Mr SNOWDON (9:46 PM) —I am proud to have stood at the last election for the Labor Party and won arguing against this particular policy, which is contained in the Private Health Insurance Incentives Bill 1998 . I was very interested in Comrade Nelson's contribution. I was interested for a number of reasons, one of which goes to the last points he made when he was talking about people with acute medical problems going to private hospitals because of the acuteness of their illness.

I wonder if he could explain this to me: why has the Darwin Private Hospital all but failed? Could he explain to me why the emergency department of the Darwin Private Hospital has been closed down? Could he explain to me why the Northern Territory government, in an effort to boost up the private hospital system in the Northern Territory, has announced a decision—and today a bill was introduced into the parliament—to privatise the management of the Northern Territory's public hospital system, not just one hospital but all of them? Does he know why it has done it? We know that the Darwin Private Hospital has failed. It is an absolute abysmal failure.

I have to profess and declare my interests. I am a private health insurer. I have lived in Alice Springs for the last 14 years and, due to my own idiocy, contributed to the private health insurance industry for at least the last 25—and I have not received one dollar out of that system in terms of hospital access. We are told that there is a market in private health somewhere out there. Why is it that only 25 per cent of the Northern Territory's population are privately insured? If there is such a market, if private health insurance provides such an attraction to people, why is it that only 25 per cent of the Northern Territory's population are privately insured?

I just want to go to a couple of points about the nature of the private hospital in the Northern Territory and then go to a couple of points which were made by our leader here this evening about what I would do with $1.5 billion. I know the member for Bradfield has a great interest in Aboriginal health. I know what I would do if I had $1.5 billion. I would throw the $720 million into the public hospital system and I would spend the other $700 million on primary health care. I would spend a large proportion of it on Aboriginal communities.

Fifty per cent of the bed days in the Northern Territory public hospitals are occupied by Aboriginal people. I would imagine—I do not know—that there would be very few, if any, Aboriginal people with private health insurance. A number may have it, but not many— certainly none who live outside of Darwin and, I imagine, very few who live inside Darwin.

This afternoon we again heard the Leader of the Opposition articulate very clearly those people who hold private health insurance in this place and who will benefit from a rebate as a result of the government's decisions if they are passed through this parliament. I am one of those people, at least in getting something back from the God knows how many tens of thousands of dollars I have contributed to the private health insurance industry over the years.

But, frankly, if you asked the population of the Northern Territory what they would rather do—whether they would rather have this rebate or have an efficient public hospital system—they would say unanimously that they want an efficient public hospital system because they know that, if they go to the private hospital, they will be wheeled through the passageway into the public hospital since that is where they will get their treatment. Not only do they have to go there to get their treatment but the private hospital is also now borrowing doctors from the public hospital.

This is a forlorn approach by the now Northern Territory government under Minister Burke. He made a contribution today in the Northern Territory Legislative Assembly which was rather illuminating. Talk about ideology! These guys are flat out ideologically driven. I notice the member for Eden- Monaro knows all about it. He knows how ideologically driven these people are and how busy they are shovelling money into the pockets of the private sector. This is just another example.

The Accident and Emergency Services section has been a longstanding joke. It has never worked and is all but closed down. Burke himself, the minister, gave the private hospital a blast for its poor management; yet, as we speak, the Northern Territory government are proposing to privatise the Northern Territory hospital system. They say that they are not; but that is in effect what they are doing. In the process, what they are attempting to achieve is to move the public hospital system into the hands of private enterprise.

I do not know what the altruism behind it is. They would argue that it is to provide a better public hospital system. They say that they need about $120 million per year in addition to the current investment in public hospitals in the Northern Territory in order to make them work more efficiently. I am a bit uncertain as to how they expect to get this out of privatising the place, seeing that only 25 per cent of the population is privately insured. Perhaps you can tell me. The logic escapes me.

I want to give you an example of some of the incidents which reflect poorly on the way in which this subject has been debated in this parliament. I am not opposed to private health insurance. As I say, I happen to be one person in this parliament—another of the people on the Labor side of this parliament—who has held private health insurance for a long time. Like the Leader of the Opposition, I have paid a great deal of money for it.

An honourable member interjecting—

Mr SNOWDON —Well, you may not. But I am deadset opposed to the bill. I am deadset opposed to it on the basis not only of equity grounds but of the efficiency of the allocation of public resources. As the Leader of the Opposition said this evening, this is very bad public policy—very bad public policy indeed.

I note that when I was talking about the Northern Territory government—and this encapsulates the argument, in a sense, about the nature of the private health insurance industry, especially as it relates to Northern and remote Australia—not only was the minister for health in the Northern Territory espousing his concerns some one month ago about the management of the private hospital in the Northern Territory but he is now also espousing the benefits of private health care. He said in interviews on ABC Radio on 15 October, `I am a great believer in the private hospital system, particularly in the Territory where the privates have the capacity to capture money that the public system can't capture, and that is health insurance funds money.'

Who in the Northern Territory is going to contribute who does not already contribute? I ask you that question. Who is going to contribute who does not already contribute? The fact of the matter is that, if they cannot make one private hospital work, how the hell are they going to make what amounts to two different private hospitals pairing with two minor hospitals in regional Northern Territory work? They propose to pair the Darwin public hospital with the Nhulunbuy public hospital and the Katherine public hospital and sell them off to a private sector management team, and to do the same for the Tennant Creek hospital and the Alice Springs hospital. How are they going to get any efficiencies out of that process, apart from shifting the cost burden in the community and ensuring that somehow or other they get backdoor payments for public health? But they will not, in fact, because it will fail.

I want to record in the debate this afternoon a contribution which was made by the Northern Territory minister for health, if I can find it. I will come back to it in a moment. He has made very clear in that contribution that he is fixated with the idea of having a private health system in the Northern Territory at the expense of the public health system. Not only is that illogical but it shows that they have not really comprehended what in fact they should be doing in terms of administration of public health in Northern Australia.

This is why, when we are looking at the priorities of the government, we have to ask ourselves how they can see equity and effi ciency in the way in which they are proposing to administer this measure. It has already been amply demonstrated—by, among others, the Leader of the Opposition and the shadow health spokesman—how inefficient and inequitable this particular exercise is going to be. We know already that there is no evidence to substantiate the claim that giving this rebate to people who are already in the private health system is going to increase the membership of the private health sector. It is not.

The government's own figures, as the Leader of the Opposition demonstrated amply this evening, demonstrate that even they do not believe it will. They are proposing to provide $1.5 billion as the cost of this exercise. That will see a marginal, if any, increase in the membership of private health insurance funds; it will not change the problem. It will just put money into the pockets of people who are already getting private health insurance. It will not improve the situation in relation to public hospitals. The only way you will improve the situation in the public hospitals is to invest money in them and to put that $720 million—half of the $1.5 billion—into the public hospital system.

As I say, in the case of the Northern Territory I would then isolate the health problems in the community. What are the fundamental problems? I might indicate, in relation to that, that they are well known and are to do largely with the Aboriginal community. We know already that the life expectancy of Aboriginal Australians is 20 years less than that of non-Aboriginal Australians. The life expectancy of Aboriginal people is considerably worse than it is for other comparable indigenous populations—the native peoples of the United States and Canada, or the Maoris of Aotearoa. It is substantially less.

Aboriginal boys born today have only a 45 per cent chance of reaching the age of 65. Aboriginal girls have a 54 per cent chance of reaching the age of 65. Age standardised death rates for Aboriginal males are 2.8 times those for non-Aboriginal males. Age standardised death rates for Aboriginal females are 3.3 times those for non-Aboriginal females. Aboriginal people suffer from certain health conditions at a much higher rate than do non-Aboriginal people. For example, Aboriginal people have diabetes at a rate that is 12 to 17 times higher than the rate for the non-Aboriginal population. The figure for Aboriginal renal disease is 17.4 times the rate for non-Aboriginals. Note that, of the 64 current clients of the Alice Springs Renal Dialysis Unit, 63 are Aboriginal people.

We know that in relation to health funding, despite the greater burden of death and illness that Aboriginal people bear and contradicting popular misconception, huge amounts of money are not being thrown at the problem. In 1995-96, 2.19 per cent of all Australian recurrent health expenditure was on Aboriginal people. That is only eight per cent higher per capita than other Australians, despite the vastly greater burden of illness. A disproportionate amount of this money is spent on expensive end-stage hospital or similar care. Across Australia, 55 per cent of health expenditure on Aboriginal people is for hospital care. This amounts to about $1,218 per Aboriginal person per year spent on hospital care. This is twice the expenditure on non-Aboriginal people in hospitals—$604 a year.

On the other hand, for every dollar that non-Aboriginal Australians access through Medicare, Aboriginal Australians receive 27c. For every dollar that non-Aboriginal people get from the Pharmaceutical Benefits Scheme, PBS, for essential drugs, Aboriginal people get 22c. The Commonwealth health department funds the Aboriginal primary health care service to a level that goes some way to compensating for the lack of Aboriginal access to MBS and PBS funds. However, the level of primary health care expenditure for Aboriginal people is still approximately $100 less per person per year than the national average of $600 per year.

In addition, this expenditure on primary health care has to be seen in the context of the vastly greater Aboriginal need, as demonstrated by the mortality and morbidity statistics that I have already mentioned. Measured against need, expenditure on Aboriginal health is clearly inadequate. The clearest way to address this inequity is to ensure Aboriginal access to the large, mainstream funding sources of MBS and PBS. It is also by coming to terms with the basic problem—keeping people out of hospitals.

If you are going to spend $1.5 billion, spend it where it is most needed. Spend $720-odd million on the public health system and then spend the other $720-odd million preventing people getting there. Start to talk turkey. I do not think this government is fair dinkum about health. It is certainly not fair dinkum about Aboriginal health. If it were, the Minister for Health and Aged Care would come into this place and say, `We have made a mistake. Our priorities should not be the ones we are now advocating.'

It is very clear that the people who are bearing the burden of these decisions by the government are those most disadvantaged in the community—the poorest in the community, the people most in need, the people who have most to express in terms of their concern about the nature of the public health system; the public health system that this government will not support. What they have to do is very simple: they have to change their decisions. They have to understand that going down this route of putting money primarily in the pockets of the most wealthy in our community is not going to fix the problem. They have to do what the Labor Party has been advocating—that is, properly fund the public health system, properly fund public hospitals.

I want to finish on the issue of the private hospital system in the Northern Territory. A report by the Australian Institute of Health and Welfare concluded that the daily cost of a bed in a private hospital is more than the rate in a public hospital. Experience in America and elsewhere shows that the market base health care costs more. Millions of dollars are wasted in executive salaries, profits for shareholders and in costs of regulation.

In the context of the Northern Territory, one other group of people who will suffer from this approach of the Northern Territory government are those people employed in the public hospital system currently. It is very clear what will happen to them. They will be moved into the private sector, many of them will lose their jobs and their wages and conditions will suffer. These people are not rich. In the course of the recent election campaign I had the opportunity to visit the Katherine hospital. I spoke to the day workers at the Katherine hospital. Their average incomes were $22,000 a year. These are people with families. How are these people going to benefit, firstly, from the proposal by the Commonwealth and, secondly, from the proposal by the Northern Territory government, in league with the Commonwealth, to privatise their public hospitals—the Katherine public hospital.

How are they going to benefit? They already suffer the highest cost of living of anywhere in Australia. If the government want a decision that will help public health in this country and prevent people going to hospital, therefore nullifying the need to put all the money into the public hospital system or, for that matter, the private hospital system, they would do a simple thing like—I invite the minister, who is not here, to think about it—immediately convince cabinet to come up with the $800,000 to $900,000 they will need to fund the use of avgas in remote Aboriginal communities as a substitute for petrol. That is what they would do. That would do more for health in Aboriginal communities than this decision.

In the decade between 1981 and 1991, at least 70 young people died as a result of petrol sniffing in the top end of the Northern Territory. One way of preventing petrol sniffing was to substitute the stuff they were sniffing. Change it—pull out the petrol and put in avgas. What have we seen? In July this year this government took the tax off avgas so that light aircraft would find it cheaper to fly around the bush, which is welcome, and then they imposed a 45.2c excise, the current excise on petrol fuel, on avgas when it is used as a substitute for petrol in remote Aboriginal communities.

Do you know what you pay for a litre of petrol in some of these communities? Two dollars. These are the poorest people in Australia. The government are not concerned about public health, because if they were they would take the decision. They would say tomorrow that they would remove the excise from avgas when it is used as a mechanism by Aboriginal people in remote communities to prevent the community having access to petrol, which they would sniff, and therefore prevent a health problem emerging. But they are not smart enough. All they think about is changing the private health care system to the extent of ensuring that you and I benefit, not the poorest in the community, not those most in need.