Full text: Report of the Royal Commission on National Health Insurance

Mw 
Q9 
MAJORITY REPORT : RESERVATION. 
RESERVATION BY Sir ANDREW DUNCAN AND 
Proressor ALEXANDER GRAY. 
1. While concurring in the terms of the Report signed by the 
majority of our colleagues, we consider that there are two further 
matters which ought not to be ignored in any review of the 
problems presented to us, more particularly if due weight is to 
be given to the reactions of our social legislation on the trade 
and industry of the country. In supplementing our assent to 
the Majority Report with certain observations on these points, 
we postulate, as an elementary principle, that in promoting 
schemes of social legislation the State should avoid incurring any 
expenditure which is not essential to the achievement of the end 
in view, and further, that the funds, required and collected by 
its authority, should be so collected as to involve a minimum 
disturbance to industrial enterprise. 
2. The first point to which we wish to draw attention—the lack 
of co-ordination in our social services—is one which has been the 
subject of comment in many quarters. We desire in this place 
to point out the inconvenience, and by implication the waste, 
which it occasions. In a sense this question may not be within 
our Terms of Reference, but it is impossible to survey the field 
of Health Insurance without realising that the problems of 
Health Insurance are closely interwoven with wider questions 
from which, in fact, they cannot be divorced. It would be unjust 
to say that our social legislation has grown up haphazard, but it 
is indubitable that the various schemes contrived for the pro- 
tection of the worker against the accidents of life have been 
elaborated—doubtless very properly—as and when occasion 
offered. Poor Law Relief, Old Age Pensions, Health Insurance, 
Unemployment Insurance, Widows’ Pensions have grown up in 
large measure independently : when they are reviewed, they are 
reviewed independently. They are financed in different ways ; 
they are operated by different agencies. On the possibility of co- 
ordination, on the alternative methods and machinery of operating 
a co-ordinated scheme, we have received no evidence, or only 
incidental evidence; and on all such matters we express no 
opinion. But we do desire to emphasise that there is here a 
problem which calls for urgent consideration. It may be that in 
a co-ordinated scheme different machinery would still be necessary 
for the administration of different sections of the work undertaken 
but prima facie it appears reasonable to assume that an economy 
of expenditure and of effort would be effected by viewing the 
problem of social insurance as a whole and not sectionally. 
3. While we do not dissent from the present arrangements 
under which the employer’s contribution is on a flat rate pro-
	        
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