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Thursday, 7 May 1970

Dr FORBES (Barker) (Minister for Health) [3.10J- Mr Speaker, I think that the honourable member for Wills (Mr Bryant) has placed on record what is really in the mind of the Australian Labor Party should it ever come into office and introduce a health scheme. A number of matters have been raised in which members have sought elucidation, mainly from this side of the House. At this stage I propose to refer to only one of them because I know it is of great interest and I will address myself to the others at the Committee stage because I wish to use most of my time in closing the debate in addressing myself to the Opposition's amendment. One matter that was raised by honourable members - I recall that it was certainly raised by the honourable member for La Trobe (Mr Jess) and the honourable member for North Sydney (Mr Graham) - is the question of recognition of and referral to specialists. The Bill, as honourable members know, provides for such recognition and the administrative machinery for the recognition will be simple. It is already necessary to recognise specialists for the purposes of the present scheme, and this is our starting point. Due to the greater emphasis on specialist benefits and referral, however, a more formalised procedure is necessary and clause 19 of the Bill provides for specialist recognition committees to be established. A medical practitioner who is registered as a specialist or consultant physician under State or Territory law is also entitled to be recognised as such for the purposes of the National Health Act. That is the first point.

This means that practitioners who are registered as specialists under the present Queensland or South Australian laws, under the present Western Australian workers compensation legislation, or under future State or Territory registration laws, will be recognised as such for the purposes of medical benefits. I might add that at the recent conference of Health Ministers the Ministers of the other 3 States, that is, New South Wales, Victoria and Tasmania, which have not registered specialists, indicated that they proposed to introduce registration in the near future. However, recognition under this Act will not by any means depend solely on registration under State or Territory law. In each State and Territory, including those which have specialist registration laws, a specialist recognition advisory committee will be appointed to advise the Director-General of Health on applications by medical practitioners for recognition as specialist and consultant physicians under the National Health Act. In considering every application by a doctor who practises in a State or Territory which does not have specialist registration laws or by a doctor who practises in a State or Territory which has such laws but who has not been registered under those laws the clearly appropriate criteria will be applied, namely, the doctor's qualifications, his experience and standing in the profession and the nature of his practice. These criteria will permit of the recognition of medical practitioners who are fully qualified by training and experience to be so recognised whether they practise as individuals or members of groups, including those who also provide services in other areas of medical practice, as well as the recognition of those who practise their specialities on a full-time basis. Regard will be had to the advice of the advisory committees in these types of cases.

Honourable members will also note that provision has been made for a practitioner to appeal to an independent specialist recognition appeal committee against a refusal to recognise him as a specialist or consultant physician under the National Health Act. The Bill will therefore provide a sound basis for the payment of medical benefits at the specialist rate where a specialist or consultant physician renders a service in the practise of his recognised speciality. Consideration is also being given to a referral system under which a general practitioner could refer a patient either for an opinion and immediate treatment or to continue treatment over a period for a particular illness. I am confident that a referral system will be developed which will fully safeguard all sections of the medical profession, the Government and the community generally.

The Bill before the House aims to provide the people of Australia with the most substantially improved medical benefits system in 20 years. What has been the response from the Opposition? The Opposition's colourful clutch of 5 medical practitioners - colourful in various ways - has contributed not a single constructive idea advanced thinkers from the profession, were among the lot of them. Surely, the Parliament has justification for hoping that these wielders of the scalpel would also have incisive minds, that they would be men able to cut quickly to the core of concern in this debate, namely, the welfare of the people of Australia, the welfare of the patients. Instead, the atmosphere of torpor generated by their soporific waffle has made them appear more like specialists in anaesthesia, which I understand the honourable member for Kingston (Dr Gun) is.

Certainly they receive no inspiration from their mini-minded shadow Minister for Health, the honourable member for Oxley (Mr Hayden). So familiar is he with the endeavours of the Department he aspires to administer that he could not even put his tongue properly to the name of its permanent head. The best he could do in this debate was to open it with a vituperative attack on me, proceed to make a series of ill informed and utterly irrelevant comparisons between Australia's health scheme and those of other countries and conclude by proposing an inane amendment totally in conflict, with a Bill he says he will not oppose. He has presented this pot-pourri of piffle - if I can call it that - pretentiously garnished with classical allusions, the whole delivered - J am sure all members, at least on this side, and quite a number on his own side agree - with a grotesque display of arrogance. He has revealed himself as a creature of little shadow and less substance.

But what about the patient patient? Who among the Opposition has pleaded the case of the patients? Nobody. The shadowy shadow Minister for Health who supports the Bill yet indulges in an orgy of selfjustification by paying lip service to the hopeless hypothesis which Labor hopes lo pass off as a health scheme proudly labels himself as a Democratic Socialist. Yet he merely demonstrates that he cares much for polemics but nothing much for people. This Bill is based not on some high flown Democratic Socialist ideology - or whatever the honourable member for Oxley calls his Party's alternative scheme - and not on some hideous hybrid mutation in the minds of those who would hopefully pluck for indiscriminate transplant here, aspects of overseas health schemes which appeal to them; it is based on the facts. Our scheme is bused on the facts of life here in Australia, lt is based on fees now being charged by both general practitioners and specialists. It is based on the need to protect patients against existing disproportionate consequences of illness. Nobody either in or out of this House has come to me with a suggestion which he can demonstrate will give patients a better deal than the one that the Government is offering them now.

By proposing his amendment that a national health insurance commission financed from graduated contributions would pay for medical and hospital services for all Australians more equitably and economically than the health benefits plan as proposed in this Bill, the honourable member for Oxley is rehashing his leader's confidence trick of the last election. I admit it was a good one - a very good one. A lot of people fell for it. The front men were 2 Melbourne economists, Messrs Deeble and Scotton. They were supposed to give the proposition an air of respectability. The proposition, you will recall Sir, was that a specific set of health proposals could be introduced on the basis of a \i% levy on taxable income plus a matching Commonwealth subsidy.

In a particularly scurrilous attempt to add substance to his fraud, the Leader of the Opposition, in this same statement, indeed, in the following sentence, implied that an officer of my Department had approved Labor's proposals in sworn evidence before a Senate select committee. What the officer said, and this is particularly clear when it is looked at in context, was not that Labor's proposals were soundly based but that the work - the arithmetical and statistical projections of Deeble and Scotton, insofar as they went, to quote the officers' phrase - was soundly based. He said nothing about their conclusions; nothing about whether their calculations, as far as they went, could be translated into proposals which were workable.

Dr Klugman - How close were your estimates?

Dr FORBES - I will come to that in a minute. But even assuming that the Deeble and Scotton proposals were properly costed and could be introduced on the basis of a li% levy on taxable incomes plus Commonwealth subsidy, let us recall what the

Labor Party did to them. What Labor did was to alter and embellish them so that even if they could have been initially financed on the basis of the originally proposed H% levy, they ultimately had but 2 chances of being financed in their amended form - Buckley's and none. Yet here we have the honourable member for Oxley again wheeling up Labor's goon type cardboard replica of Deeble and Scotton's health insurance commission. He is wheeling it up in this amendment to the Bill.

Let rae remind the House of the sort of surgery the Labor Party did on Deeble and Scotton. Originally they declared that a deterrent was necessary in respect of general practitioner and specialist unreferred services and proposed that a patient should have to pay 80c for a general practitioner surgery consultation, $1.50 for a general practitioner home visit and $2.50 for a specialist unreferred consultation. The Labor Party has done away with this patient payment. It has done away with it in spite of the fact that the Saskatchewan Medical Care Insurance Commission - Labor is always quoting Canada - was forced to introduce utilisation fees for physicians services from 15th April 1968, as stated in the 1968 annual report of the Commission. The annual report stated: 'As a check to the rapidly increasing costs of tax supported medical services.' The report goes on to state:

For most insured medical services a beneficiary is liable to pay a utilisation fee direct to the physician or optometrist, where applicable at the rate of $1.50 per office visit or $2.00 in the case of a home, emergency or hospital out-patient visit.

In other words, the deterrents that Deeble and Scotton recommended but which the Labor Party brushed aside now turn out to be what the Canadians whom it professes to admire in relation to their health scheme felt to be essential to make the scheme work and keep it within bounds.

The amount to be met by the patient for general practitioner services under the health benefits plan proposed in this Bill are 80c for a surgery consultation and $1.20 for a home visit, where the doctor charges the common fee. By deleting the patient payment proposals in the Deeble and Scotton scheme the Labor Party has made certain that a scheme on the lines proposed would cost a great deal more than the cost placed by Deeble and Scotton on their own particular proposals. Deeble and Scotton proposed that there should be a disincentive to the submission of small claims by patients; that as a contribution to the cost of handling them all claims covering expenditure of less than $1.20 would be subject to a deduction of $1. The Labor Party has abandoned this charge. The Labor Party's proposed commission would not be able to process medical benefit claims more economically than do the health insurance funds at the present time, despite the assertions to the contrary. It is well established that mere size of health insurance funds is not synonomous with economic operation. Indeed, there is much evidence - a great deal of evidence contrary to what the Labour Party asserts - that the reverse is true.

If the doctors do not accept 85% of the common fee for their services the number of claims to be processed would be the same as it is now. I am talking about what the Labor Party wants to replace our proposals with in ils amendment. 1 invite all honourable gentleman, just on the basis of some of the things that have been said in the last few months, to ask themselves whether the medical profession in Australia would accept 85% of the common fee in full payment, because some people have forgotten that this is absolutely integral to the Labour Party's scheme. As doctors' bad debts and accountancy charges do not take up anywhere near 15% of their income I assert that there is no basis for imagining that they would be willing to accept only 85% of the common fee. Deeble and Scotton proposed that there should be a limit on the amount to be levied of $100 for each taxpayer. This has been changed so that the maximum of S 1 00 will apply in the case of a man and wife where both are working. Apart from the administrative difficulty in assessing the amounts that would he paid bv the husband and by the wife there is the consideration of the loss of revenue to the proposed health insurance fund that would result.

The Labor Party proposes to exempt from contributions married couples or persons claiming at least I dependant if their taxable incomes do not exceed $1,600 or their actual incomes $2,000. A proposal of this kind was not included in the Deeble and Scotton scheme. The 2 figures given of $1,600 taxable income and $2,000 actual income are not necessarily linked. For example, a widow with the actual income of $1,950 may be supporting a child and have other concessional deductions of $42 in which case her taxable income would be $1,700. The Labor Party has not seen fit to make it clear whether she would be eligible for exemption under its proposals. The estimated cost of this proposal given by the Labor Party is $3.5m, which would, of course, not be collected by way of the li% levy on taxable income but would have to be found from general revenue.

Deeble and Scotton proposed that their scheme would be financed in part by the withdrawal of income tax concessions on net medical and hospital expenses and contributions to voluntary insurance organisations. The Labor Party has not specifically indicated whether net medical expenses would be tax deductible under its scheme. The question of whether net medical and hospital expenses would be tax deductible is extremely important. If doctors do not bill the fund direct the patients will be required to meet 15% of the cost of each service - not $5 on a very large medical bill but 15%. In the case of a major operation the net cost of the operation and associated services could well be $60 compared with $5 under the new health benefits plan.

The Labor Party has also proposed to replace the present insurance organisation with a national health insurance commission. The role of the voluntary fund will be to provide hospital insurance to cover the cost of intermediate and private ward or private hospital treatment. Even if the funds were to accept this role, which is far from certain, the contribution rates would be proportionately much higher than under the present scheme because management expenses would absorb a greater proportion of contributions. If the hospital fund had not provided insurance against intermediate or private treatment the intermediate or private patient would have to meet the cost of his hospital treatment directly. The expense would be quite considerable, especially in the case of prolonged stays. On the basis that the Labor Party would pay benefits of $10 a day the patient would have to pay an additional $8 a day for private hospital treatment. If he were hospitalised for 60 days the cost would thus be $480. Under the present scheme a contributor may get cover for his family against hospital charges of $18 a day for $1.30 a week.

Yet another embellishment of the Deeble and Scotton proposals is the proposal of the honourable member for Oxley for financial inducements to persuade doctors to practise in areas not adequately served by doctors. Notwithstanding all these costly significant departures from the specific Deeble and Scotton plan the Labor Party still maintains that its proposals can be financed by a 11% levy on taxable incomes together with a matching Commonwealth payment and a levy on compulsory insurance. That claim is simply untenable and I have no doubt that it would be necessary for the Labor Party to provide at least $138m more than was paid in 1968-69. The figure would be very much higher in 1970-71. All this would have to be found from general revenue. We would probably soon reach the position that is applying in Canada, where the Minister for National Health and Welfare has announced that reductions of 25% in votes for both emergency health services and emergency welfare services will be effected in 1970-71. Other areas involved are the combined general and national health grants, which will be reduced by $4m from the 1969-70 level. This has been the demonstrated consequence in Canada of the sort of thing the Labor Party is asking us to vote on by proposing its amendment.

Compared with the Labor Party's deceit the Government has been absolutely direct. The Prime Minister (Mr Gorton) in his policy speech last year promised improvements to the scheme which would cost $16m. At the same time he told the people that for a small increase in fund contributions they would get infinitely greater benefits. Subsequently the Government decided that its promised cover could be extended and said that it was prepared to spend up to $32. 5m. The honourable member for Oxley, once again well under par for the course in sincerity and veracity, has tried to suggest that the cost of the Government's original proposals had doubled. The original proposals were accurately costed, as I explained in my statement to the House, at $16m. That was the cost at election time and it would be the cost now for the same proposals. The proposals additional to those made in the policy speech will, of course, cost additional money.

There is another matter which needs to be clarified, and that is the Government's attitude to differential rebates. This matter has been mentioned a number of times in the course of the debate. In past months on behalf of the Government I have repeatedly made it clear that this legislation, which is based on fees and procedures now existing in the medical profession and recommended for adoption by the Australian Medical Association, is nonetheless flexible legislation. Different fees are now being charged by general practitioners and specialists for the same medical services. I have said that patients must be covered in both instances. However, I have also said that if the profession can collectively guarantee its members' acceptance of another system which will meet whatever new requirements they may have but which will not disadvantage the patient financially, I will be happy to look at it. That undertaking stands not only in regard to this matter but also to other fears or reservations the profession may have about the new scheme.

Let me conclude my remarks by once again stressing that the Labor Party's scheme is not the Deeble and Scotton scheme. There is no basis whatever for the claim that it would be more economic and equitable than the plan provided in the Bill. Economic operation is by no means an automatic consequence of giving the conduct of a service to a government monopoly. Decentralisation of administration, which is inherent in the existing plan, produces its own dividends in the form of efficient service and contributor satisfaction. I believe that the Australian people will be rightly sceptical whether the alleged economies promised from a government health insurance fund would ever eventuate. But there is more to this than economy and efficiency. If we transfer the conduct of health insurance to a single government fund we have established one more area where freedom of individual choice is denied - a freedom which all of us would value and the loss of which we would lament if it ever occurred.

It is true that the honourable member for Oxley was at great pains to assert that it is only within the insurance system that the Labor Party wants to impose its socialistic philosophy on us. Our right to select our own doctor, according to the honourable member, is to be retained. But much of what other members of the Opposition said in the debate left us in a great deal of doubt as to whether even this basic right would continue to be enjoyed if the Labor Party were entrusted with the management of our health system. The oft repeated praise by honourable members opposite of the United Kingdom scheme and its socialised base leaves the strong impression that socialised medical services would duly follow socialised insurance in the name of alleged economy and equity. The Government rejects absolutely the amendment proposed by the Opposition.

Question put:

That the words proposed to be omitted (Mr Hayden's amendment) stand pari of the question.

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