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Thursday, 22 September 1983
Page: 1203

Mr CARLTON(5.56) —What a dreary world the honourable member for Lilley (Mrs Darling) inhabits. It is a very stark and awful world, but it is also a very simple world in which all the people on her side of the House are caring, compassionate and wise, and all those on the Opposition side of the House are ravening monsters who are preying on the weak and the poor. If one listens to the honourable member day in and day out, one has to regard her speeches as a grave reflection on the Australian people because, for the best part of this century, they have entrusted to our parties the work of social reform in Australia. Most of the social reform legislation on the statute books of the Commonwealth of Australia has been written into them by parties of our persuasion. The Liberal Party of Australia, set up in 1944, has been a party of moderation and reform. If it had not held office for most of the last 30-odd years, Australia would be a much less satisfactory place than it is.

I give credit to honourable members opposite for having objectives for the betterment of the Australian people, which they honestly hold. I hope that the honourable member for Lilley, as her time in this place goes on until the next election, when I understand that it might cease, will find out in that time that all those on this side of the House are not quite as bad as she claims we are day by day.

I refer to the Budget Speech of the Treasurer (Mr Keating) and the paragraphs in that speech which relate to the provision of health services by the Commonwealth, and I refer also to the implementation of Medicare, legislation for which has passed through this House and through the Senate with some amendment, and is now back with the Senate. I should like to make a few comments about Medicare. On Wednesday of last week we had a very lengthy debate in the House. We were not allowed to have any air time. We were not allowed to speak about it in response to the Minister for Health (Dr Blewett) when the proceedings were being broadcast. The previous week, in introducing the legislation, the Minister made sure that he spoke during air time. So it is necessary for the Opposition to point out some of the difficulties of the Medicare scheme now, in an objective and quiet way, whilst the proceedings of the House are being broadcast.

Firstly, I point out that Medicare is not really about the improvement of health care delivery in Australia, but it contains measures which threaten good health provision in the future. In fact, Medicare is a major act of nationalisation. It will add $1.7 billion to federal taxes in a full year. It will add about 2,500 expensive extra staff to the public sector. It will add a great deal of unnecessary computer equipment and extra offices for Medibank in the public sector, and it will result in the sacking of 5,000 people in the private sector within the voluntary health insurance funds. Those 5,000 people are employed at generally lower levels of conditions than the public sector employees who will replace them.

The unfortunate aspect of Medicare is that it obscures the real costs of health care. The Government claims that the one per cent levy on taxable incomes will make people aware of the true costs of health in Australia; but the one per cent levy will raise in a year only about $1 billion in additional tax whereas the Federal and State governments spend about $8 billion a year on health. The Medicare levy will cover only about one-eighth of the nation's government- supported health costs. That will not give any real idea at all to the people about what the costs of health care are. It is basically a political levy. It is set at one per cent in order to make the Labor health scheme appear cheaper, but honourable members will notice that of that $1.7 billion additional tax to be raised in one year, only $1 billion will be from the levy. The other $700m is a straight increase in ordinary taxes.

Another way of obscuring the real costs of health care occurs in the doctor's surgeries and in the hospitals. The purpose of Medicare is to make surgery visits to the doctors apparently free. Its purpose also is to make public hospital beds apparently free. Under Medicare public hospital beds will be available free of charge, without any means or income tests. The money for those beds, of course, will have to come through the tax system and the subsidy for doctors' surgery visits will have to come through the tax system. The purpose of Medicare is to disguise the true costs of health care. Medicare raises big problems for consumers.

Pensioners will be hit substantially as a result of Medicare. Although pensioners with pensioner health benefit cards will still get the same benefits after the introduction of Medicare, the effects on the consumer price index of the introduction of Medicare will mean that pensions will be reduced effectively in 1984 by $3.90 a week for married couples and by $2.30 a week for single people. Those pensioners who currently have pensioner health benefit cards and do not have to pay for their health costs will not have to pay for their health costs under Medicare but will, nonetheless, suffer because of the 2.6 per cent reduction artificially in the consumer price index on which their pensions are based. As a result, in 1984 married couples will lose $3.90 a week and single people $2.30 a week.

Many people may well drop private hospital cover, trusting in the Government's propaganda that they will be covered by Medicare for their health costs. In fact , people will not be covered for everything by Medicare. It will cover 85 per cent of doctors' fees and public hospital beds with no choice of doctor. If people wish to have choice of doctor in a public hospital or to retain the option of going to a private hospital, which will be a necessary option as the squeeze on public hospital beds occurs, they will have to take out additional private insurance. Medicare will provide no cover in private hospitals. The lowest $5 private hospital cover with private funds-assuming that it is $5; the Minister says it will be but I have been told by funds that it could be as high as $8-could leave patients on a six-day private hospital stay $400 to $500 out of pocket. They could pay $40 to $50 a day over and above what they get back from the funds and also theatre fees of a couple of hundred dollars. So if they are not careful, even if they take out the lowest level of private hospital cover, they could find themselves considerably out of pocket if they stay in a private hospital. The Victorian Bush Nursing Association, which operates almost 40 hospitals, is very concerned about this aspect of the scheme and its problems have not yet been resolved. I remind the House that those Bush Nursing hospitals are in areas where there are generally no public hospitals.

At least one-third of the existing insured will pay more, directly, under Medicare, on the Minister's estimate. I think more than that one-third will pay more when the actual figures are known and when we know what the real cost of private hospital insurance will be. All taxpayers will pay extra taxes over and above the levy to finance Medicare. Medicare also attacks private health provision. It aims to make doctors totally dependent on the Government by forcing them into the situation of bulk billing for all patients. This is being done, firstly, by propaganda. The Government is persuading all patients to ask their doctors to direct bill the Government and, therefore, give no bill at all to the patient. Secondly, the Government is banning insurance for the gap between the government subsidy and the fee charged by the doctor. There will be strong economic pressures on doctors to cave in and bill the Government directly . When the doctors are getting 85 per cent of their schedule fees direct from the Government they will be under the total control of the Government. That is a very substantial step towards the control of private medical practice by the Government, despite the constitutional provisions which should prevent that.

Medicare will also reduce the competitive position of private hospitals. By changing the comparative basis of subsidy between public and private hospitals Medicare will make insurance for private hospitals much less attractive. The problem will be that if fewer people are able to go into private hospitals, or see it as economically difficult for them to go into private hospitals, there will be an increase in pressure on public hospital beds, which in many cases are already overstressed. I believe that this will lead to queueing in public hospitals. People waiting for elective surgery, who may be desperately uncomfortable, will have to wait. They ought to be very worried about whether they get private hospital insurance.

Medicare will promote unnecessary servicing by doctors. This bulk billing about which I talked earlier, when extended to all patients and not just the elderly and disadvantaged, will promote overservicing. There will be a tendency for doctors who are getting 85 per cent of the schedule fee direct from the Treasury to try to tick the meter over a little more rapidly to make up the difference. That can always be explained in terms of patient care. There can always be an excuse for seeing somebody a little more often or for longer because some definite medical reason for that can be found. Of course, the temptation to extend that will exist because the bill will go directly to the government and the patient will take no direct interest.

The Opposition's belief is that the removal of the patient from the billing process will corrupt both doctors and patients and will certainly lead to queueing in surgeries of doctors who bulk bill. In the long run it will be highly destructive of the relationship between doctor and patient. The Government announced in the Budget a doubling of the computer surveillance equipment at a cost of $8m per annum as opposed to $4m previously. This is an acknowledgement that there is a very real concern about overservicing under the direct billing system. The Minister is like the policeman who, going down High Street at dead of night and seeing the door of Woolworths open, fails to close the door, sets up surveillance equipment on the other side of the road in order to count the goods going out throughout the night, and subsequently tries to catch the culprits by looking at statistical profiles. We suggest that a better way of dealing with this problem is actually to close the door. We are moving into a police force type of situation in relation to the doctors. The doctors will be told: 'We would like you to send all your bills directly to the Government. We will pay you 85 per cent of what you would normally get. We are going to put in an extra $4m worth of computer surveillance equipment and we will add to the staff in this area in order to keep a very close watch on you'. I believe that this system firstly will not work and secondly will have a very destructive effect on the morale of the medical profession. I think it will rebound very seriously on the Government.

What is the Opposition's view of these changes? What is our position for the future? The Opposition is examining afresh its health policy and new policies will be announced in due course. However, we make it absolutely clear at this time that we could not live with certain key aspects of Medicare. We could not live with bulk billing for general patients as opposed to the disadvantaged; in other words, we do not believe in so-called free hospital care in the surgery regardless of means. We do not believe in so-called free public hospital beds regardless of patients' means. We are in favour of the maintenance and extension of private hospitals and private provision of health care. Finally, we are totally opposed to a tax on private medical practice and we believe that fee-for -service medicine with a patient contribution is at the heart of the continuity of a healthy private sector delivery system. The independent medical practitioner in the city, the suburbs and the country is at the very heart of good health care delivery. The moment we get all those medical practitioners receiving all their income directly from the Government on fees which cannot be varied, we will be well down the way towards destroying the morale of a profession which is essential for the maintenance of good health care in Australia. This Government is taking an historially mistaken step in this direction and if it is not reversed within a reasonable period the Australian people will have something to be very sorry about indeed.

The Opposition does not claim that everything in the existing system is marvellous. There are aspects of the existing system, which is being replaced, which could have been changed to improve it substantially, but it would have been possible to make those changes without introducing this major nationalisation measure.

I shall again go quickly through the fundamentals of Medicare. The one per cent levy on taxable incomes replaces the basic insurance tables of the current scheme, the one per cent, of course, bearing no relationship whatever to the real cost of health provision in Australia; in fact, it provides only one-eighth of the cost. Patients will be entitled to a free hospital bed with no choice of doctor without means test, and 85 per cent of the scheduled medical fee in the surgery, but with the Government pressing doctors to bulk bill for all patients so that there will be no patient interest in or concern about the cost of the service.

Gap insurance to cover the remainder of doctors' bills is to be prohibited; indeed, all private medical insurance is prohibited under the Medicare bills. There is to be a $150 ceiling on patient contributions to medical bills over 12 months which is no concession at all because one can get gap insurance for less than $150 a year but which will pose very grave difficulties in overservicing because it will be possible for a patient to build up that amount of money in one series of major operations or a major operation and from then on doctors will be able to get from the Government 100 per cent of the cost of the medical procedures and consultations for that patient until the end of the year. So a great loophole has added to the others in this overservicing problem. Doctors are encouraged to bill the Government direct so that the Government can eventually control doctors' incomes precisely, and once it is seen that servicing moves up, utilisation of services will move up because there will be no control at the point of service. Then the Government will start to put the squeeze on the schedule fees and start to apply more regressive controls to the medical profession. Doctors who might believe that in the short term some of these proposals will assist them financially will find after a relatively short period that the decisions in these matters are being taken out of their hands and placed in the hands of the officials of the Department of Health and politicians. Two-stop shopping will be necessary for anybody who wishes to have private hospital cover or choice of doctor in a public hospital. People will have to go to two places-first, Medicare for the basic cover and, secondly, the fund of their choice for their additional cover and any ancillary insurance such as for dentistry, chiropractic, physiotherapy and the like.

So Medicare is no more simple than the present scheme; in fact, by requiring people to go to two separate places for their health cover, it is more complicated. Ultimately the private hospital bed subsidies will be paid, via block grant to State governments. Certainly, the relative attractiveness of private hospital insurance is reduced within these measures. I fear very much for the survival of the private hospital system when subjected to the oversight of Ministers such as Mr Brereton in New South Wales and Mr Roper in Victoria, whose hatred of the private hospital system is well known. The other aspect of the scheme is that all basic insurance associated with the levy will be processed by Medicare; that is, it will be removed from the private funds which will be left only with the extras insurance. The private funds will lose 60 per cent of their business and in February 5,000 members of the staff of private funds will be sacked.

This is a major act of nationalisation. It moves the decisions in health care very much away from the patients, the consumers and the providers who are closest to what is happening and takes them very substantially in the direction of the bureaucracy and the politicians. It is a major move away from the private sector and in the end it will have a very bad effect on the quality of health care delivery in Australia.

Question put:

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