H4 
MAJORITY REPORT. 
the £250 limit applies to non-manual workers : for the manual 
workers there is no limit whatever. But so far as medical benefit 
is concerned, Insurance Committees are empowered to prescribe 
an income limit applicable to all insured persons for whose 
medical benefit they are responsible. Where such an income 
limit is prescribed in any area, persons above that limit must 
make their own arrangements for receiving medical benefit, 
receiving the appropriate payment from the Committee’s Medical 
Benefit Fund in aid of their own expenditure. We are not aware 
that any Committees have exercised this power, so that a well 
paid manual worker would, under the present system, receive 
medical benefit on the capitation system and thus be quite free 
of any means test. 
133. Another restriction of a similar type is to be found in the 
requirement that a voluntary contributor with over £250 a year 
is not entitled to medical benefit at all, either under the capita- 
tion system or under that known as ** own arrangements,”’ and 
pays a reduced contribution accordingly. Whether this 
restriction is effectively administered we do not know, but in 
any case voluntary contributors form a very small class. This 
provision—although it then related to a lower income limit— 
was inserted in the Act of 1913 to meet the objections entertained 
by the Medical Profession agamst extension of the sphere of 
contract practice to persons who, though initially within insur- 
able limits, might later pass beyond the range of income for 
which voluntary insurance was, in their view, designed. Tt may 
suffice to accord mention, in passing, to the somewhat similar 
provision governing the medical benefit of exempt persons. 
134. These restrictions are significant as embodying in a very 
definite form the means test, even in a system which is in part— 
and so far as the voluntary contributor is concerned in a very 
large part—maintained by the contributions of the beneficiaries. 
135. The medical service provided by the Poor Law authorities 
is an extreme form of the application of the means test. Closely 
akin is the medical treatment provided by the Education Authe. 
rities for school children though medical inspection is provided 
for all, just as elementary education itself is, irrespective of 
means. The treatment of physical defects and diseases is subject 
to strict inquiry into means and to proved inability of the parents 
to provide it themselves. 
136. As exemplifying the opposite principle we may take the 
whole group of services which deal with what is known as 
"public health,” e.g., sanitation, provision for dealing with 
infectious diseases, venereal disease and tuberculosis and the 
Port sanitary service. The cost of these services is defrayed 
out of rates and taxes and no consideration in any form is 
given to the means of those most directly affected. The