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Wednesday, 14 September 1983
Page: 801


Dr BLEWETT (Minister for Health)(8.38) —First of all I wish to thank those members of the Government who participated in the debate and who have given the Health Legislation Amendment Bill their support. I am afraid that I cannot say the same about the members of the Opposition who participated, because apart from some rare exceptions, which I will note, their contributions have been simply a collection of slogans, cliches and sometimes simple abuse. Indeed, much of the debate has clearly revealed that the Opposition has forgotten everything and learned nothing from the experience of the health debate of the last 10 years. The one fortunate aspect of that, of course, is that quite a number of statements which have been made today from the Opposition benches will ensure that the Opposition members stay there.

One of the saddest aspects of the debate was that we had the gaggle of health Ministers who represented the last Government each making speeches. That is, we had three ex-health Ministers-perhaps I should exclude the last Minister, the honourable member for Mackellar (Mr Carlton), and just take two Health Ministers -who between them managed to produce five health schemes. The three Health Ministers, in what they said, perfectly reflected the frozen state of the debate . They reflected the characteristics which each of them displayed as Minister for Health.

The honourable member for Gwydir (Mr Hunt) talked about nothing but the cost of Medibank. He talked about it in terms of six or seven years back, without any recognition of the fact that in recent years most of what he said has been clearly proven to be false. Indeed, most of the analyses of Medibank usually now start off with quotes from the honourable member for Gwydir to show the absurdity of the myths he has perpetrated. He talked about the expense of Medibank. He never bothered to note that in the one full year that Medibank ran it came in under budget. It was not an open ended health scheme; it came in nearly $90m under budget. It was planned carefully, and in that one year it was allowed to operate it came in $90m under budget.

The previous Government appointed the Jamison Committee of Inquiry into the Efficiency and Administration of Hospitals to look into the costs of health care in this society. That Committee, in its 700-page report, examined and identified all the major areas of escalating health costs in this country. Not once in those 700 pages is there any suggestion that Medibank as such was responsible for the escalation of health costs in this country. The honourable member for Gwydir has never bothered to tackle intellectually the real problems posed by reports presented by his own Government. I was delighted by his final remark; he talked about how community health had been gobbled up by the States and public hospitals. Yet it was his Government that decided to hand back community health in a block grant unidentified to the States so that gobbling up would occur.

Now I turn to the second of these ex-Ministers, the honourable member for Warringah (Mr MacKellar), who of course devoted most of his speech to talking about my fundamentally dishonest approach. He said that somehow we are involved in a gross deception and a confidence trick. Let me say of the honourable member for Warringah that he is certainly an expert in deception. I have a Press release issued by that honourable member when he was Minister for Health in the middle of the election of October 1980. He made three assertions. He asserted that the Government had no intention of scrapping its health insurance policy. He said there was absolutely no truth in the rumour that the Government was planning to restrict patients' free access to public hospitals by re-imposing a means test for hospital care and that the Government had no intention of reducing funding for public hospitals and community health services. Those three statements were made in the midst of the election of 1980 by the honourable member for Warringah when he was the Minister for Health. Within six months each of those three pledges was dishonoured. If we are to have judgments about whether I have been deceiving the public we should look at who makes those statements.

Let me say by contrast to the honourable member for Warringah that we have endeavoured on every occasion to present our policies as fairly as we could and admit, as the honourable member for North Sydney (Mr Spender) said, that when certain major changes took place in the cost of public hospitals we would have to adjust the levy-and we have told the public of that. The honourable member for Wentworth (Mr Coleman) accused me of deceiving people about the need for private insurance. In every table we have put out we have presented that private insurance option. In every public statement we have made we have told people that Medicare provides only the basic cover and that they should look, if they want to do so, to the need for private insurance and its costs.

The honourable member for Wentworth epitomises, I think, what is wrong with the Opposition; that is, its refusal to examine seriously the proposals being made by the Government. He epitomises the simplistic sloganeering which contributes nothing to the health debate in this country. He said three things which were echoed by many other honourable members. He said that the aim of the Bill is to eliminate the private funds. Let me say quite clearly that the aim of the Bill is not to eliminate the private funds. We do not deny that the object of the Bill is to make basic medical care in this country a public responsibility which should be borne by a public fund. Unlike the previous Government we do not believe that basic health care in this society should be the responsibility of a gaggle of private funds; it should be the responsibility of a single public fund . But that does not lead us to believe that the private funds do not have a significant supplementary role to play.

The fundamental difference between us and the Opposition on this point is firstly, not that we wish to eliminate the private funds. We believe that the public fund should bear the basic responsibility for health care and should be supplemented by the private funds. Secondly-this is reflected in much of what the Opposition said-The bill is supposed to eliminate the private hospital sector. It does the very opposite. It seeks to provide and underwrite the best elements of the private hospital system. We have tried to provide a portable, low cost private hospital table, and in order to achieve it we have had to categorise private hospitals so that the moneys go to private hospitals in relation to their costs. I believe that the very best elements of the private hospitals system in this country recognise that that is a fair and appropriate way of doing it. Finally, the honourable member for Wentworth echoed what so many others had said; that is, that we are out to eliminate private fee for service medicine. I share many of the doubts of my colleague the honourable member for Prospect (Dr Klugman). In many ways we are underwriting private fee for service medicine. There is no doubt that this is a measure which serves to underwrite the private fee for service system in this country. It is simply a fantasy to say that somehow this is aimed at eliminating the private fee for service system in this country.

Let me turn to the remarks made by the honourable member for Bass (Mr Newman) who, after making the usual ritual obeisance to socialism and nationalisation, raised a number of worthwhile issues which I believe it is the responsibility of the Government to answer. First of all, he asked a question relating to the basis of our hospital cost calculation. We discussed with every State the expectations of the shifts and changes that would take place not only in private to public shifts within our hospitals but also in outpatient areas and in the standard medical fees paid in the public hospitals. We worked out a calculation which proved to be acceptable to most of the States. I believe that the States considered it to be a fair calculation for working out hospital costs. We have also indicated that the calculation must at this stage be hypothetical but we believe that the moneys we have indicated are the most that are likely to move over. We have indicated that every three months we will look at the shifts and changes that take place. I am disappointed that the issue of the cost sharing agreement with Tasmania has been raised because it was my clear understanding from the decision made at the Premiers Conference that:

The heads of Government agreed on the revised proposals for Medicare as outlined by the Minister for Health in the Premiers Conference, including the basis of the compensation payments to each of the States.

The basis of that statement included the cost sharing rearrangements. Indeed, the arrangements are desirable from Tasmania's point of view because if cost sharing remained Tasmania might well share half of the extra costs. The Commonwealth is prepared to bear the total costs as a result of those shifts. That is the reason we moved in that direction. I have had communications with the Minister for Health in Tasmania and I have done my best to get our officers together so that we can solve this problem. South Australia very clearly accepted that it is advantageous to it to move out of the cost sharing arrangement when the Commonwealth is willing to bear all of the extra costs related to any shifts that might flow from the system. I hope that that point will be resolved.

The honourable member for Bass asked me about the estimate of our cost for family cover for private hospitals which I have said will be about $5. That is about all I can say at the moment because it will depend on what the private funds determine in relation to the whole system when they look at it. I can tell honourable members the basis of that $5. As honourable members know, at the moment across Australia the cost of a bed in a shared ward is $122 per day. We have reduced that figure to $80 per day. Of course, over half the private beds in this country are in public hospitals. In addition, we have changed the arrangements for long term patients which will also enable the health insurance funds to reduce their charges. It is on those bases and on the basis of some minor calculations that we are fairly confident-we have had actuarial advice- that the cost will be about $5 for a family, though it will differ a little from State to State and probably from fund to fund.

Finally, the honourable member for Bass referred to the complexity of doctors dealing with the direct billing system. The reason they have great problems at the moment and there are great delays is that we have a complicated insurance system. It is necessary for both the doctors and the Government to identify whether a patient is entitled to direct billing. They have to identify whether a patient falls into one of those numerous categories of a health care card holder , pensioner health benefit card holder or health benefit card holder. They then have to check all the numbers to see that they are right. That is why we have so many delays in this system. Under Medicare, as a doctor will be able to bill directly any patient, none of those problems will occur. We are fairly confident that we will be able to return a direct billing payment to a doctor within approximately five working days of its reception. This will be a very big improvement on the present complicated system which, in my view, has quite unacceptable delays.


Mr Newman —What about mistakes with paper work? How long do you reckon that would take? It takes six months at the moment.


Dr BLEWETT —From the point of view of paperwork, that will be much simplified because in relation to the Medicare card we are offering all doctors a simple direct billing machine similar to that provided through the Bankcard system. So I think that we can fairly competently deal with that problem of delay.

No doubt I will have a chance to deal with some of the other particular problems as I gather considerable debate is to take place in Committee. I just say again that I do not believe that the Opposition's sloganeering and cliches have contributed anything to this debate. I would welcome constructive and worthwhile comments from the Opposition. I must say that I have received such comments from the Australian Democrats but, on the whole, not from the Liberal- National Party.

Question put:

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