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Wednesday, 27 May 1987
Page: 3445


Dr CHARLESWORTH(6.41) —The honourable member for Petrie (Mr Hodges) and other honourable members on the other side of the House have spoken about the burgeoning cost of health care. Of course, this is of concern to the Government. In fact, it is the reason we are debating this legislation. Significant initiatives have been taken by the Government, as announced in the May mini-Budget statement, to prune areas of fat and inefficiency in health care, to remove distortions from the medical benefits system, and to target those cuts at the changes in technology and the improper incentives that exist in the health care system. It needs to be understood by everybody who is listening to this debate that the burgeoning costs that occur in medicine are of concern to us. They need to understand that the Commonwealth has always had to pay the bulk of the health care bill. We should never pretend that we previously had a purely private health care system; it was heavily government subsidised. This legislation and the Government's May statement go towards improving the situation.

The honourable member for Cowper (Mr Nehl) was concerned about the expenditure blowout, and the honourable member for Barker (Mr Porter) was concerned about the level of waste and rip-offs. This legislation attempts to turn around those inefficiencies, to change that system. The hypocrisy of the Opposition is extreme when we consider what is going on in the health debate in this country. Opposition members are today whingeing and whining about cuts in health care, yet in their policy they are auctioning off who can cut the most. The Opposition is suggesting that it can cut $3 billion from the health care budget; the National Farmers Federation is suggesting that it can cut $5.8 billion; the Monash study group is suggesting that it can do even better than that and cut $6 billion or $7 billion. Who will suffer if that is the case? If those massive cuts are made, we will have a less fair system, a less simple system, and the acceptability, assurance and stability that Medicare has provided will be removed. The people who will suffer will be those who are less well off, the elderly, families with large numbers of children, and especially poor families. They are the people who benefit most from the Medicare system. We see that as a virtue rather than as a crime.

The attempt to save $2 billion by abolishing Medicare means that $2 billion is taken off the Commonwealth Budget and added to the budget of the nation's households. We are talking about transferring government expenditures to private expenditure and about basic health insurance levels of $27 a week for families. The Monash group has gone much further than the Opposition's proposals. It is talking about cutting out pharmaceutical subsidies and subsidies to nursing homes, and about cutting out subsidies in public hospitals so that people have to pay the full price. That will double the cost of private health insurance for families. They will be talking about spending $40 or $50 a week for private medical insurance. The public needs to understand that this is what the Opposition is about.

The honourable member for Cowper talked about the 1.8 million people who have been forced out of private cover. Perhaps we should talk about the 1.8 million people who have decided that they are happy to be covered by Medicare and who have chosen not to take private cover. He does not talk at all about the two million people who, prior to the advent of Medicare, had no cover whatsoever. They are the people for whom we are concerned. They are the people for whom we defend Medicare.

The honourable member for Barker, as he usually does, complained about hospital queues and said that there were all sorts of people who needed urgent surgery but who were missing out. The honourable member for Barker shows his ignorance of the hospital system because anybody who needs urgent surgery in this country is able to get it. I defy him to find me cases of people who are in need of urgent surgery but who are failing to have it delivered.


Mr White —What about elective surgery?


Dr CHARLESWORTH —The honourable member said `urgent surgery'. I am just quoting the honourable member for Barker, who said that there are people needing urgent surgery who are missing out. It was doom and gloom from the honourable member for Barker. Australians do not want it. They want the reliability, the certainty and the stability that Medicare has provided. Only one and a half hours ago the Leader of the Liberal Party of Australia-which is half of the Opposition, I suppose-was talking down the economy in his usual terms, talking about how he was going to provide taxation cuts which would be funded by expenditure cuts. The population needs to understand what massive expenditure cuts in health costs would do to the health care system. He also said that this election would be fought on trade unionism. He talked about trade unionism as though it was some sort of monstrous bogey about which he was concerned. We only have to look at health care to find that the Australian Medical Association is probably one of the best closed shop unions in this country. A headline in today's West Australian states: `AMA Vows Battle Over Health Cuts'. We have only to look seriously at the recent problems in the Australian Capital Territory, where doctors have been demanding significant increases far above those that are available to any other wage earner, to see that his abhorrence of trade unionism is indeed a very selective one.

If we look at this legislation and at the May statement we will see that the changes included in them are targeted towards pruning areas where there is inefficiency. They are targeted towards removing distortions within the system. They are targeted so that they relate to changes in technology where procedures have changed or perhaps have become more efficient. They are targeted to remove those improper incentives which exist in particular areas. If we look at the face of health care, at technology and efficiency in health delivery, we will see that it is constantly changing. It is necessary for us to continually revise the medical benefits schedule because of these changes. In Question Time today the Minister for Health (Dr Blewett) mentioned cataract surgery where there have been massive changes in efficiency. That surgery is the type of procedure which can now be undertaken within a doctor's surgery. So it is necessary that that benefit be reassessed.

Many of us are aware of the CAT scanner and what a marvellous machine it is. The CAT scanner saves us money in many areas. If we talk to neurosurgeons about the treatment of patients who have had car accidents they will tell us that, instead of about eight or nine out of 10 patients requiring a craniotomy as a result of serious head injury, only a very small number, perhaps one or two out of 10, now require that procedure because of the availability of the CAT scanner and its effectiveness in diagnosis. That new technology saves us money. In other areas perhaps the CAT scanner is being abused, and it is necessary for us to look at the changes that are occurring. Magnetic imaging of body structures is something that over the next decade, I am sure, will provide vast efficiencies in medicine. The necessity for the surgeon to open patients up will become less important. As a result, the saving in hospital bed time and in Medicare rebates to surgeons will be significant.

An area which is of concern in the May statement-and perhaps of concern to members on the other side of the House-is the growth of entrepreneurial medicine. One of the initiatives taken by the Government in changing the fee schedule for after hours services is directed at the growth in entrepreneurial medicine. I am sure that as a result of rationalising the benefits available for after hours services we will have a significant cutdown in that type of medicine which is inefficient and which is encouraged by the present fee structure. There may be problems for those who provide after hours locum services. However, the Minister has pointed out, very correctly I think, that benefits to those general practitioners who provide services during working hours and in their surgeries will be significant. Indeed, the Government has been very generous in providing, from 1 August, increased benefits for those general practitioners. As a result of that, it would seem reasonable for the commissions charged for locum services to be decreased by general practitioners making more substantial contributions to those services.

It must be mentioned also that, as announced in the May statement and as part of the Government's initiatives, funding is to be increased in particular areas, such as that of the acquired immune deficiency syndrome, in which the country's contribution to public health has been acknowledged by the United Nations and by international commentators all over the world. It is a vital and very important aspect of health care in this country, and it is one in which the Minister for Health has taken particular interest. Indeed, the Government is doing everything possible to make sure that the community is kept well informed. We can also look at the area of the drug offensive. Again, this Government is committed to education, treatment and rehabilitation in this area. It is important to understand that the health debate needs to be taken away from paying doctors, which it has essentially been about for a long time. It is necessary for us to talk about the very important area of prevention. Indeed, honourable members on both sides of the House have mentioned health maintenance organisations. Again, the Minister for Health has already agreed to take up the recommendation with respect to health maintenance organisations, which was made by the Better Health Commission, and pilot schemes in that area are envisaged.

I think we should understand that this legislation is an attempt by the Government to make sure that the money raised from taxpayers to provide health care is spent efficiently and effectively. We are attempting to remove distortions from the system and we are attempting to be frugal with public money. We are certainly aware that changes in technology need to be taken into account when we consider the medical benefits schedule. We are hoping that the improper incentives that perhaps exist at the moment can be reduced. I wholeheartedly support this legislation.