THE REVOLT OF THE DOCTORS.
IT is becoming increasingly clear that Mr. Lloyd George has quite miscalculated the strength of the opposition which the medical profession has offered and is offering to his Insurance Bill. The British Medical Association has very wisely consulted the doctors of the country individually with regard to the policy to be adopted, and already 20,000 have sent to the Association assurances of their support. That alone is sufficiently significant, but what is even more significant is the fact that a large number of doctors have expressed regret that the British Medical Association has not taken an even stronger attitude against the Bill. No one, on the contrary, has suggested that the attitude already taken is too strong. This general summary of the views of the medical profes- sion accords with the detailed information pouring in from different towns. Everywhere the doctors are meeting together and declaring their bitter hostility to Mr. Lloyd George's proposals, and in many cases all the members of the profession in a district have entered into a definite agreement not to undertake work in connexion with the present Bill. Instead of trying to understand the feeling which has created this outburst, Mr. Lloyd George sneeringly expresses his regret that doctors should look at the problem from the point of view of their profession instead of from the point of view of the national welfare. If doctors were to ignore their professional interests they would. be either more or less than human. We are inclined to think less, for a man owes a duty to himself and to his profession as well as to the whole community, and the first part of that duty is to see that he and his fellows receive fair play. The indignation of the doctors is due to their belief that they are not receiving fair play. They instinctively feel that Mr. Lloyd George is taking advantage of their humane feelings to trick them into an arrangement which would be absolutely disastrous to their professional prospects. In effect Mr. Lloyd George says : "You have been working at a very low rate for friendly societies. You often work at a lower rate still for your poorer private patients. Sometimes you do not get paid at all. Therefore if I arrange that you shall be paid for all your patients but a trifle above these scanty rates of remuneration you ought to be very grateful to me." The answer, of course, is that a medical man can only afford to attend the very poor for low fees, or for none at all, because he is getting reasonable fees from the fairly well-to-do and from the rich. Deprive him of his well-to-do practice and he will be unable to undertake the poorer practice at all, for he would have to abandon a pro- fession which did not supply him with bread-and-butter. Yet Mr. Lloyd George proposes to take away at one stroke the bulk of the paying practice of a large number of doctors.
When we ask why Mr. Lloyd George should do this thing the answer comes back that he is exercising his trade as a politician. It is the business of politicians to secure votes fcr themselves by promising favours to the electorate at somebody else's expense. Generally it is at the tax- payer's expense, for taxes are spread over so wide an area that the hardship falling on any individual taxpayer is seldom sufficiently acute to force him into active revolt. Mr. Lloyd George has already so piled up the burdens of the taxpayer that even he sees it is desirable to cry a halt. He must therefore look around for some other person than the taxpayer to bear the burden of his generosity. He has hit upon the doctors. They pay the price ; he gets the votes and the kudos ; and, strange to say, they do not like the process. In exactly the same way house owners object to losing their rents in order to enable Mr. Lloyd George to tell the world that he has relieved the sick man from the inconvenience of having to pay rent for the house which he continues to occupy.
Mr. Lloyd George's latest attempt to deal with the doctors is contained in a letter written to Sir Donald Macalister, President of the General Medical Council. It is a long argumentative letter, but so far as we can make out it does not in the least meet the objections which the doctors have quite legitimately raised. Let us note, in passing, the cool assumption, which is becoming more and more marked in Mr. Lloyd George's utterances, that he alone is to be responsible for the work- ing of this measure. He says, for example, that the con- stitution of the Insurance Commission will be a matter of great importance, " but I may say that it is my present intention that a doctor should have a seat upon it." In the same spirit he goes on to add : " I have always intended to put doctors upon the Advisory Committee." This is really very kind of Mr. Lloyd George, but even if his present intention should hold good, and a doctor should have a seat on the Insurance Commission as well as on the Advisory Committee, the main grievance of the doctors will not be removed. The grievance in a nutshell is the proposal of the Bill to take away the large majority of the paying patients from medical men with a working-class practice and to put these men, on whom many doctors depend for their living, on the contract system. Compared with this single point, all the rest is detail. Unless Mr. Lloyd George is willing to modify the Bill in this respect he will deservedly meet with the continued opposition of the medical profession. He has stated that he cannot modify the Bill on this point, declaring it to be politically impossible. Why is it politically impossible ? Take, first, the question of compulsory insurance. We doubt whether there is a single working man in the kingdom who wishes to come under a compulsory system. Nobody wants compulsion for himself, though a good many people may think that compulsion is good for others. Therefore there will be no loss of popularity for the Bill by limiting the area of compulsion. The Spectator has consistently supported the principle of compulsion, not because there is anything desirable in compulsion, but because
in the poorer portion of the community it is prac- tically impossible to secure a sufficiently widespread system of insurance without compulsion. When people have only a very narrow margin they naturally postpone such prudential expenditure as insurance for other forms of expenditure which bring more immediate gratification. That is the moral justification for applying compulsion to the poorest classes, but that justification does not exist in the case of a working man earning anything over Ns. a.
week or, to take the liberal standard suggested by the medical profession, 40s. a week. Men in this category are perfectly well able to take care of themselves, and it is better that the entire responsibility for their own future should be thrown upon themselves, and that if they fail to insure they should pay the penalty in future discomfort.
We believe, therefore, that, so far from the Bill losing popularity if compulsory insurance were limited to persons earning low wages, it would gain in popularity and its ultimate beneficial effect would be greater. There remains the question of whether it is practicable to limit voluntary insurance. When Mr. Lloyd George first announced his scheme he proposed no limit at all. His own children were to have the benefit of it. But he has since got to the point of saying that there is no reason why people with £200 or £300 a year should have the benefit of semi- charitable medical relief. Therefore the only question is ate hat point should the line be drawn. Mr. Lloyd George apparently suggests that a line should be drawn for clerks and other non-manual workers, but that no line at all should be drawn for manual workers, and that if, as sometimes happens, a manual worker is earn- ing £5 or £6 a week he is to be entitled to a dole at the expense of taxpayers, many of them poorer than himself. This is nothing more nor less than creating a privileged class of manual workers, which is surely out of place as the proposal of a party engaged in denouncing the privileges of peers. The dis- tinction between manual and mental workers is in any case a fine one, and in no case does it justify the kind of privilege which Mr. Lloyd George wishes to create. The State has no business to ask how a, man is earning his income so long as he is earning it honestly, and there is absolutely no reason why a subsidy should be given to a steel worker which is refused to a bank clerk.
We therefore again strongly urge that the scheme should be limited at the outside to persons earning £2 a week and under. In addition we wish to press very strongly the importance of permitting contracting out. There is absolutely no necessity for establishing one uniform system of insurance throughout the kingdom. The whole business of the Government is to see that everybody earn- ing less than a certain amount per week is insured one way or another, and if a man can prove to his employer that he is insured with a good friendly society or with a good commercial company for benefits at least equal to those which the State proposes to grant he ought to be free from all interference. This would not only relieve the friendly societies from many of the risks which they would run under Mr. Lloyd George's scheme, but it would also stimulate employers to organize insurance schemes of their own. The Midland Railway Company, for example, has already in existence a very excellent scheme giving far better terms than the Government proposes to go. It would be a wanton act to destroy this private scheme in order to force all the workpeople concerned to come into the gigantic State scheme which Mr. Lloyd George aims at creating.
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