a tax on invalids ! it is shameful that such a levy should be collected by a ministry of health &amp;hellip; worse still there is a tax on childhood . let &apos;s give the welfare state a shot in the arm . by Kenneth Barrett . increased national health charges . a further conjuring trick with national insurance contributions . the Minister of health &apos;s announcement the other day of changes to take place in April was a signpost on the road of retreat from the first vision of nationwide personal security . there have been other signs of this retreat over the years . to many of us it has long been evident that the welfare state was in danger of destruction from within . first of all , the administrators have muddled one of the main issues . they have been determined to uphold a meaningless fiction . they have insisted that part of the national insurance stamp should go towards the cost of the national health service . this has deepened the widest-spread fallacy in the community - the mistaken idea that the man who buys his national insurance stamp pays for the national health service . he does n&apos;t , of course . the total cost of the national health service in this financial year will be about &amp;pound;867,000,000 . of that vast sum , &amp;pound;663,000,000 comes from general taxation , not from national insurance stamps . confused . small wonder that the man-in-the-street is confused . because the existence of the stamp as a source of supplementary revenue to the national health service is a temptation to the administrator in search of the appearance of economy . it gives him a chance to make the health service look as if it costs less . today the employed man pays 9 s 11 d a week towards the whole bill of social security in his weekly stamp . of that , 1 s 10 1/2 d is earmarked for the health service . in April he will , as a basis , pay 9 s 9 d a week and the same amount of 1 s 10 1/2 d will go to the health service . at the same time , from April , he will have to pay , if his wages are high enough an additional contribution to the state &apos;s massively confusing graduated pension scheme , unless his employer contracts out . if he is earning &amp;pound;15 a week , he will be paying , in all probability , 5 s 1 d a week towards the graduated scheme . the Minister of health &apos;s proposals will alter the position again in July . his total basic contribution will be 10 s 7 d . of this a larger proportion , 2 s 8 1/2 d this time , will be earmarked for the health service . with the highest contribution to the graduated scheme , his stamp will cost him 15 s 8 d . do n&apos;t think for one moment that it &apos;s going to stop there . higher pensions will be sought . the health service will cost more . the contributions , total and fraction , will all go up again . the mere cost of the complex administrative tasks involved in recording contributions is vast in proportion to the amount of tax that is collected . yet the tempting fiction of the stamp will always be there . enemy . but the health service has another inside enemy . it is , of course , on the face of things , reasonable to charge people a little when they get some special extra benefit . why should n&apos;t the ordinary citizen , in an age of high wages , pay some proportion of the cost of dentures or of spectacles ? that &apos;s the question . why should n&apos;t the special beneficiaries pay a little extra out of their own pockets ? it &apos;s an insidious argument . it seems so reasonable . but once you start agreeing that the proposal is reasonable , you can reach the extreme lengths of unreason . for example , a well-paid patient , whose firm still continues his wages , who draws sickness benefit on top , may have surgical and hospital treatment costing many hundreds of pounds . and if he needs spectacles , when in hospital , he gets them free . and yet a widow , whose pension , for which her husband paid , is wiped out because she works for a living wage , will now have to pay 12 s 6 d for each lens in her spectacles , and 17 s 8 d for the frames . this is what the Minister proposes . the truth is that you can n&apos;t make sense out of small private charges under a vastly expensive public scheme . you can only alter the shape of the national bill . but , at least , it ought to be a Minister &apos;s duty to refrain from doing positive harm just to collect a token tribute to the total tally . and social harm , I fear , is what two of the proposed changes are going to achieve . for example , from March 1 , each item on a national health service prescription is to cost 2 s . children . I leave out of account , for the moment , the estimate which I have been given - that nearly one-third of such items cost less than 2 s . I am thinking of the marginally poor , who happen to be in constant ill-health . there are countless thousands of them . the retired folk , getting on in years , with their retirement pensions and &amp;pound;3 or so a week from their old firms . the man who , in protracted illness , receives half-pay from his firm . the army officer &apos;s widow . I could go on indefinitely . they may need half a dozen prescribed items a week , easily . twelve shillings a week . a tax on invalids . it is shameful that such a levy should be collected by a Minister of health . worse still . there is the tax on childhood . pregnancy , like death , is democratic . the last war forced the state to protect the health of children through the maternity clinic . with the help of the national health service it has become a possession beyond price . all mothers go there . the solicitor &apos;s wife , the schoolmaster &apos;s wife , the clerk &apos;s wife , the plumber &apos;s wife , and the wife of the chap who is doing a stretch in gaol . never has the health of children been better . never has infantile mortality been so low . and one of the reasons was that it cost nothing , or very little , to take advantage of everything the clinic had to offer . from June 1 , instead of paying 5 d for the bottle of orange juice and getting a free supply of vitamin tablets and cod liver oil , there are to be higher charges . the orange juice will be 1 s 6 d , the cod liver oil 1 s , and the tablets 6 d a packet . these sums might have been deliberately fixed to keep the poorest sort of mother away . and it will be the child that suffers in health . by these particularly petty tactics , the Minister will save &amp;pound;1,500,000 out of the &amp;pound;800,000,000 and more that we have to pay . I have been very close to the crises , the challenge , the hopes , needs , and anomalies of the welfare state . and I think the time has come to take a close look at what is going wrong . slash this health service red tape . you will have noticed the fierce House of Commons rumpus over the proposed health service changes and charges . I gave my views in detail about these last Sunday . it seems from the size and shape of my mail that most of you agree with me . over the debate in the House the other day brooded the shadow of the late Nye Bevan . he was the architect of the health service . the act of 1946 defines his vision . it gives the health Minister the duty of establishing a comprehensive health service to secure improvement in the physical and mental health of the people &amp;hellip; and the prevention , diagnosis and treatment of illness . to the creators of the service there was no hesitation about one further principle . it was to be free . how far have these great objectives been achieved ? there are no longer two standards of medical treatment , one for those who can afford it and another for those who can n&apos;t . doctor &apos;s mercy . no longer does a deduction from the wages of the lower-paid worker simply cover him during sickness , leaving his wife and children to the mercy of the family purse or the doctor &apos;s kindness . no longer is there a patchwork of clubs and voluntary associations seeking to ensure some kind of medical treatment for those who were not on the panel . of course , there were ominous rumblings at the start . the best people , it was passionately argued , would still prefer to pay their own doctors . the best doctors , it was alleged , would stay resentfully out of the national service , refusing to become the minions of a Minister . all these were myths created by prejudice . within three months of the appointed day under the act , 39,000,000 were on health service lists . it is officially estimated today that 97 per cent of Britain &apos;s inhabitants are using the health service . only 600 doctors engage wholly in private practice . this is indeed a success story . but it is my task to look critically and constructively at the flaws and the failures . there is , in my mind , no doubt about the first mistake . the nationalised industry of medicine presents a stupendous administrative challenge . it is now so complicated that the prime purpose of it all , the prevention of ill-health , the welfare and re-assurance of the sick , can disappear in the difficulties of departmentalism . today , regional hospital boards plan hospital and consultant services . management committees administer hospitals at local level . executive councils are responsible for the general practitioner , the dentist , the supply of drugs . the local health authority looks after maternity services , child welfare , the visiting midwife , the health visitor , the home help and the ambulances . Minister &apos;s jungle . somewhere up at the top of this jungle the Minister of health is supposed to keep an eye on it all . no wonder he can n&apos;t see the wood for the trees . the hospital service , the general medical service , the local authority , each tends to work in isolation . the family doctor is not encouraged to study his patient in hospital . often there is no follow-up system from the hospital to the home , or , if there is one , it does n&apos;t work . each service washes its hands of responsibility when it passes a patient to another branch of the system of national health . these divisions can rise to ludicrous levels . an ambulance will take a patient to a hospital which can n&apos;t admit him but , quoting the correct rules , will refuse to drive him to a hospital which can treat and cure him . the costs of each section of the health service are scrutinised as though they were isolated problems . of course , they are all interdependent . busier and better general practitioners in one area can reduce the financial burden on the local hospital . more money spent on local authority dental services when the children are at school keeps down the bill of the general dental service when they are grown up . a rise in prescription costs may mean a shorter period of sickness . to take one illustration . hospitals are given a certain amount of money to spend in any one financial year . they can n&apos;t save any of it up and spend a little more in the following year . during the last month or two , therefore , of the arbitrary annual accountancy , there is a mad rush to spend anything left in the kitty . a national health service is bound to be expensive . it deserves to be so if it works . we still spend less than 4 per cent of the national income on keeping people well and treating them when sick . I do n&apos;t call that unreasonable . the cost of prescriptions is a topical problem . here is an ever-rising and very significant part of the bill . let &apos;s look at it . it has more than doubled since the service started . last year 214,000,000 national health service prescriptions were made up . goodness knows how many unidentifiable pills linger in bathroom cabinets and how many bottles of cough linctus were emptied down the sink after the first distasteful dose . five prescriptions a head last year , for everyone in the United Kingdom at nearly 7 s a go ! the bill still goes up . not primarily because doctors prescribe more , but because drugs cost more . 