Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
 Download Current HansardDownload Current Hansard   

Previous Fragment    Next Fragment
Thursday, 19 March 1987
Page: 1171

Mr REITH(5.29) —That was an interesting contribution from the honourable member for Canberra (Mrs Kelly). The honourable member kept talking about Medicare but she would not talk about the hospital queues. We are told that Medicare is a great system for all Australians. In 1983, the Prime Minister (Mr Hawke) said: `We are going to give you the best medical and hospital system in the world'.

The honourable member for Canberra will not talk about the hospital queues in Australia because this problem is a massive embarrassment and a massive indictment of Medicare. Those are the facts. We have just had a classic example of a Labor member, a member of the Government, skirting around what all Australians are concerned about, and that is the right to go into hospital and to have hospital treatment as and when it is required. The honourable member also talked about costs. I have heard some baloney in this place but that really took the cake. I just ask ordinary Australians to ask themselves: Why did the Government jack-up the levy last year by 25 per cent? The Government jacked it up because that is just one symptom of the Medicare system and its costs running out of control.

The amendments in the legislation deal with a number of matters, including some changes to the pharmaceutical benefits scheme. Whilst the Opposition is not opposing these provisions I want to make it clear that, when amending the National Health Act, I think we ought to be addressing some of the major issues, the relevance particularly to this legislation being that the changes proposed to the pharmaceutical benefits scheme introduced last year were aimed at saving costs which have been out of control. The amendments today will tidy up some of those changes which, as I have said, were introduced last year.

Whilst the Government portrays health care as being free, the reality is that the health bill in Australia is massive. The Budget estimate for expenditure on pharmaceuticals in 1986-87 is $787m. The current arrangements are that drugs on the PBS list are supplied to the general public at a cost of up to $10 per item. It used to be $5 per item before 1 November 1986. The Government likes to talk about price control yet we have the Minister Assisting the Treasurer on Prices, the Minister for Science (Mr Barry Jones), who is not even allowed to answer questions in the House. The Government talks about prices but here is a massive increase from $5 to $10 courtesy of this Government.

Health card holders, including the unemployed, low-income families, social security pensioners and veterans' affairs service pensioners and their dependants who do not hold pensioner health benefits cards, have a concessional rate of $2.50 per prescription which is up 25 per cent-another price rise for this Government that claims to be concerned about price increases in the community. These rates are also available to pensioner health benefit and sickness beneficiary card holders and their dependants at no cost, and to individuals and families which use more than 25 prescriptions per annum at no cost over and above their contribution to the cost of the first 25 prescriptions, which is the safety net scheme we are talking about. The Commonwealth also meets the full cost of items on the PBS list and the repatriation scheme of pharmaceutical benefits for veterans with war-caused disabilities and their dependants. Lastly, it applies to war widows and their dependants at no cost. Of course, prior to November 1986 those people had access to the repatriation schedule but now they are restricted to the PBS list only, as are holders of pensioner health benefit cards.

Clause 3 of the National Health Amendment Bill amends the definition of `basic private table' so that pathology services performed after a patient has been discharged from a hospital or day hospital will be deemed to have been rendered whilst the patient was still an in-patient. Whilst I do not oppose that provision I would have to say that many people in my electorate are more worried about getting a bed than about the financial arrangements once they leave. The hospital system in this country is in a complete mess. We just heard the honourable member for Canberra, in a typical Government member's response to an issue such as this, claiming and portraying the Australian Labor Party as the sole repository of compassion for the disadvantaged, when those are the very people for whom the Medicare scheme was introduced. Those are the very people who are at the end of the ever-growing queues waiting for entry into our hospital system.

Tom Roper, a former Victorian Minister for Health, said in 1982 when he took over health responsibility in my State of Victoria: `We have the best system in the world'. We could not say that today. As I said a minute ago, the Prime Minister said that Medicare was `the best health care system Australia had ever seen'. What a sick joke that is now! The queues around Australia contain about 100,000 people and, in my State of Victoria, about 35,000 people. What does Medicare give to people waiting in those queues? It does not give them access to a hospital; it gives them a number-No. 35,001 or No. 35,002. That is what Medicare gives the people. If people need a hip replacement there is no prospect of getting in.

I had a constituent in to see me the other day. What are people such as myself, the local member on the Mornington Peninsula in Victoria, supposed to say to a 76-year-old man who comes in, who has had a good work history in this country? In fact, he worked for the Department of Housing and Construction for many years. I understand that he did a good job there and he has a good reputation in the local community. He came in to see me and said: `I am in pain. I am increasingly putting more weight on my right leg because my left leg needs a hip replacement, but as I put more weight on my right leg that starts to go as well'. He said: `I have been to see my local doctor and he says that there is nothing that can be done. All he could suggest was for me to go and talk to the local member of parliament'. Doctors are saying: `The only way you will get into the hospital is if you yell and scream louder than the other bloke down the road who needs a hip replacement'. That is where we are up to. Medicare says to people who require hospital treatment urgently: `If you want to get into hospital you have to scramble your way past all the other people in the queue'. The 35,000 people who are waiting in queues is not just a figure; it is real people. I can tell the Minister for Health (Dr Blewett) that these people are in my office on a regular basis.

The Minister has said, as the Government has said from time to time on all these major issues: `It is not our fault. It is probably the fault of the last Government or it is some overseas condition or something'. There is always some factor which is beyond the Government's control. At some stage, not for the sake of the Opposition that wants to make a point or for the sake of any vested interest but for the sake of those people who really have a need for a hospital bed, I just hope that the Government will just stop worrying for once about scoring political points and ask itself what is going on in the system; it should have a look at Medicare. The Government is a fraud. It tells people that health care is free, which is just not true. It is not just me or members of the Opposition saying that. Many notable persons who have much experience and knowledge in the medical field are also saying that. Let me quote Professor Penington, a person who has been used by governments on a number of occasions to provide them with advice on medical matters. In April 1986 he described Medicare as `an open-ended cheque for 85 per cent of the cost'. He also said:

A fee for service system in which supply-side' controls have been virtually abandoned is, in my view, unworkable . . .

He went on to say:

and it represents a bottomless pit into which unlimited moneys could be poured.

That is a damning indictment of Medicare! Professor Penington is not alone. Let me quote from a booklet issued as a community service by the National Association of Medical Specialists. Let me quote what the booklet states on its introductory page:

The major problem with universal health care in Australia is undoubtedly the escalating cost to the public purse. Quite apart from influences of inflation and CPI on the prices of materials, services and equipment, overall costs have increased dramatically over the past ten years-notwithstanding efforts by successive Governments to contain them. We believe that the chief contributing factor to the `blow-out' of costs is a levy on taxable income of a mere 1 1/4 per cent and the `I'm going to get my levy's worth' attitude of the public-fostered by the availability of bulk-billing.

It goes on:

It must surely be obvious to politicians of all persuasions that human nature cannot be changed by legislation, and we would postulate that if there is a minimal, or zero patient moiety payable for health care at the point of service, then there is no personal responsibility devolving upon the consumers. This concept, known technically as `moral hazard', has been well documented. The diminution of over-utilisation by increasing the coinsurance rate (`gap') has been calculated.

That summarises the sorts of fundamental problems that we have with this Medicare system. The problems of Medicare are absolutely everywhere. In my home State of Victoria beds are being closed. How does one explain that to somebody who comes into the office when all that person knows is that he has been waiting for 18 months in a hospital queue and no-one can tell him when he will have his hip replacement done? How does one explain that in Victoria beds are being closed? I am told that an average of 1,500 beds per annum-one in 10 beds-were closed in Victoria in the last year.

There has been a massive drop in the number of people who are privately insured. That means that additional funding for medical and hospital services is being focused on a government that increasingly is strapped for funds. There have been massive cost increases. Effectively, people are being required to pay more. Many people are prepared to pay more if they are getting value for the dollar but they are not getting that value because they are paying more and getting less. Many people do not just pay once. Effectively, they pay twice. Particularly in regard to hospital cover, as they see it they pay once with their levy and, for those who can afford it-and it is no consolation to those who cannot, the ones that Labor claims particularly to represent-they need to pay a second time.

I have talked about the growing queues. There is also the matter of the growth in entrepreneurial medicine. What has bulk billing done to medicine? It has encouraged the so-called entrepreneurial practitioners. Some doctors are doing very well because there is always a minority-it is a small number, a few apples in the barrel that are not what they should be-that simply takes advantage of Medicare and rips into us taxpayers. The pressure on public hospital resources is well documented. To give an example of the utilisation of resources-again just looking at the Victorian situation, the Government there has not exactly been doing what it could to encourage the most efficient allocation of resources-we had a case last year of the Victorian Government requiring hospitals to have their linen cleaned at the central linen cleaning service. Why was that? It was not for reasons of efficiency and not because it would be cheaper for the taxpayer but because the trade union wanted to see linen cleaning services centralised to increase its industrial muscle. That is an example of a government-the Victorian Government in this case-being tied to the trade union movement and dancing to the tune of trade union bosses.

Pressures on nurses and staff in hospitals generally have led to their own repercussions. We should ask ourselves why we have seen increasing militancy amongst Victorian nurses. I refer to them because I am better aware of the circumstances in Victoria. The nurses over many years could probably fairly be said to have been underpaid. Moves to improve the employment conditions of nurses would generally be accepted and welcomed by people on both sides of the House. But the fact is that as a result of the increasing pressures placed on nurses, particularly those in the public hospital system, we have seen increasing militancy. That has given a lever and a base for the rise of such people as Irene Bolger. We saw a classic case last week in Victoria. Nurses were going out on strike all over the place over the following circumstance. There was an operation in October last year in the Central Gippsland Hospital. Mr Parkington, who was the surgeon, asked the nurse for an instrument which he required to carry out the operation. He was not passed the instrument because, he found, some nurse had lent it to another hospital. The matter was subject to investigation and the nurse was demoted. After that six nurses imposed work bans. They were sacked. They then went to the State Industrial Relations Commission to claim unfair dismissal. The State Industrial Relations Commission said: `We do not accept your claim'. Then the Royal Australian Nursing Federation reckoned that that was a great issue to bash the Government over the head with and we had nurses going out on strike all over the place. These are the sorts of incidents which are rife throughout the hospital system in Australia and many of them are traceable back to the pressures brought about by the introduction of Medicare.

If we are ever to be able to provide decent hospital and medical services for people we will have to do something about Medicare. In the twentieth century when we can put people on the moon and have advanced technology of all sorts, and when doctors and specialists have skills and knowledge of the highest possible standard, we have to ask: `Why is it that we as a community cannot organise ourselves so that the people who require hospital treatment, the people who are sick and disadvantaged, cannot get the treatment that they need?'. The answer is that it is the way we have organised ourselves, the way we have set up our systems in Australia to deliver health care services. The fact is that Medicare is not the way to go. It is a socialist system, introduced by a Minister who has a strong ideological streak and whose ideological streak is more important to him than is the welfare and health of ordinary Australians.

Mr Shipton —What about the waiting lists?

Mr REITH —I thank my colleague the honourable member for Higgins for his comment. I will finish by saying that the growing hospital queues in the end are the bottom for ordinary Australians. Ordinary Australians cannot feel secure that if they are sick tomorrow they will be able to get the hospital treatment they require. That is a massive indictment on this Government and a massive indictment on its policies and Medicare.