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WEDNESDAY, MAY 1st.The Medical Profession and the lnsurance Act.

Mr. GRANT called attention to the administration of the medicalbenefits under the National Insurance Act ; and moved " That thisHouse is of opinion that immediate steps should be taken by the Govern-ment to ensure the cooperation of the medical profession in the admin-istration of the National Insurance Act, and that. until such coöpera-tion is ensured, the Act will fail efficiently to provide medical benefit."The honourable Member said that the main object he had in view was toelicit from the Government information as to their relationswith the medical profession in connexion with the administra-tion of the’ Insurance Act. He believed that the fault forthe deadlock did not lie with the medical profession. Thefact that Parliament had to face was that the Government was not in aposition to give the medical benefits which had been promised. If theChancellor of the Exchequer wanted the brains and experience of themedical profession he must fairly and frankly meet its minimumdemands. It was the duty of the Government in any future negotia-tions with the medical profession to treat them not with abuse butwith courtesy and understanding. If they did that, there seemed tohim a chance that the Act would not be a failure, and would carry outthe hopes which had been entertained for it. He understood that itwas anticipated that medical men would be paid 4s. 6d. per insuredperson per annum. Such a payment would not attract the best men, andwould also act as a deterrent to clever young men entering the medicalprofession. £225 a year would not be an adequate sum to pay adoctor to look after the health of a thousand persons. The medical pro-fession flatly declined to work the Act on these conditions, and withoutthem it was unworkable. The profession said that the Act could not beworked at less than 10s. per head, including medicine.Mr. PEEL seconded the motion.Dr. C. ADDISON did not see what purpose the discussion served at the

present time. The questions which the House were discussing werereserved for consideration of an Advisory Committee. That committeewas to meet next week. Surely in these circumstances it was pre-mature to ask the Chancellor of the Exchequer to announce beforehandwhat the Government proposed to do. The resolution did not touchany of the cardinal points demanded by the medical profession. Medicalbenefits could not, under any circumstances, come into operation untilnext January. He hoped that the Chancellor of the Exchequerwould say that he was not going to prejudice the advice which the com-mittee would give. He was sure that the medical profession would notdesire the decisions of the committee to be prejudiced. The BritishMedical Association had appointed 12 members to serve on this AdvisoryCommittee. Did honorable gentlemen opposite think it was going tohelp these 12 members if the Chancellor of the Exchequer took thedecision out of their hands ? He went on to deal with the various pointsin connexion with the Act in relation to the medical profession. Astatutory limitation of ;E2 per week of an income was not workable inregard to the Insurance Act. What medical men wantedwas proper pay under honourable conditions. It was thepatient that was the doctor’s concern, and certainly he did notwant to act as a private detective into the patient’s income. Hehoped that the Government would-and he believed that they would-meet the legitimate demands of the medical profession and give themhonourable conditions for the work that they did. He emphasised thefact that the Insurance Act took the medical benefits away from thecontrol of the Friendly Societies and gave them to the control of theInsurance Committees. It gave free choice of doctors, and he believedthat the result would be to abolish club practice from one end of thecountry to the other.

Sir ROBERT FINLAY remarked that the honourable Member (Dr.Addison) had said that he was the friend of the medical profession.The honourable gentleman was also the political friend of the Chancellorof the Exchequer.Mr. LLOYD GEORGE : Why not the friend of both ?Sir ROBERT FiNLAY: The Chancellor evidently thinks that both

could be predominant. The right honourable gentleman went on tocondemn the contract system as bad both for medical men and patients.The tangle into which things had got was due to the way in which theBill was rushed through Parliament. The medical profession werethoroughly united in their attitude of hostility towards the terms thatwere being offered to them.

The Chancellor of the Exchequer and the Medical Profession.Mr. LLOYD GEORGE, replying to the debate, said that the Insurance

Commissioners had to-day received a letter from the Councilof the British Medical Association asking them to meet them,and the Commissioners replied that they would. The righthonourable gentleman went on to say that 75 per cent. of the Idemands of the medical profession had been embodied in the Insurance Act. It was impossible to adopt a uniform income ’,limit applicable to the whole country, but the machinery had I,been set up to fix the minimum in each district. There was inot a single demand in regard to the character of the machinerywhich was asked for to which the Government did not agree. ISurely all that should be recognised. The income limit was a matterto be discussed in the localities themselves, where regard could be hadto the wages of the district and to the conditions under which medicalpractice had been carried on in the past. There had been a good dealof discontent with contract practice on the part of medical men. Itwas justified in many cases. There was nothing in the Insurance Actwhich enforced contract practice. It did not prescribe contract prac-tice anywhere. It simply said that there could be provision formedical attendance. He had no desire to extend contract practice.He did not introduce this Act with the desire to extend contract Ipractice. There were four courses under the Act in relation to medicalbenefit. The first oorrse was that where there was contract practice at Ithe present moment and the medical profession were prepared to goon with it, they should put it on a fair and eq mtable basis. Thenegotiations which would take place ought to ensure that themedical profession got a fair return for their services in those dis-tricts. The second course, which applied to places where the medicalprofession would not agree to contract practice or where contractpractice was unsuitable, was the method of pooling all themoney available for medical benefits in a particular district.All that money should be divided amongst the medical pro-fession in proportion to the bills bent in. If there was a

deficiency it was made up by the patients themselves. The third

course was that the sum of money which was set aside for medicalbenefit should be returned to the individuals. The last course wouldbe to pay the contribution to the Friendly Society itself and letthe society make its own arrangements. These were the four courseswhich were open to the Commissioners and the medical profession.The right honourable gentleman went on to say that he hopedthat the House would not at this stage interpose any obstaclesto a practical settlement which would be satisfactory to allparties. It was the sincere desire of the Government to meet thelegitimate wishes of the medical profession. The Governmentwere, in fact, in negotiation with them. They had set up theAdvisory Committee, on which there were 33 members of the medicalprofession out of a total of 161. The committee, he hoped, would appointsubcommittees to deal with this matter, and on them the medicalrepresentation would be considerable. The House must await the report ofthe committee before they pronounced any judgment on the best method.He did not think that that was an unreasonable demand to make. Hewould appeal to individual Members of the House of Commons during thecourse of the next few weeks to cooperate in bringing these negotia-tions to a successful conclusion rather than to put difficulties inthe way.’ He was certain that there would be a patrioticresponse to that appeal. This was a matter of great con-

sequence not only to this great profession, but to the 15 millionsof insured persons. He thought that everyone would agree thatto demand £3,000,000 in addition to what was already providedwas a demand which the friends of the medical profession them-selves would admit was excessive, but he was not complaining thatthey should put forward their highest demand. The Governmentwould enter into these negotiations without any prejudice at all.They should enter into them with a view to see that the medicalprofession was adequately remunerated for the very great,onerous, and responsible work which it was discharging. Hetrusted that on both sides they would get the negotiating temper.He did not say that it would be possible to get an arrange-ment with the medical profession without asking the House ofCommons to make some additional provision. This was a matter whichwould be made clearer when they embarked upon the negotiations. Hepointed out that there were very considerable benefits in the Act besidesthe medical benefit. It was far better that the arrangements for medicalbenefit should be made through the machinery provided in the Actthan by the Friendly Societies themselves, because the Act providedelaborate precautions for the purpose of protecting medical men againstany unfair bargains being forced upon them by competition amongstthemselves. He saw no reason why the Government should not assentto the motion.The motion was agreed to unanimously.

Appointments.A

Successful applicants for Vacancies, Secretaries of Public Institutions,and others possessing information suitable for this column, are

invited to forward to THE LANCET Office, directed to the sub-Editor, not later than 9 o’clock on the Thursday morning of eachweek, such information for gratuitous publication.

ADAMSON, OSWALD, J. W., L.R.C.P., M.R.0.S., has been appointedSenior House Physician at the Prince of Wales’s General Hospital,Tottenham.

Asarorr, GEORGE,fM.D. Viet., has been re appointed Medical Officer forHome Patients at the Manchester Royal Infirmary.

DONNAN, W. D., M.D. R.U.I., has been appointed Certifying Surgeonunder the Factory and Workshop Acts for the Holywood District of

, the county of Down.DUFFIELD, FRANCIS A., M.B., Ch.B. Edin., has been appointed Demon-

strator in Experimental Physiology and Pharmacology in theUniversitv of Sheffield.

ECCLES, W. McADAM, M.S. Lond., F.R.C.S. Eng., has been appointedSurgeon to St. Bartholomew’s Hospital.

EDE. C., M.B., B.C. Cantab., has been appointed House Surgeon at theDreadnought Hospital, Greenwich.

GARLAND, ALBERT I., M.R.C.S., L.R.C.P. Edin., has been appointedClinical Assistant to the Chelsea Hospital for Women.

GiBSON, A., M.B., Ch.B. Edin., has been appointed House Surgeon atthe Dreadnought Hospital, Greenwich.

GREEN, JOSEPH, M.B., M.S. Glasg., has been appointed County SchoolMedical Officer for Lancashire.

HAYES, G. CONSTABLE, F.R.C.S. Eng., has been appointed Lecturer inOtology at the University of Leeds.

JEFFERSON. J. C.. M.R.C.S.. L.R.C.P. Lond., has been appointed JuniorHouse Surgeon at the Manchester Royal Infirmary.

LAWSON, R. S., M.B., Ch.B. Edin., has been appointed House Physicianat the Dreadnought Hospital. Greenwich.

MACCoRMAO, HENRY, M.B. Edin., M.R.C.P. Lond., has been appointedAssistant Physician for Diseases of the Skin at the DreadnoughtHospital, Greenwich.

McEWAN, W. C., M.D. Edin., has been appointed Certifying Surgeonunder the Factory and Workshop Acts for the Tranent District ofthe county of Haddington.

MARTYN, V. C., M.R.C.S., L.R.C.P. Lond.. has been appointed ClinicalAssistant to the Chelsea Hospital for Women.

PAUL, C. B., M.B., B.S. Edin., has been appointed Assistant Surgeon tothe Cumberland Infirmary.

PERDRAU, JEAN RENE. M.B., B.S. Lond., M.R.C.S., L.R.C.P. Lond..has been appointed Senior Assistant Medical Officer and Patho-

logist at the County Asylum, Herrison, Dorchester.PHILLIPS. B., M.B., Ch.B., has been appointed House Physician at the

Dreadnought Hospital, Greenwich.RUSSELL, D. H., M.B., Ch.B. Edin., has been appointed Second Assist-

ant Medical Officer at the County Asylum, Herrison, Dorchester.TRAVIS, G. L., M.R.C.S., L.R.C.P.Lond., has been appointed Certifying

Surgeon under the Factory and Workshop Acts for the LlandudnoDistrict of the county of Carnarvon.

WILLIAMS. J. R., M.D. Edin., has been appointed Certifying Surgeonunder the Factory and Workshop Acts for the Conway District ofthe countv of Carnarvon.