HEALTH INSURANCE FOR AUSTRALIA
Commonwealth and Foreign
AUSTRALIA has just taken a great stride forward in social security. Hitherto the Commonwealth has been without National Health Insurance, although invalid and old-age pensions (non-contributory) go back to 1908, the year of the Asquith Act in Great Britain. This surprising defect in the economy of a country which forty years ago was advanced in social legislation, is now made good by the National Health and Pensions Act coming into force on January 1st, 1939.
Worked out with the expert assistance of Sir Walter Kinnear, until recently head of the Insurance division of the Ministry of Health in Whitehall, the measure is believed by the Com- monwealth Government to comprise a scale of benefits hardly equalled in any other country. It fulfils a pre-election pledge of the Federal Prime Minister, Mr. Lyons, and is welcomed almost everywhere as embodying the general will. New Zealand is about to follow ; the Savage Government is committed to a Social Security Bill far more expansive than the Australian.
The Commonwealth scheme of insurance is designed to cover all employees earning up to £7 a week. This limit, however, does not apply to manual workers, though relatively few of them, even on the Australian wages standard, have incomes exceeding £365 a year. Of the other exceptions (later to be regularised) the most important are those employed persons who are already subject to superannuation and kindred schemes under some form of Government guarantee. The large body of self-employed whose incomes come within thelimit—small farmers, shopkeepers and so forth—are to be dealt with, if possible, later.
The plan, of course, is compulsory, and its mechanism follows the British model. The insured person will have his stamp-card, for which the employer will be responsible, since he is empowered to deduct the value of the stamp from wages. The Act is to be operated entirely through approved societies. Australia, like England, contains many well-established benefit societies, but only in rare instances have the trade unions built up sick-benefit services. The unions will now enter the held. Approved societies must have a minimum member- ship of 2,000, and each is required to form a separate section for the purposes of the Act. One noteworthy condition is that insurance societies and companies carrying on business for profit are excluded from the definition of approved societies. The administrative authority is a Commission of three members, presided over by Mr. J. B. Brigden, the Tasmanian economist.
The insured citizen will be entitled to the fullest possible medical attention through life. The principal benefits are : Sickness—men 20S. a week, women 15s. for six months ; Disablement—men 15s., women I2S. 6d., which may con- tinue until the pension age. Juveniles between 14 and 16 are also included, to the extent of 5s. a week sick benefit. Married minors to receive the same as adults ; unmarried minors, I25. 6d. and los. The sex differentiation, regular in scale throughout, is defended on the ground that in the long run the benefits will prove rather more favourable to women. Periods of free insurance are clearly defined. The weekly contribution is suspended during sickness and is fully credited. Insured mothers are excused for a fortnight before and four weeks after confinement.
The scale of contributions affords an illuminating compari- son with that of Great Britain. In all cases employer and employed contribute equally. Men will pay Is. 6d. weekly, women is., juveniles 4d. At the end of five years there is to be an increase of 3d. a week from both parties in respect of all adults and five years later a further increase of 3d. for men only. With the doctors there has been the inevitable sharp debate on remuneration and conditions. A capitation fee of I I s. per annum has been provisionally agreed upon, and a Royal Commission is to review the whole question. Medical attendance for the scattered people of the Outback involves, of course, very great difficulties. The flying doctor segvice will be developed.
Pensions begin at 6o for women (15s.), at 65 for men (20s.). Should a woman wish to raise her pension to the men's level, she may do so by a special weekly contribution of 6d. A woman may on marriage continue her insurance for the pen- sion at the rate of Is. a week. Widows receive 15s. a week until death or remarriage, with 3s. 6d. for each dependent child.
The widows' pensions of 12s. 6d. a week and the allowances for orphans and dependent children are new in Australia, and the Government rightly regards them as a most important part of the plan. The sole qualification is that the husband shall have been insured at death, have been fully in order for twa years, and have paid an average of 26 weeks during the pre- ceding three years. All children dependent upon an insured person are provided for at 3s. 6d. a week. Orphans 7s. 6d. to the age of 15.
The Treasury's contribution comes under three heads : (I) £100,000 annually for the administration of Health Insurance : (2) los. per insured person to meet the liabilities for health benefits : (3) for Pensions £r,000,000 per annum for five years, rising thereafter by £500,o33 per annum until (by 1961) the yearly grant is stabilised at £10,003,033.
To the criticism that a fund so large must be a heavy charge upon a nation still under 7,033,033, the Commonwealth Treasurer, Mr. R. G. Casey, has a convincing reply. He points out that the steadily rising cost of the existing invalid and old- age pension compels the adoption of a contributory scheme.
Rather more than 300,033 are now in receipt of pensions (19s.
per week) at a cost to the Treasury of £16,030,003 per annum. If this system were continued Australia within 4o years would be paying over £30,030,000, whereas it is a reasonable guess that the net annual cost of the completed scheme, with its great social benefit, should not be greatly in excess of that figure. At the start, it is estimated, the number of insurable persons should be about i,85o,o03. With dependants, this means a total of 3,600,003 coming within the range of the benefits—roughly, 52 per cent. of the population.
There is no need to stress the point that in relation to national insurance population figures are of exceeding interest. In 5o years the Australian death-rate has fallen from 35.5 to 16.4. The birth-rate is now 9 per thousanl. The vitality of the people continues to rise, but as in all other modern countries the community becomes steadily more middle-aged and elderly. There are today in Australia 590,030 people over 60— men 210,000, women 380,003. This striking disparity will not decrease. By 1977 the country may have more than millions over 6o, the women numbering 850,033. The population, it is estimated, may increase slowly for forty years and then enter upon a progressive decline. In working out these probabilities the actuaries could not take account of immigration : there are no data. During the past quarter of a century the public provision in Britain for the unemployed and the aged has been a large although never calculable element in the fall of emigration. The new social security policy of Australia brings a new factor into migration policy, that subject of unending and anxious debate in Greater Britain. Once again (in the House of Lords particularly and in the West End of London) the White Australia basis is being questioned or assailed, but the principle is upheld by 90 or 95 per cent. of the Australian people. And yet anyone who sees the island continent with a declining population by 1970 is living in a world of dreams.
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