I move—

Sir, what I am going to say here to-day, I say in a constructive spirit, and if my criticism of any present services are viewed in any light at all, I would like them to be viewed in the light of constructive criticism and not destructive criticism.

One of society’s greatest problems not only in our own country but throughout the world is the ever-increasing burdens placed on individuals and on the State to combat and overcome ill-health. The problems facing us today are greater than they were in years gone by and they will not easily be solved, but if they are tackled now and tackled energetically, I feel that at the very least we can lighten the burden that is placed on the individual considerably. I do not think that money alone can solve this problem. I think there has to be a willingness on the part of all sections of the community to work together to solve the problem that faces us at the moment. We have to have co-operation between the individual, the State, the doctors, the chemists, the nursing profession and the provincial services. At the moment there is some loose link existing between these present organizations, but I feel the time has come when we have to correlate those things which we have to-day and get the best out of them; that we should make them work efficiently and make them work in such a way that all people who wish to enjoy the benefits of medical science and the benefits that the Government can give them will be able to have some stake firstly in what they are working for and secondly some assurance of security for the future.

Now, Sir, what are the problems? Firstly, there is the problem that faces the individual when he gets ill. There is the pain and the suffering and the anxiety that go with illness; secondly, the patient, if he is an adult, has to consider the cost of the illness and thirdly, he has the additional anxiety, if he is the wage-earner, which goes with loss of earnings during an illness, but he also has the fear that because of the illness he may possibly lose his employment. This anxiety of the patient is one of the great problems that we have to face. Many of the mental ills and the psychosomatic diseases are already associated in some way or another with financial difficulties. When the person who is ill has the additional anxiety of not knowing whether he is going to be able to afford to pay for his illness, I feel that his basic troubles will be aggravated during the period of treatment and will not respond to treatment as he would if he had a clear mind and knew that come what may he would be assured of being able to meet the expense of the illness. Sir, I do not think that the minor illnesses that we find in a home—the everyday coughs and colds and the little infectious fevers—present any great problems. I do not think they are probems which we cannot meet in our ordinary every-day life, and I think that they can quite easily be met by some pre-paid medical insurance. It is the major illnesses which constitute the great problem, and here we are faced with the difficulties which have come to the individual through the advancement of medical science. Not very long ago a major illness very often was met by a general practitioner or even a specialist with the phrase, “ I am sorry, I cannot do more for you ”, and very often the patient was left to die. His pain and suffering were alleviated but his chances of recovery, his chances of being put back into an active and productive life, up to just a few years ago, were virtually nil. With the advancements which have been made; with the new techniques in surgery and with the new medicines which have been discovered, we find that the hopeless case to-day is not viewed in the same light in which it was viewed some years ago but that every hope is given not only to cure the disease, not only to keep the person alive but to keep that person an active citizen. These techniques which have been evolved, especially in the field of surgery, require a team of workers, special facilities in the hospitals, special accommodation in the wards, special drugs, special nursing and naturally a special, a very special banking account. How can the ordinary individual today face an operation in the case of a child who has to have the chest opened and the heart operated on? We have all read of the miraculous cures which have been made in recent years in heart surgery, but I want the House to know that it is not one person who does the operation; he has a team of experts to assist him, men who are specially trained in that field of surgery, and they work for hours and hours a day doing one single operation. Can you imagine what the bill at the end of the operation is like? How is it possible for the individual, who is a working man at even R40 a week, which is considered to be a good wage to-day, to meet such an emergency? But it is not only in those fields of surgery that we find increased expenses with the new techniques; there are many other fields. From the head to the toe there are new methods of approach, new ways of treating disease, new ancillary services and new expenses. Those are the problems that not only face the individual and the family but those problems of payment have to be met and faced by the existing schemes of Medical Aid Societies. Sir, is the present medical aid system capable of facing up to this type of expense? Have they got to make special provisions and set aside certain sums for this type of emergency? Fortunately it is not an everyday occurrence but it may quite easily be, and for that one reason alone—the difficulty of the individual and the difficulty of the existing medical aid societies and the existing benefit societies—I say that investigation, and correlation after the investigation should be done so that the problem can be met more easily. The State has its own problems, and what the individual has to meet in his own private capacity, the State now has to meet perhaps one hundredfold, because in its organizations as they are set up to-day, in the provincial hospitals and some of the Government hospitals, we find that greater time is needed for these operations, for the special techniques, bigger staffs are required, and the doctors who are employed by the State have got to reach certain stages of speciality before they can undertake this type of work. So it means that not only is the State faced with the additional expenditure for this work, but also they are facing a risk of not being able to provide sufficient staff to do the work. We are fortunate in this country, Mr. Speaker, that we have got in the medical profession and in the nursing profession a band of people who are willing to learn, to go overseas and learn the best techniques, and I am happy to say that in the main they are true South Africans, and the true South African doctor after he has got as much knowledge as he possibly can get, as much knowledge as he can gain from overseas techniques, is only too pleased to come back to our country and work here for us. To those people who have done that, I think, we in this country owe a great debt of gratitude. Because not only have they gone over and learned, but to-day those very same people are the teachers of the younger group of medical practitioners. So that the State then has got a further burden, a further problem to meet, and the State must make sure that we produce sufficient medical men in this country who are able to learn the technique that the others are able to teach them. Not only must we have a first-class team of specialists, but we must make sure that we have sufficient of the general practitioner type of doctors. With the increase in population, the State has got one further problem. As things are at the moment, the wage structure being what it is, are the people in the lower income groups able to pay for any kind of medical assistance? That requires some sort of investigation, but you will find, Sir, that as costs go up, and they are ever-increasing as the hon. Minister knows, bigger and bigger demands for free treatment from a larger and larger group of people. How is this going to be met? Will it be met in the hospitals, will it be met by the district surgeons? If my information is right, the district surgeons are already inundated with work. Those doctors who are district surgeons on the platteland for instance, have got to travel miles and miles today to see a handful of patients. There are not enough hours a day for them to get their work done. They are willing to do their work. And in the hospitals in the towns where individuals go to the hospital because they cannot afford private treatment, we get an unavoidable state of affairs which we of the medical profession feel very unhappy about—long queues of people waiting to be attended by the doctors on duty. One tries one’s best in hospitals to accommodate as many people per day as possible and to give the best possible treatment, and they do get very good treatment. But, Sir, can we imagine what the individual who is ill feels like, after he has travelled with a sick body from his home, by bus or by tram, to the hospital, and then has to wait to pass through the portals at the entrance where it is determined whether or not he is able to pay something towards the cost. Then he has to wait until a file is made out for him and a card is made out for him. Then he takes his place again in the queue and awaits the attention of a doctor. These are unavoidable waits. Those of use who are in practice still know how long a patient waits in a busy consulting room. It is unavoidable. But how can we make things easier for the individual? Surely the method would be to try one’s best that where necessary one should be able to send a doctor to the patient. If it is found impossible, then for the patient to go to the hospital.

Let us consider the question of an old-age pensioner who is ill. Let us take that man as an example. He probably falls in the lowest scale of income. The old man who is a pensioner gets ill with a cough, and he says “Well, I can’t get a doctor, I can’t afford to pay a doctor. What shall I do?” He takes, very often something from his meagre pension, and goes to a chemist and buys a bottle of cough mixture in the hope that it will cure him. Well, old people very often get worse. They do require medical attention. And things develop rapidly. In a matter of days they urgently require medical attention. Can that pensioner get a doctor to come and attend him? I know from my own experience that doctors would be willing to go and not charge these people at all. We have done it all this time, over and over again, day after day; but we do not want to continue doing it, not because we do not want to give the service, but primarily because of the other demands on us. So we say: How can this person get in touch with a district surgeon for attention? And there the scheme very often breaks down. There is no connecting link. These people very often don’t even know that they can get that sort of attention, and it is only through the advice, very often, of the attending general practitioner that he learns that he can get district surgeon service. Otherwise if his illness justifies it, he is sent to the hospital by the doctor. But there is such a demand for beds in the hospitals that a casualty officer who meets what he considers not a serious illness, has got no compunction whatever to send that man back home again with a bottle of medicine and a box of tablets. They may be first-class tablets, they may have given the right bottle of medicine, but the man goes back to his room again and he lies there and he does not get better. He has to get out of his sickbed again and make another attempt to get into hospital. And remember that these people are not living next door to a hospital. They have to travel, and very often they find it almost impossible to pay the small transport charge from their own rooms to the hospital.

Then we go to the problem of the individual who has got a family and has got to meet illness there. To some extent the same thing applies. Minor illnesses he is very often able to meet, but when it comes to the major illnesses, he is faced with one or two alternatives. Either he gets in a doctor and he decides beforehand that he is going to pay what he possibly can, and that is all he can do, or alternatively, he is going to seek admission into a hospital. Now that is not easy, because in the Transvaal and in the Cape and in Natal and in the Free State you cannot just walk into a hospital if you are earning a certain amount of money. You have got to pay towards it. But what I have read I think is correct: In the Transvaal only a small percentage of the working population are admitted into hospitals. I read the other day in an article in the Transvaler that in Pretoria there is an amount of more than Rl,750,000 owing to the hospital by patients who have already left the hospital. That amount is still owing to the hospital by patients who have received treatment and gone out of the hospital and who have failed to pay their accounts. That is another problem we are faced with. These are all problems that the individual is faced with or the State is faced with. What can we do to_; alleviate this state of affairs? We have in existence to-day several methods of help. We have the benefit society schemes, the medical aid schemes and we have got the private insurance schemes, and then we have that group of people who have practically no problem facing them at all and those are the people that the State looks after, the people in the services, the soldier, the sailors, the airmen, the police. They are looked after by the State and their problems are not very great.

Now I come again to the benefit societies. Here we have got a scheme that has been in existence for well over 50 years and it consists of a method whereby the employer ensures his workers against illness and he insures the family of the worker at the same time. In its way it is a good scheme, but it has its drawbacks. One of the big drawbacks of the medical benefit society is the fact that there is no choice of doctor, that the individual who belongs to the benefit society has a limited panel of doctors from whom to choose, that there are very often limitations in prescription and very often limitations in the type of hospitalization. But they do make a very great contribution to the welfare of the individual who is a member, and there are many of these people belonging to a benefit society, and the benefit societies which are at present in vogue are those run by the mines, Iscor, the Johannesburg Municipality and certain other groups. Those are closed panels, there are limitations of prescription and hospital facilities. Then you have the insurance companies. They insure people against illness on a business basis. You pay so much to an insurance company and you get certain benefits. They have their conditions which are laid down beforehand, and if you want to abide by those conditions, good and well. They say, for instance, that if you pay so much a month, we will pay so much towards your illness, and if you want us to pay the doctor, we will pay the doctor what we consider a fee adequate for the services rendered. We say that you cannot get any insurance before you have established yourself with the association over a trial period. In other words, you may be paying for two or three months, without receiving any benefits. It is not a very popular system and I am not so sure that it is a very good system, but it is available to people who want it and if those people subscribe tb that system, it is their business; they do it voluntarily and nobody is going to ask them to leave it and nobody is going to force them to join.

And now we come to what I consider the most popular and the best system. That is the medical aid system. Here we have a growing group of people who for the good of their fellow-workers have banded themselves together to provide a service for those people who wish to join. The medical aid societies charge a fee and for that fee they give a service. They are able to negotiate with the medical associations, the pharmaceutical societies and get preferential tariffs for their subscribers. The medical aids are run on a voluntary basis, and the only amounts of money that are deducted from the subscriptions are the amounts that are required for administrative purposes. We find that on the whole the close on 200 medical aid societies that we have in South Africa to-day, almost 180 of these, are associated in some way or other with the medical association, who in turn have given these medical aid societies their blessing. They are good, they are very good. The doctors are satisfied, the patients are satisfied and because of the value to our community I feel that the time has come for us to correlate all the goodness that these medical aid societies have brought to us, that we must find some sort of uniformity; that we must ascertain how it is possible to run these societies as economically as possible and yet at the same time give to the subscribers as much as possible. I feel that, from the investigations that I have made, the time has come for our state, our Government, to take a hand in helping these medical aid societies, not directly—that I don’t think anybody will advocate, but help can be given directly to the subscriber. That is the importance of having a state medical aid scheme and a scheme whereby the subscriber is helped to contribute to a medical aid scheme. I want to make myself perfectly clear. I want to say that nobody in South Africa, I feel, who has considered the problem carefully wants a state medical scheme. We don’t want medicine to be nationalized here: We want freedom for the individual to choose who shall attend him in his illness. We want freedom of the individual to choose who shall receive his contributions and we want freedom of the individual to be able to say to whom he will go and where he will go when he gets ill. These are very, very important considerations and I don’t think there is any doctor practising in South Africa to-day who would agree to a state medical service, and I don’t think our Government would sponsor such a service. What we want is a building up of the existing facilities. We want those facilities encouraged to grow and to give more and more facilities to more and more people. But, Mr. Speaker, the lower income groups are finding it more and more difficult to join these benefit societies, and as the fees for treatment go up, in whatever branch it is, so we will find that the demands on the individual will grow, and instead of the membership of these medical aid societies growing, we will find that many will have to fall by the wayside because the individual cannot afford his subscription. So what I would like is for the Minister to consider carefully whether the time has not come for our Government to assist the individual who subscribes to the existing medical aid societies. I have heard some fantastic stories about the cost of such a scheme for the Government. But I know, and some of my colleagues here will agree with me, that you can get a very good service, probably as good as anywhere in the world for a monthly contribution of R8 for a family. We have got a population of 3,000,000 Whites. Let us say that represents 1,000,000 families. That means that if a contributor pays R8 per month for himself and his family, the income derived by the medical aid societies, if all were insured, would be R8,000,000 per month, R96,000,000 per annum. Now if the Government would contribute R for R, it would mean that the Government would have to contribute R48,000,000 per annum and the subscribers would have to contribute R48,000,000. But remember that this is a voluntary scheme and we will not have as many people as that contributing and the cost to the Government would not be as high as that, because from the 1,000,000 families we have to deduct those who are in the services, those who. are being accommodated free board and lodging in the various prisons (quite a lot) and those who are unable to pay any form of contribution to the scheme because they just have not got the money to pay—the pensioners, the lower income groups. I said it was a voluntary scheme and there is no reason as far as I can see for the million families to be made up not only of White people …

Where will the money go?

I am coming to that. But I am saying that it should not only be available to the White people, but if a Coloured in the Cape region should wish to join the medical aid scheme, he should be allowed to do so, and if the Indians in Natal wish to join, they should be allowed to do so. But remember that it is not going to be a uniform Scheme, so that there would not be a fixed contribution. The lower income group would still perhaps be able to pay less than the upper group, but those are details which I do not want to go into, because we would only get ourselves tied up. But I would like to say that broadly speaking we could get a first-class service for 1,000,000 families if the individual contributed R48,000,000 per annum, and the Government contributed R48,000,000. Now the hon. member for Vanderbijlpark has asked me where that money will go. That money would go where it goes now, in the main to the existing medical aid schemes. I for instance would like to join Scheme X, the hon. member for Vanderbijlpark would join Scheme Z. It may be a matter of convenience. It may be better for me to join a scheme that is established in the Cape than for me to join a scheme that is established in the Transvaal. So there would be the schemes in the various provinces and they would remain established under the Friendly Societies Act. There would be no danger of any squandering of money. They have been in existence voluntarily, they are rendering services. Now once you get the help from the Government in a matter of this kind, automatically one would say “Well, the Government will take over control”. I don’t think so. That should never be necessary. I for one would never suggest that such a scheme should be brought into being without the watchful eye of the Government over the distribution of the money. So that committees should be established in the various provinces consisting of individuals elected by the contributors, by the medical aid associations, by the medical associations, by the pharmaceutical associations, and these people should be there to keep a watchful eye on the organizations and help them to run their affairs properly but without too much interference. It will not be easy. None of the things that come into existence find it easy at the beginning. We know from experience that for 15 years the Medical Association has agreed that medical aids are running their affairs efficiently. And those medical aids that do not run their affairs efficiently fall by the wayside, but every few have done that. They continue to grow; they grow with difficulty, but they grow for one reason and that is that there is a demand for help and people are willing to take their last penny and subscribe to medical aid societies. I am concerned, Sir, with those people who cannot afford R8 per month to ensure the health of their families. It is for those people primarily that it becomes so important for the Government to step in and give assistance.

I am not afraid of the bogey that some medical people are afraid of that all the rich people of the country will join these medical aid societies, grab what they can and pay as little as possible.

They will join.

If they want to why shouldn’t they? But I know what the rich people are, like. They want their own doctor, they want, the prescription written in such a way that they are absolutely certain that it is the correct thing. In my own practice, Mr. Speaker, I have had people coming to me and saying: “Doctor, please don’t write your prescription on the Benefit Society form; give.it to me privately”. They honestly and truly think. that writing a prescription on a piece of my private paper is far more safe than the one which, is written on the Benefit Society form. People have these ideas. When the rich man goes into hospital he becomes very important. All his friends know he has gone in. He wants a private ward; he; wants a telephone; he wants flowers; he wants a day nurse arid a night nurse; he wants his business associates to contact him in the hospital. He has become; a very important person during that time. He. does not want one doctor, he is not satisfied with his family doctor’s diagnosis, no, he wants a consultant and then he wants a second consultant. And what does his wife say at the tea table: “What do you think? He is terribly ill. He had four doctors to-day.” Everybody says: “Is that so? Tell us all about it” and so it goes on till it becomes quite a business. Do you think a man like that is going to join a medical aid and that he is going to go into a general ward? Never. There is no danger of that happening. A number of my colleagues are going to be afraid that the high fees that they have charged in the past will not come to them if people are allowed to join medical aid societies. My own associates would like to see a set-up where people earning more than £2,500 per annum should not be allowed to join medical aid societies. Psychology being what it is there is no real danger of the very rich man wanting to join a medical aid scheme. Because he thinks it is something inferior. He still wants to say: “I had to pay 250 guineas for my wife’s operation”. He wants to brag about how much money he has paid and what it has cost him. I am not concerned about those people. I am concerned about the little man with a family of five or six who is afraid that anybody in the family should get ill. That is the person that I want to see helped more than anybody else. If the others want to come into the scheme let them do so.

Mr. Speaker, I have bundles of notes here, but I do not think it is necessary for me to go through them all. I have been speaking for nearly three-quarters of an hour, but I just want to read what Lord Cohen of Birkenhead said recently. He is a leading man of the medical profession in England and he said this a year or two ago—

He said that in England upon the introduction of a national health scheme. I have said that we do not like it. I am talking for myself but I am also talking for a number of my colleagues. But if he as a leader of the medical profession can say that, as far as State medical scheme is concerned, how much more pleasant would it be for this country if we had a voluntary scheme in which the individual was helped by the Government. I do not want to elaborate and keep telling you what good things will come of it. But let me just briefly reiterate that the cost will not be prohibitive, that the existing services which we have can be built up by this scheme, that the Government will still be required to give assistance and virtually run those services which it runs at the moment such as the mental health services, the infectious diseases services, the vaccination services. All those services must be continued by the Government. Only later when the time is ripe, will they be included in a medical aid scheme. But there is one branch which I mentioned first, namely the mental disease service, which has become so integrated in our ordinary health, where we are finding it difficult to separate the one from the other, that they will very soon have to be bracketed with normal health and normal ill-health. Medical aid schemes will have to look after those people. I have said, Sir, that the cost is within the reach of the individual if he is helped and I do not think that it is going to be a bad investment for this Government to assist the individual to maintain this scheme, to get it to grow, to get more people to join it, because in turn we will have a healthier country, we will have a better and healthier working force and the Government will recoup itself not only in respect of the loss it suffers to-day in the loss of manhours because of illnesses which are not properly treated, but financially a great deal of the money which the Government pays to the individual to join the medical aid scheme will come back to it, it will be paid back into the coffers of the provinces through the hospital schemes. It will not be a case of giving the money to the individual and getting nothing back.

Before I sit down, Mr. Speaker, let me just say one thing. We must not confuse the high cost of medical treatment to-day with the apparent high cost of drugs. That is only one branch. I for one do not believe that the chemists are making such fortunes in serving drugs to the public as is commonly believed. You know, Mr. Speaker, the changes that are taking place day by day in antibiotics alone and the number of new antibiotics that come on to the shelves of the chemist shops, are becoming almost fantastic. Drugs are put on to the shelf at the beginning of the year and by June of that year they are already out of fashion. And the chemist is left with those drugs on his shelves. The wholesaler does not take them back and a lot of them become dated and useless. I have been told over and over again that the chemist shops are just like bazaars to-day, they sell everything. Well, I do not think for one moment that a professional man is going to sell toys in his chemist shop if he did not have to do that to keep going. When we talk about the profits made by chemists on their drugs you cannot compare that with the profits made by a dress shop or a shoe shop. If the shoe shop or the dress shop has an accumulation of clothes or shoes on its racks it has a sale. Do you think a chemist can have a sale of drugs, Sir? Do you think he can start selling drugs at half price? So what happens? They go down the drain. Both of them sometimes—the chemist and the drug. I think too much stress is being laid on the fact that drugs cost a great deal of money to-day. It is not the chemist’s fault entirely that antibiotics cost so much. The manufacturers say: “I have spent millions of pounds on research. You in your country, in South Africa, have no research projects as far as drug manufacture is concerned. You get the benefits of what we have done in America or Germany or Switzerland. So you must pay.” A great many of these drugs, when they have been perfected, are sold under permit, under licence. That gives the manufacturer the right for 15 years or more, I think, to charge what he likes during that period. I am speaking from memory but I think when penicillin was first introduced we paid 27s 6d for 100,000 units and to-day we pay 2s for three million units. The price has come down because that period of protection that the manufacturer had has expired. There is competition, the know-how has been spread to other companies. The price has fallen from 27s 6d for 100,000 units to 2s per three million units. So you have it all along the line. I think three years ago aureomycin cost R7 for 16 capsules, to-day it is R4 for 16 capsules. They are bringing down the cost, but we in South Africa pay; we are paying higher prices than they do overseas because we have not got the facilities for our own research workers to produce these drugs. While we are importing them we have got to pay for the privilege. So remember. Sir, the cost of drugs, however high it may seem on the face of it, is not because the chemist has been making fantastic profits. But there is a gradual tendency of increases in prices throughout the service. Before the war a doctor’ fee for a visit was 10s 6d, R1.5c. Today it is R2.50c. I do not know what my colleague from Durban (Central) (Dr. Radford) charges, but I think his fees have gone up 100 per cent. I am not sure but he will tell us presently. He is in the upper income bracket. The same is the case of hospitalization. The costs there have gone up. Theatre fees have gone up etc. So do not say that if you can bring down the cost of a prescription the problem will be solved. That is not the problem. The problem is this that the people are not earning enough to-day in the middle income bracket to pay for an efficient medical service. That is the crux of the matter. And to provide an efficient medical service we need help. Assistance is being given at the moment by the Medical Aid Association and their medical aid societies. We now want the Government to help by giving a contribution equal to that which is paid by the subscriber.

Mr. Speaker, I am very sorry that, when a matter such as this is under discussion, the attendance in the House should be so sparse. We know that there are two or three Select Committees sitting who have taken a number of the members away. But let me say this, Sir. To me. legislation of this kind, when introduced, is of the greatest importance. It is time that we in this House should remember that the welfare of the people is of far greater importance than some of the legislation that is put through this House and gets a full attendance because it happens to have the added attraction of noise. To me. Sir, this is what the country wants. That is the reason why I have spoken here to-day and that is why it gives me great pleasure to move this motion.

I second. Mr. Speaker. My colleague, the hon. member for Rosettenville (Dr. Fisher), has outlined very eloquently the skeleton of the scheme. At the moment it is only a skeleton and should be regarded as such. I do not propose to fill in the flesh on the bones, but rather to join him in advocating that such a scheme should be seriously considered by the Government.

Before doing so, Sir, I look around the House and I remember last Friday when we were faced here with a horde of attackers pointing out to us the grave mistakes of the medical profession. To-day not one of those attackers is here in the House to give us a chance to show to some extent the unselfish nature of the profession to which I have the honour to belong, a profession, Sir, to which every man in this House owes a great debt, particularly for the communal work which the profession has provided. Every time hon. members drink a glass of water they should say: Thank God the medical profession has seen to it that we get clean and healthy water. The milk supplies of the country, the sanitation of the country, the good and clean food of the country, the personal hygiene of the country, all these are matters which are the result of great discoveries most, Sir, by that great surgeon, Lord Lister, who pointed out that it was the germs with which we walk this earth and which we carry with us that cause contamination. We have the communal service of the tuberculosis service; we have the communal service to deal with infectious diseases. All these, Sir, are State projects fathered by the medical profession. And now we come forward because we feel that the one field which has to some extent been neglected, the one field in which the State has let the policy of laissez faire perhaps go too far, is the field of the personal health of the individual. We feel that the time has come, as so many other countries have found, when the State must step in and try to provide a health service. Great Britain, as my colleague pointed out, introduced a national health service scheme in 1948. Other countries such as New Zealand, have done the same. But I do not think that this country can possibly carry a type of service of that character. We must, therefore, look around and see what we can do, what we can suggest to make provision. Provision that will give to the individual citizen the freedom to consult a doctor without considering the cash and which will remove from medical practice much of the mercenary element which circumstances have forced it to introduce over the last 50 years.

One of the great movements in this country, one which some of us at times perhaps view with a little suspicion and doubt, is the great co-operative movement which government, all governments, have from time to time introduced into the life of this country. Co-operation in trade, co-operation in farming, cooperation in carrying fruit, etc. and selling it. And this, Sir, is a scheme of co-operation; a scheme fathered and helped and supported, we hope, by the State, but carried through by those who partake of it on the one hand and the doctors and the nurses and the various ancillaries of medical service on the other hand. Any scheme of this nature must have Some form of local control. My own experience in practice over many years with this type of society has taught me that there will always be complaints. There will always be difficulties. There will always be local conditions which vary from one place to another and so this scheme must in general follow the principle of co-operation, and local co-operation. My experience has taught me that in general the public do not grumble about their contribution. It is curious that they grumble about most things they have to pay for but they rarely grumble about the contributions to their sick fund. For very many years I was the senior surgeon for the Railways and Harbours in the Natal system and I heard grumbles right and grumbles left, grumbles about conditions of service, grumbles about pay, grumbles about sick leave, grumbles of all kinds but I cannot recall one man grumbling about the deduction which was made for his sick fund. I go further and say that individuals, faced with a long illness in the family will deliberately join the Railways in order to enjoy the benefit of its sick fund. I am speaking about things I know. A married man who has a child born with club feet will leave his job and take a job with the Railways because he knows he is faced with a long expensive treatment for that child. When a husband has exhausted his funds on a querulous and complaining wife he will join the sick fund so that he can at least say to her: Go and see the sick fund doctor. It is a god-send to those people who are faced with long illnesses to be able to feel that they are not going to be faced with high expenses.

Any scheme will be faced with certain problems which must be foreseen. In the first place, nearly all the existing schemes consist of selected individuals. On the Railways, for instance, the man is sent for a medical examination before he is accepted for employment. Admittedly his family is not examined. An effort was made for some time by doctors to have the wife examined before employing the husband. However, that was never accepted by the sick fund authorities and I must say in my younger years I was inclined to agree that it was hardly right that the sick fund should dictate to whom a man should be married. But the fact remains that these sick funds consist of selected persons. Even individuals who enter the banks, although they are not examined, are questioned about their health. But they are young and if they are not healthy individuals they soon fall by the wayside. The bank gets rid of them and so they get out of that particular benefit society. Any State scheme will be faced with the problem of an extra load, an extra load of people who have failed to enter the existing schemes. The tendency will be for the better lives to go into the existing schemes. That is just one aspect to which I wish to draw attention. I agree with my colleague on my right when he said that the expense would not be high. I believe that on a very moderate cost—I would not venture to consider the actual figure; because there are more well people than there are sick people, and the well people pay for those who become ill—such a scheme could be introduced. That is the whole basis of the scheme. The scheme is that the unfortunates who fall ill are carried on the backs of those who do not fall ill, and there must be some benefit in it because companies like the S.A. Mutual Insurance and Sanlam have gone in for this type of insurance. They are offering insurance, although they did not have very happy experiences in the beginning and they are complaining. But that does not alter the fact that they went in for it and that when they have overcome their teething difficulties, which are quite understandable, they will make a profit and they will not desert this type of insurance. Therefore, it cannot be quite so expensive as many people believe. But sick insurance with insurance companies, except for these two companies and a few others, is not a very happy thing. Most of these schemes are based on Lloyds, and Lloyds will not issue any policy for longer than a year. Therefore, the average man who takes out insurance for illness finds that when he has a grave illness the company pays; they carry him through his illness and they are honest, but next year they do not accept him again. So, in his real need, at the time when it really becomes necessary, he finds that what he thought was a prop has been taken away, and in addition to that the insurance company will not carry him beyond a certain age, somewhere in the region of 65, just when this sort of care becomes necessary. But they are business people and one cannot altogether blame them. It is a great pity that the hon. member for Green Point (Maj. van der Byl) was not here when I mentioned the S.A. Mutual.

That is why I rushed in.

Anyhow, if we have any scheme at all, it must be a comprehensive scheme which offers all services, it cannot be, as was suggested by my colleagues, a limited scheme in some respects. There can be no limit. We must assume that in any scheme of this nature the individual is cared for from conception to the grave. I deliberately mention “conception” because so many of these schemes exclude maternity benefits, and that is one of the most vital matters that must be included. It cannot be applied to the whole country because there are too many believers in witchcraft, some even members of this House, as we heard last Friday. [Laughter.] But there are sufficient people among the wage-earners who earn sufficient to keep such a scheme going. It will be welcomed, I am sure, by all wage-earners, and it will replace many bad schemes. Because there are bad schemes in existence, mostly schemes introduced by individual industries or factories, because there they introduce the policy of having a salaried doctor. Now, far be it from me to consider that a salary is a bad thing for anyone, or that it detracts from the value of the doctor, but when the impression that the doctor makes on the administration is more important than that which he makes upon the patient, you begin to get bad doctors. When a doctor, as he is sometimes, is influenced perhaps to keep a man at work or to keep him away from work for the convenience of his employer, then there are evils which are difficult to avoid, because the doctor is paid by the owners of the factory. Further, if you have a salaried service you change competition between doctors for patients into competition to avoid patients. Any service must be comprehensive, and here I agree with my colleague that the mental service, up to the point of certification, somehow or other should be included. The time has come, as I have said before in this House, when the mentally ill should walk through the same gate as the man suffering from the ordinary physical ailment, so that to start with there is no stigma and no fear, and at the same place such services can be supplied. I hope, in passing, that the promise which was made last session by the introduction of the Mental Health Bill has been as successful as the hon. the Minister of Health had hoped. The effect on the public will be enormous and the effect on the doctors will be even greater. They will no longer feel handicapped by the fact that the patient will be worried about cash payments. The health workers will probably be given better conditions to work under and fair rewards for their work according to their professional qualifications, responsibility and ability. Profęssional freedom and professional discretion and professional education should be available to all health workers. At present the doctor is forced by the system of vicious circles to be a slave of circumstances. He works hard and studies for six years, or perhaps more, after he leaves school. He walks the wards for pocket money and at the age of 25 he comes into the world without money. If he wants to be a general practitioner he has to burden himself with a great deal of expenses for transport and consulting rooms, and if he wants to be a specialist he is faced with another five years of hard study. For this he hopes to get a reasonable reward and by a scheme of this nature in which a moderate return is guaranteed in a co-operative effort, a scheme by which he will realize that he has at least a modicum of returns coming in every month, he will break the shackles of the awful conditions under which he works. The main benefit will come to the individuals and to the State. And the State will benefit in another way.

It has appeared from services in other countries that statistics of diseases are compiled in this type of service, because the certification necessary indicates the disease and the benefit societies, finding perhaps a constantly recurring disease, draw the attention of the authorities to it and investigation is carried out. This has been most noticeable in the United Kingdom. In the first medical services introduced in Britain by Lloyd George in 1911, the national health insurance for workmen, it was found that the greatest loss of working time was due to a type of influenza, and that led to investigation which is still continuing. But now, out of this new 1948 health scheme, it is emerging that rheumatism of various types is the commonest illness that occurs in Britain, and the result has been that the British health authorities have turned the best brains to finding ways and means of dealing with rheumatism. They have established centres in the great cities where sufferers can receive treatment from specialists in this disease, and they have established particular centres at places like Harrogate, where there is a spa, and these people receive great relief with the result that to-day England, from being a country considered very poor in the treatment of rheumatic diseases, is the leader in the field, much to the surprise of the great watering-places on the Continent of Europe.

Another great advantage is that doctors see the patients earlier. Patients come along sometimes, we think, with rather trivial complaints and it disturbs us, but with patience and observation we realize that these people, even though they come along with what seem to be trivial complaints, are coming earlier with the genuine complaints they have. Instead of first trying the family medicine chest and ultimately getting so ill that it is difficult to do much for them, they come earlier, sometimes so early that we cannot diagnose them and have to put them off for a few days to see what is incubating. It is a great advantage from the point of view of absenteeism from work that people should be encouraged to come in the early stages when we can still do something for them and perhaps eradicate a disease which, if untreated, will ultimately kill them.

The main thing in any scheme of this nature is that here should be a free choice of doctor. I know that this is regarded by many as a fetish of the doctors, and of course in some cases it is quite impossible. In a village with one doctor, well, there is only one doctor, and in a small industry there is perhaps only one doctor. But there should be freedom to the doctor to refuse to take patients, and there should be freedom for the patient to move from one doctor to the other, because it happens that the doctor does not always hit it off with the patient and you do not always see what is wrong with him, whilst someone else would see it. Therefore there must be that possisbility of moving from one to the other. If the Government will consider this problem, will take it up and try to introduce a contributory scheme, because it is not good that people should get anything for nothing, they would be conferring one of the greatest benefits they possibly can on this country.

Mr. Speaker, I think this Session, more than any other session for some considerable time past, has offered excellent opportunities for the discussion of health services, and I personally have regarded it as a very great privilege this year to be able to review public health on so many different occasions.

We have just listened to the hon. member for Durban (Central) (Dr. Radford). I should like to say that in listening to the hon. member we listened to somebody who is and throughout his life has been one of the great champions of medicine. I want to add what is perhaps not generally known that it is true that he is one of the greatest surgeons that South Africa has ever produced. But I do not think he will hold it against me if I go on to say that many of the things which he said here were not strictly relevant to the motion. But the observations made by him have once again brought home to me the enormous achievements of medicine, but in addition to that his remarks have brought home to me even more the tremendous responsibility resting upon medical practitoners in South Africa. I should like therefore to extent my hearty congratulations to the mover on having chosen the hon. member to second this motion.

As far as the hon. member who moved this motion is concerned, I just want to say that anybody who expects that there is going to be a great clash here to-day is mistaken. There may be a clash of ideas, but there will certainly be no fight with regard to this matter, because I think the hon. the mover has rendered a service to this country and to this House in bringing this matter to our notice. I should like therefore, with a view to having a fruitful discussion, to move the following amendment—

In other words, he specifically asks that there should be a medical aid scheme, that the Government should introduce it, and that it should be voluntary. As I understood him, he really proposed that the Government should grant financial assistance, but that assistance should be given to the existing schemes and those which may still be established. In other words, I do not regard his speech as a proposal to establish a medical aid scheme but rather to establish a central fund to assist medical aid schemes. He has worked out that the Government will have to pay R48,000,000 and the patients R48,000,000, and this money is to be used then to subsidize the existing schemes. If I understood him correctly—and I can interpret his remarks in no other way—it is perfectly clear to me that he is not asking for the establishment of a medical aid scheme in South Africa by the Government but that he is merely asking for the establishment of a central fund.

I want to say at once that it seems to me that if we go so far as to do that, we shall be setting in motion what will eventually develop into a State medical service, and I am just a little perturbed about the fact that the quotation which he read out towards the end of his speech is too sympathetically disposed towards a State medical service in South Africa. I do not want to put words into the mouth of the hon. member, but my problem is that if the Government accepts responsibility for the financing of the sick funds as they exist to-day—the responsibility for granting financial assistance to them—there is a very great danger that the service will develop into a State medical service. I want to associate myself with the hon. member where he expressed himself against a State medical scheme. I think that this country and this House should resist any scheme which even tends to point that way. In any event I want to express myself strongly against the establishment of a State medical service or anything which may lead in that direction.

There are other countries from whom we can learn a lesson and let me say at once that I think some of them have instituted State medical services with great success, others with less success, but there is one fact which is true when one looks at the British State medical service and that is that the quality of the service that is being rendered has deteriorated since the establishment of the state service when one takes into account the enormous advance in medicine over the past 12 years. In Norway and Sweden they have also had a great measure of success. I had the privilege of witnessing how these services work there, but various persons in high positions in Norway told me that they would be only too glad if they could revert to the old system, as we still have it more or less in South Africa to-day.

Two things have become very clear to me in considering the possibility of the introduction of a State medical service or any scheme which would lead to a State medical service, and I want to deal with them here. The first is that the health service that is given to a country must fit in with the character and the mode of living of the nation. The second is the financial implications, and this is a most important factor. I want to say very definitely that I do not think a State medical service would suit the conditions in South Africa. Our character and mode of living and philosophy are such that a State medical service would not be a good thing for South Africa. And I think the situation that we have at the moment has developed from the philosophy and from the character of our people. The hon. member referred to it briefly, but let me just do it again for the sake of the argument. The State is responsible for certain services in respect of mental health, infectious diseases, etc. The local authorities and provincial councils are responsible for hospital services and clinical services. All these things are of territorial or national scope, but as far as the day-to-day medical requirements of the individual are concerned, the position has always been—fortunately that is still the position —that that is the responsibility of the individual, and when I talk about the individual it is usually the head of the family. The position has developed in this way that the head of the family has accepted this responsibility in the form of insurance against illness based on the principle of private initiative. If we deviate from this, I think we shall be rendering a very great disservice to the public of South Africa in the first place, because when one looks again at the British State medical service one notices—and here lies the difference in character and mode of living to which I referred—that that service was instituted at a time, just after the war, when the British people had become accustomed to many years of want. They were used to the coupon system and to control and standing in queues for most necessaries of life. All these things helped, when this service was instituted in 1949, to induce the British people to accept this service, and I think that is also the reason for the great measure of success that they have achieved with that service.

But the circumstances in South Africa are entirely different. The average South African, in the cities or in the rural areas, is accustomed to space and freedom with the result that we have a very high degree of individuality, and this individuality, the self-determination of one’s mode of living, also extends to the decision as to who shall enter the sickroom when there is illness in one’s home. To my mind this is one of the fine characteristics of the people in South Africa and I should not like to see it lost through the introducing of a socialistic system, as a State medical service undoubtedly is.

I said that too.

Yes, and I fully concede that point to the hon. member. I am afraid therefore that his motion, if accepted, may eventually lead to the situation that the State will have to take over everything.

I would also add that in my opinion the proposal of the hon. member that there should be voluntary contributions, that there should be a central fund and that the contributions made by the Government should be divided amongst all the sick funds, will not be able to work in practice. Let me just point out one problem. If it is voluntary you would find in the case of a sick fund with, say 1,000 members, that only 500 of them would contribute to the central fund, and you would find that a sick fund has various types of members, a fact which in my opinion makes it altogether impracticable to institute such a scheme.

But to come back to the situation as it has now developed, we find that while the individual has accepted responsibility for medical services for his family and that to-day he discharges that responsibility largely through the medium of sick funds, we have the fortunate position that the patient in the first place does not lose his responsibility but that the employer has also been drawn in to-day to a large extent in financing these schemes. And, thirdly, we find that for the medical practitioner there still remains the incentive of competition and that undoubtedly raises the standard of the services rendered by him. In other words, it seems to me that in the case of the development of these sick funds the underlying principle is the same as the principle that we find in all welfare organizations —this fine desire on the part of people that such organizations should come into being voluntarily and that it should be accompanied by certain sacrifices on both sides and, moreover, that the public and the employer should be able to contribute their share. I should like to see the retention of these sick funds which have come into existence as well as the retention of the voluntary services which have been put into it in various quarters. That is why I wanted to express myself very strongly at the outset against a State medical service. Because let me say at once that the moment that we begin to give effect to the proposal of the hon. member we are going to find that the development which has taken place up to the present moment is going to suffer, because it remains a fact that the moment the State steps in the voluntary organizations are inclined to sit back. The moment the State steps in much greater demands will be made for services than the sick funds are able to provide at the moment, and I am afraid and I foresee that the present system may disappear if the State enters this field.

I just want to deal with a second aspect in connection with a State medical service, and that is the question of finance. We have noticed in Britain that there has been an enormous increase in expenditure, and that expenditure is still increasing steadily. The other problem is that in the initial stages of such a service or even in the initial stages of a fund such as the hon. member proposes, the contribution of the State will be very high indeed. Hon. members are aware of the calculations that were made in respect of a State pension fund, and there one of the insurmountable problems is the initial contribution that the State has to make. In this connection I just want to say also that since that is the position, we must not forget that in South Africa there is an additional consideration that we have to face squarely, and that is that in South Africa we have non-White population, and if the State does enter this field, I can hardly imagine the State doing so only on behalf of the Whites, and when we come to the non-Whites, and particularly when we bear in mind the hon. member’s proposal that this scheme should be a voluntary one, that there should be contributions from both sides, then I think I am not being pessimistic in saying that I foresee practically insurmountable administrative difficulties. I want to make it perfectly clear therefore that in my opinion a State medical service in South Africa—and I think that is a fact that we must accept for the future—is quite impracticable and altogether undesirable. In addition to that, it is something that we should oppose at all times in the interests of the high quality of the service and in the interests of our national character. Sir, I have made these observations not so as to contradict what has been said by the mover of the motion or his seconder; I say this simply because I think that it is a good thing for South Africa to know that this has always been the attitude of the Government in the past and I do not think that anybody will ask in this House in the future for the establishment of a State medical service.

To come back to the amendment that I have moved, namely that we support the Government in its policy of encouraging the present pattern of insurance against sickness, I think it is necessary in the first place to ask ourselves with which categories of people we are dealing here. The hon. member also made reference to this in passing. In my opinion there are three categories that one must consider in respect of health services in South Africa, and here I refer to the everyday needs; the person who is sick at home, the person who wishes to go to the consulting room and the person who needs operative treatment. In the first place there are the indigent, whether they be young or old, and the pensioner. I think there is ample provision for them in South Africa to receive free services. The second category is the well-to-do person. Here I want to say that I listened with great pleasure to the hon. member for Rosettenville when he gave this House a dissertation on how many well-to-do people regard health services as a luxury item. But may I just add a word to that. I think there is one thing that the well-to-do people in South Africa must realize very clearly and that is that it is no longer necessary to-day to go beyond the borders of South Africa for medical treatment. The medical services available in South Africa to-day are just as good as those available anywhere else in the world, and I make bold to say that there are certain fields in which the services available in South Africa are even better than those available in the rest of the world. It makes me sad to see in the newspapers sometimes that there is an appeal for funds to send a patient to some wonderful place or other overseas when one knows that the operation or treatment in question can be performed or given with just as much success here in South Africa by men whose names we could mention specifically. Mr. Speaker, there are many fields in which South Africa has made a name for herself in the world, but in the field of medicine South Africa is definitely on a par with the best countries in the world. Sir, I have said that we are not perturbed about the well-to-do people, but then there is the middle income group. The hon. member referred to the lowly paid section, but I would also add the middle income group. Even if a person is fairly well-to-do to-day, health services may impose an enormous financial burden on him. Here I have in mind the factory worker, the official, the clerk, the teacher, the professional persons and—a group which has always been overlooked in this respect—the farmers of South Africa.

They are always negelected.

I think I am one of the few members of this House who can really be proud of a remark from the hon. member for Cradock (Mr. G. F. H. Bekker) by way of interjection.

You are not a “boerehater” (“Boer hater” or “hater of the farmer”).

This middle income group is undoubtedly the group to which we should give our very serious attention to-day. In the old days medical services were simple and less expensive, but it is a fact to-day—and there are good reasons for it—that modern medicine is expensive as the result of unprecedented development, expensive apparatus, and expensive remedies. Mr. Speaker, has it occurred to you that a public servant or a teacher or any person in that category may be entirely ruined financially if he has a prolonged illness in his home, and I think it is this fact which has given rise over the years to the desire for security in respect of financial burdens resulting from illness. I just want to show the House how strongly this need has been felt over the years. When one looks at the history of the development of sick funds, one finds that the first sick fund was established in South Africa in 1889; I refer to the De Beers Consolidated Mines Benefit Society. In 1910 there were seven sick funds; in 1939 the number grew to 48, and in 1960 it stood at 214. But we must bear in mind the fact that during this period 33 of them dissolved, and since September of last year something like 20 new funds have come into existence, and then I must also add that since 1957 the insurance companies have also entered the field of insurance against illness. I am informed that they mostly insure groups of people and that at this stage they are insuring about 8,000 groups in South Africa. When one looks at the individual schemes, one realizes what a great need there is for insurance against illness. We find that in 1940 the Public Servants’ Medical Aid Society, which is a voluntary organization, had 927 members; in 1960 the membership stood at 9,467. The Post Office Medical Aid Society, which is also a voluntary organization, had 1,147 members in 1940 and 10,714 in 1960. In 1940 the association of commercial banks had 5,802 members; in 1960 the membership stood at 20,865. It is estimated that approximately 1,500,000 persons are insured against illness in South Africa at this moment, that is to say, about 50 per cent or, to be precise, 48 per cent. but I want to point out that this figure may be misleading, because in the case of the Police Force, the Defence Force, and the Prison Service, medical services are provided free of charge, and we also find that the State provides various services. There are 391 part-time district surgeons; there are 63 full-time district surgeons, and then there are still the various mental institutions, etc., and in addition to that there are the services provided by the provincial administrations and the local authorities. Taking all this into account, it appears to me that the figure may be much higher than 50 per cent: that at this stage possibly 70 per cent of the entire population of South Africa is covered by some form of insurance against sickness.

I want to point out that this development has been a spontaneous one and that it has taken place on a voluntary basis. It is a spontaneous development which has grown out of the desire to be insured in times of illness against financial ruin. Here I want to associate myself with the hon. member; in my opinion the most desirable form of insurance against illness is the medical aid fund in contradistinction to the medical benefit scheme. I do not know whether hon. members know what the difference is between these two. In the case of a medical aid fund a group of persons contribute to a central fund from which sickness benefits are paid but a certain portion of the account is always paid by the patient himself, with the retention of free choice of doctor on the one hand but also a free choice of patient on the other, while in the case of the medical benefit scheme it is usually a closed panel. The medical practitioner is an official to a very large extent and in some cases a full-time official, and the patient is not responsible for the payment of a certain portion of the fee. I want to say at once that in my opinion the medical aid fund is by far the best, and in South Africa we find that it is most popular with both the patient and the medical practitioner.

I also want to refer here to the attitude which the World Medical Association adopted at their congress in 1955. In that year the World Medical Association met in Vienna, and after they had very fully discussed this whole question of insurance against illness, they accepted the following points—

You will see therefore, Mr. Speaker, that here we have a spontaneous development which has always taken place on a voluntary basis and which has already assumed very great proportions. In this connection I want to refer to an article in the South African Medical Journal which puts this whole matter very clearly and which has convinced me entirely that the sick fund system as we have it to-day in broad principle in South Africa, is the soundest system for a country like South Africa and that it is a system which should be extended. Where a scheme has developed spontaneously and on a voluntary basis to such an extent that 50 per cent or probably 70 per cent of the population is already covered by it, I think it would be extremely unwise to bring about a change in the situation as far as the principle is concerned. I shall deal later on with changes so far as improvements are concerned. This article very clearly points out the importance and the benefits of this scheme. I refer to the Medical Journal of 8 May 1954—

I think I have said enough, together with what has been said by previous speakers, to bring these facts very clearly to the notice of this House, namely that here we have a spontaneous development, that this development has already assumed enormous proportions and that this development undoubtedly has very great advantages for the various interested parties. But at the same time I am fully aware of all the problems which are experienced at the moment by the sick funds, all the problems which are experienced by medical practitioners and all the problems which are experienced by the insurance companies, but I make bold to say that not one of these problems, as we know them to-day, is insurmountable. As a matter of fact many of them have already been resolved. But I want to add that it seems to me that the time has come when the Government will have to lend a hand in overcoming these problems and in placing this whole development of the sick fund system in South Africa on a firm and sound basis. I think one can put the problems which arise into three categories. The first problem is in respect of membership, the second is in respect of financing and the third is in respect of the benefits that these schemes ought to offer to the public. As far as membership is concerned, the position to-day is that most concerns—factories like Iscor and others—have made it one of the conditions of service that their employees must join the sick fund established by that organization. This was also accepted in principle by the Government when it was made compulsory for railway officials to become members of the Railway Sick Fund. That also applies to Iscor, which is a semi-Government undertaking, and it also applies in many other cases. There are still various organizations where membership is not compulsory, as in the case of the public service, the post office, the provincial authorities and the local authorities. But I should like to point out that if membership of a sick fund is voluntary, it undoubtedly creates financial problems, and it seems to me that the normal development is for the employer to make it compulsory for his employees to become members of a sick fund; I am not talking about compulsion brought to bear by the Government but compulsion brought to bear by the employer, and here I include the provincial authorities and the local authorities and the post office.

One finds that in the case of 137 out of the 169 independent schemes, compulsion has already been introduced and that the remaining 32 are all very keen to make membership compulsory. I say that this is a matter in regard to which one should have an open mind, but my present attitude is definitely that in the various spheres of employment where compulsion has not yet been introduced, it should be made obligatory for all employees to belong to the sick fund which is at the disposal of that particular undertaking. There is no doubt that where membership is made compulsory, it increases the benefits which such a scheme can offer. At the moment I am far from convinced that the Government itself can do anything in this matter, because if the Government were to step in I think it is doubtful in the first place whether the scheme would be capable of implementation in practice, but in the second place, if the Government were to step in, it would have to make a contribution to the whole scheme and it would have to see to it that the obligation imposed by it is carried out, and it seems to me that the normal development that the employer should make compulsory membership a condition of service is the most suitable way to ensure that the vast majority of the population will eventually belong to sick funds.

The second matter that one has to consider is the question of financing. Well, in this connection there are a number of problems. The first is that at the moment there is such a thing as an upper income limit; at present only persons earning below a certain income may belong to sick funds approved by the Medical Association, and the reason for this is quite a sound one, and that is that a preferential tariff is given to those people. In other words, they get medical services more cheaply than other people. But I want to say very clearly here—and that is why I made that interjection while the hon. member was speaking—that to my mind it is unsound and unnecessary to impose any income limit. The preferential tariff should always be such that the medical practitioner is able to make a good living. There are sound reasons for the granting of a preferential tariff by the medical profession—and I think that is how they accept it—because the fact of the matter is that if all your patients are members of sick funds, the possibility of bad debts is entirely eliminated, and it is for that reason that the medical profession is able to grant a preferential tariff. My personal opinion is that this attitude that there should be an upper income limit is not a sound one. There is also another argument in this connection and that is that the contribution of the member is assessed in most cases on his income We have the principle already therefore, as in all fields of life, that to some extent the rich man subsidizes the poor man.

In this connection I want to say that in the Medical Journal we find a very clear picture in respect of fees and tariffs, and this throws further light on what I said a moment ago. The Medical Journal says—

In this connection I just want to say that since this article was written in 1954 there has been a great improvement and that employers have contributed to a much greater extent to the sick funds which give their employees medical cover.

May I come back now to the contribution of the employer. I have said that there has been a great improvement, but as far as this principle is concerned the State has also taken a definite stand. The State is subsidizing the Railway Sick Fund; the State is subsidizing the public servants’ sick fund, and I think that is a very sound principle. Since this principle has been accepted—and to some extent this links up perhaps with the proposal of the hon. member for Rosettenville—I think in the long run it may prove beneficial—and I say this again pending the report of the Snyman Commission—if the Government, particularly with a view to uniformity and the combating of administration costs, will consider the question of giving a certain subsidy to every member belonging to a sick fund. In the nature of things it would be small but it would give the Government an opportunity to impose certain conditions perhaps in respect of unduly high administration costs, in respect of the benefits to be provided, etc., because I have not the slightest doubt that in contrast with a State medical service, in contrast with a central fund from which everything is to be financed, the Government will have to step in to give a lead and also to assist perhaps in coping with the problems that we are discussing at the moment.

I now come to the other problems which have arisen. These problems have come to the fore especially since the insurance companies have entered the field of insurance against sickness. Let me say at one that I have no misgivings in my own mind; I think it is a good thing that the insurance companies in South Africa have entered the field of insurance against sickness. The costs are so enormously high to-day that it is a sound and good thing and one which is in the interests of the patient that this field should be entered by a financially strong organization or organizations to combat the high administration costs. There is always the condition, of course, that we should have a much sounder basis and a much sounder system than we have at the moment. When one thinks of the fixation of fees, for example, it is perfectly clear that this has created enormous problems in the past, because on the one hand the sick funds and insurance companies want to have the fees of the medical practitioner to be fixed as low as possible and on the other hand the medical practitioner is entitled to a reasonable and good living. In this connection I just want to say that one cannot easily gauge, the remuneration to be paid to a medical practitioner in the same way that one measure remuneration in other professions. A medical practitioner is on duty 24 hours of the day; he may work eight or 10 hours out of those 24 hours, but it is that responsibility which continually rests on him to be available for which the medical practitioner in my opinion has not been adequately compensated in the past. Up to the present time the fixation of fees has been in the hands of the Medical Association. Let me say at once, although I am a member of the Medical Association, that in my opinion it is wrong that the fixation of fees should be done unilaterally. In the first instance this is a matter which least of all concerns the two parties, in question, namely the sick fund, or the person who has to pay, whoever he may be, and the medical practitioner. At the moment it is the Medical Association which represents the medical practitioners, but we are faced with this problem that if we leave it entirely to them, it is very difficult to get the sick funds to stand together. They have made an attempt to do so; in 1952 they established a committee to bring about uniformity, but it is not working, and it seems to me—and more and more I am beginning to realize this—that it will be welcomed in all quarters and that it will be a sound thing if the Government lends a hand in the fixation of fees. It is not so difficult to fix fees, but then it must not be done unilaterally; all parties concerned must have a hand in it, and I wonder whether it would not be advisable for the Government to consider establishing a Sick Fund Council, or a committee or whatever one would like to call it, which would fulfill one of two functions in respect of funds —either to act as arbitrator where no agreement can be arrived at between the Medical Association and the sick fund, or perhaps it should be so constituted that it represents all those interests and it could then once and for all fix a tariff of fees that would be acceptable to everybody.

Another problem that crops up is the question of uniformity of benefits. As I have already stated, the sick funds felt very strongly that there was a need for uniformity. In 1952 they appointed a committee to try to bring this about, but nothing much came of it. But in my opinion it is an absolute necessity, and there I agree wholeheartedly with the hon. member for Durban (Central) (Dr. Radford) that the benefits offered by these sick funds— it does not matter whether they are connected with insurance companies or whether they are associated with employees’ organizations— should be uniform and that all aspects of medicine and dentistry should be covered. One could perhaps make a few exceptions. I cannot see, for instance, why it should be necessary for a sick fund to pay if a person undergoes a cosmetic operation to change the shape of the nose, slightly or to remove a few blemishes or to have a face lift. Such operations can perhaps be excluded. I am not at all sure either that mental illness should not be excluded as well. But there must be uniformity and there should be the widest possible cover for all the patient’s medical and dental needs. Furthermore, I feel that the supply of medicines should definitely be included. I know there are tremendous problems in that regard, but there is not a single one of them which cannot be solved if we have a central council devoting its attention to these matters. I feel further that hospitalization should definitely also be included. But then a change must be made in two respects. Firstly, hospitals should not do what they do to-day, at least some of them, namely to exclude patients and send them to private institutions merely because they are members of a sick fund. Because it is very clear that unless sick funds are encouraged in South Africa and unless they develop further and hospitalization is included, the burden on the provincial hospitals and particularly on their out-patients sections will become increasingly heavier. I feel that if hospitalization is included the burden on the hospitals will be alleviated, and it will eventually be only the needy patient and the pensioner who will really have to be dealt with by the outpatients section of the hospitals. Then one will perhaps again be able to restore in honour the splendid practice we had in the past that the medical man who gives his services to the out-patients section of the hospital, or who as a doctor in the hospital itself renders services to needy patients, will not be an official but will do so voluntarily on an honorary basis. It is a great pity that this system has died out in South Africa. I have this considered opinion by a very important person in South Africa, who also says that the inclusion of hospitalization with sick insurance will make the burden on the hospitals much lighter—

It is obvious that if 80 per cent or 90 per cent of the population are covered by sick funds and hospitalization is included, the burden on the provincial hospitals will be infinitely less, and that can only be in the interest of South Africa.

The last matter to which I wish to refer, and perhaps it is the less pleasant one, is particularly the serious financial problem created for sick funds and insurance companies as the result of abuses. Now there are three people who can abuse it. The first is the funds and the insurance companies. In the case of some of them the administration costs are far too high, and I am not so sure that some of them do not make use of the high administration costs in order to make a profit. In the second place, the direct profits should never be too large. Because to me it is as clear as daylight that it is in the interest of any insurance company, that it is in the interest of the general business it does, also to cater for sick insurance. Let me in passing just say that I think that these abuses can easily be coped with if in the first place we ensure that there is registration of sick funds, and that registration is made subject to certain conditions and the exercise of control if those conditions are not complied with. We have that at the moment. We have the registration of building societies and of pension funds. They must comply with certain requirements. Now it is true that sick funds at the moment are in fact registered in terms of the Mutual Aid Societies Act of 1956, but because no demands are made and no conditions are set, this registration is of no value at the moment.

Then I feel that the other person who makes himself guilty of abuse is the patient himself. We find that there are patients who expect the doctor to visit them unnecessarily and at inconvenient times and that they expect to be given medicine quite out of proportion to their needs, and that they are only too inclined to expect that the moment they join a sick fund they must get everything to be found in a chemist’s shop which they desire. But again it is easy to deal with these anomalies. We today have the system in many employers’ circles that there is a permanent committee of employers and employees, and that all cases of abuse by the patient are referred to that committee and generally such cases are dealt with very easily. But secondly I believe that the best way of dealing with these abuses is the system of medical funds where the patient must pay a share of all the expenses incurred in respect of his illness. There is not the least doubt that this is one of the most important matters, and probably this is one of the conditions which should be imposed for the registration of a sick fund.

Then I come to the third aspect, and I find it very difficult to discuss it, namely the abuses committed by medical men and chemists. Let me say immediately that I have always been very careful about saying anything in this House which can in any way reflect on the medical profession; and I think we should try as far as possible not to do so. But it remains a fact that there is a small group of the 9,000 medical men we have in South Africa to-day who conduct themselves in such a way in regard to fees and other matters that it constitutes a big blot on the good name of the majority of medical men who behave absolutely professionally. I am very sorry to say so, and one does not expect it, but the fact is that we cannot deny that some of the problems of the sick funds and of the insurance companies emanate from the fact that there are doctors who exceed the limit in regard to fees. I want to express the greatest praise, and I do so wholeheartedly, for the medical profession and for what it has done in the past in performing such a tremendous amount of work completely gratis. But all these things are negatived by the conduct of some of our colleagues when it comes to fixing fees.

I just want to mention a few examples. One finds that the wrong descriptions are given of illnesses so that claims are paid for diseases which are excluded from the benefits granted by the fund; wrong descriptions of operations so that higher fees can be charged; changing the dates of treatment so that claims are paid in respect of periods during which the member was not entitled to such benefits; the treatment of other patients, such as servants, as insured members on the account of the member; additional visits to cover the cost of medicine supplied by doctors where the member is not insured under the medicine scheme. You know there are certain schemes which do not provide medicine; the booking of visits which were not made in order to increase the account; superfluous visits, particularly in the case of less serious illnesses; the unnecessary utilization of the services of specialists; operations in private nursing homes where appreciably higher hospitalization costs have to be paid than in an ordinary hospital (and in many cases the surgeon has an interest in the nursing home); and then of course operations of a cosmetic nature and the utilization of specialists in operations where normally those services would not have been rendered if the member himself had had to pay for it.

I have pointed to these matters simply to indicate that we should not allow this spontaneous development of sick insurance and the spontaneous development of the participation by insurance companies to be wrecked as the result of this sort of behaviour which can easily be coped with in South Africa.

Formerly I adopted the standpoint that the Government should only give active guidance and advice and encourage the development of sick funds, but I am increasingly coming to the conclusion, and again I say this in expectation of the Snyman Report, that the Government could fruitfully devote attention to establishing a sick fund council, a council which in the first place should encourage the establishment of further sick funds on the basis of the relationship to the sphere of employment of these persons, and also to encourage the development of the present schemes which the insurance companies have, and to give direct advice, and which will have officials who can go to a company to advise and assist them in the establishment of a scheme, and in the second place to deal with the registration of all sick funds and to lay down the conditions for the establishment of a sick fund. And finally, to ensure that these conditions are complied with. And, thirdly, as I have already mentioned, to assist in determining the fees. Personally I feel that if this council is properly constituted it can fix the fees itself and it can cope with the evils committed by the funds, by the medical man, by the patient and by the chemist itself, because in the final result the composition of such a council should be such that it consists of representatives of the funds (i.e. the patients), of the insurance companies, a representative of the medical men, and of the chemists. This type of composition would result in a body which can devote attention to all these problems, and I believe that with the guidance they can give and the work they will be able to do there will be such a radical change in South Africa in respect of the administration of sick funds that the time will soon arrive when only exceptional individuals will not belong to a sick fund, and the benefits granted will cover practically all possible needs on payment of a premium which is not too high, even for the lowest-paid person in South Africa, to afford, because we will still retain the principle that the rich to some extent will pay for the poor. That is a sound principle and we cannot get away from it.

Business suspended at 12.45 p.m. and resumed at 2.20 p.m.

I had just concluded my remarks in regard to sick funds when business was suspended, and in conclusion I once again want to emphasize very strongly that I feel the time has now arrived that, as opposed to a State medical service, the Government should give encouragement and guidance in respect of the establishment and expansion of sick funds, and that it should not only stop at guidance and advice, but that perhaps it should also play an active part in the determination of fees and combating the various problems and anomalies which have developed during the years.

I second the amendment and I want to congratulate the hon. member for Rosettenville (Dr. Fisher) heartily on the fact that he has succeeded in creating a different atmosphere in this House from that which prevailed yesterday and the day before. I think the people outside will be grateful for the fact that the hon. member has focussed attention on the importance of national health services. I am sure that if more motions of this nature were discussed in this House, we as a nation would learn to understand each other better, because, our brains would be clearer and it would assist the medical profession to bring into relief certain things which are a little obscure at the moment. I am very pleased that the hon. member has referred to a matter in connection with which I would rather not have had a commission, and that is the question of the costs of medicines. The medical profession consists of doctors, dentists and pharmacists and as far as the appointment of the commission is concerned (although that is not the intention at all) people are of the opinion that if a commission to investigate the price of medicines were appointed, it will be found that the pharmacists are the people who make tremendous profits over the counter. I am pleased that a surgeon of the standing of the hon. member over there has raised this question. I may perhaps just add this that the appointment of the commission has created the wrong impression amongst the public, that it is in connection with the organization which provide the medicines and not in connection with the pharmacists who sell it. I know of cases where a doctor has prescribed a certain expensive medicine which the pharmacist has had to stock for the sake of the few people who may need it. That doctor goes somewhere else and another one takes his place. The pharmacist has acquired a large stock of the expensive item for the sake of a few patients and the other doctor says that he does not want to prescribe that medicine, he wants to try something else. The pharmacist is then left with that medicine for which he has paid an enormous amount of money and it may happen, particularly in small towns on the platteland, that medicine is never used again. That is why I should much rather have seen a commission appointed to investigate the medical profession as such as far as their fees are concerned, without a reflection being cast on anyone in particular. In my humble opinion the public outside is not sufficiently aware of the great services which the medical profession as such is rendering to the people.

I want to say at once that I personally am grateful to the hon. member for Rosettenville for having moved this motion and that the fact that we have moved an amendment does not mean that we are not appreciative of his motion. The only reason why we have moved an amendment—and I am speaking for myself only—is that I personally feel that the less we tamper with the medical profession or with anything else connected with national health, the better. I think it is necessary that we view the position in South Africa in the light of the composition of the nation before we discuss the matter, and whether or not we should bring about a change or whether we should allow things to develop normally as they are doing at the moment. I just want to draw your attention to the fact, Mr. Speaker, that the South African nation consists of plus/minus 3,500,000 Whites and 9,000,000 or 10,000,000 non-Whites and I do not think we can establish a scheme without taking into account the fact that the nation consists of those various sections. We cannot lose sight of the fact that up to the present those 3,500,000 Whites have had to carry the non-Whites as far as hospital services, for example, were concerned. In the circumstances, if any change is contemplated, that fact should be borne in mind. No country can provide more medical services than it can afford and I think that in the case of our country, if we think what is being done and we compare that with what is done in other countries for the under privileged sections of their community, there is no doubt that what we in South Africa have done for our under privileged people is at least equal to if not superior to what is being done in other countries for their under privileged people. I think the idea has unfortunately gained ground in South Africa to a great extent that the Government should see to these things. You no longer find a feeling of gratitude towards the doctors or the Government of anybody else for the services which are being rendered. People also have the idea that if they get anything cheaply or for nothing, that it is not of the value which it would have been had they paid for it.

The hon. member for Rosettenville has told us of his experiences in his consulting rooms. The fact remains, Mr. Speaker, that if you provided the public with cheaper medicine or medical services than that paid for by other people they will think that you are giving them an article which is inferior to the one which the other person gets. It is not always a case of people wanting to boast about this or that operation which they have undergone and that they have had to pay so much or so much for it. I think it is mostly a case that they think they get a better service if they pay more for it.

Mr. Speaker, there has been a tremendous increase in the cost of medical services. It costs the ordinary person much more to-day than it did in the past to undergo medical treatment and as the hon. member over there said, I do not think there is any possibility of those costs coming down in the future or even remaining where they are at the moment. I think those costs will continue to rise. I think, therefore, that these voluntary organizations and these voluntary workers have stepped into the breach in order to make it possible for the public to undergo medical treatment and to get the necessary medicine and other services. I want to assure you, Sir, that those services have expanded tremendously. I can assure you that there are very few complaints about the way in which the public is treated by those societies and by the doctors. I think, therefore, that the amendment moved by the hon. member for Vanderbijlpark (Dr. de Wet) probably reflects the correct approach to this matter. What has happened during this time that medical costs have increased the way they have? Medical aid schemes gradually came into existence. There were 12 sick funds in 1944. As medical costs increased that figure increased to 158 over 11 years. That means that the figure has increased 14-fold during a period of 11 years and all that has been brought about by voluntary workers, by people who offer their services voluntarily in order to promote and to encourage those services. In 1940 five of the most important schemes had a membership of 8,878. By 1960 it had risen to 45,221. To-day there are 169 independent schemes which are operated by voluntary workers. And according to my calculation those members pay more or less one-third of the normal tariff and the running costs amount to approximately 10 per cent. Everything has more or less been established by voluntary workers. They have a member-ship of 368,890 to-day with 588,997 dependants. I am afraid that the moment the Government introduces such a fund—such a voluntary medical aid scheme as my hon. friend calls it in his motion—as soon as something like that is introduced with the assistance of the Government, there will be a decline in voluntary services. Experience has taught us that happens the moment the Government steps in. As soon as the Government introduces a fund or whatever it may be, you will find that the public outside will more and more pass the burden on to the Government. Eventually, instead of it being a fund, there will be requests from time to time that the Government should establish a medical aid scheme. I think we as a small country will find it very difficult to introduce such a medical aid scheme. I shall tell you in a moment, Sir, what such a scheme is costing Great Britain. We know that such a scheme was introduced in England in 1948.

I should like hon. members to remember what I said at the outset. I think the doctors themselves can play a very important role—I include the dentists and pharmacists—in helping to provide the poor people with medicine and the best services. I should like to give an example. I do not know whether my hon. friends opposite studied overseas but if they obtained their degrees there, they will confirm it when I say that at Edinburgh, for example, in the Royal Infirmary, they get people who are experts in their particular subject to provide medical services. They are prominent people, outstanding not only in Great Britain but throughout the world. I think of people such as Sir Harold Stiles and Dr. Rayney— I am talking about people who have achieved world-wide fame—who attend to the poorest of the poor. The poorest man could have asked Sir Harold to perform an operation on him and he used to do so free of charge. Why? Because if a doctor were asked to lecture on a certain subject in a hospital, that was regarded as one of the greatest honours that could be conferred upon him. The result is that when he is appointed as professor or as the head of a department of the hospital, patients come to him in Scotland from all parts of the country and even from Europe for treatment. The result is that what he loses in treating the poor free of charge in hospital he gets back twofold and tenfold in the form of the people who come to him from other parts, because by having done that he has acquired world-wide fame. I think if something similar could be introduced here in South Africa where we have the clever doctors and surgeons whom we have, we will be rendering the country a great service and I also think that those doctors will be trebly remunerated for their services.

The hon. member also said that if such a medical aid scheme were established, the cost would amount to approximately R96,000,000. It would therefore cost the Government R48,000,000. He naturally arrived at that figure as far as the White section of the population alone is concerned. As I have said already, we cannot establish a scheme which will exclude the non-Whites. If the hon. member’s figure is correct, therefore— which I doubt—it means that the Government will have to find between R450,000,000 and R460,000,000 and once you reach that stage, Mr. Speaker, then as sure as the sun is shining outside, we will be heading more and more in the direction of something which even the doctors themselves do not want, namely the establishment of a national medical scheme.

Now I want to give you an idea, Mr. Speaker, of what it costs the Government of Great Britain to run the State medical scheme which they have introduced there where more or less three-quarters of the population pay fairly high taxes. Their taxation is much higher than here and three-quarters of the population pay fairly high taxes, whereas that is not the position here in South Africa. I want to give you a rough idea of the costs and I want to quote from the “Official Handbook” of Great Britain for the year 1962. It comes under the heading “Health Service Finance”—

That is 3½ per cent of the national income. I do not know what the national income of Great Britain is but as you will realize, Sir, being such a big country the national income must be enormous. But that is not all. That does not include all the costs connected with their national health scheme. There are still the following—

You can imagine, Sir, that if this scheme were to develop and it will develop, whether it happens during our lifetimes or not, if such a scheme were introduced, it will develop into a national health scheme. You can imagine how the people will complain and say that the Government should contribute more than it is contributing. That is not the only money that is needed—

That means, Mr. Speaker, that apart from that money they will have to pay 2s. for every item on a prescription and over and above that in proportion to the services which they receive—

Hospital medical staff are either full-time and salaried or part-time; part-time medical officers are usually paid on a sessional basis and are free to accept private patients. General medical practitioners in public service are remunerated mainly by capitation fees according to the number of persons on their lists.

If we accept the suggestion of my hon. friend opposite, as I see it—and I hope I am wrong—that is what will happen here—

I just want to give you a rough idea of the numbers that have to be paid—

Can you imagine all doctors in South Africa being prepared to do that—

Mr.Speaker, if the position were to develop in South Africa that it will eventually become a national scheme of the Government’s, it will not be as effective as the present system is at the moment. I want to conclude by saying this I trust the discussion which has taken place to-day and the motion introduced by the hon. member opposite and the amendment of the hon. member for Vanderbijlpark, both prominent medical men, will bear fruit and that we shall have similar discussions in this House in future, because that is what the public outside want. If the people are healthy their brans are healthy; and if our brains are healthy we will understand each other better than we do in this House on occasions. I am grateful for the fact that I have had the opportunity of taking part in such an important discussion as this.

I am pleased to see that there is such unanimity on both sides of the House as far as this important subject is concerned. Where there have been differences of opinion on a few points raised, I am convinced that was due to a misunderstanding. I think the hon. member for Durban (Central) (Dr. Radford) has made it very clear that this side of the House is not asking for a State medical scheme. We are not asking for that at all. We believe it is not such a success overseas and we are not asking for that at all. For the rest I am grateful for the amount of unanimity which there has been. It is clear that if anything is praiseworthy to-day, it is the realization which has manifested itself that we should look after the welfare, the happiness and health of the worker. I want to elaborate on that and say not only the health and happiness of the worker, but that of all citizens of the country. It is true, of course, that as far as the workers are concerned, most industries and big employers of labour have realized, as has already been said, how important it is that the welfare of the worker should be looked after so that he will live a calm and healthy life. Most of the big employers of labour realize that if a man is worried, if he is worried about illness, about going to hospital and about a big operation he cannot do his work properly.

Legislation and agreements with employers provide for sick leave etc. and most of the big employers of labour even go beyond what is required of them by law or demanded of them by the law. We find that most employers—I am talking of big employers of labour —form one or other kind of medical aid society which deals with the costs of medical treatment, hospitalization and medicines. I think most people realize to-day in South Africa that the costs of the services which I have mentioned may run into a figure which is beyond the means of the average worker. I contend that the costs can very easily run into a figure which is beyond the means of the ordinary person, even though he lives frugally and looks after his money and even though he gets a reasonably high salary. It is a well-known fact that in many cases illness has led to serious poverty. I say again that I am talking about the person who receives a reasonably high salary. I realize, of course, as everybody in this House realizes, that those people with a low income do receive free medical services through district surgeons and they get free hospitalization at provincial hospitals. Strangely enough because of the very fact that there has been such wonderful progress as far as modern medicines and modern surgery are concerned, the people who have to pay for those services are in the financial difficulties in which they are. It was clear from the speech of the hon. member for Rosettenville (Dr. Fisher) why that was so—because of the expensive research work that has to be done in order to discover those wonderful medicines; the years of study which a person has to undertake, the years of training that he has to undergo before he becomes a skilful surgeon—all that has contributed towards the high costs of medical and hospital services.

Mr. Speaker, I have already said that employers of labour realize only too well that medical aid schemes have to be established in our country. We consequently find that the numbers of medical aid schemes are increasing month by month. According to the S.A. Medical Journal of April 1960 there were 135 plus 23 medical aid schemes as at that date. On the 10th December 1960— six months later, that number had increased to 143 plus 23 plus 89. In other words, there were 255 medical aid schemes. The hon. member for Mossel Bay (Dr. van Nierop) has given us the membership figure and the number of dependants of those members; those are the people who are covered by these medical aid schemes. But, Mr. Speaker, who are those people who are covered by the existing medical aid schemes? They say the following according to the Medical Journal of the 6 February 1960—

It is clear from that it is only a certain type of employee who is covered by the existing medical aid societies. I repeat that it is the “white-collar” worker, and only the “white-collar” worker of the most prosperous industries and business undertakings who share in these medical aid schemes. What is the position on the platteland? What is the position of the person in the small town who is self-employed? The hon. member for Vanderbijlpark asked what about the farmer? But he did not enlarge upon that. I think it is clear from what I have read that it is the “white collar” worker, the more refined worker, in the most prosperous business undertakings who is covered under these schemes.

The worker who wears the “white collar” is not necessarily the most refined worker.

I accept the hon. member’s explanation but we need not quarrel on that score. As I have said the person with a low income is in this position that he can go to the district surgeon and he receives free medical services. The person with a low income can go to the provincial hospitals and his hospitalization costs him practically nothing. But the man who belongs to the middle income group, the self-employed person in the small town, the person who has a small business and who employs four or five people, cannot establish a medical aid scheme. What must happen to the farmer on the platteland.

Unfortunately my figures are not up to date, but I have tried to ascertain how many doctors there are on the platteland and how many in the towns and cities. I was interested to find that there was one doctor for every 446 souls in Cape Town; In Pretoria one doctor for every 1,100 souls. In Johannesburg one for every 700. As you will notice, Mr. Speaker, the figures in respect of Cape Town and Johannesburg do not differ greatly. In Pietermaritzburg one doctor for 1,400 souls. Pretoria and Pietermaritzburg are closer together in this instance. Now I come to the platteland. There is one doctor for every 14,000 souls in the magisterial district of Utrecht, the little town where I live. There is one doctor for every 12,000 souls in Babanangu. That is in Natal. In the Transvaal there is one doctor for every 15,000 souls. There is one doctor in Groblersdal for every 17,000.

How many witch doctors are there.

We are discussing a serious matter, Sir. If the hon. member for Pretoria (District) (Mr. Schoonbee) is interested in witch doctors I suggest that he takes the people who vote for him to them.

The position is not quite as bad in the Cape Province, but we find that the problem here is the long distances. In some parts of the Cape Province, in the Transkei for example, the figures are very high but they are not so high on the platteland of the Cape Province although the distances are so much longer. I make this point because long distances mean high costs when you have to call a doctor. All the specialists are concentrated in the cities. Every visit of a doctor costs you so much more. The hospitals are concentrated in the big cities. Take the case of a person on the platteland who becomes ill. Assuming he lives 200 miles from Cape Town. He has to be brought to Cape Town and here he receives the best medical attention possible. In the meantime it is costing his family more than it would have cost the ordinary Capetonian because his family cannot let him lie alone in the hospital. If it is the husband his wife has to say here, often for weeks, so that he is not alone in the hospital. And if he is seriously ill, Mr. Speaker, the children have to be brought down as well. Those are all additional costs. But the fact remain that because of the long distance the costs are so much higher in the case of the person who lives in a platteland town and in the case of the farmer and the self-employed person than in the case of the person who lives in the city. I think it was the hon. member for Rosettenville who said that coughs and colds could be treated by the person himself. But in the case of the farmer and the small self-employed person in the small town, that cough and cold may get worse. That means that the person on the platteland must be satisfied to try to get along as best he can even if he is seriously ill.

I want to remind you, Sir, that there are only 1,000,000 people in the country who are covered by medical aid societies; the remaining 2,500,000 must still be covered. There are thousands of people in the country who have to think seriously before they call in medical assistance, with dire consequences. That “cough and cold” often develops into something serious. I have referred to free medical services and I have said that the person with a small income could get free medical services either through the provincial hospitals or through the district surgeon. There is one point, to which I want to draw the Minister’s attention and that is that a property owner is not entitled to free medical services or to the services of the district surgeon. The fact that he is a property owner, even though it is mortgaged, the fact that he owns a little house, even though it is not worth much, deprives him of the right to get free medical services.

I found it interesting to learn what types of medical aid schemes and medical aid societies there were. Here I have the list for 1960 with me and it gives for example African Cables Medical Benefit Fund, African Explosives Medical Benefit Fund, Argus Medical Benefit Society, Associated Employers Medical Benefit Aid, Bakers Ltd. European Sick Benefit Fund, Bloemfontein Municipal Employees, Friend Medical Aid, General Motors Medical Aid Scheme, Germiston Industries, Hubert Davies and Kransberg Mines Medical Aid Society. You find that the people who are covered under these various schemes are mostly people employed in industry. It is in this respect that our motion is of such importance, and it is in this respect that I should like the Minister to give his serious attention to the matter. There are thousands of people to-day who would like to join a medical aid scheme, but they cannot do so because there is no one which they can join. It is true, that insurance companies insure against illness, but in this case too, some difficulty arises, because I find that they say the following in the Medical Journal. I want to add that I have nothing against the assurance companies because I am pleased that they are doing it and that there are people who avail themselves of that facility. I find, however, that they say the following—

I am not criticizing them. I am simply stating the fact that has been the finding. We have this layer of people in between who are anxious to belong to a medical aid scheme but who are deprived of that privilege. It is there where the Minister and the Government have to step in and where, with their assistance, another medical aid society should be established, a voluntary society, which anybody can join if he wishes to do so and which will cover that great number of people who are not covered at the moment.

Mr.Speaker, the interesting debate in which we are participating at the moment deals with a great ideal, the ideal of humanity and assistance for people who find themselves in a difficult position. It is an idea with which we can all on both sides of the House associate ourselves. The only difference between us, however, is the method to be adopted in order to give effect to this idea.

There are a few facts we have to face and accept in our search for a solution to this problem. The first is that the cost of medical treatment is high, and it is high as the result of the excellent medical services we receive to-day, and because of the tremendously high cost of medicines as the result of all the research involved. We must accept that in fact we can do very little to reduce the cost of medical services. We may perhaps be able to do something, but in the long run it will be very little. In the second place we all accept that the solution of this problem, the problem of making the financial burden caused by illness bearable to the ordinary person, does not lie in a national health scheme but in sick funds, medical aid societies, insurance schemes, etc. The question we must answer is in what way the State can manage to ensure that everybody who is ill and has to bear the high cost of illness can be protected so that the burden will be bearable. In order to decide that it is necessary to review for a moment the existing position in South Africa.

South Africa has already done much for the poor section of the population and for the Bantu. That section of the population is catered for by the State by means of an extensive system of district surgeons and hospitals. It provides medical services and hospitalization gratis. South Africa can be proud of the fact that it is one of the countries which first gave consideration to the poor section of the population. We took them into account before considering the average man. The average man in South Africa, the man with the average income, was mainly left to his own devices. He had to provide for himself, and to a large extent succeeded in doing so through the establishment of sick funds, medical aid schemes and insurance schemes. Medical coverage to-day is part of the pattern of civilization throughout the world, and consequently also in South Africa. The need we all felt to make provision for illness started as far back as 1898, as the hon. member for Vanderbijl Park (Dr. de Wet) pointed out, and to-day it has already reached such a scope that according to the figures he quoted 1,500,000 of the White population, or 48 per cent of our White population, is covered by such schemes. These medical aid societies and other schemes render a praiseworthy service. In many respects one can say that they render a wonderful service. They make it possible for the ordinary man, who otherwise would never have been able to afford it, to make use of the best services possible in South Africa.

Now the success of these associations lies in the exertions of small groups of people who offer their services gratis and who, by personal sacrifice and work, have succeeded in doing something for their fellow-men, and the underlying motive is not profit. The attempt to initiate sick funds and medical aid societies mainly emanated from the sympathy these people had with others and at the same time from the desire to do something worth while. In many cases the executives of these medical funds and associations do not receive a penny compensation for their services, and sometimes they themselves have to pay costs such as travelling expenses. In this way the administrative costs of these funds are limited to a minimum. These associations function very successfully amongst working communities like those of the Railways, in offices, in industrial or commercial undertakings, and there these sick funds particularly perform a service which one sometimes loses sight of. There they not only organize or collect funds and pay accounts. There they render a social service, because the sick fund in the first place becomes a bond between the workers, a bond of mutual help and co-operation. But they do more. They create a bond between the employer and the employee. Because in most cases the employer contributes a large amount to the funds of those schemes. It is calculated that in South Africa the employers contribute from one-third to 100 per cent of the funds of these schemes, and in addition they also often bear the entire costs of administration. In that way a bond of friendship and co-operation is established in our large undertakings between employer and employee. Every employer in the country will testify to the fact that where there is goodwill and co-operation between the employer and the employee, it goes a long way towards ensuring the success of the undertaking.

Now the motion of the hon. member for Rosettenville (Dr. Fisher) says that the solution of our problem is to be found in the establishment by the State of a voluntary medical aid association. Let me for a moment analyse the effect of this motion. I think that in the first place we should accept it as axiomatic that if the State were to start establishing sick funds or any medical scheme it would have to provide only the very best services. The State would have to do so at a tariff which would be as low or even lower than the member has to pay to any other scheme. In other words, the State services would have to compare with the best services rendered by the best associations, and it would have to make the premiums as low as those of the fund with the lowest tariff.

Now the motion of the hon. member for Rosettenville contains this basic proposition, that in the first place it must be a voluntary scheme. Now there is this difference between voluntary and compulsory schemes, that in voluntary schemes the contributions of the members are much higher than those of compulsory schemes, and the reason is obvious. It is because the young and healthy man does not easily join a voluntary scheme. The people who join it are those who have reached an advanced age, and because the costs of those associations are already high the contributions must also be high. Therefore the first problem in the scheme of the hon. member for Rosettenville is that it must be established by the State to render the same services to the public as other schemes, but in the most expensive form, which means that the burden on the State will already be appreciably heavier than the burden borne by any other scheme. But in the second place, the hon. member’s idea holds the following problem, that in almost all existing medical aid schemes the member only pays a small proportion of the income of the fund, whilst the employer contributes usually between 50 per cent and 100 per cent. It will therefore mean that if the State starts a medical aid scheme it will have to be prepared itself to contribute the employer’s share, because unless it does so either the services rendered by that scheme will be infinitely worse, or the contributions paid by the members will be infinitely higher. It means that the State will have to contribute between 50 per cent and 100 per cent of the funds of the scheme. Let us accept that the State will contribute only 50 per cent, and let us now go further. In the third place, the scheme has this weakness, that in the majority of medical schemes the employer bears the administrative costs, but if the State were to initiate such a scheme it would also have to pay the administrative costs. In the fourth place, in the ordinary medical scheme the members of the executive render their services gratis, but the State will not be able to rely on the gratis services of members of its scheme. It will have to pay everybody. In other words, the costs of administration will also have to be borne by the State.

I now want to make a calculation, and I want to put it on a much lower basis than the hon. member for Rosettenville did. The total contributions paid into these medical schemes to-day is approximately R20,000,000. That is the total income of these medical schemes. Let us assume that the State pays only half of it, then the State would have to pay R10,000,000 per annum. But the costs of these medical schemes amount to approximately 7.8 per cent of the income. In other words, the State will have to pay another 7.8 per cent on a total income of R20,000,000, i.e. an additional R1,500,000. But this will still be only for the half of the population which is not covered yet, and when the other half which is covered now eventually demands that they should also be covered by this scheme, the cost to the State will amount to twice R11,500,000, i.e. R23,000,000 per annum. That is appreciably lower than the estimate made by the hon. member for Rosettenville, because he calculated that it would cost the State R48,000,000 a year. But the hon. member made another concession which makes the problems still more serious. The concession he made was that when one establishes a medical scheme for the Whites, one will eventually be forced to establish it for the non-Whites also. Now one can foresee that eventually the non-Whites will insist on having it, and will eventually get it too, if the State agrees to initiate such a scheme itself. That would mean that one would have to initiate a scheme for the whole population, and let us then look at the picture. Then it will no longer, according to my estimate, be R23,000,000 a year, but five times R23,000,000, or R115,000,000, and then, according to the calculations of the hon. member for Rosettenville, it will be five times R48,000,000 or R240,000,000 per annum. In my humble opinion the country cannot possibly afford it, and however much we want to assist where we can, we are eventually limited by the economic potentialities of the country.

But what is more, the unfortunate aspect of the scheme proposed by the hon. member is this, that it eliminates the burden which to-day is borne freely and happily by the public. The public which is insured under these medical schemes to-day and which contributes towards them, and also the employers who contribute, will all be relieved of their obligations, or of the major portion of their obligations. It means that by introducing such a scheme we would be shouldering an unnecessary burden which we could have avoided.

But that is only one portion of the costs of such a State scheme. That is only the financial cost, but there are also social costs connected with it, namely that by means of such a scheme we would be destroying everything that is splendid in all these hundreds of schemes. We shall be destroying the unselfish service rendered in love and self-sacrifice towards others. Those sacrifices which constitute the most splendid aspects in our elements in our society, which enrich our lives as people towards one another, and which ennoble our society, that intangible thing which is the bond between people, will be destroyed. But we shall also be destroying the pride we have in those groups of people throughout South Africa who take the lead in this work, the people who undertake it out of love for their fellow-man, and out of a feeling of pride that they are doing something worth while. It is a pride and a spirit of initiative which cultivate leadership, and we shall lose that also if we accept the idea of a State medical scheme.

But, thirdly, we shall also be destroying that valuable bond which these associations to-day create in our industries, that bond between the employer and the employee, the bond of goodwill and co-operation. Then the worker will again become a number and the employer will again become merely the writer of that number. But the problem confronting us still remains how we can provide medical coverage for every member of the population. Our population is divided into three sections, the poor and the Bantu who are already receiving medical treatment on a reasonably sound basis, secondly the 48 per cent of the population already covered by the existing schemes, some of which are good and some not so good; and, thirdly, those who are not covered at all. The motion of the hon. member for Rosettenville will have the effect that eventually the existing system of sick funds will simply be abolished and replaced by a State scheme. In my opinion, that is the wrong solution. I think the correct solution is that the State should rather try to expand and to improve the existing medical schemes, to eliminate their weaknesses and to consolidate them, and to assist that 52 per cent of the population for whom there is no medical coverage to-day to organize themselves to establish such schemes on their own. That seems to me to be the solution we should try to achieve.

The existing medical schemes show little uniformity. There are very great differences between them. Some give few benefits, others many, and some give exceptional benefits, so much so that if they are to continue in that way, they will eventually find it impossible to continue existing. Some provide for dental services, others again for maternity benefits, and others for the services of specialists. Some even provide for funeral costs, others for death benefits and for labour disabilities. Some provide for the payment of the whole of the patient’s account, whilst other again pay the accounts only up to a certain maximum amount. Some require the member to pay the initial portion of every account. In this way there is a total lack of uniformity. Some of these undertakings are actuarially sound, others doubtful. The great need is for expert assistance and guidance. They say they need a body to assist them and to guide them and to place them on a sound basis. In 1950 an advisory board for the medical aid associations was established. This body achieved considerable success, but not completely so. They are now requesting the State to establish a body which can serve as the liaison between them and the medical profession, to assist them to solve their problems and to place themselves on a sound basis. The establishment of such a body by the State is advocated by no less a person than the chairman of the committee of contractual practitioners of the Medical Association a number of years ago. It was also advocated by the advisory council for medical aid societies. If we want to provide sufficient medical coverage for the whole of our population, it seems to me that this is the direction in which we should think. It seems to me that this is the solution of the problems we would all like to solve.

Towards the end of 1959 the Commission of Inquiry into the high cost of medicine and of medical services in South Africa was appointed under the chairmanship of Prof. Snyman, the vice-president of the Medical Council. At the same time a small departmental committee in the Department of Health was appointed under the chairmanship of Dr. Reinach to make a study of medieál funds and medical aid associations. This committee of Dr. Reinach’s was eventually incorporated in Prof. Snyman’s commission of inquiry, and I hope that the report of this commission will be submitted this year still. In the meantime Dr. Reinach has already performed valuable services in this respect in the Department. His assistance and advice have already repeatedly been called in by medical aid associations and sick funds in connection with the problems with which they are faced every day. Dr. Reinach has already assisted in the establishment and development of new medical schemes for groups which were not covered before, and since he concluded his task towards the end of August last year, no fewer than 20 new medical schemes have been established, of which only half already represent 20,000 members. I hope that one day when this small section in the Department of Health is functioning properly it will help to realize the object we are all striving for in this House, namely the improvement of the existing medical associations and medical schemes and the expansion to cover the whole of the population of South Africa. It seems to me that in this way we will succeed in attaining the great ideal we all envisage in South Africa without derogating in any way from the existing sound system of sick funds and medical associations we have.

I think that the speech of the hon. Minister of Health has come as rather a disappointment to many members of this House, because it is quite obvious from the speeches which have been made in the course of this debate that we all feel that something must be done towards bringing down the increasing cost of illness to the ordinary man in the street. I feel that the motion moved here by the hon. member for Rosettenville (Dr. Fisher), which calls upon the Government to consider the advisability of introducing a voluntary medical aid scheme, is one which should have been accepted by the hon. the Minister. The hon. member for Rosettenville has nut forward his suggestions as to what form such a medical aid scheme should take. We all realize that there are enormous difficulties involved in formulating any scheme of this nature. However, it is felt that if the Government had accepted this motion and considered the advisability and investigated the possibility of introducing such a voluntary medical aid scheme, it would have done a great deal to alleviate the present position. The hon. the Minister, in the course of his speech, mentioned the millions of rand being expended on medical services and he dealt with the cost of a scheme such as that proposed by the hon. member for Rosettenville. I believe that these enormous expenses which the Minister outlined here this afternoon all go to show the necessity of instituting a more realistic scheme to bring about a more practical spreading of costs. The position as we have it to-day, where people who are not members of a medical aid scheme, suffer severe financial difficulties, particularly in the latter part of their lives, is one which I believe requires the immediate attention of the governing party. With the introduction of a medical aid scheme, we feel that an effort will be made to alleviate the position, but at the same time the difficulties that will be experienced in the initial stages will be great; we are the first to concede that, but we are fortunate in that various other schemes have been introduced in other parts of the world and they are available to the Government. I am thinking particularly of a scheme which is gradually being introduced in New Zealand. I realize that there are certain members opposite who will immediately suggest that such a scheme is socialistic; some might even suggest that it is communistic. However, far from advocating a welfare state or any form of socialism, we do feel that social security must be a comprehensive Security cover which allows for all circumstances that may arise during a person’s lifetime; and in such a scheme of social security, the knowledge that the finest medical brains will be available to every man, irrespective of his economic status, will provide great comfort and a feeling of security to the patient. Sir, I have made a study of the system of social security as it exists in New Zealand to-day. There they have an all-embracing scheme where the medical benefits are considerable and certainly in advance of the medical benefits and advantages of the medical aid scheme put forward this morning by the hon. member for Rosettenville. I would like to draw the attention of the House to some of the items which are provided for in New Zealand, because I feel that in considering the advisability of introducing a medical aid scheme, we should look around to see where such schemes are being successfully implemented. We find that in New Zealand, according to a booklet that was published by the International Labour Office, the health benefits which come under the Department of Health incorporate maternity benefits, hospital benefits, medical benefits, pharmaceutical benefits and supplementary benefits as x-ray services, massage services, district nursing services, domestic assistance, laboratory diagnostic services and dental benefits. The question will be raised immediately as to what the cost would be of providing such a scheme to the people. The whole question of the financial structure of such a scheme is based on two sources of income—a tax known as a social security contribution, plus an annual grant from the consolidated revenue fund. The New Zealand comprehensive social security fund derives its revenue from a contribution of 7½ per cent of all salaries, wages and other income of persons over 16 years of age. This is the all-embracing social security scheme which includes medical benefits. The revenue that they derive from such a source is only sufficient to meet the demands made upon that fund; it is not a question of accumulating funds with a view to building up a large financial reserve. The latest figures available, which are outlined in this booklet, shows that the cash benefits under this scheme amounted to £34,455,000; in other words an amount of £18 12s. 3d. per head of the population. The health benefits, other than cash benefits, amounted to £7,875,000, in other words £4 5s. Id. per head of the population. The overall scheme which allows for these benefits, goes on to outline the various conditions under which these benefits are available to all sections of the community in New Zealand. And here I fully realize the difficulties involved in our own country with the large number of non-Europeans requiring expensive hospitalization and medical services; I realize that is a very big problem indeed. I know that in the province of Natal, where the ratio between the Bantu and the Whites is 8 to 1, an enormous strain is placed on our provincial hospitals to maintain the high standard of medical services rendered to the non-Europeans, to such an extent that the financial resources of the province are seriously affected by that drain. However, I am merely giving details of this particular scheme to show that there are other schemes where medical aid is rendered to the people and that those schemes are working successfully.

With regard to other medical services which are made available to these people, they also have out-patient services in all public hospitals, and these services are provided entirely free. Under this scheme you find that people take timeous steps to see that they do not develop serious health problems, with the result that the ultimate cost of the scheme is far less than it would have been if these timeous steps had not been taken. These people are not discouraged by the prospect of incurring high medical expenses. We know very well that there are many people who neglect to approach a doctor because of the fear of the financial burden that will be placed upon them as the result of such a consultation. We all know to-day that there is rarely a cheap remedy available for any illness from which you might be suffering. These people, because of this failure to consult a doctor timeously. find that their health deteriorates considerably. The provision of these free services, however, encourages people to take the necessary steps to see that their health does not deteriorate. Sir, since the health and productivity of our labour force play such an important role in commercial and industrial undertakings, it is in the interest of the employer and of the national economy to see that a high standard of health is maintained. This scheme which they have in New Zealand is one which goes a good way towards providing all the needs that arise from time to time. For instance, the cost of any approved drugs, medicines and appliances prescribed by a doctor in the course of providing medical services is met from this social security fund. Similarly, the necessary facilities are also provided for persons requiring the attention of opticians. Certain hearing aids are also supplied at the cost of the State, and in respect of other approved aids a subsidy is paid towards the cost. For instance, in the case of artificial limbs 80 per cent of the cost is paid by the State. In addition to this service, a free dental service is also provided, and this scheme gives a complete coverage in regard to all situations that may arise during the course of a person’s lifetime, as far as his health is concerned. Where schemes of this nature are provided in other countries for the benefit of the people and are incorporated in a comprehensive social security scheme, it is important that this matter should also receive attention in South Africa, where Governments of the past and also the present Government to a certain extent have encouraged certain steps to be taken in regard to social security measures. After all, the Unemployment Benefit Fund, which makes provision for persons who are unemployed, the Workmen’s Compensation Act and even our social pensions, are all a form of social security. Unfortunately, however, our social security programme falls short when it comes to the question of health services. We find that many people are suddenly faced with enormous bills which cripple them financially for a number of years. It is hoped therefore that the hon. the Minister will not stop at this stage in his investigations in trying to reduce the high cost of illness. We always talk about the high cost of living, and here we have had an opportunity to-day to talk about the high cost of illness. We have heard from the Minister about the committee of inquiry which has been set up to inquire into the high cost of medicines, and we naturally all look forward to receiving the committee’s report. I feel that at this stage of South Africa’s development, where we need a healthy labour force for the development of our country. where the family man should receive every encouragement, the Government should come forward with some tangible assistance to provide the necessary security for our people. I feel that the hon. member for Rosettenville who has moved this motion to-day calling upon the Government to consider the advisability of introducing such a voluntary medical aid scheme, has put forward a motion which requires the very careful attention of this House.

I as a newcomer regard it as a privilege to have listened to speeches in this House to-day of such a high standard. I think the House and the public outside owe a debt of gratitude to those members who have conducted this debate on that high level. As a layman, and not as somebody who belongs to the medical profession, I think it is only fair that we should express our gratitude to the hon. member for Rosettenville (Dr. Fisher) for having introduced this motion in the House to-day. We are grateful for the fact that it has been discussed in the calm manner in which it has been discussed. This motion has been introduced because hon. members are concerned about the health of the people outside, but I think we are justified in saying that the health of the people of South Africa probably compares favourably with the health of the people in most other countries in the world. We are proud of the fact that our doctors have contributed to that high standard of health in South Africa. As a layman I want to pay tribute to those doctors who have made their contributions to maintain that high standard of health. At the same time I want to pay tribute to the Minister of Health, the Government and the Provincial Administrations for the fact that they have all along maintained the health of the people on such a high level and for having made so many facilities available to the people. When we think of all the facilities that are available to-day in the form of health services and medical services, we are grateful to all those who have assisted in bringing about that state of affairs. I also think we should pay tribute to our South African doctors and specialists for what they have done. I want to mention a case, Sir, which happened in my own constituency—and in this respect I wish to support the hon. member for Vanderbijlpark. People are inclined to-day to go overseas for any special operation, and I agree with the hon. member that those operations can be performed in South Africa equally well. For example, there was a child of a less privileged person in my constituency who had to undergo an open-heart operation; that operation would have cost him from R3,000 to R4,000, but that team of doctors did that operation on the child free of charge. We want to say thank you very much to the doctors for what they are doing for us in South Africa. Mr. Speaker, what is the real problem to-day? We have all these different medical aid societies to-day, but practically every one of them is in financial difficulty. Every one of them is approaching the employers to assist them. What is the real reason why those medical societies are in financial difficulties to-day? The reason is that it has not as yet been made compulsory for the employees to join the medical aid schemes which have been established for their benefit. Most of these schemes are today still being conducted on a voluntary basis. Take the municipalities, for example. It is only during the past three years that it has been made compulsory for the municipal employees to join the medical aid societies. When the worker enters the employ of the municipality or the factory or whatever it may be, his attitude is that he is healthy and that he does not need a doctor. The result is that while he is young he is not making the contribution to the society which he ought to make. But at a later stage, when he is older, when he has children, he joins that society and he places an additional burden on it, with the result that the society cannot fulfil its obligations and higher demands are made on its members. I want to plead with the Minister this afternoon and ask that legislation be introduced to make it compulsory where such a factory or company establishes a medical aid scheme, for the persons who work in that factory or with that company to become members. It will have the added advantage that those societies will be strong and able to develop.

We also welcome those other medical aid schemes which the insurance companies have introduced. Here again the insurance companies are doing pioneering work by making it possible for people who would otherwise not have been able to belong to a medical aid scheme, to become members of this society. But this too is another case of group insurance. When representatives of those insurance companies get to the platteland and ask the teachers of the local school to join the scheme, only a few of them do so; those who are young and healthy refuse to join. The farmer on the farm may also become a member of that medical society to-day, but we all realize that it is an expensive scheme and that it costs a great deal of money. We should not try to transfer the responsibility of the head of the family on to the State; and in that respect I agree with the Minister that we should make propaganda so that the existing facilities and the existing schemes will be expanded and so that the head of the family will realize that it is his duty to see to the health of his family. Just as the head of the family is concerned about what his income will be when he retires, he should be concerned about the health of his family and he should see what he as head of that family can do; he should not be as inclined as he is to-day to expect the Government to do everything for him. I agree with the hon. the Minister that we cannot simply introduce a scheme which does away with all the existing schemes. I personally think that is an impossible task and as soon as the Government starts contributing towards such a scheme we will find that far greater demands will be made than those which are made today.

At 3.55 p.m. the business under consideration was interrupted by Mr. Speaker in accordance with Standing Order No. 41 (3) and the debate was adjourned until Friday, 30 March.

The House proceeded to the consideration of Orders of the Day.

In these times of sudden change in which we live it is of course a fact that since I spoke on 16 February on the motion of the hon. member for Gardens (Mr. Connan), to which an amendment was moved by the hon. member for Wakkerstroom (Mr. Martins), both the motion and the amendment have to a certain extent become antiquated because conditions have changed so much in the meantime. Where we had a full-blooded Thursday yesterday, we are to-day having a full-blooded Friday, particularly in view of the fact that the hon. member for Drakensberg (Mrs. S. M. van Niekerk) took part amiably in the discussions. Let us then conclude the day on that note. It is just a pity that so little interest is being evinced in the matter at his hour of the day, judging by the numbers present in the House.

Mr. Speaker, you will remember that the hon. member for Gardens expressed his concern about the falling prices of agricultural products and the rising production costs, as well as the growing surpluses, and that he asked that the Government should consider the desirability of combating these evils and making available sufficient market facilities. In Col. 1274 of Hansard (12 to 16 February 1962) the hon. member says that two years ago we imported 3,000,000 lbs. of butter from New Zealand, and he added that before that consignment arrived here we sat with a surplus and had to get rid of 24,000,000 lbs. of butter and 8,000,000 lbs. of cheese. With this admission by the hon. member for Gardens that such a change could take place within a short time, I want to ask the hon. member whether he has a formula in terms of which the Government under similar circumstances can find a market by some magical means to neutralize this position which really arose overnight. In Col. 1276 the hon. member says that means can be evolved to give these surpluses to those people who really need them, at a reduced price—we all feel that way about it—and then the hon. member says that it simply must be done and that methods can be evolved and that it should be done. But if one stops there with one’s advice, one has made no progress at all. The hon. the Minister pointed out, when he addressed the House, how by paying a subsidy of 2½c per lb. on butter and a reduced price of 2½c per lb. on butter fat, the Government had already taken steps to make this product available to the less privileged people at a price which was reduced by 5c per lb. We must remember that when something like this is done, somebody has to pay for it. In this regard the hon. member for Bethlehem (Mr. Knobel), in my opinion, said a very good thing; he gave advice but he said one, of the great things which are said throughout the years and are then buried in Hansard. It is that consideration should be given to the idea that the profits made by local authorities on the sale to non-Whites of White man’s liquor should be used partially to provide subsidized dairy products to the less privileged non-White children. I just want to refer to what was said by the hon. member for Pietermaritzburg (District) (Capt. Henwood). He also predicted—and it is a good thing that hon. members should draw attention to it—the possible loss of our market for dairy products in the United Kingdom, if the United Kingdom joins the European Common Market. The hon. member also pointed to the danger threatening our egg market for the same reason, because the six countries which are already members of the European Common Market will demand preference in regard to the sale of their eggs. Here we again have a case of a market being lost very suddenly for a certain commodity, and I therefore again want to point out with what problems the Government has to cope. Here we have the loss of the market for a certain product as though by the wave of a magician’s wand, and nowhere else in the world can a market again be found for that commodity simply by the wave of a magician’s wand.

Then we had a less pleasant episode when the hon. member for South Cost (Mr. D. E. Mitchell) was speaking. Now the position is that one can call the motion moved by the hon. member for Gardens a political motion, and one can turn it into a political motion if one wants to (nothing is easier than that), and one could call the amendment moved by the hon. member for Wakkerstroom a political motion and make it a political motion, and that is what the hon. member for South Coast really attempted to do. I want to point out that I right from the beginning did not set out with the idea that the motion of the hon. member for Gardens was a political motion, just as little as the amendment of the hon. member for Wakkerstroom was a political amendment. I am just referring to the challenge issued by the hon. member for South Coast when he said: “I will now sit down timeously so that the Government can vote on the motion of the hon. member for Gardens and the amendment of the hon. member for Wakkerstroom!” Now you will remember what a stormy reception the member for Water-berg had the moment he got up to sing the swan-song in the debate.

And he is still singing.

Yes, it is the kind of swan which sings a swan-song in order to remain a swan and to be able to sing again another day. Where the motion of the hon. member for Gardens perhaps unjustifiably—I do not want to say that it was intended that way—to some extent wish to intimate that the whole agricultural industry was in a deplorable position and further insinuated that the Government had neglected the farmer to a large extent in this regard, the hon. member for Wakkerstroom in his amendment clearly pointed out the assistance given to the farmer through the Marketing Act, through the activities of the Department of Agriculture to raise the standard of production, the financial assistance given by the Land Bank, by the Farmers’ Relief Board and other institutions, and the hon. member did it so as to put the matter in the correct perspective when we compare this motion and the amendment with each other, and in order to get the true picture against the proper background. I had thought that both the motion and the amendment could supplement each other nicely if the temptation is not always there to seek an excuse to drag into politics those things which we all say we want to keep out of politics. It is not easy to resist the temptation in an unguarded moment to drag something into politics if one thinks one can derive a little political advantage from it. In Col. 1323 the hon. the Minister referred to the assistance given to the farmers in the past in the North-Western Free State, as we all remember still, and here I want to add also the recent assistance given to the North-Western Cape and the assistance now being given in the Northern Transvaal. Before I pass on to refer more specifically to the practical assistance now being given in the Northern Transvall to the farmers suffering from foot-and-mouth disease and drought, I just want to read again the fourth paragraph of the amendment moved by the hon. member for Wakkerstroom, namely—

I emphasize “areas in which unsatisfactory conditions have arisen in the agricultural industry because of climatic vagaries”. That is precisely what the position is to-day in the Northern Transvaal, practically from the Magaliesberg to the Limpopo. In regard to the Northern Transvaal I want to point out what precisely has been done, and that will serve as the reply to the motion of the hon. member for Gardens, and I also want to deal with the assistance which is further envisaged. The assistance rendered in regard to foot-and-mouth disease covered the northern part of the Palala soil conservation district, the Koedoesrand soil conservation district and the Gregory and All Days soil conservation districts. That is a large area in which to-day indescribable misery prevails as the result of having been afflicted by foot-and-mouth disease for 22 months, followed by an unprecedented drought which has now lasted for four months already, where the fierce summer sun is baking the earth and everything is dying to such an extent that, according to the latest figures sent to me from my constituency, to date about 5,000 cattle have died because the farmers cut their throats or died before their throats could be cut. About 1,000 farmers and about 150,000 to 200,000 head of cattle are affected, and in order to alleviate the urgent need the following proposal was submitted to the Cabinet for its approval. I am at liberty to mention it now because it has already been published in the Press, and I merely mention it to show that the Government actively renders assistance when necessary: In the first place rebates, (a) on the transportation of animals by road motor services of the S.A. Railways, 25 per cent of the costs of transportation. I imagine that we are dealing with a new principle here, something which has never been granted in the past, and which was not easy to obtain. But as the result of the conditions prevailing there and the fact that the Government realized the position, and because, as we know, the Government is the friend of the farmers, this step was taken. I think we are dealing with a new principle here and that proves to us the integrity of the Government in regard to its attitude towards the catastrophes to which the farmers are subjected and over which they have no control. Then 50 per cent of the costs of transportation of fodder by S.A.R. road motor services. But rebates were also granted in connection with private transportation, because there is no railway line in that area and there are not many railway buses, but there are quite a number of people who obtain permits from the Road Transportation Board to transport stock and fodder there, and on the transport of fodder by private persons a subsidy is paid to a maximum of R1.75 per ton for a maximum of 120 miles, and on the transportation of stock by private transportation a maximum of 80c per beast for a maximum of 120 miles. And before that time fodder loads were also granted.

It is the first time in history that such transportation was subsidized.

Those are the concessions the Government made in those circumstances to the farmers of the Northern Transvaal who were in trouble, and it is unprecedented and the Government has laid down a new principle, well knowing that in future this precedent will have to be followed in times of necessity. But this Government does not mind doing that and opening this door. Originally the aforementioned assistance was to have applied only to the end of February, but immediately we saw that this period was too short we asked for an extension, and our words were hardly cold when the assistance was extended to the end of March. For the purpose of this assistance the costs were estimated at an approximate amount of R30,000 on the basis that at least 30,000 head of cattle and 3,500 tons of hay would have to be transported in that 1½ months.

But the drought conditions in the area became worse by the day. I arrived back from that area yesterday and death is on the threshold and in some places it is in the house. There is nothing. In the meantime the farmers made further representations to the hon. P. M. K. le Roux during his visit to Potgietersrust, and submitted by me. but in view of the fact that these representations are still being considered by the Cabinet I do not feel justified in saying more about it at the moment, although I have every hope that further assistance will be forthcoming.

Now people say so easily: Just increase the prices of agricultural produce. The hon. member for Drakensberg also said so when she stated that the farmer must receive an entrepreneur’s wage on which he can live. It really amounts to an increase in prices. Allow me to mention just one example to show what this nonsensical increase of prices can lead to, and that in the past prices were in fact increased. I just want to say a word about meat. Meat prices were increased during the past two decades, in regard to the floor price, by not less than 30 per cent, and now I just want to say that the average selling price during the plentiful months, i.e. February, March, April and May, was 30 cents above the floor price. If one increases the floor price by only R1, one has the position that the floor price is then 75 per cent higher than the average selling price, and where will that lead? It will result in a greater surplus which the Board will have to buy and will be compelled to buy, whereas in normal circumstances during these four months I have mentioned the Board is already buying 14,000 carcases.

I may just add that during the same period the following concession was also made to the farmers afflicted by foot-and-mouth disease and drought, namely that Minister Nel, Minister of Bantu Administration and Development, rented the Native Trust lands to the farmers for grazing at 7½cent per head per month, whilst under normal circumstances the price is 25 cents per head per month. And in addition, it did not matter whether the farmers were plagued with foot-and-mouth disease or with drought.

We should not lose sight of the fact that when we see that the farmers are in trouble and we want the Government to assist them, all kinds of factors come into play. To what extent can the freedom enjoyed by the farmer, for instance, in practising his profession perhaps assist in creating the problem of overproduction and marketing? Let us take, for example, the crop farmer, the man who makes his living from cash crops. In the first instance the farmer buys land just where he likes. If he buys land in a desert area he does so because he has the right to purchase it there and wants to do so, but if he buys in a desert land he must expect trouble. The farmer also buys as little or as much land as he likes and if he buys a very small bit of land then it is an uneconomic unit and he can also expect trouble because he is not able to make a living on it. But it is his own free will, perhaps because he cannot afford to pay for more land. Then the farmer plants what he likes, and I do not say that in any bad sense of the word. He farms scientifically and he perhaps thinks it is the best thing to do and he plants what he likes, and it is not easy to tell him what he should plant. Just go to the closer settlements and see how people are sometimes sceptical of the advice given by the superintendent and his committee of control there. Very often one hears someone say: “If only they had left me to myself to plant what I wanted to plant, I would have had a crop”. Of course, nobody can control that because he did not plant that thing and could not have a crop. But the farmer’s freedom goes much further. Not only does he plant what he likes but he also selects his own seed, and the agricultural technical officials tell us that it has been proved that the crop can vary by as much as 25 per cent depending on whether one sows good or bad seed. But the farmer is also at liberty to select his seed, and he does so. I want to point out that the farmer also plants as much as he likes. It makes no difference that last year we had a maize crop of about 52,000,000 bags and are still sitting with approximately 30,000,000 bags surplus. We planted again this year and expect a crop of between 55,000,000 and 60,000,000 bags. That is the freedom enjoyed by the farmer, and now I would like hon. members opposite to consider to what extent the liberty enjoyed by the farmer in exercising his profession contributes towards the problems with which the Government, together with the farmer, has to cope later. But, Mr. Speaker, the farmer also supplements his labour force as much as he likes, and one can use one’s labour force very economically, but also very wastefully. And the farmer buys and uses whatever implements he likes, and in regard to fertilizers he buys what he thinks is suitable, and spends much money on it. I have now mentioned eight freedoms, absolute freedoms. And now I come to the ninth and tenth. He has now harvested his crop and two more steps remain. Now he must have a market and he must receive a price, and it is here that the Government comes into the picture. Hitherto the farmer has had general freedom, and he has come to the stage where he is faced with a fait accompli, where supply and demand probably no longer correspond at all. At that stage he is faced with a fait accompli, and if the supply exceeds the demand the Government immediately enters the picture and it is also faced with the fait accompli and the farmer and the Government are confronted with what is commonly called a marketing problem. And it is at this stage that constructive consultation between organized agriculture and the Government rather than destructive criticism in order to sow suspicion give the best results to the farmer and facilitate the task of the Government.

The hon. member debated the question as to whether the motion of this side of the House or that on the Government side was a political motion or not. I should like to inform him that the mover of our motion (Mr. Connan) did his level best to frame a motion that could be generally debated over the floor of the House without any political implication whatever. The motion was a very plain one—

1. (a) The downward trend in commodity prices; (b) the upward trend in production costs; and (c) the accumulation of commodity surpluses.

To this motion the hon. member for Wakkerstroom moved an amendment which was a typical “thank the Government motion” as we are accustomed to from the Government-side.

A very good amendment.

The hon. member says that was a very good amendment, so I need not stress that the Government side favoured that particular amendment, and then of course you immediately find that politics are introduced in the debate. That is the reason why the hon. member for South Coast (Mr. D. E. Mitchell) challenged the Government to come to a vote.

The hon. member for Wakkerstroom (Mr. Martins) quoted a number of figures to prove the country’s prosperity. It is of course very easy to quote figures, because our finances in this country in general have increased to an enormous extent. When I first came to Parliament, our annual revenue was something like R74,000,000 per annum, now it runs into R800,000,000 per annum. So it is very easy to play with figures, and the danger of figures is that they sound convincing. But I would like to remind the hon. member that it is stated in medical reports that people who have too much to do with figures are very subject to thrombosis. That is why our Natives for instance who have never anything to add up are in the lowest category as regards that particular complaint. Then again the hon. member for Vryburg (Mr. Labuschagne) suggested that mealie-meal now should be mixed with our wheatenmeal in making bread, I don’t know how that is going to be accepted by the country, but I should like to remind the Government that this side of the House was put out of power as a result of introducing mealiemeal to our bread in time of war. We on this side of the House are very much perturbed about the financial position of this country and about the position of the farmers in particular. The position is giving us considerable anxiety. We have had a few strokes of luck, but they are mere bagatelles. For instance the sugar industry was able to enter into a very favourable contract with Great Britain, under which they sold 150,000 long-tons of sugar. This quantity will be taken by Great Britain annually for five years at almost double the world price. But that is only 16 per cent of our production in this country and when the Pongola area is developed, our sugar production then will be such that the sugar industry may have to face a very parlous period. And in regard with our sugar production too I would like to state that at present there is 1,000,000 ton surplus in the world, which by next year may be 5,000,000 tons, and besides that we have considerable surpluses of butter, cheese and eggs and canned fruit, and even if we become an associate member of the European Common Market, we could not face the surpluses that market is building up. And if Great Britain joins the European Common Market, we farmers will have considerable misgivings. We know that Great Britain is going to negotiate to protect the Commonwealth countries, but we are a foreign country. We are now an independent republic and we are dependent on our own resources, and we must not expect imperial preferences being applied in our case at all. We are also worried as regards our general co-operatives in this country. We do not feel that there is that cooperation that there should be, that our cooperative organizations are perhaps working against each other and not working for cooperation. Generally speaking the finances of our country are such that the Government to-day can only assist farmers who are actually bankrupt. I can assure you, Mr. Speaker, that there are many farmers in this country who fear that may not even last too long, and that farmers will be thrown entirely on their own resources. We in this country are apparently looking for some miracle to take place, such as that Great Britain will devaluate her currency again, or that there will be an increase in the price of gold, or that we may unearth some rich new gold-reserves. We must not expect miracles to happen. We must be practical. We, as a new nation, must put our shoulder to the wheel and if the Government will assist us and go slow perhaps on its separateness activities and concentrate on extending our home markets and rather encouraging the production of surpluses and developing a well-fed happy nation, that would be the solution. If we have a well-fed happy nation, we would have a prosperous farming community, which is the basic necessity of any nation, and if we want peace generally among your people, you must see that they are well fed.

Mr. Speaker, at this stage, I want to move—

I second.

Agreed to: debate adjourned.