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Wednesday, 9 May 1984
Page: 1804


Senator CROWLEY(11.24) — It is very interesting to know why we are debating this issue today. It could look as though Senator Baume has a genuine concern for the rules and regulations governing the Australian Capital Territory, but if one refers to page 1060 of Hansard of April this year one will find why we are debating this matter. My suggestion to the Senate is that Senator Baume, who questions whether he would be able to have the opportunity of bringing those regulations and this ordinance before the Senate, is actually just testing that he is able to do so. I think he has discovered that he can do it but he is not really interested in the content of the disagreement, just the fact that he can do it. In fact, he asked the Minister for Social Security, Senator Grimes, during the committee stage of the debate on section 17 of the Health Insurance Act, questions about whether there would be confusion about the time of royal assent to the Act and whether that could happen within 12 to 13 sitting days and therefore prevent the disallowance of regulations. His question was answered by Senator Grimes first of all making clear what Senator Baume was asking. He then stated:

The commencement of the Act is after the day of royal assent.

Hansard then reports:


Senator Peter Baume —Does the Government intend to lay before each House of Parliament the guidelines which have already been introduced?


Senator GRIMES —Yes.


Senator Peter Baume —So that it will be possible for the Parliament to consider the guidelines which have already come forward, but which are yet to be laid before the Parliament.


Senator GRIMES —Yes.

I think Senator Baume is today testing that those yes answers were really yes answers. I think he is determined to run through the procedure to see whether the procedural possibilities are open to him. They are. So far as a consequence we are again debating the issues that have been so well-or if not well, extensively-debated on two previous occasions. As Senator Haines so succinctly said, there is nothing new about the debate today; there is no real issue. Senator Baume is testing that he can do what Parliament has always allowed him to do and which the Government has said it was possible for him to do. He has done it. I hope he is satisfied that he has discovered that but I do not think he should be satisfied by the extra contribution to the debate. There is nothing new.

We have had some criticism to the effect that every time this Government speaks it has an ideological commitment to doctor bashing. I totally reject that as one of those doctors on this side of the chamber who are not into bashing the profession. If honourable senators care to read my comments in Hansard they will see that I am inclined to speak well of the profession with some stunning exceptions to the gloss and glow of this profession. However, today we are debating the ideological commitment of the Opposition to the doctors' right to public support, taxpayers' support, for private fees with no controls on behalf of a curious argument that says that it is the inalienable right of doctors to deal directly with patients. It is a chronic furphy but I think the Opposition is beginning to buy its own rhetoric.

Senator Haines has made it quite clear that there is no point, no new issue, no changed proposals and no hidden agenda. We are rerunning an old record. We have heard the Opposition argue about the point of having ordinances and regulations about existing contracts when people are already charging the schedule fee. The question may well be put: What is the point of arguing that we should not have them when that is already the case? Why were doctors so distressed about what they have already agreed to? In South Australia more than 60 per cent of doctors in this condition-that is, those who do private work in public hospitals-had signed contracts and were charging the schedule fee. What was the problem?

The problem is not really about the schedule fee; the problem is not really about signed contracts; the problem is about one point of resistance by the Australian Medical Association in the face of the introduction of Medicare. It was hyped up and extended well beyond the reasonable opposition that the AMA mounted about section 17 of the Health Insurance Act. That point has already been addressed. The legislation has been amended. Even so the Opposition wants to continue running the old dog argument. There is no real issue here. There is not a problem of fee control. There is the addressing by the Government of the responsible use of the taxpayers' dollar. I draw the Opposition's attention to the remarks by Sir John Gorton. I understand that from time to time some members of the Opposition disowned Sir John Gorton, but it is true that he spent quite some time as a member of the Liberal Party of Australia. In a speech in the House of Representatives on 29 March this year Mr Snow, the honourable member for Eden-Monaro, referred us to a comment by the former Prime Minister, Sir John Gorton. Mr Snow stated:

Sir John Gorton said that he did not believe that any profession should be able to fix its fees at any level which appeals to it when it is supported by public money.

In other words, responsible members of government from either side of this chamber would appreciate that when we have the taxpayers' dollars, public dollars, supporting private work then it is responsible for the government of the day to be able to account for those dollars and to put some reasonable guidelines and limits on them. It is not an irresponsible, interfering and grasping government but a responsible government. I made those points at length in the speech I made about this matter earlier; I do not see any need to run over them again.

However, it is worth while reiterating the points made by Senator Grimes that what we have here are public facilities, public equipment, public support staff, public buildings, public administration and doctors who have been trained in their profession by public tax dollars through their university degrees and their payment for public hospital work who suddenly feel that they should not have any constraints put upon them when it comes to the private work they do in all those public facilities. I think it ought to be understood that the majority of doctors did not feel that way. They had signed the contracts. They had agreed to those terms with their State public hospitals; they had agreed that it was very responsible and reasonable to have contracts, to have a schedule fee limit, and to have some attempt to account for the private work being done in public facilities. The spokesmen for the AMA, representing, they said, some large percentage of the profession-clearly they were wrong-were the ones who said things that were in direct contradiction to what many of their professional colleagues were doing. I think that point needs to be stressed again and again.

There is another very important reason why we have to have some responsible government say in all this. We hear the Opposition draw this fact to our attention quite often-that there are not sufficient public tax dollars to cover all of the things we would like them spent on. Now that the Australian Labor Party is in government it is deciding the priorities and those priorities seem to be the problem that is upsetting the Opposition. From time to time the Opposition will tell us that it is responsible to know what happens to those tax dollars. However, it seems this is not the case when we are paying them directly to the medical profession. This is a point that the Opposition simply fails to acknowledge.

It is also interesting to read some of the comments from Senator Baume, who seems to fail to understand even further what goes on with hospital contracts and the funding under Medicare. On 2 April this year, as reported at page 1032 of Hansard, he stated:

However, I come back to the fact that details in those contracts will not affect the payments, the outgoings, under Medicare.

He queries how the payment of benefits can rise if they are fixed at 85 per cent of the medical schedule fee. He asked:

. . . how can it rise, even if the fee rises?

I would have thought that, if the fee rose and 85 per cent of that was fixed, of course it can rise. But more importantly the question we have to address in the area of pathology, radiology and diagnostic work in public hospitals is not the cost per unit but the number of units done. If ever there is an area that has been clearly open to the problem of overservicing it has been to do with diagnostic work in the areas of pathology, radiology and so on. An enormous amount of evidence suggests that it is not a 'good guess' that there is overservicing but that there is substantiated evidence of overservicing. In fact Senator Grimes quoted in this chamber the Royal College of Surgeons, which is not exactly an organisation which is known for its socialist views.

The question of overservicing is a matter of serious consideration, not the least because those few members of the profession who have been involved in overservicing have discredited the whole profession. They have also cost the taxpayer an enormous number of dollars. It is a matter of serious consideration and we cannot just ignore it. The Opposition has argued that what it fears are contracts and schedule fees. I think what it was really talking about is a hidden agenda of a fear of price control, a fear of acknowledging that it is a responsible thing for the government of the day to have a say in what are the fees paid to professional groups. I also think the Opposition betrays a complete lack of understanding of what the conciliation and arbitration system is about. It is not about price control, but about agreements reached between negotiating partners in regard to contracts. When that agreement is reached the schedule or fees are then agreed to by both sides to that discussion before the Arbitration Commission. They are then agreed to for a certain period until further arbitration awards come before the Arbitration Commission again. The AMA seems to be composed of very good unionists when it comes to stating wants, but they seem to be less than good unionists when it comes to co-operation and participation and acceptance of the umpire's decision, although I have not heard too many AMA people complaining about the 9 per cent increase in fees awarded to them last week.

I remind the Senate again of the remark of the Minister for Health, Neal Blewett. But first I refer to Senator Baume who said that the Government is going to do things to schedule fees. Senator Baume either is failing to understand, or else he is being naughty. The schedule fee is not a matter of Government intervention and control, it is a matter of arbitration. It is a fact that we have just had a decision awarding a 9 per cent increase passed down by Justice McKenzie, the Deputy Commissioner of the Conciliation and Arbitration Commission. The Government has not said anything about that. The Government was one party that put evidence before that Justice. The AMA was another party. The Cabinet--


Senator Peter Baume —The Government initiates or does not initiate inquiries. Senator, you are being naughty now.


Senator CROWLEY —I would like to add to my remarks but cannot because of the interjections that are now enlightening the listeners. Given that the schedule fee has been set independently and that there has been some randomness to when it is set, I will quote what the Minister, Neal Blewett, said in his second reading speech when addressing himself to section 17 of the Health Insurance Act . In his second reading speech he said:

. . . the cabinet has agreed in principle to regular arbitrated review of the schedule fee, and has authorised me to enter into negotiations with the AMA to achieve this.

I ask the Opposition, what more does it want?


Senator Peter Baume —A result?


Senator CROWLEY —The Opposition cannot accept the good word of the Government because the Opposition has been disbelieving good words and behaving dishonourably for years. In that statement of the Minister there is a clear understanding that this Government is prepared to accept that there is a need for regular and arbitrated reviews of the schedule fee. The Minister has said that he will enter into negotiation with the AMA. Those discussions are under way. If the Opposition fails to accept that, I can only measure that as a score of the Opposition's failures, not a lack of this Government's responsibility. This debate is really a rehash; it is not doing anything more than allowing us to run over the arguments that led to the introduction of Medicare and the protestations of some part of the profession after its introduction of Medicare. Further responsible discussions between some members of the profession and the Minister, Dr Blewett, and the Government have resulted in very agreeable arrangements currently in place. To move for the disallowance at this stage is only going to upset the smooth working arrangement that has finally happened since the profession realised that the Government is reasonable and responsible.