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MEDICAL PRACTICE UNDER THE INSURANCE ACT.
425
apppointed to consider the report of the last spite of this claim to differ comparison may be made Royal Commission on the Poor-laws coupled with between Mr. Todd-White’s views and those of Prothat right the not unimportant corollary that fessor Benjamin Moore referred to in THE LANCET those choosing their doctor should pay themselves of April 22nd, 1911, p. 1090. Mr. Todd-White informs us that he has advocated for more than 12 a portion of the cost. Medical services dealing with special classes- years the formation of a Ministry of Public Health and has now taken a step further under e.g., the Poor-law, the army, navy, &c.-which Insurance Act, being brought by it to the conother than the for State reasons conditions the require to medical attendance common all templation of a possible National Medical Service requirement that the best professional skill shall be avail- under a Minister of Public Health. He strongly able, must necessarily make large inroads on the advocates the better representation of the medical principle of " free choice," and it is only equitable profession in Parliament, but does not make it that those who are denied the choice of a doctor quite clear how he would bring this about in these should not be called upon to pay towards the cost days of all-powerful and accurately organised of the medical service. But it is otherwise in the political caucuses, even though the profession were case of the community generally, who are com- willing to pay the election expenses of "at least pelled individually to pay towards the cost of their 10 more " members. His proposals for the organisamedical attendance, and no proper analogy can be tion of a national service are made in a somewhat drawn between a State medical service to attend sketchy form, but his paper may well be included the community and the State services existing at in the bibliography of an important subject, and he makes a good point in urging the medical prothe present time. I do not share Mr. Parker’s opinion that the fession to consider its position with regard to a public has not been loud in favour of the right proposal for a National or State Service which may The public can only otherwise come upon it more or less unexpectedly of " free choice of doctor." I am, Sir, yours faithfully, speak through its representatives, and on a from outside. E. A. A. Feb. 2nd, 1914. memorable occasion during the passage of the National Insurance Act the unanimity of both the .parties in the House of Commons on this subject MEDICAL PRACTICE UNDER THE affords a striking proof of what the public think. INSURANCE ACT. The individual members of Friendly Societies also are of the same opinion, as was shown by the To the Editor of THE LANCET. small minority, according to Mr. Parker’s figures, SIR,-May I call attention to two curious misthat were in favour of anything like a State service. The reason why the leaders of the takes made by the writer of this article in THE LANCET of Jan. 10th ? Your correspondent says Friendly Societies desire to control the panel doctor that .the German sickness fund (kasse) "does not is on the score of cheapness. As under the old contribute to the maintenance of insured persons club system, if the medical attendance was cheap in the hospitals." This statement is singularly not to its did trouble much as so efficiency, they as your correspondent will allow if he now the panel system would be popular enough misleading, consults the Sickness Insurance Law, the German if it cost less money. It is quite true that, as annual reports issued by the German Governwith the compared ordinary private practice, panel relative to the administration of the law, or system has encroached largely on the principle of ment the reports of any of the 20,000 or more sickness free choice." Still, half a loaf is better than no In point of fact, these sickness funds paid funds. bread, and if the profession is wise it will never in for the maintenance of insured persons 1911 a be the of must support system which abnegation all free choice, as any form of real State service in hospitals and other institutions no less than .e3,167,000, or 4s. 2d. a head for all their 14,519,000 must necessarily be. Mr. Parker says: " It would be possible under a members. The other error which I would corect State Medical Service to extend the possibilities of arises from a want of acquaintance with German local government. Your correspondent says: " It a free choice to practically the whole population." What he means by this statement he perhaps is the magistrate who decides what has to be done knows, but few of his readers will be in that for those who are ill, are not insured, and cannot if your correspondent were only conhappy position. It would seem to most a much pay." Even the English word magistrate"and the easier proposition to prove the impossibilities offusing German word name of the municipal (the magistrat free choice under any such system, so that it ’ would be interesting if Mr. Parker would formulateexecutive), he would- still be wrong, for the Poor] some concrete scheme to manifest these " possi-law is administered by a mixed deputation or com-, ] of the local authority. May I call your bilities" to the intelligence of his professional mission correspondent’s attention to a White Paper entitled I am, Sir, yours faithfully, brethren.
I
"
"
Hackney-road, N.E., Jan. 31st, 1914.
MAJOR GREENWOOD.
To the Editor of THE LANCET.
" Medical
Benefit
under
the
German
Sickness
] Insurance
Legislation," published in 1913 at the price o. 4½d. ? In it he will find many facts bearing upon this subject. I am, Sir, yours faithfully,
SIR,-Nomenclature is becoming very difficult in R. M. Jan. 31st. 1914. connexion with the National Insurance Act. The " term National Medical Service " is applied to the subject of a paper read last December before the HUNTERIAN SOCIETY.-The next meeting of South-West Essex Branch of the British Medical t this society will be held at St. Bartholomew’s Hospital (in Association by Mr. A. Todd-White, and an explana-the t at 9 P.M. on Wednesday next, Feb. llth, when library) tory footnote informs us that the term " national "the t annual Hunterian Oration will be delivered by Dr. Arnold is used in order to distinguish the author’s scheme Chaplin, ( his subject being John Hunter and his Work, and from all others published under the title " State the t Past and Future of the Medical Profession. All members c the medical profession are invited to attend. Medical Service," which are " quite different." In of
apppointed to consider the report of the last spite of this claim to differ comparison may be made Royal Commission on the Poor-laws coupled with between Mr. Todd-White’s views and those of Prothat right the not unimportant corollary that fessor Benjamin Moore referred to in THE LANCET those choosing their doctor should pay themselves of April 22nd, 1911, p. 1090. Mr. Todd-White informs us that he has advocated for more than 12 a portion of the cost. Medical services dealing with special classes- years the formation of a Ministry of Public Health and has now taken a step further under e.g., the Poor-law, the army, navy, &c.-which Insurance Act, being brought by it to the conother than the for State reasons conditions the require to medical attendance common all templation of a possible National Medical Service requirement that the best professional skill shall be avail- under a Minister of Public Health. He strongly able, must necessarily make large inroads on the advocates the better representation of the medical principle of " free choice," and it is only equitable profession in Parliament, but does not make it that those who are denied the choice of a doctor quite clear how he would bring this about in these should not be called upon to pay towards the cost days of all-powerful and accurately organised of the medical service. But it is otherwise in the political caucuses, even though the profession were case of the community generally, who are com- willing to pay the election expenses of "at least pelled individually to pay towards the cost of their 10 more " members. His proposals for the organisamedical attendance, and no proper analogy can be tion of a national service are made in a somewhat drawn between a State medical service to attend sketchy form, but his paper may well be included the community and the State services existing at in the bibliography of an important subject, and he makes a good point in urging the medical prothe present time. I do not share Mr. Parker’s opinion that the fession to consider its position with regard to a public has not been loud in favour of the right proposal for a National or State Service which may The public can only otherwise come upon it more or less unexpectedly of " free choice of doctor." I am, Sir, yours faithfully, speak through its representatives, and on a from outside. E. A. A. Feb. 2nd, 1914. memorable occasion during the passage of the National Insurance Act the unanimity of both the .parties in the House of Commons on this subject MEDICAL PRACTICE UNDER THE affords a striking proof of what the public think. INSURANCE ACT. The individual members of Friendly Societies also are of the same opinion, as was shown by the To the Editor of THE LANCET. small minority, according to Mr. Parker’s figures, SIR,-May I call attention to two curious misthat were in favour of anything like a State service. The reason why the leaders of the takes made by the writer of this article in THE LANCET of Jan. 10th ? Your correspondent says Friendly Societies desire to control the panel doctor that .the German sickness fund (kasse) "does not is on the score of cheapness. As under the old contribute to the maintenance of insured persons club system, if the medical attendance was cheap in the hospitals." This statement is singularly not to its did trouble much as so efficiency, they as your correspondent will allow if he now the panel system would be popular enough misleading, consults the Sickness Insurance Law, the German if it cost less money. It is quite true that, as annual reports issued by the German Governwith the compared ordinary private practice, panel relative to the administration of the law, or system has encroached largely on the principle of ment the reports of any of the 20,000 or more sickness free choice." Still, half a loaf is better than no In point of fact, these sickness funds paid funds. bread, and if the profession is wise it will never in for the maintenance of insured persons 1911 a be the of must support system which abnegation all free choice, as any form of real State service in hospitals and other institutions no less than .e3,167,000, or 4s. 2d. a head for all their 14,519,000 must necessarily be. Mr. Parker says: " It would be possible under a members. The other error which I would corect State Medical Service to extend the possibilities of arises from a want of acquaintance with German local government. Your correspondent says: " It a free choice to practically the whole population." What he means by this statement he perhaps is the magistrate who decides what has to be done knows, but few of his readers will be in that for those who are ill, are not insured, and cannot if your correspondent were only conhappy position. It would seem to most a much pay." Even the English word magistrate"and the easier proposition to prove the impossibilities offusing German word name of the municipal (the magistrat free choice under any such system, so that it ’ would be interesting if Mr. Parker would formulateexecutive), he would- still be wrong, for the Poor] some concrete scheme to manifest these " possi-law is administered by a mixed deputation or com-, ] of the local authority. May I call your bilities" to the intelligence of his professional mission correspondent’s attention to a White Paper entitled I am, Sir, yours faithfully, brethren.
I
"
"
Hackney-road, N.E., Jan. 31st, 1914.
MAJOR GREENWOOD.
To the Editor of THE LANCET.
" Medical
Benefit
under
the
German
Sickness
] Insurance
Legislation," published in 1913 at the price o. 4½d. ? In it he will find many facts bearing upon this subject. I am, Sir, yours faithfully,
SIR,-Nomenclature is becoming very difficult in R. M. Jan. 31st. 1914. connexion with the National Insurance Act. The " term National Medical Service " is applied to the subject of a paper read last December before the HUNTERIAN SOCIETY.-The next meeting of South-West Essex Branch of the British Medical t this society will be held at St. Bartholomew’s Hospital (in Association by Mr. A. Todd-White, and an explana-the t at 9 P.M. on Wednesday next, Feb. llth, when library) tory footnote informs us that the term " national "the t annual Hunterian Oration will be delivered by Dr. Arnold is used in order to distinguish the author’s scheme Chaplin, ( his subject being John Hunter and his Work, and from all others published under the title " State the t Past and Future of the Medical Profession. All members c the medical profession are invited to attend. Medical Service," which are " quite different." In of