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MAJORITY REPORT.
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128. Between these extremes lie those who would retain the
insurance principle as a means of raising part of the necessary
funds and would weave it, in some way not very clearly defined,
into the financial web. For example, the British Medical Asso-
clation contemplate a line drawn horizontally across the structure
of society. Above that line everything is to be left tc private
effort, except those services which are of a, public health character
in the strictest sense. Below that line they would admit a com-
prehensive service embracing all medical elements and incor
porating all the activities of the local authorities which stand at
present apart from the insurance service. The service which
would thus be limited so far as concerns those for whom it would
be available, although in its content of the widest scope, would
be financed from a combination of public and insurance
funds. The principle governing the limits within which such
a service would be available is enunciated in the following words
** The medical provision should be available for those persons,
and only for those persons, who would be unable to obtain it
without the help of an Insurance Scheme the medical
provision made for such persons should be, as far as possible,
complete.”” (App. XI, VII, 8; Q. 14,689-14,708, 14,806-14,817.)
In other words, the witnesses who appeared on behalf of the
British Medical Association, contemplate a unified and complete
service resting in part on insurance funds which should, however,
be restricted to the poorer classes of the community.
129. On the other hand, such a scheme would be broader than
the present scheme of Health Insurance, as it would ignore
the distinction between those employed under a contract of ser-
vice, and those working on their own account who are at present
outside the scope of the Acts. This scheme would, moreover,
include the dependants of both these classes. We questioned
the witnesses closely as to the income limit at which the line
should be drawn, but did not receive any very definite suggestion
on the point. They apparently contemplated something sub-
stantially higher than the present destitution test for the com-
plete medical attention given by the Poor Law authorities, but
lower than the present insurability limit for non-manual workers
(£250 a year), with the further proviso that dependants should
only be included if the person on whom they were dependent had
an income substantially below that figure. The general effect
of these proposals would be to exclude from the scheme instituted
by the State a substantial number of the present insured class
but to bring within the scheme a greater number than those so
excluded, consisting of the dependants and of the various classes
of persons of small means at present outside the existing insur-
ance scheme. To this enlargement of the sphere of * contract
practice,” there appeared to be no objection on the part of the
British Medical Association, assuming that a sufficiently low
income limit should be conceded in defining those for whom