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Thursday, 19 March 1987
Page: 1098


Mr MacKELLAR(10.43) —The Australian Institute of Health Bill gives statutory authority status to the Australian Institute of Health, which is obviously conceived as a policy think tank for the national direction of health policy. The need for a statutory body proceeds on the assumption that the Department of Health needs to be freed from the responsibility of administering the Australian Institute of Health. This body was the special charge of Dr Deeble who, like the Minister for Health (Dr Blewett), has no training as a medical doctor. But he is a special pet of the Australian Labor Party and was the original author of Medibank and free medicine which, if it had been allowed to continue in its 1975 form, would have created the most profligate medical institution. If it had continued it would have by now earned a most repugnant reputation. Thankfully for Dr Deeble, he was saved this ignominious outcome of his expensive experiment by the failure of the Whitlam Government whose reputation continues as the free-spending, inflation-creating incumbency which set Australia's Federal affairs on the downward economic spiral.

We know that honourable members on the Government side are no longer enamoured of the Whitlam spending years. They refer to then somewhat sheepishly in such terms as `if only we had done things differently'. The Prime Minister (Mr Hawke) in his Question Time harangues is always keen to blame the Fraser Government for the problems of this time. I believe that is quite extraordinary effrontery but, of course, effrontery is something that the Prime Minister is very practised at.

The realities are that the Medibank scheme was an effort to produce a system of medical care which set no ceilings on public investment. It was a luxury ride to medical and fiscal irresponsibility. It became a first priority of the Fraser Government to put some onus of responsibility on to the individual for health care provision; and this is still the issue. The issue is not one of denying health care to individuals who cannot afford it; the issue is to ensure that those people who are in a position financially and socially to make forward provision for their health needs do so.

The Australian Labor party is dogged by the British Labour Party concept of public health care and by an inbuilt hostility to the medical profession. The whole creeping malaise of this approach has been brought back into the system under the leadership of non-medical doctors-Dr Blewett and Dr Deeble-with only a partial recognition of the argument that people should be encouraged to raise their sense of personal responsibility for their own health. This is a very fundamental philosophical question and one that should be an important concern for every person. If an individual is not prepared to be responsible for his welfare, the threshold of personal responsibility is diminished. The extraordinary attitude in the Labor Party is one which encourages people to be derelict about the need to provide for their future. When people are neglectful of their own health welfare, the social costs can be enormous. It is, of course, an issue which runs to concerns about the health of the individual in the work place and employer responsibilities. The theme is a fundamental one.

To weaken individual interest in his own health welfare by inviting the individual to hand over his concerns entirely to the Government is a socially very irresponsible thing to do, and successive Labor governments have done it openly and wilfully. It would be a socially irresponsible act to leave it open to industry to have the Government pick up the tab for work place health care. No one would advocate such a course and the principle of responsibility should not be abridged for the individual.

The Government's Medicare system is one of critical concern. The Government's response is to shove people into a statutory body where their claims on the Labor Party can be satisfied and the role of the Institute discounted. The whole bulk billing device which is part of the brainchild has blown up in the Government's face. The system has been the cause of the disincentive for people to take out medical insurance and has been subjected to financial exploitation by unscrupulous medical practitioners. The scandals have now been so well reported that they cease to be news. Medical millionaire entrepreneurs have descended on the financial scene, where they have been able to present their exploits under bravado.

The disillusionment is widespread. Even one of the Government's socialist left connections is worried, claiming that the public system is collapsing, which of course it is. The Federal Government and its counterpart Labor State governments, particularly in New South Wales and Victoria, have produced a human crisis in the system of hospital care. The system now threatens the life of the people whom it was designed to save. The Age newspaper only last month ran an article which began:

People with life threatening illnesses could be placed on waiting lists for elective surgery if public hospital queues continue to increase.

The total on the waiting list in Victoria alone was over 38,000. This caused the cardiothoracic surgeon at St Vincent's Hospital to say that with longer waiting lists some heart patients could be more likely to die or to suffer a heart attack whilst on the list. Another consequence is that some people cannot receive surgical treatment for two to three years.

All of this is a direct consequence of the philosophy of this Government to lead people to believe that the system of private medical insurance is an unnecessary diversion of medical resources. The worry is that those Australians who disregarded the naive views of the Minister and this Government and retained private health insurance at considerable personal costs are the only people who can be assured of elective surgery. The Medicare scheme, which was designed to meet the needs of public health care for the needy, is now destroying their entitlement. The fact is that medical care can impose unending demands on the community. The individual who takes medical insurance is aware of that fact. Those who do not take a personal interest in their health until a time of crisis do not carry a similar awareness.

In the last few days we have heard from hospital administrators a call to encourage a greater personal awareness among smokers about the social costs of their habit. There are people who resume the habit after medical treatment of a smoking-induced disease. This kind of personal irresponsibility is enhance by a general doctrine of health care which assumes that the Government will be the chief purveyor of medical benefits.

As I have said, the system is collapsing not only in Victoria but also in New South Wales. A headline in the Sydney Morning Herald at the end of last year claimed that 30,000 people were awaiting hospital admission. The same report said that virtually no elective surgical procedures were being performed in Sydney's leading hospitals; that is, the principal public hospitals of Sydney are not taking elective patients except for cardiac surgery. This is an incredible indictment of the end product of the very bad advice this Government has adopted from the Institute which has the gall to claim statutory privilege.

The waiting lists in New South Wales are appalling in their detail. Patients waiting for orthopaedic surgery, urological surgery, neurosurgery and ear, nose and throat surgery have to wait for two or three years. Is that not a terrible situation? I believe that every one of us would be horrified about that situation, particularly when many old people are so affected. An opinion poll conducted by the Australian newspaper last year found that 40 per cent of Australians considered the situation worse than at any time in years. Many of those surveyed would not have had a problem. Knowledge of the failure of the system comes to those who require treatment, so that 40 per cent would include many who have yet to try the system. It is when one tries to get some elective surgery that one comes up against the hard facts.

So the Government spends its time on gimmicks, such as we have in this particular piece of legislation. The Minister spends a great deal of his time working over his problems on the Australia Card. The Government pumps out propaganda saying the Card has 60 per cent support and that if its legislation is not passed it will make a great election issue of it. Well, I believe that the 60 per cent figure is a highly preferential one. It does not contain a grass roots explosive quality which can turn a vote in an election.

The issue we should be concerned about-the issue the Minister should be concerned about-is the issue of ensuring that there is a medical service which can give people reasonable access to health care. This is one which can and will do this Government a great deal of damage indeed. The fact is, of course, that the present Government and its colleague Labor governments in New South Wales and Victoria have made a muck of the medical system. They have set up a system which is threatening the health of people it was intended to protect. That, I believe, is a terrible thing to have done. Only those caught up in the consequence of the crisis really know-they know that a family member will have to wait two or three years for treatment and that, while waiting, the condition can get worse. Indeed, the practical decision hospital administrators now have to make is that one can be taken off the long list only by being near death.

So the Government has succeeded, with the help of the Institute, in bringing into the health equation a new factor-insecurity of treatment. People are being told that they need treatment for their complaint, and then the are told that nothing can be done for them unless they wait around for a couple of years or join a medical fund. I believe that is exactly the wrong basis on which to encourage people to join a fund. On this side of the House we are prepared to say to people: `Your health is one of the most important things in your life. Provide for it in a responsible way. Join a health fund and insure yourself. You may not always enjoy good health, but the health fund investment will protect you'. This Government, on the other hand, attacks private medical insurance, distracting people by an attitude which suggests that the Government can provide for all exigencies. In effect, no government can afford to do this and it is foolish to try to do so. But it is part of the socialist lore that medical care should be provided free. So Government members deceive people into a complacent approach. Then they are surprised when the system breaks down. People are distressed, but their Government ignores that distress with its `too bad' attitude.

There is another aspect. The Government has engendered-and the Institute must take responsibility for this outcome-a sorry relationship between the medical profession and the Government. The non-medical Dr Deeble was always on hand to the non-medical Minister to jump on the representatives of the profession. Clearly this has provided a disincentive for the best medical attitude to be encouraged and brought to bear on any problem. This great profession, with a reputation for public service second to none, has been impugned on the argument that there are some whose records, rightly, should be questioned. Where is the evidence to suggest that co-operation between the Minister and the profession is adequate to the crisis now before us?

I believe that the Government needs to spend less time in the academic activities of this group-I refer to the Institute-and much more time in the practical affairs of the present crisis in health care. We all know that the socialist nostrums are not going to provide a way out. It is the lack of any sense of urgency in Government which is causing people to approach the issue with as much frustration as dismay. But the crisis is upon us, and the public need is urgent; and the irrelevance of this legislation offers no reassurance at all that the Government is in any way disposed to change direction.


Dr Charlesworth —What was that about?