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Wednesday, 14 September 1983
Page: 783


Dr CHARLESWORTH —We really have had a plethora of falsehoods and dishonest innuendo today, and there were no better contributions in that regard than those which came from the two soldiers we heard speak in this debate. The honourable member for Bass (Mr Newman) suggested that we on this side did not understand the ramifications of the Medicare proposals. But for the monumental blunder of the former Prime Minister on 3 February I would still be practising medicine. I believe I have some experience which is relevant to this issue. The honourable member for Warringah (Mr MacKellar) said that he was concerned about a massive migration of free-loading sick people. That statement is laughable and absurd and is clearly an indication of the standard of debate on the other side of the House.

The red herrings have been coming thick and fast from the other side of the House. The honourable member for Gwydir (Mr Hunt) talked about percentage increases in the range of 90 per cent under the original Medibank scheme. I must admit that I get really angry when we hear these isolated facts. If honourable members want some isolated facts here is one: The latest Fraser health scheme- the fifth scheme-introduced on 1 September 1981 resulted in a massive increase in bed charges in public hospitals from $50 a day in August 1981 to $110 a day in September 1982. That was an increase of 120 per cent in 12 months. Honourable members opposite want to quote isolated facts!

The honourable member for Gwydir suggested that there would be a collapse in private hospitals. Again honourable members opposite choose to ignore the facts. Bed occupancy during the year of the original Medibank scheme was 319 bed days per 1,000. Last year the bed occupancy rate was 292 bed days per 1,000 in private hospitals. I am afraid the facts do not concur with the comments we have heard. The honourable member for Mackellar (Mr Carlton) is concerned about fraud and overservicing. He must have a very low opinion of the medical profession and the people of Australia. He sees doctors being unable to resist the temptations that will be put before them. He suggested that they are greedy rip-off merchants who are waiting-champing at the bit, so to speak-to make huge profits. We on this side of the House do not subscribe to the view that the honourable member for Mackellar holds, but any government would be delinquent in its duty if it did not intend to pursue criminal fraud and overservicing.

The honourable member for Mackellar cried tears of blood for pensioners. He suggested that they would be queueing in doctors' surgeries. Perhaps he is suggesting that a number of pensioners will finally have health care available to them at a reasonable cost. Present indications are that more than 352,000 pensioners in this country are without fringe benefits that entail health care. The new proposals will make health care available to pensioners in those circumstances. I could go on talking about things that members on the other side of the House have suggested.

The Government's policy-it is tied up in this legislation-is not reactionary and not ad hoc; it is well conceived and it has been well presented. Only one political party in this country has not hidden health policies when elections have come around, and it is the Australian Labor Party. Health policy has been a major plank in our Party's platform. The full details were available for more than a year before the election, and they were responsibly amended during that time. Discussions and negotiations with interested parties have been going on ever since the election. This of course is in sharp contrast to the previous seven years when the Opposition avoided public debate and scrutiny of its health schemes.

In government the Opposition made changes that were swift and ruthless. In 1976 the changes to health insurance were accompanied by a unilateral statement that agreements that had been negotiated with the States with regard to cost sharing were invalid. The State health ministers first heard of the quite dramatic changes to the present health system in 1981 when they were announced in the Federal Parliament. The thrust of this legislation will, I hope, finally lay to rest the health care debate in this country, a debate which has for too long centred on health insurance. Hopefully, the fundamental issues of access, equity , efficiency and accountability will be resolved and discussion will then be centred on the role of prevention and the setting of health priorities. The Medicare proposals will move the Government's role to one of balancing its social and economic objectives in a cost-effective and efficient manner.

The former Government had great difficulty assessing its health care objectives . The cornerstone of the Labor Party's policy is its social objective of universal cover. We believe it is a right and not a privilege for people in this country to have health cover. Indeed, the former Government's discussion paper in 1978 entitled 'Paying for Health Care' stated:

In view of its acceptance and theoretical advantages it should be regarded as a permanent feature of health financing in Australia.

I am talking about universal coverage. The paper went on to state:

Under Medibank it immediately became apparent that the goal of basic universal cover had been attained with remarkable administrative efficiency.

The Labor Party opposed the amendments made in 1981. Indeed, in June 1981 the present Minister for Health (Dr Blewett) made the following chilling predictions :

On pre-1975 expectations, at least one and a half million Australians will remain uninsured. If the conditioning of recent years has had any impact that figure may be considerably larger.

He went on to outline those people who would be uninsured, and, again with commendable accuracy, he included in that group those who were unable to afford expensive flat rate insurance, those who took risks with their health, those who gambled with their health, the feckless and the confused. Certainly, the policies of the previous Government have been very confusing. It chose to ignore its advice and embarked on a number of programs of short term expediency. The off-shoot was that 2 million Australians were without health insurance, as was so ably forecast by the present Minister. On top of that, the present scheme asks low income earners to pay a much higher percentage of their income than other income earners pay. It is inequitable and regressive. Thankfully, this package of legislation, with its universal coverage and an income-related levy, will redress the socially abhorrent aspects of the present scheme.

The next matter we turn to during the health debate is economics. We have heard all the Opposition's arguments before, and it has trotted them all out again today. They talk about the private enterprise panacea-the cure-all. Health is not a perfect market. Unfortunately, or fortunately for whatever the reasons, the suppliers dictate the usage of health care and not the consumers. Therefore the promotion of a free enterprise health system as the most efficient, unfortunately does not carry weight. This idea has been promoted to the extent that even the medical profession has come to believe it. I shall quote from a speech made earlier this year by the retiring President of the Western Australian branch of the Australian Medical Association. I suggest to all honourable members that the AMA is not a hot-bed of socialist or left wing doctrine. The President said:

I am continually surprised to learn that many of our profession do not know that for every dollar paid out by a benefit fund for a medical service 30c is supplied by the Federal Government.

It is unreasonable then that the Government, or the benefit fund for that matter, should not want to know where every cent of their money is going.

The United States has traditionally pursued a free market health care scheme. Only relatively recently has the Government in that country assumed responsibility for disadvantaged people through its Medicaid and Medicare schemes. Despite the pursuit of a competitive health scheme in that country, the bastion of the free enterprise market, the cost of health care continues to rise in quantum leaps. If we look at the figures we see that health care increased by 15 per cent in that country during 1981. As a percentage of gross domestic product the figure was 9.4 per cent in 1980. But across the border in Canada, where there is a universal, publicly funded scheme, as a percentage of gross domestic product 7.3 per cent was spent in 1980. I am suggesting that health schemes, such as the one that exists in Canada and which is in parallel with the scheme the Labor Party is wanting to implement in Australia, contain costs. Cost containment in Canada stems from effective government control on the supply, demand and cost of health care. Centralised administration of Medicare will lead to cost containment. While at present administrative costs consume $1 in every $ 10 in Australia, the administrative and advertising costs consume $1 in every $ 25 in Canada.

Mr Deputy Speaker, I suggest to you and to all honourable members opposite that this legislation represents a milestone in health care. I hope that its passage will enable us to put the health insurance debate behind us and to concentrate on reassessing and examining other priorities in the health area. Prevention, health education, research and industrial health are just some of these pressing problems. This legislative package will help to achieve the social objectives of accessibility and equity. The economic aims of efficiency and accountability will also be achieved. The legislation will represent an important part of the social wage concept which is fundamental to the prices and incomes accord. Therefore, I commend the Bills to the House. I support them and I congratulate the Minister for Health on presenting them.