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Wednesday, 29 April 1987
Page: 2004


Senator GILES(4.46) —Our matter of public importance this afternoon, which might puzzle people listening to this debate on their radios, is actually about families and health services in Australia. In listening to what has been said over the last hour or so, one might envisage that the average Australian family spent most of its time either lining up for a hospital bed or lining up to see the doctor. We have heard very little about actual health care apart from that delivered by doctors or by hospitals. I would like to go into that a little later. Because there seems to be such an obsession in the Opposition about the cost of Medicare and other issues that go to bulk billing and the progressivity of the Medicare levy, I had better spend a little time concentrating on them and dealing with a few of the shibboleths we have heard.

It is no secret at all in Australia that the Opposition dislikes Medicare intensely, that it totally deplores bulk billing and that it also rejects entirely the progressive nature of our Medicare levy. That is not at all surprising when one considers that Medicare is one of the most popular of the Hawke Government's initiatives. Contrary to what we have been led to believe this afternoon, the stability and predictability of our universal health care scheme is endorsed by the vast majority of Australians. This, of course, upsets members of the Opposition no end. If they want to talk about hospitals or doctors' services, they could perhaps so phrase their matter of public importance to direct it towards that.

We have heard a great deal indeed about extra costs to families. Let us talk about the average family which Senator Teague seems to be so concerned about and for which, in fact, we have considerable concern. Let us take the case of a married couple on one income with average yearly earnings of $23,600. That family is now paying $5.70 a week by way of levy to cover all medical and hospital treatment it may need. For the vast majority of Australians that is a very satisfactory state of affairs. Let us look at what that family would pay under what we have been led to believe would be the case under a Howard government. The Opposition wants to shift 2.5 million families-that is, all except pensioners and welfare beneficiaries-back to private insurance under an opting out provision. The Opposition says that this will save $3 billion.


Senator Knowles —At least they wouldn't be paying twice then.


Senator GILES —If Senator Knowles will just wait a little while she will find that that family would be paying not once, not twice, but three or four times what it is paying now. The family has three choices.


Senator Knowles —What rubbish!


Senator GILES —The honourable senator should listen and she will hear a few things that she needs to know. It could shift to private insurance, stay in Medicare or go back to no cover, as it probably had prior to Medicare. If this family tried to go to private insurance under Howard's scheme, it would pay $27 a week for medical and hospital cover, compared with the $5.70 weekly under Medicare-$27 a week by comparison with the current $5.70.


Senator Knowles —The first thing you should do is go and buy yourself a calculator.


Senator GILES —Why is it $27 a week? The honourable senator should listen and she will hear. Firstly, honourable senators will recall that no one is now privately insured for medical services. Private insurance currently covers only hospitals because Medicare covers all medical services. So, for a start, a family would need to spend at least $7.90 a week for medical insurance, just to see the doctor. Then you have to add on hospital cover. Howard would have to cut subsidies to patients treated in public hospitals in order to get the balance of his $3 billion savings about which we have heard.


Senator Michael Baume —That's all done with mirrors, isn't it?


Senator GILES —It is all done with mirrors, says Senator Baume. A Howard government would have to cut Medicare compensation grants and identified health grants, and I will come back to those in a moment too. To cover this loss of revenue public hospitals would have to dramatically increase charges for private patients, thereby increasing private insurance premiums. To make up the effect of the loss of the subsidies would add a further $9.60 a week to the current basic hospital insurance rate of $9. The total cost to our average income family then under the Howard scheme is: Medical insurance $7.90, basic hospital insurance $18.60 and 50c in administrative costs.


Senator Knowles —You can't talk about your own scheme, can you? You have to talk about somebody else's.


Senator GILES —I will come back to our scheme shortly; just be patient. If our family chose to stay in Medicare, rates would greatly increase because of higher income earners opting out. Indeed, levy rates could go as high as 5 per cent, which would represent a cost of $22.60 a week. That is, our family-the one that members opposite are so concerned about-would be worse off by $14.70 a week or $764 per annum. The progressive nature of Medicare which members opposite profess to despise actually gives the scheme an equitable financial base, that is, it costs more for high income earners and less for low income earners.

Under the 1.25 per cent levy a worker on $300 a week pays $3.75 while someone receiving $500 a week pays $6.25. That is one of the very few socialist things, I am sorry to say, about this particular scheme which in fact props up private medicine very efficiently. About two million people had absolutely no cover before Medicare. These people are definitely much better off now than they were previously.


Senator Michael Baume —What are they getting for the money they pay?


Senator GILES —They are getting security, predictability and stability. For the vast majority of families that is what they seek in relation to their medical and hospital care. We have already covered quite efficiently I think this afternoon questions about improvement in the social wage for Australian families. Senator Coates has gone into the question of overuse; and we have also gone into the question of costs. I refer to a study done for the Health Reinsurance Fund and the conclusion, as follows:

In examining the cost to the government of Medicare, it needs to be remembered that there are savings with Medicare and there were (and would be) government health insurance costs without Medicare. The introduction of Medicare has slowed the rapid increase in health insurance costs which was occurring before 1984. The Medicare levy does cover the extra cost to the government of a universal health insurance system.

We have not seen anything from the Opposition which makes us feel that we should go in for any drastic change at this stage.

Let us look briefly at the question of the shortage of hospital beds. Let us for one moment concede the Opposition's fantasy that there are vast numbers of desperately ill people in Australia waiting for beds. The cause for this is acknowledged by all people as, first, a result of nursing shortages. What did conservative governments do over all those years about nursing shortages? Conservative governments presided over a rapid exodus out of the nursing profession by highly trained, highly skilled and highly motivated women who were not prepared to wait around until someone organised proper tertiary training for them. They had to wait for the Hawke Government to provide that transition from hospital based to tertiary based training, which has begun to attract women back into the nursing profession. In many cases they are still waiting for the wages and conditions that will once again make nursing the attractive and fulfilling profession that it was when Senator Walters and I and several other women in this place did our nursing training many years ago.

A shortage of specialist medical services, of course, is creating difficulties but who controls those specialties? Who holds the gate to those specialties? It is the colleges that control entry and make sure that there is only a certain number of, for example, orthopaedic surgeons and eye surgeons in Australia. If there is a fault to be found anywhere surely it is in the short sightedness of those colleges and the numbers they have allowed into those specialty areas over the past few years. Technological change has brought amazing procedures within the reach of very many people who otherwise were never going to consider for themselves coronary bypass surgery, lens implants or hip and other joint replacements. As a result of the improved technology those people are now demanding that they have parts replaced, that they have their quality of life substantially increased and their life expectancy increased.


Senator Knowles —How long do they have to wait for hip replacements?


Senator GILES —In many cases they are waiting too long but, as I say, that is not as a result of one particular policy of this or any other government; it is a result of a number of circumstances which have developed over the years and which could and should have been foreseen and forestalled. I think we could talk about waiting lists for an hour or so and we would still not come to any sort of agreement. There is a strong possibility that there are many people on waiting lists who are not in any urgent need of surgery or medical attention and who probably will get better in many cases without it, and they are sometimes booked into a number of hospitals.

The only State that has done any serious study into its waiting lists is Victoria where a thousand beds have been closed; and it is estimated that an extra 73,000 people could be treated in one year if those beds were re-opened. There are also 1,400 nursing vacancies. All of those issues will have to be redressed before it is possible to make any substantial inroads, I would think, in regard to waiting lists. At the same time I believe that many doctors should be more closely examining their hospitalisation procedures and perhaps asking some more searching questions about the need for hospitalisation. Of course, the development of day hospitals will take quite a lot of pressure off the more costly overnight stays for less complicated procedures.

I want to get off the question of those people who seem to have obsessed the Opposition this afternoon and get on to those people we are keeping out of hospitals and away from the doctors. For the benefit of the Senate I will recount a number of programs which have been introduced by this Government over the past two or three years. In the 1986-87 Budget the Government allocated an extra $1m for family planning services. This is on top of the usual recurrent funding for family planning and for family planning education. It has allowed the actual opening up of extra family planning and sexual counselling services in various places around the nation where they are badly needed and where there has been very little expansion in the range of family planning services over the past few years.

A couple of weeks ago I had the great pleasure of attending the opening of a new sexual counselling service in Mirrabooka, Western Australia. The service is booked up for the next three or four weeks without any difficulty at all. Also in 1986-87 the Government allocated nearly $1m, and will do so again in the next financial year, for immunisation against measles. There is an international campaign on called `Just One Shot', the purpose of which is to ensure that all the world's children are immunised against measles by 1990. If this is possible, and we believe it is, it means that a great deal of mortality and, just as importantly, morbidity will be avoided as children are immunised against what can be a very debilitating infectious disease.

Over the next three years an extra $26m will go into public health-a whole range of health services to keep people healthy and living in healthy conditions. In 1986-87 we allocated $59m for medical research, an increase of nearly 100 per cent on what was allocated to medical research in the last Budget of the Fraser Government. We have allocated $2.8m to immunise babies who are at risk against hepatitis B, which is a dreadfully dangerous disease which attacks tiny children. That is an extremely valuable program and, once again, one that will make inroads into mortality and morbidity in that very vulnerable group of neonates. Talking about dangerous, debilitating and drastic diseases, we have allocated $10m to the treatment of AIDS. In the last 12 months $7.7m has gone towards a very important matter as far as health care delivery is concerned-the transfer of nurses to the tertiary education sector to give them the professional status, the tertiary education, the confidence and the recognition that they so much deserve. I and other members of the Government totally reject the thesis of this extremely spurious matter of public importance.


Senator Michael Baume —You pretend that the queues do not exist.


Senator GILES —I do not pretend anything does not exist, but I acknowledge that a great many things do exist, greatly in excess of what was available in the time of the Fraser Government. We have no proof whatsoever that there would not be regression to those dark days if indeed there were a change of government.