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Wednesday, 27 May 1987
Page: 3438


Mr NEHL(5.57) —I must say that I am very pleased to support the honourable member for Barker (Mr Porter) on this important amendment. It really becomes a little of an anti-climax after the announcement that was made to the House a little while ago, but I could not help but notice that the Prime Minister (Mr Hawke), in concluding his remarks, made the point that his Government's strategies were in place. I suggest that, as far as health and so many other things are concerned, these strategies are strategies of failure. They have failed to contain inflation, interest rates and unemployment, and they have certainly failed to contain the blowout on health expenditure.

Unfortunately, the Health Legislation Amendment Bill is just a little cut and tuck operation, rather like a facelift; it does not really address the main problem of Medicare, which is the real cost of the Medicare program. Total health expenditure in Australia is about 7.5 per cent of gross domestic product, or $13 billion a year-that is, State and Federal government expenditure combined. Commonwealth expenditure on health is 2.88 per cent of gross domestic product, and estimated total expenditure by the Commonwealth in 1986-87 is $7.3 billion in general health fund expenditure and $1.6 billion in identified health grants. In its 1986-87 Budget, the Government estimated that it would spend $4 billion on providing medical and hospital services under Medicare. In spite of that, the Medicare levy of 1.25 per cent of personal income tax is expected to raise only $1.7 billion, leaving the Government with a $2.4 billion gap. In fact, it was interesting to note that, should the levy be increased to a point where it had to pay for the real cost, it would have to be trebled.

Frankly, the Government's record on health care to date is not a happy one at all. It includes the elimination of 50 drugs from the pensioner free list, forcing the people who can probably least afford it to pay the full cost for these drugs for the first time. Patient contributions for pharmaceutical prescriptions have been increased from $5 to $10 and the Medicare levy was increased by 25 per cent, despite the Government's promise that that would not happen. Of course, the people of Australia are accustomed to the Hawke-Keating Government breaking promises. The subsidy to the private hospitals was abolished. When we come back to basics, we are talking about ordinary Australian families. We are talking about men, women and kids who are trying to make ends meet, who are trying to survive. Prior to Medicare the average wage earner paid $9.66 a week for basic hospital and medical cover and since this Labor Government, this socialist Government, came to office that has increased to $14.30 per week, 50 per cent more. This Bill will increase it again, probably by an average of an extra $1 a week.

I was interested to hear the honourable member for Prospect (Dr Klugman) mention the 100,000 people who are waiting for elective surgery. There is an incredible waiting list throughout this country. As a proportion of our population, many people are waiting. The honourable member for Prospect, in a rather dreadful attempt to dismiss the significance of having 100,000 people waiting for surgery, said: `This is only one week's turnover'. It may be only one week's turnover to the honourable member for Prospect, but for a person who has been waiting for a year to get a new hip and who is in agony every day of his life, it is more than a one-week turnover. It is significant that while we have so many people waiting for surgery to ease their pain, 9,000 private sector beds are vacant each day. I submit to this House that it is an absolute disgrace that our health system has got so out of kilter that we have people waiting for surgery and there are 9,000 empty beds. It is absolutely crazy.

Let us look at the way it has happened. Since 1983, when the Hawke Government came to office, Medicare has forced 1.8 million Australian people out of private hospital cover and 10 million people have been forced to give up private medical cover. Traditionally this country has been based on private industry, free choice and free enterprise but, above all, we have always treasured the ability to have some choice. I assure the people of Australia and this House that after 11 July, when the Howard-Sinclair Government is in place, there will be a choice. I assure honourable members that the choice will be there.

This Bill forces private health funds to bear 25 per cent of the medical costs incurred by specialist treatment in hospitals or day hospital facilities, but only for privately insured patients. Consequently, the contributions paid by the consumer must rise. We have a situation where there is injustice and inequity because people who are already paying once with their Medicare levy, and are paying again with their private hospital fund contribution, will be forced to pay a little more.

It is distressing that this Bill makes no attempt to cut the administrative costs for the Health Insurance Commission, which in 1985-86 amounted to $185m. Nor does this Bill seek to utilise the facilities existing in the private health funds. I suggest to the House that this is one avenue that should be pursued. In June 1983 the Health Insurance Commission had a staff of 1,863, plus another 1,110 people in the Department of Health who were concerned with medical and hospital benefits. That number has now grown. From June 1986 the staff of the Health Insurance Commission has blossomed and ballooned to 4,592. It is obvious that the Government's cuts are merely a window-dressing. The Minister for Health (Dr Blewett) refuses to save money by even attempting to dismantle the administrative superstructure of Medicare.

Medicare has 264 offices and agencies nationally which deal with only 22 per cent of Medicare claims. These are the over the counter cash payments. Fifty per cent of all claims are bulk billed and in the case of another 28 per cent cheques are either sent by post or paid in person to hospitals. Substantial savings could be made by the Government agreeing to one stop health insurance shopping and using the voluntary funds as agents for Medicare. On the figures that have been presented to me in just this minor area, savings of at least $65m a year could be achieved. The people of Australia are being inconvenienced. This is symptomatic of this Government's approach to people. It does not really care. A person has to go to the Medicare office to get one bit of business done with his medical claim and then he has to go to the Health Care Fund, the Medical Benefits Fund or whatever his private fund is. It is just inconvenient. I believe there is a possibility of our having a more convenient, one stop, health insurance. It is interesting, too, that voluntary funds have 69 per cent of the market, and it seems very silly not to use them. After all, while Medicare has 264 offices, the private health funds employ only 3,829 people and have 552 offices around Australia. It is a facility that could and should be used to the benefit of the Australian people.

As I said earlier, this Bill will force up private premium rates by at least $1 a week and will force more people out of private cover. With the $10 a day hospital bed cost increase announced only today by the New South Wales Government, more premium rises will be inevitable in that State.

In March 1987 personal health costs for each individual in this country had risen by 26.9 per cent-three times the current inflation rate. I suggest that this gives the lie to the 1983 election policy speech promise made by the Prime Minister that under Labor `nine out of 10 Australians will pay less for the health needs of themselves and their families'. This is most definitely and specifically not true. Let us just run through that point and detail what has happened: Fifty drugs have been removed from the pensioner pharmaceutical list; the patient contribution for prescriptions has increased from $5 to $10; there has been a 25 per cent increase in the Medicare levy; and there has been a reduction of $140m in the private hospital daily bed subsidy which was $16 a patient day. This just reinforces the point that the Prime Minister's promise that nine out of 10 Australians will pay less for the health needs of themselves and their families is totally wrong. It is obvious from the figures I cited at the start of my remarks that the amount for the average wage earner has gone up quite significantly, from $9.66 to $14 a week.

This Government is supposedly committed to cutting costs. Of course, I applaud it for any action it takes to cut expenditure, but the way Medicare is functioning is an incentive to disregard the costs. As the honourable member for Prospect has said, it is an incentive for some individuals to write their own cheques against the Health Insurance Commission. Australia gets by with 1,300 bed days per thousand head of population a year. This has been reduced from 1,400 bed days last year because of strikes. Health maintenance organisations in the United States of America get by with 420 bed days per thousand population, in part because the emphasis in the United States is on health, not sickness. I think it is relevant that we should address the problem in this nation, that we should start treating for health and not just for sickness. When considering the future of health services we need to consider the possibilities for introducing health prevention methods rather than sickness cure methods.

Unfortunately, this Bill does not reduce the number of extra public servants Medicare has added to the payroll. The number involved has increased from 6,571 in June 1983 to 8,726 in June 1986. In addition, we heard the Prime Minister say only an hour ago that when he goes to the polls on 11 July he will be talking about the Australia Card and what a wonderful job it will do. The people of Australia will know better. They will express their opinion in the only opinion poll that counts, and that will be on 11 July. Of course, not only has the Department of Health grown from 6,500 to well over 8,500 employees, but the Minister for Health wants to employ another 2,150 just to introduce the Australia Card proposal. It will not save this country money, it will not cut down on the social security fraud and it will not do much to prevent tax cheats.

In 1983, the enrolled Medicare population was using an average of 5.8 services per year. In 1986, the figure jumped to an average of 7.5-an increase of 28 per cent. Obviously, with the growth in population we would expect the total number of health care services to grow, but attention must be paid to the fact that in only three years of the Hawke Government the number of health care services per head, on average, has increased by almost one-third. I suppose that, in one way, it may mean that the Australian people have become more unhealthy under Labor, and who can blame them? If the growth of Medicare and the Department of Health had been contained, instead of encouraged by bulk billing, savings of $600m would have been achieved.

The Bill does not attack the 42 per cent blow- out in the cost of medical services in the first three years of Medicare. Goodness knows what the blowout will be in the next three years if, by some ill-fated chance, Labor is returned on 11 July. The people of Australia are not fools. They know this Hawke Labor Government has failed. They know that it is running scared. They know that it is going to the people with an election before it is game enough to bring on its horror Budget in August. The people of Australia will deliver their verdict on 11 July when they toss out Hawke, Keating and the rest of them.