Object: Report of the Royal Commission on National Health Insurance

120 
MAJORITY REPORT. 
RA 
surpluses are larger and the additional benefits greater and more 
widely distributed than could have been anticipated : in addition 
the whole picture is drawn on a larger scale as the result of the 
increase in rates of contribution and benefit which were made 
after the War in view of the change in money values. What we 
are concerned with, however, in this connexion is the degree of 
divergence from the average that is shown by particular Societies, 
and this is quite unaffected by the circumstances mentioned. 
Indeed such changes as have come about since the scheme was 
originally framed have operated to reduce the relative inequalities. 
We refer in particular to the establishment of the Contingencies 
Fund and the Central Fund, the purpose of which was to protect 
the Societies in deficiency from suffering either reduction of 
benefits or increase of contributions. We have emphasised these 
considerations because the demand for some measure of pooling 
of surpluses is often founded—as we have shown, erroneously— 
upon the theory that experience has in this respect falsified the 
expectations entertained by the authors of the Scheme and held 
out by them to the public at its inception. Although, however, 
this theory is shown to be untenable there remains in our opinion 
matter for serious consideration in the large gulf which now 
divides the most prosperous from the least prosperous Societies 
as respects the standard of benefits which they are in a position to 
provide for their members. We have shown that on a cold 
analysis the inequalities that exist can be justified. But in this 
matter, if we may apply a much quoted judicial aphorism, it is 
not sufficient that justice should in fact be done; it is equally 
important that the public should realise that it is being done; 
and we are satisfied that on grounds of broad policy it is desirable 
that some concession should be made to the feeling, which we 
believe to be widely entertained, that in a universal compulsory 
scheme of insurance to which a substantial contribution is made 
from the general resources of the State some element of mutual 
aid should be included, by which the more fortunate sections of 
the insured community will be enabled to contribute out of their 
abundance towards the needs of those less happily placed. These 
considerations, taken by themselves, would incline us to view 
with favour the introduction of a measure of partial equalisation 
of benefits so limited in its operation as to preserve the incentives 
to sound and economical administration on which we have laid 
stress above, but at the same {ime going considerably beyond the 
restricted scheme of pooling which was introduced, so far as 
Societies actually in deficiency are concerned, by the establish- 
ment of the Central Fund; and we find that they are powerfully 
reinforced by the further consideration that such a measure would 
set free additional resources that could be applied in the pro- 
vision of extended benefits which are greatly needed and which, 
to be effective, should be provided for the whole insured com- 
munity. We accordingly adopt the principle that the surpluses
	        
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