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Thursday, 6 December 1973
Page: 4418


Dr EVERINGHAM (Capricornia) (Minister for Health) - Many criticisms have been made of the proposed national health insurance scheme. They have been made in a sweeping and unfounded fashion. The honourable member for Hotham (Mr Chipp) has said that he proved some of his points. But his proofs have been based on words and not on facts. Let us compare what the facts are about what will happen under a scheme such as that which is projected by simply looking at what is happening under such schemes and not at what some working party or some professional group suggests would happen. Much has been made of the fact that various professional organisations have opposed the national health insurance scheme. We on this side of the House have been informed that we do not know anything about that because we are not professional people. The only professional people who have spoken in this debate came from this side of the House. I submit that they have been as active in those discussions as any of the professional organisations opposed to the scheme.

One of the major points that seems to exercise the minds of members of the Opposition is that the scheme will cost more. In their arguments, in their misguided zeal to prove this, they have drawn on examples from overseas - from the United Kingdom, Canada and various other places - but they have neglected to look in their own backyard. We already have in Queensland most of the features they condemn - a State which is run by the new National Country Party of Australia, the National Party of Australia or the Country Party, depending on what the current name may be. That Party came to power in that State many parliaments ago with a new platform and a new policy, one which it had until that time completely rejected and bitterly opposed. It had criticised any preceding Labor governments which had persisted with that policy since World War II. I refer to the policy of free hospital beds at the point of service to all who want them free - without charge and without means test.

That policy is Australian Labor Party policy - that there should be available to those who want them hospital beds without charge at the point of service and without means test. Every State in Australia had this policy shortly after World War II when there was a Labor Government in Canberra. Shortly after the government in Canberra changed colour the States, with the exception of Queensland, one by one decided that it did not pay them, that it cost more. Whom did it cost more? Certainly not the patient. That public hospital system cost the State more per head of population and it still is costing Queensland more. However, it is costing Queensland less per public hospital bed. This is not altogether a good thing because no allowance is made to Queensland for the extra commitment by that State alone among the Australian States. It carries the burden that in other States is carried in part by public patients who pay for beds and in part by other patients who go into intermediate and private wards because they are not eligible for public care.

In part the burden in the other States is borne by this Government subsidising the costs of medical and hospital fees for patients who voluntarily insure themselves. In all these ways the Queensland Government has shouldered an extra burden. But it was not that extra burden which caused the other States to terminate their system of so-called free hospitals. What ensured that they imposed a charge on public patients subject to means test was a decision of the Liberal-Country Party Government in Canberra which said: 'We will pay the States 6s a day for every bed, but if you can induce those patients in those beds to insure themselves voluntarily against the costs of medical care we will give the State £1 a day'. So Queensland was faced with a situation where less than half the population voluntarily insured themselves for hospital and medical care. Most of the occupants of public beds were not insured. Most of the public beds in Queensland received 6s a day from the Commonwealth while the great majority of beds in the other States were receiving £1 a day. This was an extra burden imposed on Queensland as a penalty for its political decision to maintain a free hospital system. The Government changed, and the Country Party-Liberal Party Government in Queensland that has been there ever since has not considered it to be politically expedient, or has not considered it good policy, or has not considered it to be good for patients to terminate that free hospital system. Honourable members may take their pick about the motive, but the fact is that at election after election the Government has promised that it will not terminate Queensland's free hospital system.

Why do honourable members opposite not make some comparisons with Queensland? Why do they have to go to Canada or the United Kingdom? Why do they have to go to the blanket percentages for the whole of Australia "every time they try to analyse what all these things will cost? One of the speakers on the Opposition side pointed out that it would cost a lot more because at one hospital in his electorate it would require 3 surgeons under the Hayden scheme to replace the one surgeon at that hospital. This is an example of the sort of logic I am talking about which is worked out on words and not on facts. There has been no great influx of surgeons into Queensland to take up paid hospital appointments. It may attract them a little to be told that if they go to Queensland they will not have to do honorary work, that if they are appointed to the local hospital as a consultant they will be paid for their work there by a part time salary or by a sessional payment. It may attract some there.

No doubt this was one of the factors that induced Queensland to adopt or retain the scheme. The medical school was small in those days when compared with medical schools in the southern States. That can no longer be used as an argument. People are not flocking to Queensland to take these appointments. But they get the operations done. I have not heard of the long queues in Queensland that there are in Melbourne and

Sydney. I know there is a shortage of beds in Brisbane. I know that there is an urgent need for more hospital beds, particularly in the deprived western suburbs, but exactly the same applies to Sydney and Melbourne. In fact, when I moved from a private general practice in the suburbs of Sydney - in those same western suburbs - to Rockhampton, one of the factors that persuaded me was that I knew, having been a junior resident in the hospital there, that when I got to Rockhampton I could always get a bed in any of 4 hospitals - private, public or intermediate. I could always get a bed except at the height of an epidemic when I might have to wait 24 hours.

In Sydney the story was very different, and it is no better today under the system of charging for public beds. The doctor rings up. Perhaps he spends half an hour on the telephone before he gets a bed. When I was there I very often spent that amount of time trying to get a bed for an urgent case such as an acute appendix. I ended up telephoning an officer who was on duty 24 hours a day for the State of New South Wales to find beds for doctors who could not find them. He kept a list of where .the empty beds were all around Sydney. I think that 2 out of 3 times the patient was sent to Prince Henry Hospital, as it was then, or to the Royal North Shore Hospital, about an hour's trip by ambulance from where I was. As a rule, none of the adjoining hospitals had empty beds. The position is still the same today. I heard recently of one patient having to go to Gosford from Sydney to have an acute appendix operation. This argument that it will cost more because there will have to be more surgeons ignores the plain fact that it does not require more surgeons in the Queensland system, and there is no earthly reason why that should be the case in any other State. The surgeons in Queensland are on call for just as long for their public patients as for their private patients, and so they will be under the proposed scheme.

People do not go from 9 a.m. to 5 p.m. clocking on and off and not answering their telephones just because they are receiving salaries or sessional payments. For many years people in the Public Service, like quarantine officers, have had to give a 24-hour service. They have had to get up in the middle of night to go on ships. They are on salaries: they do not get fees for service. Yet we are asked to believe that immediately the method of pay ment of a doctor is changed and one does not rely on his human charity to work for nothing for those who are deprived financially, he loses his dedication and becomes cynical and mercenary. My experience is the reverse - that the man who is cynical and mercenary is the man who is crying the loudest - in the Society of General Practitioners in particular - about his civil rights to charge what he likes and saying that medical care is not a right, it is a luxury, and that those who want it must pay for it. That is the sort of talk we are getting from people who are championing fee for service at all costs and saying that at the moment a doctor is paid a salary he becomes cynical and mercenary, that he does not give value for money, that he is not devoted to his patients, and that that valuable personal relationship is lost.

Every one of those doctors has worked as a full time salaried doctor. Every one of them, if he is in private practice now, has worked as a resident salaried doctor in a hospital. Yet he is asking people to believe that he was cynical and mercenary then and he suddenly became dedicated and devoted when he went into the market place to sell his goods at the price that he insists on having the untrammelled right to set - without any kind of arbitration or judgment being made on the prices he charges. He demands the definite right to charge what he wants, and he also wants 2 bob the other way. He wants the system to continue whereby two-thirds of his income is now met by the taxpayers - by the general public purse.

Already the taxpayers pay more than $2 in every $3 earned by doctors in the private sector of medicine, and I am not talking about the public sessional payment positions or salaried positions that doctors may hold - and, incidentally, there has been a large increase in the percentage of doctors on salaries over the last 30 years, the ratio having increased from one in 7 to 2 in 5. The public sector of medicine is growing whatever government is in power and whatever system is operating. That has happened under the system which we are told by the Opposition is basically sound. The taxpayer's contribution to the private sector of medicine has grown to $2 in every S3 expended in that section, and it. will continue to grow. We have been told by the Deputy Leader of the Opposition that the cost of our scheme will escalate faster than the growth in taxed income, and that means also faster than the health insurance levy, and that therefore the 1.3S per cent levy will have to rise or more will have to be contributed out of general tax revenue.


Mr Chipp - I will bet it is the latter.

Or EVERINGHAM - The honourable member for Hotham suggests that it will be the latter. I think he may well be right because that is exactly what has been happening to the voluntary scheme; more and more has been contributed out of general tax revenue, not by increasing premiums. I think that the amount paid out of the special fund last year was $40m, and it is growing very rapidly. This special fund is used to make up to the private insurance funds the money lost in the bad risk cases, and there are more and more of them. They include people with pre-existing ailments, people with chronic ailments, people who need a long stay in hospitals and so on, and the funds are getting very efficient at ferreting them out. One of the things that the funds do is to send a questionnaire to the patient for his authority to get medical details from the doctor, and the doctor is asked such questions as: 'Has this patient ever had high blood pressure?' This question may be asked on the occasion of a single attendance.

Usually the funds wait until a bit of a bill is run up, but I have had the experience of being asked to fill in one of these forms after seeing a patient on a single attendance at which that patient suffered from a heart condition. I was asked had she previously had high blood pressure. Looking back over the records of my predecessor I found that the patient had given to my predecessor the history that 12 months previously a certain doctor had treated her for high blood pressure. I duly recorded this, and her claim was turned down, not because I was treating her for high blood pressure but because the particular heart condition - cardiac asthma - is recognised medically to be associated with high blood pressure and because of this, actuarially speaking, the patient was a bad risk. She could not be covered because she was more than ordinarily prone to this disease, and so, of course, a claim was made on the special fund.

The Opposition's proposals for an alternative scheme sound very fine, and I will deal with some Of them briefly. One proposition is that health care is a right that is readily available. It is all very well to have guidelines on these things and to have working parties working on them. But we had working parties working on them for many years while we were in Opposition, without the benefit of the expert assistance that is available to Ministers. That assistance was available to honourable members opposite when they were on this side of the House. They had plenty of time to have working parties on these things, as we did, and they could have come up with the solutions much more quickly than we did. We believe that we have met the first point of their plan - that health care is a right that is readily available. We have put forward a scheme whereby that can happen. The Opposition has not spelt out what it is. It has said that it is a guideline. It is good to have guidelines and to be able to agree on them, but let us get down to tin tacks, and that is what we aim to do.

Secondly, the Opposition wants a review of the present scheme, but that has already been done very thoroughly. Thirdly, it wants integration of the pensioner and subsidised health benefit schemes with our insurance scheme. The Opposition is just a little late on that because we have put that up, and this is part of our proposals which the honourable member for Hotham {Mr Chipp) and others have acclaimed as one of the good features of our scheme - more than I can say, unfortunately, for the Federal President of the Australian Medical Association who informed us at a meeting of the Caucus Welfare Committee in Canberra some months ago that he could see no good thing in the scheme and there was no point in discussing it.


Mr Chipp - In what scheme?


Dr EVERINGHAM - The Government's national health insurance scheme. He said he could see no good points in the report of the Deeble committee, even though that proposal was contained in the report and it was AMA policy. He was a very difficult man with whom to discuss any one point to which he objected. He said: 'I object to the lot'. A number of us spent much time in trying to get him to be specific. The Opposition's fourth proposal is that the scheme must be available to the maximum number of people. No scheme that the Opposition or any of its professional advisers or objecting professional groups have come up with has ever suggested a way to cover the maximum number of people. We have. There is one way to cover the maximum number of people and that is a universal scheme, and nobody except this Government has put it up.


Mr Chipp - Britain has not got it.


Dr EVERINGHAM - Again, the Opposition brings in Britain. May I remind honourable members opposite that Queensland is much closer, and everybody is in the scheme there.

Mr DEPUTY SPEAKER (Mr Berinson)TheMinister's time has expired.







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