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Wednesday, 29 April 1987
Page: 1991

Senator CROWLEY(3.25) —Despite what people might think, having listened to Senator Michael Baume's contribution, the Senate is discussing a matter of public importance brought on by the Opposition. That matter is: The hardship imposed on Australian families by the failure of the Hawke Government's health policies. I want to address the issues involved in that rather than the extraordinary contribution made by Senator Baume. What measure of hardship was given to us by Senator Baume? None.

Senator Walters —I will tell you.

Senator CROWLEY —I am sure Senator Walters will have a say on just about anything, but would she mind waiting her turn? What measure was there of the Hawke Government's failure? What measure did we get from Senator Baume of the failure of the Hawke Government's health policies but an extraordinary net as boringly predictable as one could ever imagine that went to, would you believe, waiting lists in public hospitals in the State system; a slather and whack about bulk billing and overservicing, with misrepresentation of the facts, which I will come to in a short time; some extraordinary figures that seemed to suggest that the closure of public hospital beds but the opening of private hospital beds was not a balance and that there was chaos, all due to Medicare; and then finally Senator Baume suggested that, with high technology and the supply of highly technological equipment, as a result of the control introduced by this Government under the Minister for Health, Dr Blewett, we have problems of increasing costs, and that these costs would be reduced if these things were left to market forces and competition prevailed in this area. That is an extraordinary comment by Senator Baume, especially as he went on to say that competition would hold the costs down, and he implied that anyhow, because patients do not have to pay much with Medicare, without Medicare-when they would have to pay more-they would be better off. Senator Baume has been the shadow Minister for Health for only a week; it is quite clear that he needs to do some more homework. Either he wants patients to pay more, or he wants patients to pay less. His arguments and the case he presented on this matter of public importance were nothing but a series of artificial claims and wild confusions.

His claims about the hardship imposed on Australian families by the failure of the Hawke Government's health policies were a grab bag that went with great predictability to waiting lists, to bulk billing, to claims about overservicing, to the number of hospital beds, which he says is rising and falling like a yo-yo, and somehow strikes got in there. I notice there was some mention of nurses but absolutely no mention of the doctors' strike, their disgraceful performance in New South Wales. There was no analysis of the Australian Medical Association's report on its own profession, recently published and carried out by a Mr Cotton, a one time contributor of great significance to this country. His report and the AMA's acknowledgment of it goes to some difficulties within that profession. I think Senator Baume needs to be more comprehensive. If he is going to ask us to look at his contribution on the hardship imposed on Australian families, let us have some fact; let us not have a wild slather and rhetorical claims going to such things as people dying while on waiting lists.

The first claim I would like to pick up is his claim that this Government intends to do nothing about those waiting lists. These problems have been clearly recognised by the Government and by the Minister on any number of occasions. The answer given by the Special Minister of State, Senator Tate, to the honourable senator's question preambling the matter of public importance I think covers not only what Minister Blewett would say and what this Government says but also what is agreed by all of Australia's Health Ministers-not some, but all. They all agree that there are a number of factors increasing waiting lists and waiting times around the public hospitals. They are nursing shortages that resulted in bed closures; the supply of some specialist medical services such as those provided by orthopaedic surgeons; advances in technology allowing a greater variety of procedures such as coronary bypass surgery, lens implants for eyes or hip and other joint replacements to be more readily performed; and a greater public awareness of new improved technology leading to greater demand. That is not an exhaustive list but every State Health Minister, as well as our Federal Health Minister, agrees that those matters have to be taken into account when we are looking at the increase in hospital waiting lists. The problem cannot be sheeted home in a simplistic fashion to Medicare in the way in which Senator Michael Baume tried to suggest. He went on, I think very disgracefully, to say that this Federal Government-even if it knew of the problems-intends to do nothing. I think that is most dishonourable because the Minister for Health has made it quite clear--

Senator Michael Baume —Didn't you hear the answer?

Senator CROWLEY —Yes. The honourable senator might wait a minute. The Health Ministers of all States have agreed to develop programs with the Commonwealth to address the real issues. The programs will be developed on a bilateral basis recognising the specific needs and proposals of each State and Territory. It is envisaged that such proposals will include improved day surgery, domiciliary nursing for long stay patients and more effective use of acute hospital services. This was put out in a joint statement by the State Health Ministers and was also put out in a Press release by the Minister for Health only in the last week, I believe. In doing that he acknowledged the bilateral basis of the Commonwealth contribution that in some ways is a recognition by the Commonwealth that it can help, even though it is not required to, in addressing these difficulties that the State Health Ministers acknowledge in this area.

It is most dishonourable of Senator Michael Baume to say that the Federal Government, having recognised the problem, intends not to address it. It has to this point; it has now come up with further proposals that will be worked out with Commonwealth-State agreement. The contribution of the Federal Minister and his generous assistance in taking steps to deal with the problem once having recognised it have to be acknowledged.

We must also acknowledge the increased funding contribution by the Commonwealth for public hospitals. I draw to the attention of the Opposition that the Minister for Health is recorded in House of Representatives Hansard of 14 November 1986 as saying:

The previous Government in its last year of office paid $1,261m to the State public hospitals systems. This year-

that is, in 1986-

we are paying $2,713m. In four years we have virtually doubled the payments to the public hospital systems.

This in comparison with the previous government expenditure in this area. That is another thing this Federal Government has done to help the public hospital system. Also, for the first time, this Federal Government has paid into the public hospital system of the States $50m a year for the upgrading of equipment. The Opposition when in power did not make a single contribution related specifically to equipment.

Senator Michael Baume cannot have it both ways. He cannot accuse this Federal Government of doing nothing and ignore those facts. This Federal Government has done things to deal with the difficulties in the public hospital system up till now and it is offering to take more steps, as I have just listed, to deal with the matter in the near future-as a consequence of proper, responsible discussion with the State Health Ministers, who all recognise that the problem of increasing waiting lists is a complex issue which cannot be dealt with by the simplistic sloganeering that we have heard from Senator Baume opposite.

I turn to the next point raised by Senator Baume. It was no surprise to those of us on this side of the chamber that he did not address the issues raised in the wording of his proposal of a discussion of a matter of public importance. He suggested that bulk billing was the next of the causes of all the disasters we are confronting. I do not know how bulk billing can be disadvantaging families in Australia when it is clearly directly advantaging them. In particular, it is advantaging those who are least able to pay; that is, the poorer people, the pensioners. I understand that even the Opposition would be inclined to continue bulk billing for people in those groups. Should we understand that they are not to be included in Senator Baume's definition of `family'? Senator Baume should not give us simplistic comments; bulk billing is of enormous advantage to families in this country. Opposition support for bulk billing completely contradicts the terms of the wording of the matter of public importance.

Senator Michael Baume further suggested that somehow bulk billing is responsible for over- usage. He gave figures showing that in, I think, the last year of the Fraser Government the average was 5.8 medical services per person per year. That is wrong. Basically, the Opposition has taken the utilisation rates for the first few months of Medicare and scaled them up for a full year. When full yearly statistics are compared it can be seen that in 1983, the last full calendar year of the final Fraser Government health scheme, each Australian used an average of 7.70 medical services. How does that compare with the 1986 calendar year figure given by Senator Michael Baume of 7.68 services under the current Medicare scheme? There is very little difference. A study in the 1970s by the Australian Medical Association showed that under the Medibank agreement of the Whitlam Government there was almost no increase of services. The figures suggest that there is not much difference under the bulk billing proposal and the current arrangements for Medicare.

Senator Michael Baume may by all means criticise the scheme, offer constructive criticism, but he should not falsify figures and rabbit around with wild claims about bulk billing being the cause of, according to this proposal, hardships on Australian families. It is directly advantaging many Australian families. Senator Michael Baume thinks that by misrepresenting the facts he will be able to make some long, discursive track into some kind of tax payments by people which might be disadvantaging some families. Further, he added that if the Opposition gained government it would continue bulk billing. I am not sure what sense we can make of that except that Senator Michael Baume has not done his homework comprehensively in that area.

Senator Michael Baume —You have not listened.

Senator CROWLEY —I had to sit here for 20 minutes listening. Let me compare the health costs of comparable countries. The health bill in Australia as a percentage of gross domestic product is 7 1/2 per cent compared to the United Kingdom figure of 6 1/2 per cent. Canada, with a comparable system and a comparable population, has a figure of 8.2 per cent. The United States of America, which has nothing like our current Medicare scheme, has a figure of 11 per cent. If the Australian health costs were to go from the current 7 1/2 per cent of gross domestic profit to the 11 per cent figure of America, that would cost the taxpayers of Australia an extra $9 billion. That would bite. The health bill in Australia is very responsible and the Medicare costing to the taxpayers of this country compares very favourably with the freer scheme in America, which is very expensive. Again, hardship being imposed on Australian families by the failure of the Hawke Government's health policies cannot be sustained on those figures.

Recently the Economic Planning Advisory Council released Council paper No. 27 on aspects of the social wage, which is a review of social expenditures and redistribution. I would like to turn now to that because it also highlights another significant contribution of this Government to the betterment and benefit of families in this country and completely refutes the claims of Senator Michael Baume's proposal. This document defines a social wage. It says:

Social wage can be broadly defined as that part of government spending which provides benefits to individuals and families chiefly comprising government spending on health, education, social security, housing and community amenities. The social wage refers to those items of government expenditure that are capable of making a direct contribution to living standards of households.

On page 29 it goes on to say:

The social wage plays a particularly important role for households with dependent children and again in later life when age pensions support retirement and when health benefits become more important.

In this matter of public importance we have a claim that hardships are being imposed on Australian families. Australian families are very varied. The definitions include those with or without dependent children or dependent elderly people. If we take the definition of family to include those with dependent children, this social wage, as mentioned in this EPAC document, plays a particularly important role for households with dependent children. The EPAC paper illustrates this point and points out how the social wage is of great benefit to families in Australia-again in complete contradiction of the claims made in this debate today. The social wage particularly advantages families because it returns to families in this country great benefits under the social wage government expenditure. It is a point often lost-I think almost invariably lost-by the Opposition when it argues that families are suffering in this country.

This is a time of great difficulty for people in this country. There is no doubt about that. But at the same time, and despite these difficult times, this Government has managed, through its creation of jobs, its income policies and its very significant increase in social wage expenditure, to benefit Australian families. That is in complete contradiction of the terms of this matter of public importance. I draw Senator Michael Baume's attention to that document. It is very useful and would make a great contribution to further debates in which he may wish to participate.

The EPAC paper, which is entitled `Aspects of the Social Wage', indicates the relative decline in social wage support for families which took place under the Fraser Government and the greater support that families have had in this area from the Hawke Government. That is undeniable; it is absolutely true. I do not understand how the Opposition can ignore the fact that the social wage has benefited so many families in this country-those families that have access to education at every level and those families that have access to dramatically increased health cover. I find it remarkable that the Opposition would say that things are much worse for families. Prior to the introduction of Medicare, two million Australian people were not covered by insurance. Those two million people had to remain ill or risk a huge bill when they went to the doctor. Those two million people are blissfully ignored by the Opposition when it examines the benefits of Medicare to Australian families. Those were the two million people who remained in Medibank with the first of the five variations that were introduced under the seven years of Fraser. There is clear evidence that many people choose Medicare and, in that choosing, appreciate the benefit to them and their families of being in Medicare.

Because of the time constraints, I will not illustrate the examples in that EPAC document about the social wage. But they very clearly support the social wage contribution through health expenditure that is of great benefit to Australian families. Through the redistribution and the progressive nature of the Medicare funding, it is of particular benefit to Australian families at the lower end of the income scale. We benefit from Medicare outlays not only in general but in particular too, because a Medicare levy does not have to be paid until a single person's income reaches $8,030 or a married couple's or sole parent's income reaches $13,370, with an addition of $1,660 per dependent child or student.

Those people at the lowest end of the income scale in this country are also guaranteed their Medicare health coverage under this Government. I say to Senator Baume that many of those people are what we call family people. Those people at the lowest level of income, that is, a married couple or a sole parent with an income up to $13,000-plus and those couples with two children and with an income of $16,000 do not have to pay any Medicare levy. That, plus the redistribution of Medicare funding and arrangements for the delivery of services, advantages enormously those Australian families who are least able to provide for their health care compared with those who are better off and better able to contribute towards it.

Finally, Senator Michael Baume's abusive terms about the state of medical care in this country are really appalling. Very recently I received from the Australasian Epidemiological Association a letter which finished with the following statement:

The Australian health care system has achieved an enviable reputation for delivery of therapeutic health services. Its ability to deliver effective preventive care is just beginning.

Another great contribution of this Government, both in Medicare funding and in other initiatives, is in the area of preventive health. All of those things are of great benefit to Australian families. They make for an improved health status of the community which has to be of benefit to Australian families. There is no way that the Opposition can claim any support, any justification from facts or data, for the terms of this matter of public importance.

The ACTING DEPUTY PRESIDENT (Senator Coleman) —Order! The honourable senator's time has expired.