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Wednesday, 14 September 1983
Page: 817


Mr CARLTON(10.33) —Mr Deputy Chairman, our concern about these clauses of the Health Legislation Amendment Bill is that they relate to the bulk billing provisions of Medicare. Also, one of the clauses relates to the sacking of the private health insurance funds as the agencies for handling pensioner payments when doctors do not bulk bill and when pensioners are required to recover 85 per cent of the schedule fee through a private insurance fund acting as an agent of the Government. We indicate to the House our very grave concern at the step being taken by the Government in moving away from the concept of a patient contribution to each service. The fundamental point is that patients ought to be expected to make contributions, if they are able, to medical services. We also indicate our displeasure at the Government's action in sacking the private health insurance funds from yet another of their current functions.

Underlying these three clauses are principles which we regard as of fundamental importance. In the earlier part of the debate on other clauses-it also relates to these clauses-certain members of the Opposition expressed views about the medical profession and its propensity to indulge in actions which, if not illegal, are at least against the public interest. I refer to the possibility of overservicing. It should be understood that when I became the Minister for Health a Joint Committee of Public Accounts inquiry was in progress and there was a very substantial amount of public criticism about the medical profession. That criticism was led by the Australian Labor Party and it was very much supported by the Press because bad news is good news for the Press. I do not blame the Press for that but I blame certain members of the Australian Labor Party, including its former parliamentary leader, who made a very vigorous attack on the medical profession in a speech in Melbourne, and I blame certain people outside the Parliament who supported the Labor Party in this action. I refer specifically to the Doctors Reform Society, whose former President, Dr Andrew Refshauge, has now been selected as the left wing Labor candidate for the State seat of Marrickville in New South Wales, and to certain academics who made the same kinds of statements.

I took the view that these attacks on the medical profession were utterly unwarranted in respect of 99 per cent of it. I took the view that it was important to support the good members of the profession against such attacks. I took the view that it was important to point out that the parliamentary Public Accounts Committee, under the chairmanship of my colleague the honourable member for Bradfield (Mr Connolly), was taking a middle of the road course to examine the facts but not to carry out a witch hunt of the medical profession. Time and again I spoke in support of what I called the good doctor. My support of the good doctor was certainly upheld by the public in an opinion poll published by the Bulletin during that inquiry which indicated that the esteem of the medical profession still ranked at the very top.

Let it be perfectly clear that members of the Opposition have very firmly, both in government and now, supported the good doctor. We are interested in excellence, professionalism, good medicine and good health care. We do not blind ourselves to the possibility that some members of the profession might be tempted to go over the mark and provide unnecessary services and that some may well indulge in fraud for which they should be prosecuted. Let us make quite clear what we are against in this matter. We are against moving the boundary so that more honourable members of the profession, might be tempted into error.

In Canada, for example, most patients never see an account. The doctors send the bills directly to the Government, and the only surveillance of their activities is through an overall computer profiling system. We do not believe that that is satisfactory. We believe that more and more people will be tempted to pass across a boundary which will become increasingly blurred in respect of what is an acceptable service. We believe that once we take away the constraint caused by patient contribution, we will be on perilous ground. We acknowledge that we are already on perilous ground with regard to pensioners and the disadvantaged. We accepted in the past that difficulty because we saw no other way of giving taxpayer contributions to the needy. But to accept that for 80 per cent of the population where it does not occur at the moment we regard as being absolutely unnecessary. It also places this profession in dire peril. We believe that these measures-they are certainly embodied in these clauses of the Bill- will put the medical profession in an even closer, more direct relationship with the Government. If the present Minister for Health (Dr Blewett) achieves his objective of having all medical services paid direct from the Government at 85 per cent of the schedule fee, how can he possibly say that the medical profession is not bound hand and foot to the Government?

Any professions at the moment that this is only a modest measure are not really acceptable from the present Minister. Over some considerable period he has indicated in speeches that he has made that he believes that private practice, with a fee for service, is a basically unacceptable way for the medical profession to operate. In fact the Minister indicated this in a speech to a meeting of the Australian Hospital Association in Adelaide last year at which I was present. He acknowledged that the general feeling of the Australian community was such at this moment that the Australian Labor Party felt constrained in this matter. It felt it could not go directly to such a system. But he made absolutely clear his personal direction in this matter. Certainly he made it clear to me at that time that any measures he brought in-he has persuaded this Government to bring in this measure-would be stages along the way towards closer control of the medical profession. Anybody in the profession who does not read the Das Kapital or Mein Kampf of this Minister-the things he said earlier-and who does not realise what they might be in for as a result of the clauses in this Bill is living in cloud-cuckoo-land.

Fundamentally therefore, we are opposed to these clauses because they embody this movement towards bulk billing and this movement away from the private health insurance sector. These clauses require that that sector will no longer be able to process the claims of pensioners who were not on the bulk billing system. For that reason the Opposition opposes these clauses.