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Wednesday, 31 August 1994
Page: 696


Senator CROWLEY (Minister for Family Services) (3.46 p.m.) —Here we go again—the opposition on health care. A lot of us in this place, and people out there listening, would have to be sick and tired of the opposition's claims that Medicare is sick. On any evidence it is not. If it were sick, why has Senator Woods and his party, at least to this point, endorsed bulk-billing which is the principle underpinning plank of Medicare?

  Why was Senator Newman in here yesterday complaining bitterly about a push to move away from bulk-billing? Good heavens! Let us be consistent! There is nothing sick with Medicare. It is hugely popular in the electorate and it is delivering all that it should. It is delivering an excellent service in public hospitals. The people in this country who do not like their rapidly increasing premiums for private insurance or the fact that with private insurance they get a very big bill—the only place they can get a big bill—are leaving private insurance and moving to the excellent public hospital system. That is what the community is saying and doing and that is why Medicare is not, not, not sick.

  Senator Woods argued in the most peculiar kind of way, covering old, out-of-date and tired points that were never valid and are certainly not valid today. One could ask Senator Woods what his previous health policy got him. It got him into opposition, on the back bench and into the Senate. I would have to say that was pretty good for one health policy. I am glad Senator Woods is smiling because he made a great contribution to the re-election of the Labor government. And why? Because the community loves Medicare. People know it; it is simple and it is clear. In large part, that is what the opposition agrees with and that is why it will not change it dramatically. That is why Senator Woods is standing up here making very curious comments about private health insurance.

  Senator Woods claimed that the government will increase the cost of private beds in public hospitals. For years the Private Hospital Association has been begging for this in the name of freer competition.


Senator Woods —It puts premiums up.


Senator CROWLEY —Of course it puts premiums up. I can tell Senator Woods about it. I chaired a committee and sat opposite the protagonists—the private health insurance industry and the private hospitals. The representative of the private hospitals said, `Please remove the discrimination. Remove the subsidised private bed contribution for private patients in public hospitals. This will make fair competition. This will ensure that our beds are no more expensive. This will mean that people will return to the private hospitals in droves.' When he turned around, the representative of the private health insurance industry beside him was ashen faced and said, `You can't do that. It'll push premiums up.' Of course it will push premiums up. It will push premiums up if it is done without all the other changes.

  It is part of a package of changes and deals with the thing that Senator Woods argued for and said that we are not doing—introducing more competitive practices, encouraging a fair comparison of the costs of a private bed, without subsidy, in a public hospital. That is what the Private Hospital Association wants and what the private health insurance industry will be able to incorporate in this whole package of changes. So Senator Woods cannot come in here and whinge about it when the Private Hospital Association is desperate for it to happen and the private health insurance industry, including its spokesperson, Mr Russell Schneider, feels it can be more than accommodated.

  In today's Australian medical writer Steve Dow stated:

The Victorian Minister for Health, Ms Tehan, has said that preferred-provider arrangements will fail to stop the decline in private insurance coverage . . . because it had not done so in Victoria.

On 25 August the health writer for the Age, Bill Birnbauer, stated:

The Health Minister, Mrs Tehan, conceded yesterday that reduced waiting lists at public hospitals had contributed to sharp falls in the number of privately-insured Victorians.

She made no apology for that. So efficient and effective are the public hospitals in Victoria that it has taken away an inducement for people to take out private insurance. The waiting list argument is a spurious argument. It always has been and there is Minister Tehan saying so. She then changed her mind very quickly. I am sure people rang her up and said, `Woops, hold on, that is a line for the opposition.'

  Today's Australian also states:

. . . the chief executive of the Australian Health Insurance Association, Mr Russell Schneider, said yesterday the Victorian deals had never been "genuine" preferred-provider arrangements because fund benefits had risen to meet hospital charges, rather than hospitals lowering their charges to meet the demands of funds.

That is exactly why there is a change; the package of goods allows for that to change in a very different way. A number of the regulations that have constrained private health insurance have gone. The consumer focus is there. There is a requirement for single billing, more patent costing of charges and the medical expenses to be made clear to patients before they purchase. All of those things will be ways in which private funds will be assisted to be more competitive.

  Perhaps the most important point that we have to deal with is the continuing false argument about public hospital waiting lists being a cause for major concern. There is a very small amount of concern as Senator Woods, more than most people, would know. He knows that that is a false argument. In his own state of New South Wales he can get those figures, and they are very encouraging. For all emergency procedures, something like about half of the one million or so fronting up at New South Wales public hospitals are dealt with within 24 hours and, of course, it is usually very much less than that. If there are any doubts about that, the honourable senator could ring Kerry Packer, who is an excellent example of the efficiency and the good practices of the—


Senator Woods —A public patient, was he?


Senator CROWLEY —In that particular case a man with a critical heart attack was taken to Westmead Hospital where his life was saved. After all of that, Mr Packer then moved on to the comfort of a different arrangement, but it was the public system that saved his life.


Senator O'Chee —Ha, ha!


Senator CROWLEY —Senator O'Chee may laugh, but when he has an emergency coronary he will be going there.


Senator O'Chee —The point is that he didn't stay in the public system.


Senator CROWLEY —The point is that the public health system is excellent.


Senator O'Chee —He did not stay in the public health system.


Senator CROWLEY —No. His life was saved in it, Senator. What do you want? Do you want him comfortably dead or healthily alive? He went to the public system and the public system does what it does everywhere: it deals with emergencies straight away.

  The next point is that of the majority of people who are coming in for non-emergent—that is, elective—surgery Minister Tehan says that the waiting list is largely gone in Victoria. I do not think Senator O'Chee would want to argue with the Minister for Health in Victoria. In New South Wales the figures show that only a small percentage of people have a longer time to wait. We all know that that longer waiting time is the thing that matters and that that is unacceptable. That is why the government has introduced special arrangements, including increased funding, as incentives to reduce those waiting lists.

  We also know that a number of private hospitals had been initially willing to take those public patients into their private beds—there are some good examples in New South Wales—and then the doctors refused to do the work on public patients in private beds. It is a disgrace, but that is what we have had to deal with and, indeed, why there has been a continuing unacceptable waiting time for some people in specialist needs for elective surgery.

  What we do know is that the opposition is trying, particularly with a whole series of new announcements, whereby the consumers will be the big winners. The contribution of private health insurance is being encouraged by ways in which the cost of premiums will be reduced; where patients will have more access to information, a charter of rights, so that they will know more clearly what the obligations of hospitals and the health service is to them; where they will have single billing; and where the requirement is for medical practitioners to outline to the patients what they can expect to pay before the procedure, so that they do not find a series of bills coming in afterwards that shocks them.

  Senator Woods knows more than most that this notion of crisis in Medicare is absolutely untrue, confirmed again and again by the popular polling on this matter and confused by things like the state hospitals, particularly New South Wales and Victoria, dramatically cutting their funding out of health under the guise of casemix. They have had higher funding than they have ever had and as the Minister for Human Services and Health, Dr Lawrence, says the Commonwealth pours the money in from one end and the states are taking it straight out the other. They have taken 12 per cent out for the Victorian health system and 2 per cent out for the New South Wales system. Minister Phillips then has the gall to come asking for another $10 million. Minister Phillips should spend what he has got and fix it up for the people of New South Wales. He should not anticipate an imminent New South Wales election, particularly after he has been clobbered in the Parramatta by-election.