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Thursday, 19 February 1987
Page: 380


Ms MAYER(4.17) —I am not entirely sure whether the honourable member who has just spoken, the honourable member for Page (Mr Ian Robinson), was advocating the same sort of program with blood testing as we had with compulsory X-rays which, I might remind him, were abandoned as being more dangerous than helpful in the fight against tuberculosis. Does he feel that it would be an adequate answer to the problem-he might faint on the floor if we decided to do this-to put free condoms in every public place. That might be a little more practical and not nearly so much an intrusion on one's privacy.

The very terms of this matter of public importance raised by the honourable member for Barker (Mr Porter) simply do not make sense. The honourable member is concerned that Medicare fails to provide adequate health services. Medicare is not a provider of health services. I would have thought that that was blindingly clear. Medicare is a universal health insurance scheme, making it possible for every Australian to receive a repayment for the cost of health services provided by doctors of various types and through payments to the States to provide free of cost public hospital treatment. I do not know why an insurance scheme should be seen to be, or be expected to be, a provider of health services. I think that every provider of health services in this country would be rather opposed to the notion that the Health Insurance Commission should be providing health services. Other health insurance schemes, including Medibank Private-by far the best of them all, in my opinion-enable those who can afford to do so to take advantage of health services in addition to those covered by Medicare. None of the health insurance schemes provides health care; they provide insurance to help cover costs.

The States provide public health care in the form of public hospitals, clinics and community health centres. It seems from the terms of the matter of public importance that the honourable member for Barker has a problem with clear thinking, but then we have all known that for some time. Yes, there are problems with parts of our health care systems, and there are reasons for those problems, which have nothing at all to do with health insurance. They are supply and demand problems.

Of course, there is an area of health care in which there are few problems, and that is the area of general practitioner consultation. There is no shortage of GPs. The supply is sufficient to meet the demand; in fact I think it is an area of oversupply. The nature of the demand is fairly simple. GPs do not need several nurses each; they do not need beds for their patients; and they do not need the enormous infrastructure required by hospitals. So we have a more than adequate supply of practitioners, simple technologies and modest support needs. We do not have a problem there. Medicare covers 85 per cent of the schedule fee, or the whole fee if the doctor chooses the very efficient direct billing system. Doctors can, and often do, choose to charge more than the schedule fee; that is a matter between doctor and patient. It is fortunate that there are doctors around who do choose the direct billing system. Whatever the choice of fee, the supply is equal to the demand placed on it. However, in some areas, as we all know, the demand is greater than the supply; that has been so for many years, as I will show later. Sometimes this is because the number of practitioners in the demand area is not enough, and that is often due to self-limitation by the professionals themselves. One of those examples is orthopaedic surgeons. We simply do not have enough coming through the colleges of surgery. We do not have enough radiologists for much the same sort of reason; in this country five new radiologists are accredited each year.

In public hospitals the supply of beds is limited largely because of a shortage of trained nurses willing to accept the pay and conditions of that profession. It is interesting that the Opposition had nothing at all to say about that. It is time we realised that for many years our public hospitals have ridden on the backs of underpaid and overworked nurses whose pay and conditions in no way reflected their responsibilities. The redress that is now taking place, with nurse education having been removed from apprenticeship-type training to the tertiary education system, is a long overdue recognition of the reality of today's medical practices. The improvement in pay still has a long way to go to make nursing a sufficiently rewarding profession to attract sufficient entrants. Until that situation is properly resolved, public hospitals will continue to have empty beds.

There are several other factors. I simply repeat what the Minister for Health (Dr Blewett) told this House last November. General surgery has increased by 77 per cent in the last five years. The ability to repair human defects has increased so much that the demand has well and truly outstripped the supply of professionals able to deal with it. That has absolutely nothing to do with health insurance, but it has a great deal to do with waiting lists in hospitals.

I would like to remind people that waiting lists in public hospitals have always been longer than desirable. For example, back in the 1960s, people had to wait sometimes for up to two years for admission for non-urgent surgery, and that was long before the explosion in medical technology which has led to that 77 per cent rise in general surgery in the last five years. However, we did not hear too much criticism then from the conservative parties, who were in government federally and in the States. It seems a bit odd that long delays were acceptable then but are now suddenly morally repugnant to them. Perhaps it has something to do with the conservative parties not being in government. However, I do not want to dismiss the problem of these delays for admission to public hospitals as not important. We have talked about one cause; I now want to talk about another.

We are looking at an increase in medical technology. The sort of treatment that is able to be given has expanded and this has put a great strain on our hospital funds. We have all sorts of new techniques: Nuclear medical techniques, computerised treatment, CAT scanners and biochemical analysis. That has meant that not only do the treatment and diagnosis now take longer but also the costs have skyrocketed.

I go back to the point that no State government has actually claimed that Medicare has caused increased waiting lists. The Royal Australian Nursing Federation does not claim that either; nor do the administrators of public hospitals claim that delays are caused by Medicare. We are looking at a decrease in productivity in hospitals. We are looking at the need to allocate a much greater proportion of hospital budgets to wages rather than treatment; that has been compounded by the shortage of qualified staff.

In conclusion, I remind the House of the situation that existed before Medicare. A pensioner or beneficiary with a health card could obtain free of cost public hospital treatment, or at least he could get on to a waiting list. It is no wonder that that card was known as the poor card. If a person did not have a health card and could not afford private health insurance, he was probably one of the two million Australians who could not afford to make use of the available health services. Such people were taxpayers too, incidentally, but they fell into that dreadful hole created by conservative government policies. The inability of such people to cover the cost of medical services or to obtain insurance to assist with those costs was one of the most shameful features of the health insurance schemes of our predecessors. The fact that Medicare provides insurance cover for the cost of basic health services for everyone apparently offends the ideology of the honourable member for Barker (Mr Porter), who seems to have found no offence in the plight of those two million Australians.

Yes, there are problems with the provision of appropriate health care for all Australians. But we have not heard, and will not hear, from the Opposition any useful debate on these matters; we have simply heard blind, ideologically biased opposition to the Medicare health insurance scheme only because it is an act of a Labor government fulfilling basic Labor Party policy-that no Australian should be unable to afford basic health care. That is our philosophy. That is our policy. We have carried it out. All of the side issues that the Opposition will not tackle-the increase in technology, the need to train more nurses and pay them a great deal more, the infrastructure required in hospitals today, the sophistication of training and the shortage in some specialist surgical areas-are of no interest to the Opposition. What the Opposition wants to say is that Medicare is to blame for waiting lists in hospitals, that Medicare is to blame for the acquired immune deficiency syndrome perhaps, that Medicare is to blame for the drug problem and that Medicare is to blame for everything that the health system, which is struggling to cope with difficulties in all areas, is encountering.


Mr DEPUTY SPEAKER —Order! The honourable member's time has expired.