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Wednesday, 9 May 1984
Page: 1806

Senator WALTERS(11.39) —Today we are debating the Medical Services ( Fees) Ordinance 1984 which in part states:

Where a medical practitioner renders a prescribed medical service to a person who is a private patient in a hospital, the medical practitioner is not entitled to receive for that service any amount that exceeds the amount of the prescribed fee in relation to that service.

We just heard Senator Crowley say that doctors need not be worried. She quoted from a Cabinet decision agreeing to a regular review of the schedule fee. Australians must take the Government's word and medical practitioners must accept that word as fact. I will come later in my speech to some other statements made by this Government-by the Prime Minister (Mr Hawke) in his policy speech. I will show how much notice the people of Australia should take of promises made by this Government. I have a list of such promises a mile long.

First I put in perspective what we are debating here today. As Senator Peter Baume said very clearly there is no example of doctors charging private patients more than the schedule fee in Australian Capital Territory public hospitals. Both Senator Townley and Senator Baume on this side of the chamber have asked why the Government is introducing this ordinance. The Government has not got a problem. The Government does not have to legislate against a problem; so why is it bringing in the legislation? The Government is setting a precedent in order to take on all the other professions. Lawyers, accountants, dentists and all the rest are well warned that as a result of this regulation once control is established in Canberra then they will be at risk too. They had better take that on board. That is the philosophy behind the Government's regulation. We know that this Government engages in doctor bashing. Senator Crowley said: 'Never'. Senator Grimes said: 'Well, if we have done a bit, we have done it in the heat of debate and no one should really take any notice of it'. Senator Grimes knows darned well that he cannot say he has not done that because it is all recorded in Hansard. I will quote one of his comments. He said of the doctors:

. . . they will make a lot of noise but they will interrupt that noise occasionally by putting their snouts in the trough of public funding.

He does not doctor bash-not much! He does it only in the heat of debate in this place. Senator Tate carries on too. He assured us that all the doctors in Hobart are ripping off the system. Not just one doctor, two doctors-he is not taking a guess-but all the doctors of Hobart are ripping off the system.

Senator Peter Baume —Where did he say that?

Senator WALTERS —It is all in Hansard. Senator Baume will find that in the interjections. We can also find other statements in the Estimates Hansard. Doctor Crowley assured us that she was proud of the profession and that she would not do any doctor bashing. We were then talking about the amount of fraud and over-servicing in this country. That is what the Government talks about incessantly. When doctor bashing the Government talks about fraud and over- servicing. During the Estimates Committee hearing I asked the Department of Health officers whether they could give me the number of convictions, the number of cases and how much money was involved in overservicing and fraud for this financial year. The answer was: 'I will get you the amount of money involved'. The officer continued:

These are suspected--

I interrupted to say:

I am not wanting anything that is suspected, I am wanting hard facts of fraud and overservicing and successful prosecutions.

Mr Deputy President, you will be interested to know that this financial year that has cost the Australian taxpayers $3.5m and for that amount we have four convictions. That represents nearly $1m of taxpayers money for each conviction. Senator Crowley was not satisfied with that because she said:

I, unlike Senator Walters, would be very interested to know how many suspicious characters are around. What is your broader figure?

She continued:

How many are sniffing in the wind?

Senator Crowley is not doctor bashing; not a bit! She is not interested in hard facts. She wants to know how many are sniffing in the wind. Mr Taylor, who was answering our questions, said:

Perhaps I should explain the background. A total of 277 cases were listed at the end of March. I must qualify that by saying that these are simply indicators . A good many of them come from our computer system. All the computer system does is show a deviation which may or may not indicate fraud.

Senator Crowley, in a very disappointed tone which unfortunately the Hansard does not indicate; said:

So it does not mean a thing?

Of course it does not mean a thing because when the computer throws up the deviation all it shows is that a particular doctor in a particular town might do more varicose veins than another qualified surgeon does in the same town or in a nearby town. It does not indicate that it might be his particular speciality and that particular doctor is sent cases from all over the country. These sorts of matters are not indicated on the computer, but these are the sorts of things that are thrown up as being suspicious by the Department. The cost to the community, the cost to the taxpayer, to prosecute four doctors this financial year is $3.5m. It just seems to me to be out of all proportion. Since this Government has been doctor bashing, what do we get? Let me quote the latest public opinion polls in the Bulletin, which I have quoted previously in this place. Over the years the Australian Labor Party has been doctor bashing and we now have this situation. Let me quote from a public opinion poll from the Bulletin of the profession. Who tops the list?

Senator Archer —Parliamentarians.

Senator WALTERS —No, Senator Archer is way wrong. It is not politicians, it is doctors, believe it or not. Over the years that the Labor Party has been doctor bashing the rating has gone from 62 per cent to 63 per cent, and now it is 64 per cent. If Senator Grimes is interested, he will find that his rating, and unfortunately, because of him, every other politician's rating, is way down to 19 per cent. We are way down at the bottom of the list while the doctors are at the top of the list. Despite the Government's doctor bashing, the people of Australia realise that doctors give honourable service and that they are members of an honourable profession. It does not seem to matter what the Government does , the doctors' rating continues to rise. The people get the service and they realise what is happening. They are the ones who are paying $3.5m to get four doctors convicted of fraud.

The Government has now set up this regulation, and I will deal with the reasons why the Government is doing it. The other professions are on notice that this is the beginning of price control. I stress again that there was no evidence at all that any doctor in the Australian Capital Territory charges more than the schedule fee to private patients in public hospitals. If it is not open confrontation when it is laid down in a regulation that doctors cannot charge more, when they do not, then what is? It is nothing short of open confrontation.

Senator Crowley, Senator Grimes and, indeed, Senator Haines all said it is all to do with the abuse of the tax dollar. It has nothing to do with the tax dollar . I do not know which one of them is too dumb to understand or too dishonest to acknowledge it, but it has nothing to do with the tax dollar. Patients who go to the public hospitals get all their services for nothing. If they choose to go to a private doctor, they pay and not the Government. It has nothing to do with tax dollars; the patient pays. A distortion of the truth is being perpetrated here.

Today Senator Crowley was again doctor bashing and referring to over-servicing and large amounts of money. I interjected: 'How much?' She would not say, but in the Estimates Committee she mentioned a figure of $100m or $200m. The officer of the Department said: 'Senator Crowley, it is not that much. Our computer, which only shows deviation, brings up $130m'. But Senator Crowley was up $200m. My interjection was: 'What, $300m, $400m? Any advance on $400m?' The Government never ceases its doctor bashing, and Senator Crowley is well included in that. She really has not got a clue. She does not understand how the schedule fee is arrived at. The Australian Medical Association, the Government and other people make a submission to an independent tribunal. There does not have to be an agreement, as Senator Crowley said there did, between the AMA and the Government on what the schedule fee will be. There has not got to be an agreement at all. The independent tribunal brings down the decision and, whether the AMA agrees or not, that is the schedule fee. The schedule fee is struck and the doctors are entitled, because of our Constitution, to charge anything they like.

The Government has relied on the States for getting around the Constitution, and this is the way it has done it. Now the Government is saying: 'We are really the State Government of the Australian Government Territory and so we will be bringing in this regulation in order to price control the doctors in the hospitals here'. The Government has attempted to circumvent the Constitution, but it has done this on other occasions. We have only to look at what the Government did to my State under the external affairs powers. The Government circumvented the Constitution and we had a situation where the Attorney-General (Senator Gareth Evans) sent in spy flight planes and told the pilots-this is written in the documents that were tabled-to be as inconspicuous as possible so that they would not worry the Tasmanians. Anyone in Australia can read that. It shows the absolute rank stupidity of this Government. Senator Crowley mentioned that doctors should be able to trust the Government. She quoted Dr Blewett as saying:

. . . Cabinet has agreed . . . to regular . . . review of the schedule fee . . .

Of course we will not stop the independent tribunal meeting.

Let us look to see whether the Government is trustworthy and whether the people of Australia and the doctors in particular can trust the Government. I find these facts very interesting. On 16 February, Mr Hawke in his policy speech said that he would not be touching the pensioners' cheques, that he would not take money out of the pensioners' cheques. We have a very popular Prime Minister in Mr Hawke. We all know how popular he is because on every television appearance he tells us. He says that he does not know why the other 30-odd per cent do not love him too.

Senator Peter Rae —Which faction is that?

Senator WALTERS —We do not know which faction, but we believe they all come from Government sources. We have a situation where this wonderfully popular Prime Minister makes all the very popular announcements. On 16 February he said he would not touch the money in the pensioners' cheques. Who did he leave to tell the bad news? He left it to Mr Keating. On 19 May in his economic statement Mr Keating had to break the bad news to the population and the bad news to the over -70s. He said: 'We are going to change that a bit. We intend to introduce an income test for the over-70s'. It was Bob Hawke, the popular Prime Minister, who gave the good news.

What else did he promise? Remember, he said: 'We will not touch the money in the pensioners' pay cheques'. As I have said, he said that in his policy speech on 16 February, before the election. What happened when the assets test was announced? He left that to his Minister for Social Security, Senator Grimes. Senator Grimes had to announce the bad news and say to the people of Australia: 'Oh, gee, we will not touch the money in the pensioners' cheques. We will just introduce an assets test'. It was left to Senator Grimes, not the popular Prime Minister, to announce the assets test. Then we had the popular Prime Minister, at the National Press Club, with all the television people and all the media there, saying: 'Senator Grimes made an awful mistake about that assets test. He really did a very bad job on it. I am going to abolish the assets test'. At the Press Club the popular Prime Minister took away the assets test and left his Minister for Social Security-who, to do him justice, did not want the assets test in the beginning-to carry the burden, left him to say to the people of Australia: 'We are going to have an assets test but it will not be that one; we did not like it. We will set up something different'. The Government has set up a committee.

A headline in yesterday's Sydney Morning Herald states: 'Assets: pay as you die plan'. Those are not my words; that is the headline in yesterday's Sydney Morning Herald. I wonder what the popular Prime Minister will do about that? Which Minister will he blame for that one? Honourable senators can rest assured that it will not be the popular Prime Minister who takes the blame. We also have that popular Prime Minister assuring the airline pilots and the Australian Council of Trade Unions that there will not be any tax on superannuation. So we had the Prime Minister, that popular fellow, telling the ACTU that he would not put any tax on superannuation. Who did he leave it to, to give the bad news? He left it to his Treasurer, Mr Keating. On 19 May Mr Keating said: 'From tonight we will introduce a tax on superannuation'.The Prime Minister did not make that announcement, not that popular fellow; Mr Keating announced it. He left it to his Treasurer.

What else do we find in the Prime Minister's policy speech? Mr Hawke, that popular fellow, also said in his policy speech: 'We will introduce tax cuts immediately we get into power'. Who did he leave it to to break the sad news? His Treasurer again. I do not know why Mr Keating keeps on supporting the Prime Minister. It was left to Mr Keating to state that the Government was not going to implement those tax cuts. It was left to Mr Keating at the National Economic Summit Conference to say: 'No, we are not going to have any tax cuts yet. We are going to have to put them off'. He did not add: 'Until the next election. We got in on this one, so we will put those tax cuts off until the next election'. It was left to Mr Keating to break the bad news that Mr Hawke's popular promise would not be abided by. Again, that popular fellow, Mr Bob Hawke, said: 'We will lift the pensioners tax threshold to $5,893 so they will not be forced to pay tax'. Those are popular statements coming from the Prime Minister. Who did he leave that to to break the bad news? Again he left it to his Treasurer. He left it to his Treasurer to say: 'Not on your life; not yet'. So pensioners, both married and single, are now paying tax on the $30 a week that they earn. While I am on the matter of tax let us have a look at the petrol price. We heard that popular Prime Minister in his policy speech say: 'We will take 3c a litre off the price of petrol'. What happened? Who was that left to, to break the sad tidings? Which Minister copped the flak this time? It was left to Mr Keating and Senator Walsh to say: 'No, we are not going to take off the 3c. Indeed, what we are going to do is index the price of petrol annually. We are going to index it automatically with the consumer price index'.

Senator Grimes —Mr Deputy President, I take a point of order. We are all being amused and entertained by Senator Walters but I remind you that we are debating a motion for the disallowance of health regulations and a health ordinance. It is now 20 minutes since Senator Walters last made any reference to anything at all in that area. I ask you to bring her back to the point.

The DEPUTY PRESIDENT —The point of order is noted. During the debate the point was made by Senator Crowley that the medical profession could trust the promises of the Government. In that respect Senator Walters is entitled to develop cases where she thinks this is not so. I think she has probably done so fairly exhaustively and should return to the matter before us.

Senator WALTERS —Not yet, Mr Deputy President.

The DEPUTY PRESIDENT —You cannot go on endlessly on that line, Senator Walters.

Senator WALTERS —Mr Deputy President, I cannot go on endlessly as I have only two more examples. I would like to continue. I will not, as I indicated when I commenced my speech, categorise all the occasions where we cannot trust the Government, just the ones in which I am particularly interested. We have done the petrol one; let us have a look at the health insurance rebate. On 3 March, two days before the election, Mr Hawke, that popular fellow, assured us that he would not be touching the financing of Medibank until Medicare's introduction on 1 February this year. Who was it left to, to break the sad tidings that all Australians would lose their health insurance rebate? It was left to the Treasurer at his Summit meeting. It was left to the Treasurer again to cop the flack through the people of Australia losing out. What other promises does the Prime Minister have up his sleeve? He said that he would not bring in a capital gains tax. But we note that the Minister for Industry and Commerce, Senator Button, keeps flagging that he is the one who thinks it ought to come in. Will he be the one who cops the flack? It will be jolly interesting to see, will it not? That is why the medical profession and the rest of Australia will not trust this Cabinet decision that the Government will review the schedule fee regularly . It is no use Senator Crowley coming into the chamber quoting Cabinet decisions . They have been made publicly. We know how untrustworthy Cabinet decisions are. We have read the Prime Minister's policy speech. That popular Prime Minister made all the happy, popular decisions and left it to his Ministers to break the bad news.

I come now to the Australian Democrats' contribution to this debate. Senator Haines seems to me to be completely unaware of what this debate is all about. She referred to our Government, the previous Government, bringing in price control on pharmacists. Obviously Senator Haines has not attended any of the meetings of the Pharmacy Guild of Australia because at the last one I attended it was suggested, following one of the reports, that it ought to be allowed to open up prescription costing to competition. Mr Deputy President, I can assure you that the Pharmacy Guild said: 'Not on your life; we do not want it. We want this control on prescription costs. For heaven's sake don't take it off'. For Senator Grimes and Senator Haines to say that the former Government introduced price control on pharmacists is a lot of rubbish because the pharmacists want it . The pharmacists begged us not to take it off and allow any competition. They want it; they asked for it. That is a totally different thing than to bring in regulation in a profession which does not want it, did not ask for it and certainly does not beg the Government to bring it in.

Senator Haines said that a letter from the AMA states that it has agreed to recommend to doctors that the schedule fee be charged pending the result of the Penington inquiry. She just does not understand, or is so insensitive to the situation that she does not comprehend, that there is a very big difference between asking them to do something that is quite legal and demanding that they do it and legislating for it under regulation. She is completely oblivious of the difference. It is like saying to the Waterside Workers Federation 'you have not decided to do this but we will legislate to stop you,' even though that organisation has never suggested it. Can honourable senators imagine the result if that happened? I assure the Government that it would certainly know the difference if that occurred. At the moment it is pretending not to be able to see it.

Senator Haines said quite clearly that all the Government was asking the medical profession to do was not to charge more than the schedule fee. That is not true. The Government is not asking the medical profession to do anything; the Government is telling the medical profession. There is a very big difference . If the Government had said: 'We notice that you have not charged over the schedule fee in any public hospital in Canberra. You have not charged your private patients over the schedule fee in Canberra so please will you continue to do that until after the Penington inquiry?' there would have been no question about it. But it did not do that. It legislated to stop something which was not occurring. That is the difference. As I said, for Senator Haines to say that all the Government is doing is asking the doctors to do something and that the former Government brought in fee control for pharmacists shows how out of touch she is with the situation in Canberra.

Question put:

That the motion (Senator Peter Baume's) be agreed to.