THE NATIONAL INSURANCE BILL. T HE text of the National Insurance
Bill, and the explanatory memorandum which accompanies it, give a much clearer account of this gigantic scheme than it was possible to obtain from Mr. Lloyd George's speech. From many points of view the scheme, as now expounded in cold print, is more satisfactory than it appeared to be when judged from the speech of its author in the House of Commons. On one point in particular the later explanation goes far towards removing a good deal of anxiety that was previously felt. In the explanatory memorandum just referred to, which is signed with Mr. Lloyd George's initials, the principle is clearly laid down that the final financial responsibility for the success of the scheme rests not upon the State but upon the approved Societies through whom the State will, in the majority of cases, work. The words of the memorandum are so important on this point that it is worth while to quote them : " The greatest evil which has to be guarded against in all eases of this character comes from the danger of malingering. This scheme is so worked that the burden of mismanagement and maladministration will fall on the workmen themselves. If through any such cause there is any deficiency, the workmen must make it up either in diminished benefits or in increased levies." It is hardly too much to say that the enunciation of these principles marks a complete departure from the tendency of recent legislation. Since 1906 the Liberal Party has been engaged in giving effect to the Socialist doctrine of collective responsibility for individual failure. Mr. Lloyd George now lays down the principle that the individual himself is to be primarily responsible, and if that principle is adhered to we may yet hope to receive from the present Liberal Party measures of social reform which will encourage, instead of discouraging, the spirit of self-help upon which the strength of the nation finally depends. When, however, the text of the Bill is examined, it will be discovered that only a very meagre attempt is made to carry out the principle so clearly enunciated. This may be simply a defect in drafting, for, in spite of the seventy-eight pages covered by the provisions of the measure, a number of points still remain unexplained. The memorandum, for example, clearly indicates that the cards bearing in stamps the contributions of the workman and the employer are to be handed over by the workman to his own approved Society. This implies that the Society itself will manage the whole business of collecting the money and distributing the bene- fits. If that is really the scheme which Mr. Lloyd George has adopted we can congratulate him with all the fervour which comes from the pride of parentage, for this is the identical scheme which has been frequently advocated in our columns. The Bill itself, however, expressly states in Clause 39 that all the sums paidout of moneys provided by Parliament are to be paid into a fund, to be called the National Health Insurance Fund, under the control of the Insurance Commissioners, and that the sums required to meet expenditure by approved Societies and Local Health Committees are to be paid out of that fund. In other words, instead of leaving the Societies as autonomous units to manage their own receipts and expenditure, all the receipts and all the expenditure are to be pooled in one gigantic central fund to be administered by an army of new officials located in London.
We strongly urge that, so far as regards this portion of the scheme, the Bill should be amended to make it tally with Mr. Lloyd George's intentions as de- scribed in his explanatory memorandum. To be explicit, we suggest that each workman should at regular intervals hand to the Secretary of his own approved Society his card with the stamps upon it The secretary of that Society would then claim from the Post Office the sums due as indicated by the stamps upon the cards in his possession, and would, in addition, receive at the same time the State grant. Under this scheme the function of the State in the matter would be limited to the supervision and to the supply of whatever sum was required for the State grant. Not only does this mean an immense saving in administra- tive expenditure, but also it preserves the autonomous character of the Friendly Societies and of the Trade Unions, and consequently leaves them free to carry on their own propaganda and to encourage their members to make further provision for self-insurance than the law compels. In this connexion it may be added that many of the provisions of the Bill for controlling the work of the approved Societies appear to be unnecessarily detailed. Provided there is Government audit of the accounts it is better to leave the approved Societies a fairly free hand, so that the workman may have the advantage of variety of choice with regard to the Society he joins. Here it may be added that there is no reason why approved Societies should be limited to those which make no profit. If an Insurance Company is willing to undertake the work of sickness and insurance for the industrial classes on com- mercial terms, and if it gives sufficient guarantees of financial stability, it ought to be allowed to come under the provisions of the Act. Incidentally, attention must] be directed to the extra- ordinary character of Clause 57 of the Bill, which gives powers to the Insurance Commissioners, with the consent of the Treasury, to " make any appointment and do any- thing which appears to them to be necessary or expedient" for the establishment of Health Committees and for bring- ing the Act into operation, and " any such order may modify the provisions of this Act so far as may be neces- sary for carrying the order into effect." This is certainly applying with a vengeance the modern principle of legislation by departments instead of legislation by Parliament.
Assuming that Mr. Lloyd George will so amend his Bill as to carry out his declared intention of working through voluntary Societies instead of through a great State Department, we can give the scheme a, cordial welcome. At the same time there are certain matters of very important detail which must be carefully considered. We are not at all convinced that Mr. Lloyd George is right in fixing a uniform payment for all classes of working men regardless of the wages they are earning. A payment of 4d. a week is a trifle to a man who is earning .23, It is a very serious matter indeed to a man who is earning only 17s. a week. The principle of a graduated charge is admitted in the case of men earning less than 15s. a week, and we think it would have been wiser if Mr. Lloyd George had carried this principle further. In any case he will have to overcome an almost incalculable amount of passive resistance to his scheme. It is very doubtful, indeed, whether the newspaper press or the politicians have in the least degree grasped the reluctance of working men and women to submit to any compulsory deduction from their wages, and if the scheme is to go through at all it must be so arranged as to make these deductions as little irksome as possible. In addition, it is of the utmost importance to try to secure some personal benefit for every individual who is compelled to subscribe. As the scheme stands this is not done. A man who enjoys good health for the greater part of his life will get nothing at all out of the scheme, except perhaps 30s. if he marries and his wife has a baby. Moreover a large number of workmen have already acquired the habit of receiving gratuitous medical treatment in hospitals or infirmaries, and in such cases the family is very often provided for by outdoor relief. Men belonging to this category will not think it worth while to pay 4d. a week for what they already receive gratuitously. The provisions for women are even more speculative, for, owing to the limitations of benefit on marriage which are perhaps necessary, a working woman may subscribe for many years and get nothing in return. For these reasons we strongly urge that the scheme of benefits should be recast so as to permit the payment of some benefit on death. Thousands of working men and women are now insuring their lives, often at considerable immediate sacri- fice, for the benefit of their children. They will bitterly resent the interception of these sums for a sickness benefit which they may never realize.
Admittedly, the difficulties are very great, for if a death benefit is to be given the whole finance of the scheme will be seriously altered. To increase the premiums appreci- ably is impossible, but two possibilities remain open. In the first place, the sickness benefit might be reduced, and, secondly, the Old Age Pensions Act of 1908 could eertainly be so amended as to render available a large amount of money now virtually wasted. It is absurd that pensions of 5s. a week should be granted at the expense of the taxpayer to persons in possession of capital amounting to £800 or even £1,000. Further, it ought to be possible in view of the appearance of this much more important scheme to reconstitute the old-age pension scales altogether. At present a man with 8s. a week may get an additional 5s., and so also may his wife, with the result that, in extreme cases, an old couple already in receipt of an income more than sufficient for their main- tenance receive a charitable grant of 105. a week. By correcting these obvious defects of the Old Age Pensions Act some millions a year could be saved and used for financing the present scheme. The object to be aimed at should be the amalgamation of old-age pensions with the sickness or infirmity pensions, and the terms should be so arranged that every subscriber to the new scheme would be sure of receiving, if he attained the age of seventy, a pension more valuable than the gratuitous pension given under the amended Old Age Pensions Act. He would, moreover, receive this as a matter of right without being subjected to any inquiries into his other means. On these lines it would be possible to guarantee to every subscriber to the new scheme the certainty of some personal benefit, and thus to secure a much more willing acquiescence in the compulsory contribution than is likely to be secured under the present proposals.
There are many other points which must be left for future treatment, among them being the very important question of the Local Health Committees appointed to deal with persons who belong to no approved Society ; but we wish at once to say that in the interests of Mr. Lloyd George's great scheme for national health insurance, we sincerely hope that he will drop out of the Bill the part dealing with unemployment insurance. The two problems are absolutely disconnected, and if the major scheme is to be properly discussed the Bill must not be burdened with irrelevant matter.
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