Sir, - In her article of October 23rd, Maev-Ann Wren appears to rubbish my assertion that the motivation for VHI was concern to end the social injustice caused by the exclusion from the health services provided under the Health Act 1953 of half-a-million people - the so-called higher income group. This group, although in large measure financing these services, could not benefit.
She repeats her charge that this concern did not arise and that the real purpose was to keep a proportion of the population paying fees in order to protect the income of doctors. She further suggests that previous attempts, during the 1940s, "to extend free medical care to the entire population in the manner of Britain's NHS" had been made by "the Department of Health and a succession of Governments", but had failed "because of the opposition of doctors and the Catholic Church". Permit me to reply as follows:
1. When the VHI was planned and established in 1959 as a non-profit making community insurance health organisation, I was present. Maev-Ann Wren was not.
2. There was no attempt in the 1940s by the Department of Health to establish free medical care "for the entire population in the manner of Britain's NHS". However desirable such a service might have appeared to be, the enormous costs involved would have rendered it impracticable. There was, however, the Dignan Plan put forward in 1944 by the Bishop of Clonfert, which proposed an improved and extended health service under the aegis of the National Health Insurance Society. This plan, although receiving considerable public support, was not accepted by the Government.
3. The Catholic Church's other entry into the debate on health services related solely to the free-for-all Mother and Child maternity service, proposed by Dr Browne in 1951. This opposition was met and ended by the restricted scheme incorporated in the Health Act 1953.
4. The Health Act 1953 provided free or mostly free hospital and specialist services for two-thirds of the population, comprising the former public assistance class and a new grouping described as the middle-income group - insured workers, small farmers, etc. These services were to be provided in local authority hospitals, or by arrangements made with the voluntary and teaching hospitals. Opposition to this Act came from the medical profession and continued until in 1956 an agreement was reached which dealt with the organisation of services between the local authority and voluntary hospitals and with the rates of fees to be paid to specialists for their services.
5. With this agreement in place the implementation of the 1953 Health Act became possible. Excluded, however, were the "higher income group" - those with incomes above £1,600 a year, and farmers with a valuation in excess of £60. These people, although paying in their rates and taxes for the Health Act services, could not benefit. They had to face unaided the hazards of serious illness with all the medical and hospital expenses involved. Hence the VHI.
6. The growth of our health services may have been haphazard and unplanned. That in itself does not mean that they cannot work. - Yours, etc.,
Thomas F O'Higgins, Monkstown Road, Monkstown, Co Dublin.