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Wednesday, 29 April 1987
Page: 1999

Senator COATES(4.15) —We are debating a matter of public importance raised by the Opposition which is framed in the following terms:

The hardship imposed on Australian families by the failure of the Hawke Government's health policies.

I deny that there has been such a failure and I therefore deny that the hardship that the Opposition claims follows. No one would try to suggest that the system was working as perfectly as we would want it to. Ideally there should be much shorter waiting lists in public hospitals, but the hardship that this involves at present, to the extent that it occurs, is nothing compared with that which existed under the multiple health insurance schemes offered by the Fraser Government and the same multiple health insurance arrangements that the Howard policy threatens to impose upon the people. I say `the Howard policy' because no member of the National Party of Australia has spoken in this debate. I presume they have not yet got their act together sufficiently to determine their policy, or even who they might have as a spokesperson on health. There is nobody here from the Queensland National Party or from the other National Party. We have people from the Michael Baume part of the Liberal Party but unfortunately we have nobody from the Peter Baume part of the Liberal Party. If we had, we might have heard a more reasonable attitude expressed.

Senator Michael Baume —It is not important enough for you to put up a Minister.

Senator COATES —The honourable senator knows perfectly well that the Minister representing the Minister for Health was not able to deal with the matter because of having to go to a Cabinet meeting. I will just deal with one matter that Senator Michael Baume misrepresented in his speech in relation to the answer that Senator Tate gave to a question at Question Time earlier in the day. Senator Baume tried to suggest that Senator Tate said that there was no concern by the Government about waiting lists and that no action was to be taken as it was for the States to take action. I suggest that Senator Baume check the Hansard tomorrow and he will see that he has misrepresented Senator Tate in his answer, who of course said, as is a fact, that because the States are responsible for the hospital system they have the prime responsibility, but that in liaison with the Commonwealth there are plans to deal with the waiting list problem and that the Government was of course concerned about it.

We had from Senator Baume and Senator Walters all this talk of crisis in health care delivery and about some policy of forcing people out of private hospital insurance cover. The Opposition feigns concern for the poor but its real concern, as in so many areas, is to add to the incomes of higher income earners in the community by reducing the cost of health insurance for those people and by increasing it for those on lower incomes. That is apart from its concern to add to the incomes of its private practitioner supporters.

The point about the Medicare system that is most important is that payment for it is in accordance with ability to pay. The Opposition says: `Oh, we would let off the poor'. There is this terrible way in which it refers to the poor under its policies. But then it says that everybody else, even those on quite low incomes and upwards, would have to pay exactly the same amount on private health insurance as the very high income earners in the community have to pay. As the Australian Democrats said, that is another example of the Opposition wanting to have indirect taxation, flat taxation, which is not in accordance with the ability to pay. I am rather surprised that the Opposition gave the health portfolio to Senator Michael Baume, taking the shadow ministry position away from direct confrontation with the Minister for Health, Dr Blewett, in the House of Representatives. I have to say that the honourable senator's performance today makes Mr Porter look good in comparison.

Let me deal with some of the matters that have been raised in this debate. The Opposition suggested that Medicare was a failure. It is obvious to everyone in the community that it is the most successful, the most stable, the most community accepted health insurance arrangement this country has seen; and those opposite want to change it. They made multiple changes during the Fraser Government years. I do not want to hark back to the Fraser years as though they proved everything.

Senator Button —Same people, Senator.

Senator COATES —There are many of the same people around, including the former Treasurer, who is now trying to be leader of one of the oppositions. Every year during that time they changed the health insurance arrangements. There were five major changes. If we take into account some of the other fiddling about the edges we see that there were 10 different health insurance arrangements during those seven years of the Fraser Government. The disruption, the uncertainty and the unfairness involved in those changes was appalling. The Opposition comes up with nothing new. The Opposition proposes the same prescription, the same opting out possibilities. It says that everybody ought to pay the same private health insurance, and so forth. It is not likely to be given the opportunity to implement those proposals, but it shows that it has not learnt a thing from past experience. Basically, it is blinded by its ideological opposition to any sort of government involvement and it wants to throw everyone back on the mercy of the private health insurance funds.

I regret that we have a system of medical care that is overwhelmingly based on `private practice fee for service'. It is a system requiring health insurance to help people cover themselves for these fees. But given that necessity I am pleased that we have developed a system of health insurance as good as Medicare is and about which there is virtually zero public complaint. There is overwhelming community acceptance and praise for it. People are pleased that at last we have a stable system that they have got to know and welcomed. It is very successful and efficient. If the Opposition were truthful it would acknowledge the efficiency of the Health Insurance Commission in administering Medicare and Medibank Private.

Senator Michael Baume complains about the fact that the Health Insurance Commission needs 3,000 people to run the system, but the number is fewer than the equivalent number that was required to administer the same responsibility when the private funds were involved. The system is universal and it is simple. Because it is simple and universal everyone is covered automatically and the system works efficiently. Most important of all, we do not have large numbers of people, as we had under conservative governments, without adequate health care cover. Health is one of those things that ought not have to be insured like a car or a house. It ought to be automatic and that is the way it is under this Government's system. The community is being threatened by the Opposition promising to return to the elitist system that operated under the Fraser Government.

The Opposition keeps raising the point about the number of services per person per year. To be charitable it has again shown how innumerate it is, but perhaps to be more honest it shows how dishonest it is with statistics. Senator Michael Baume quoted an average number of 5.8 services per person per year when Medicare began. What he did, if he would admit it, was to extend to a full year the figures for the first few months that Medicare was in operation, ignoring the fact that there is inevitably a processing lag, and then compared those figures with the most recent figures. He claims that there is a 20 per cent increase, from 5.8 to 7.7, in the number of medical services per person per year. In 1983, the last full calendar year of Medibank, each Australian used an average of 7.70 medical services. In the 1986 calendar year-a full year comparison-the average was 7.68. That is virtually an identical figure. We can make a great song and dance and say that we have had a major reduction in the number of visits to doctors per year per person, but we would not be so silly as to say that a reduction of 0.02 is a major one. We do say that it is about the same and that there can be no claim that bulk billing has led to overservicing. I just hope that the Opposition will now stop using those fraudulent figures to make those false comparisons.

The recent survey of Sydney general practitioners by the Australian Consumers Association shows that the direct billing arrangement works to the advantage of pensioners, beneficiaries and consumers in less affluent areas. That is one of the prime reasons we maintain that bulk billing is important. Not even the Opposition has advocated the abolition of direct billing for qualifying pensioners. The point is that the pensioners and beneficiaries are responsible for about 70 per cent of all direct billing services. The case against direct billing-if there was a case-comes down to the other 30 per cent of services which are direct billed to the general public. As this represents about 15 per cent of all medical services, the cost in 1986-87 would amount to about $429m. In the unlikely event that ending direct billing for this proportion of services resulted in even 10 per cent of them not being provided at all, the saving would be $43m, or $64m in the even less likely scenario that 20 per cent of these services were not performed. This is in stark contrast to the Opposition claim that direct billing is somehow responsible for a cost blow-out of $600m per annum. The figures are not even in the same range. The Opposition has failed to understand that overservicing through direct billing is at the most a marginal issue. As they offer the abolition of direct billing as a major savings option, it is clear from the figures I have cited that the Opposition has no grasp of the fundamental financial bases of the health portfolio at all.

Senator Walters cited figures from an Australian Bureau of Statistics survey. She said that 46 per cent of couples with children and a family income of less than $126 per week had taken out private health insurance. I asked her how many families were in that position. I could not believe that there would be very many families with that sort of income. They must be people on very low incomes who refuse to claim a pension. If they were a couple on a pension and had children they would, of course, be getting more than that. She has chosen from that survey a tiny extreme example which is actually less than 0.2 per cent of all contributors-a total of 16,000 families in the whole community.

Senator Walters —Look it up and do something about it.

Senator COATES —Okay. I am happy to answer the honourable senator's point despite the fact that she has picked from a survey partial and strange figures. I agree that we should not have a situation whereby 46 per cent of those people have taken out private health insurance. They should not bother. They cannot afford it. I regret that people do so, especially those who have such low incomes. They do so because of the rhetoric we get from the Opposition, from the Australian Medical Association and from other conservative groups in the community which frighten people into paying for private health insurance which they cannot afford. I regret that people who can ill afford it are frightened into paying money in that way.

Senator Michael Baume —Do the queues exist or don't they? Face up to the truth for a change.

Senator COATES —Senator Baume has no basis for claiming that he is truthful in this respect. He misrepresented figures from--

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