quite distinct, and I am very glad the Government have held to the position they pledged themselves to.
§ Mr. FORSTERThe right hon. Gentleman has told us that this Clause is put into the Bill to carry out a pledge that has been given to the medical profession, but he did not touch the point raised by my hon. Friend who moved the Amendment, and which I think is a point of substance, namely, as to whether or not there is a contract between the Government and the societies and the voluntary contributors who have entered into insurance and who pay their 2963 voluntary contribution of sevenpence per week for which they were to receive certain benefits in return. What I want to know from the right hon. Gentleman is how he proposes to carry out the obligation which the Government have undertaken with regard to the voluntary contributor.
§ Mr. J. H. THOMASIt is precisely for the same reason I am inclined to support the Amendment. The situation is, as the right hon. Gentleman has stated, that there is an obligation on the Government to the doctors. They feel that they are giving effect to that obligation in the Clause that is inserted in the Amending Bill, but surely they are not justified in fulfilling that obligation at the expense of a contract with other people! We have to determine in this case whether we are justified at the expense of the insured person in making that pledge to the doctor. We have no objection to the Government fulfilling any pledge or promise they have made to the doctor, but alternatively with that they should at least bring forward some proposal which will compensate the insured person for what he is suffering. Therefore, I think if there is no other means of fulfilling the obligation to the doctor than this Clause, some alternative scheme ought to be proposed that will compensate those people, who unquestionably were entitled to medical service and because of this Clause are to be deprived of it.
§ Mr. HARRY LAWSONThe argument of the Financial Secretary to the Treasury has very little relation to the merits of this Amendment. He simply says that the Chancellor of the Exchequer has given a pledge to the medical profession, and that is the statement made in the Memorandum on the general objects of the Bill. But because the Chancellor of the Exchequer is pledged, the House of Commons is not necessarily pledged or the Members of this Committee. They are pledged to judge this Amendment on its merits and the Amendment is one about which the friendly societies feel strongly. The Association of Approved Societies in the paper I have here state distinctly that they are opposed to the Clause as at present drafted and in favour of the Amendment. The Manchester Unity explain that this Sub-clause would press very hardly upon clerks and others who, having contributed for five years for medical benefit, become disentitled to such benefit because they happen to improve their position by an increase of salary to £160 per year. My objection, of course, is wider than that. From the friendly society point of view, you are 2964 adding to the confusion already created, and you are segregating this particular class from the general scheme. The friendly societies have suffered tremendously from having their work complicated, and I think it is unfair to complicate it any further unless there is some very strong reason. I believe that some of these people who are insured are those for whom the Committee ought to have the most consideration. I have in my employment a large number of workmen who are earning from £5 to £6 per week at present.
§ Sir P. MAGNUSIt does not affect them.
§ Mr. HARRY LAWSONBut it does affect the clerk and the man of that class about whom the Manchester Unity are talking. Is the only reason for depriving these people of benefits the pledge given, perhaps hastily given, by the Chancellor of the Exchequer? I think the friendly societies are perfectly right in objecting to the creation of this new class, and to the ordinary working of their providential system being interfered with. I hope my hon. Friend will proceed to a Division on the point, because I am certain he is representing the feelings of the whole of the thrift organisations of the country.
§ Mr. LYNCHI rise to ask if a discussion on the whole Clause would be in order at this stage? The Secretary to the Treasury said that the whole Clause must remain intact.
§ Mr. MASTERMANI only referred to the first Sub-section of the Clause.
§ Mr. CASSELThis Amendment seems to raise a very important question of principle, namely, whether Parliament is justified in any of these amending Acts to come in and rip up contracts which have been made with insured persons. That should not be done with a voluntarily insured person for this reason, that Parliament has said to them, and given them an option, that if they came in and paid sevenpence per week that they should have certain benefits. Those persons did come in, and they paid the full sevenpence per week. Then within a year of that time, without consulting them, you simply propose to annul that bargain because it suits you in an arrangement you are making with other people. Once you adopt that principle it opens the door to extending it to other Acts. I think it is an extremely dangerous principle for Parliament to commit itself to. If it is done in 2965 this case, it will be on record and form a precedent for varying the contracts of voluntarily insured persons to an unlimited extent. It is contrary to the whole principle on which leglislation has been based in the past.
§ Mr. MASTERMANI think the point is very much exaggerated. There are only 25,000 voluntary contributors altogether, and of those this only applies to those who within five years go out of insurance owing to getting over £160 per year, and I should not think they would be more than a few hundreds or thousands of the 25,000. To begin with, there is no contract between insured persons and the State, but, apart, from that, it is absurd to say that you are doing anything injurious to those insured persons. The doctors agreed to take insured persons on condition that these persons did not come in under capitation rates. For all I know, that arrangement having been made, they might not only refuse to take these persons under capitation rates, but they might refuse to take any persons if the Government refuse to carry out their part of the bargain. It is not as if these men were having money taken under false pretences. They will get the equivalent for medical benefits. A penny is their equivalent—[HON. MEMBERS: "It is more"] A penny is the equivalent of their contribution—
§ Sir R. BAKERAre they going to get back what they have paid in the past?
§ Mr. MASTERMANThey will have medical attendance until they pass out, or at the end of five years pass out of this particular scheme, so that as far as that is concerned for four years they are assured of medical attendance. At the end of that time, if they become rich, the doctors will cease to take them on the capitation payment, and they will receive back the equivalent to their medical subscriptions in order to make their own arrangements with the doctors. That is not treating them unfairly, and I do not think the Government pledge can be broken up under any criticism of such a scheme as that.
§ Mr. GWYNNEThe right hon. Gentleman has put forward a most extraordinary argument. The reason he has adduced why we should not give these men who have entered into a contract with the Government the benefits which have been promised, is that there are so few of them. The real truth of the matter he left, out. He meant that there are so few votes amongst them. 2966 [HON. MEMBERS: "Oh!"] The real question is not whether they are few or many, but whether we should treat them fairly or not. If you have made an arrangement you ought to carry it out. Even if there is only one man affected he ought to be treated fairly. I am surprised that the right hon. Gentleman should have put forward that argument.
§ Sir P. MAGNUSIt does not seem to me that any great injustice is being done to voluntary subscribers. In any case they have only been subscribing for six months and during the whole of the five years they will receive medical benefit in accordance with the understanding at the time they became voluntary subscribers. This proposal will only affect them at the end of that time, and then the equivalent of the medical benefit, namely, a penny, if that be the correct equivalent—if it is not, it will be altered—will be deducted from their subscriptions. Therefore, I cannot see that they are suffering any injustice of any kind whatever. If we consider the Amendment on its merits, we shall see how ridiculous it is that men whose income may be £500 or £600 a year should be able to obtain medical benefit by the payment of a few shillings a year. It crept into the original Insurance Act; it was pointed out at the time how absurd it was, and the Government, with that amount of sense—
§ Mr. J. SAMUELWhich characterises them.
§ Sir P. MAGNUSWith that amount of sense ascribed to them, at once acceded to the suggestion that this absurdity should be altered at the earliest moment.
§ Mr. GOULDINGThe question whether there are few or many who are to be injured by this action of the Governemt leaves me perfectly cold. I cannot see how that can in any way justify the grave injustice which is being done to these people. I ask the right hon. Gentleman to state a single case where any insurance company, having entered into a contract of this kind, whether with a few or with a large number of people, would be allowed to tear up that contract in the way the Government propose to do by this Clause. If there are so few persons affected, let the Government meet them and make a concession. The Amendment provides that the proposal shall not be retrospective. Therefore all those who joined after the passing of the Act would do so with their eyes open and under different conditions. All we ask is that no such precedent 2967 should be set because there are few, or because out of 25,000 only a small proportion may suffer injustice. I do not agree with the right hon. Gentleman that it will be a small number, because I already have a list here of a great number of people who feel that they will suffer injustice and be deprived of benefits for which they have paid, and for which they are paying now. I ask the right hon. Gentleman before we come to Report stage to see what compensation can be given to these people if he feels himself bound, as he says, to carry out his contract with the medical authorities. For my own part, I shall go to a Division on the Amendment, because I can see no justification for the injustice which is to be inflicted upon these people.
Mr. WORTHINGTON-EVANSI am sorry I cannot vote with my hon. Friend if he goes to a Division. The Government have made the important statement that there is no contract between the Government and any insured person, and that therefore it is open at any time to alter the terms upon which the insured person has come into insurance. Founding themselves on that, the Government think that if an alteration is made in the Act, they are not guilty of any breach of contract towards these
| Division No. 4.] | AYES. | |
| Baker, Sir Randolf | Lawson, Mr. Harry | Roberts, Mr. George |
| Cassel, Mr. | Macdonald, Mr. Ramsay | Thomas, Mr. |
| Goulding, Mr. | Remnant, Mr. | Tryon, Captain |
| Gwynne, Mr. Rupert |
| NOES. | ||
| Addison, Dr. | Falconer, Mr. | MacVeagh, Mr. |
| Ainsworth, Mr. | Forster, Mr. | Magnus, Sir Philip |
| Alden, Mr. | Harcourt, Mr. Robert | Masterman, Mr. |
| Booth, Mr. | Harvey, Mr. Edmund | Money, Mr. Chiozza |
| Boyle, Mr. Daniel | Hinds, Mr. | Newman, Mr. |
| Carr-Gomm, Mr. | Jones, Mr. Glyn- | Pearce, Mr. William |
| Clay, Captain | Locker-Lampson, Mr. Godfrey | Roberts, Mr. Charles |
| Craik, Sir Henry | Lynch, Mr. | Samuel, Mr. Jonathan |
| Dawes, Mr. | M'Laren, Mr. Henry | Sandys, Mr. |
| Devlin, Mr. | Macnamara, Dr. | Scott, Mr. MacCallum |
| Esmonde, Dr. | M'Neill, Mr. Ronald | Worthington-Evans, Mr. |
§ The CHAIRMANThe next Amendment standing in the name of the hon. Member (Mr. Goulding) is consequential.
§ Mr. ALDENI beg to move, in Subsection (1), after the word "case" ["in that case the weekly contribution"], to insert the words "whilst he is resident in Great Britain." I think these words are necessary: still, if the right hon. Gentleman is satisfied that they are not necessary, I will not move them.
§ insured persons. The Government are proposing to reduce the contributions made by the voluntary contributor so that he shall be able to have his money in his pocket to provide for himself medical attendance. The Government are doing that because they have made a bargain with the doctors. On the merits it seems to me that the Government are right. The doctors cannot be expected to extend capitation practice beyond the cases where it is absolutely necessary to ensure medical treatment to the insured persons. Where a voluntary contributor has £160 or over a year, he has such an income as will enable him to make his own private arrangement with the doctor, and this Clause is based upon that fact. The question whether a fair return is being made to the voluntary contributor is another matter. Whether 1d. or 1½d. ought to be deducted from the contribution is the subject of a separate Amendment which will come up presently. Seeing that the Government have made it clear that there is no contract with the insured persons which can be said to have been broken, it leaves open the whole merits of the case, and on the merits of the case I shall vote against the Amendment.
§ Question put, "That those words be there inserted."
§ The Committee divided: Ayes 10; Noes 33.
§ Mr. MASTERMANI do not think the words are necessary. Perhaps the hon. Member will withdraw.
§ Amendment, by leave, withdrawn.
§ Mr. G. LOCKER-LAMPSONI beg to move, at the end of Sub-section (1), to insert the word "halfpenny."
I have put down this Amendment to change the word "halfpenny" into "penny halfpenny." I have really put it down in 2969 order to get an explanation from the Government. I am not particularly wedded to the word "halfpenny," but I want he right hon. Gentleman to explain what really medical benefit costs the voluntary contributor at the present time. I make out—I may be wrong—that it costs him well over a penny. If it costs well over a penny then it is quite clear, if he drops medical benefit, that he is entitled to more than one penny reduction in his contribution. Probably the right hon. Gentleman will say that medical benefit costs a little over three halfpence, and that part of that three halfpence is the two-ninths provided by the State. Even if he says that, I think it is quite clear that seven-ninths of the sum over the three halfpence is more than a penny. It comes to very nearly one penny farthing, so that in every case it seems to me that you ought to give a bigger reduction than a penny to voluntary contributors if they are going to drop medical benefit. I will wait until I hear the right hon. Gentleman's explanation.
§ Mr. MASTERMANThis is a relationship between the approved society and the member. We must not pay to the approved societies money which is not rightly theirs. We must not exempt a man for more than the approved society can count. I should have thought the calculation was quite simple. Each member of an approved society pays for his medical benefit 6s. per year.
§ Mr. G. LOCKER-LAMPSONhow much is that per week?
§ Mr. MASTERMANThat is, there is paid in respect of each member 6s. per year, of which seven-ninths is paid by the Society itself, whilst two-ninths are provided by the State.
§ Mr. G. LOCKER-LAMPSONCan the right hon. Gentleman say how much that is a week?
§ Mr. MASTERMANI will show that in a moment. This 4s. 8d. per year is what the society would have to exempt a man from if it has to keep as solvent as if the man was not under its conditions. 4s. 8d. per year works out at 56 contributions. The exemption at a penny works out at contributions, which is the nearest to a whole figure, even to a farthing, that we can make. Any further exemption would mean that the approved societies would lose on the exemptions from medical benefit.
§ Mr. G. LOCKER-LAMPSONI [...]allynot quite satisfied with the explanation, It is impossible at the moment to make the calculation, because the right hon. Gentleman has not given us the weekly sum.
§ Mr. DANIEL BOYLEA penny and one-thirteenth.
§ Mr. MASTERMANIt is a penny and a very small fraction over a penny.
§ Mr. MASTERMANThere, several hon. Gentlemen who are arithmeticians, are ab[...] to tell the hon. Gentleman what he wants to know!
§ Amendment put, and negatived.
§ The CHAIRMANWith regard to the next two pages of Amendments on the White Paper, I have gone carefully through them, and it does not seem to me, except with respect to one, that they are matters germane to this particular Clause. This refers to all except one, that being an Amendment by an hon. Member who is not a member of this Committee. Therefore it will be suitable, and more convenient, to take these Amendments as new Clauses. Unless any hon. Member has any particular point of Order to bring before me, that is my ruling.
§ Mr. LYNCHOn the point of Order, Mr. Chairman. Whilst I accept your judgment on the matter, may I ask if the Clause standing in the name of the hon. Member for Salisbury can be brought in at a subsequent stage?
§ Dr. MACNAMARAWhich one is that?
§ Mr. LYNCHI will take occasion to say here that it is unintelligible in the form which it is here set down.
§ The CHAIRMANOn the point of Order. The hon. Member will be able to discuss the Clause as a whole when I put the question that the Clause stand part of the Bill.
§ Sir P. MAGNUSMight I ask whether in your general statement, Mr. Chairman, you include my Amendment at the end of the Section?
§ The CHAIRMANYes. The Amendment as I read it deals with non-insured persons.
§ Sir P. MAGNUSNo, insured persons.
§ The CHAIRMANThe Sub-section to which it applies makes it a proviso, and puts it out of order, although it does not quite come under my ruling.
§ Sir P. MAGNUSI suppose I may bring it up as a new Clause?
§ Mr. G. LOCKER-LAMPSONIn order to safeguard myself, may I take it that I may move, as new Clauses, all the four Amendments which I have down when we come to the new Clauses? They are altogether at the bottom of page 58 and at the top of page 59.
§ The CHAIRMANAs far as I can judge they are all subjects which can be properly brought forward as new Clauses. That is, so far as I can see on the face of it, that I cannot make an absolute ruling.
§ Mr. GWYNNEDo your remarks apply to the Amendment down in the name of the hon. Member for Luton (Mr. Cecil Harmsworth)?
§ The CHAIRMANSome of these Amendments are largely duplicates with the others, and deal with, temporary residence abroad, the provision of nurses and one or two other matters.
§ Mr. GWYNNEWill my hon. Friend be able to be entitled to move this as a new Clause?
§ The CHAIRMANHe will, so far as I can judge.
§ Mr. G. H. ROBERTSAm I to understand that the Amendment standing in the name of the hon. Member for Luton is in order, but that the fact that he is not a member of this Committee excludes him from moving it? Would it be competent for me to put the Amendment down as a new Clause.
§ The CHAIRMANNo, it ought to be moved now if moved at all.
§ Mr. G. H. ROBERTSI beg to move, at the end of Sub-section (2), to add the words "and shall also apply to members of any registered friendly society or trade union who have subscribed for, and been entitled to, medical treatment and the medicine for a continuous period of not less than twenty years prior to the fifteenth day of July, nineteen hundred and twelve."
I think this Amendment ought to be submitted for the purpose of eliciting a statement on the point from the Secretary to the 2972 Treasury. This Amendment refers to the Medical Institutes that exist in different parts of the country. I think everybody is desirous of preserving them, and in fact of encouraging them as much as they can. One point I object to, and that is where the Amendment states that there must be a continuous period of not less than twenty years. I think that is far too long. But notwithstanding that, I formally move, the Amendment for the purpose of getting an expression of opinion from the Government as to whether or not they would be able to accept it, or what modification they are prepared to make in it.
§ Mr. MASTERMANOf course it is quite impossible to accept this Amendment as it stands. The hon. Gentleman has quite rightly said that he has moved it at short notice for another Gentleman who is not in his place, and he has not got the facts and figures which would give the Government any kind of idea what sort of expense this Amendment would entail. I quite realise that there is a grievance in connection with certain old members of friendly societies who may have attained the age of sixty and have been paying for medical benefits for perhaps thirty years and find themselves now deprived, through no fault of their own, of medical attendance. I should like to see if, and how far, that grievance may be met and what possibilities there may be of providing a small sum of money for the purpose. But for all I know this might result in a much larger cost than the £200,000 which has been mentioned, and in those circumstances it is quite impossible for me to advise the Committee to accept it. It would mean the abandonment of some of the other benefits in the Bill. I should like to suggest if it were possible that this Amendment should be withdrawn now, and that before the Report stage the hon. Gentleman and his Friends should get some sort of statement in figures so as to show some kind of way in which we could meet some or any proportion of the cases of these old members, and then I would consider with the Government whether it was possible to provide the money. But as it stands it is not open to me to do it at all. If anything like the estimate of the money required is correct, of course it is quite impossible. We might be able to meet hard cases with a small amount and I do not wish to shut the door to that possibility. I would ask the hon. Member to withdraw his Amendment and perhaps he would give his attention, and I would give my attention, to the matter in the time intervening between this and the Report 2973 stage, and see what particulars we can obtain as to the amount of money involved and the various possible proposals for dealing with the matter in some way.
§ Mr. HARRY LAWSONWill the right hon. Gentleman consult the representatives of the great friendly societies? This is an Amendment which they are strongly in favour of. I know the Manchester Unity are in favour of it. There are a great number of small shopkeepers who will be hardly treated if this case is not met. If the right hon. Gentleman will consult these societies they may be able to suggest some scheme, and he might be able to bring up an Amendment on Report stage, or suggest some compromise.
§ Mr. MASTERMANYes, I think an Amendment should be brought up on Report stage. It ought to be an additonal charge. It might possibly go as a small Vote upon the Estimate. I know the feeling which the hon. Gentleman who has just spoken voices, and I have asked the opinion of the representative of the Manchester Unity whom I saw on the subject to see if he could provide any kind of financial statement to show the Government what amount of money would be involved. I hope the Committee will agree with me that I cannot accept such an Amendment without being able to clearly tell them how much it will involve, and that is why I ask that it should be postponed.
§ Mr. FORSTERCould the right hon. Gentleman tell us what opportunity we shal have of discussing this matter? We couldl not bring it up on Report because it would involve an increase of contributions from the State. Perhaps he might bring it up in the form of a new Clause.
§ Mr. MASTERMANThat is my idea.
§ Mr. FORSTERIf it would be in order as a new Clause I think that would meet the case entirely.
§ The CHAIRMANI cannot say until I see it. Primâ facie, if it is in order as an Amendment, it will not be in order as a new Clause, but that might be got over if the hon. Member withdraws the Amendment now.
§ Mr. G. H. ROBERTSI beg leave to withdraw the Amendment. I think it would be better for the Government and for those interested in the proposal to confer together in the preparation of a new Clause which might be introduced later on.
§ Amendment, by leave, withdrawn.
§ Question, "That the Clause stand part of the Bill," put, and agreed to.