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Friday, 3 April 1998
Page: 1966

Senator CROWLEY (10:40 AM) —I rise to speak on the Health Legislation Amendment Bill (No. 2) 1997 . My colleague Senator Forshaw has taken us through the principal intentions of the bill—to amend the National Health Act and the Health Insurance Act and to change the Social Security Act and the Veterans' Entitlements Act. The bill will do a number of things. I would certainly like to talk about the proposal to remove the requirement that the payment of benefits to private hospitals be at an acute care rate for the first 35 days of the patient's stay, regardless of whether acute care is provided. That is a very disappointing proposed change. On the one hand you can see an argument for it being reasonable and all of those sorts of things, but at the moment we have an arrangement in place that has worked pretty well for many people. It was put in place after considerable discussion and deliberation.

We all know that many people who find themselves in hospital have a need to move on to a nursing home bed and they are not going to find that bed easily. There is always a wait of a couple of weeks to try to match the patient to the bed, particularly in terms of locality. There may be a bed in a rural area, but that is of no use to a person in an urban area. In particular, there may be a shortage of beds in a rural area to which people living in and around that area would want to have access. Over times past, the arrangement of the 35 days has meant that there has been some flexibility in trying to deal with people with that need in a fairly humane and caring way.

It is a bit hard to know why there is this proposed change. It says to me two things—it is some kind of money saver and it is part of a mean-spirited approach to optimal health care. Minister, could you tell us the reason for intending to put this in place, particularly what savings are expected, who will benefit from those savings and what kind of counter argument you have for the many people who have written to me complaining about this proposed change? I would like you in your response to make clear the arguments for why there is any need to change.

The other point that caught my eye when looking through the proposals for this bill is the extension of the waiting period for benefits for obstetrics from nine months to 12 months. There are some very interesting expressions for people who anticipate that they will need obstetric care—cream skimmers; duck in, get your private health insurance for when you need it and duck out. They are one group of people who want private health insurance when for the large part of their lives they do not need it. Many expectant mothers anticipating the need for assistance at the birth of their baby have made the choice that they would like the support and backup of private health insurance. They do not want it for anything else in their lives, but they do want it for obstetric care.

Extending the waiting period illustrates exactly the challenge we have in private health insurance. Private health insurance has become an absolute dead package. It has long since passed its use-by date. People are leaving it in droves. The cost is going through the roof, and people are saying, `How can we make private health insurance more attractive?' Here is a small group of people who are indicating that they do find private health insurance attractive; that is to say, they like the comfort or the assurance of private health insurance for the period of pregnancy, childbirth and shortly thereafter.

I find it interesting that nobody in the private health insurance industry has approached the minister with an alternative proposal on how to market private health insurance to this specific group of people. Over the years, there has always been an indication of a large sympathy for parents having private cover for childbirth. There are, of course, an increasing number of people who find our major women's and children's public hospitals more than sufficient to the task—particularly, too, as most of the private specialists would be the people they would meet in the public hospital sector. It would be interesting if, for once, somebody in this area proposed a change in the way private health insurance is packaged, proposed or marketed, instead of the old, `Let us just extend the waiting time.' It is really in the nature of punitive—that is, `If you are going to take our benefits, then you're going to have to pay to get in and you're going to have to stay a long enough time.'

I do believe it is important to start challenging private health insurance to be much more aware of what the community needs and not necessarily proceed the way it is proposed in some parts of this bill. I certainly think it is clear evidence that private health insurance is past its use-by date. It is a very bad package indeed. I made some comments about this in previous speeches and I am very prepared to make them again.

The central objective of this bill is to make private health insurance more attractive to consumers to make it better value for money. Try telling that to the families of Australia who have been leaving private health insurance in droves. Senator Herron is in the chamber and I note that, by way of passing comment the other day, he did correct his outrageous claim that it was under the Labor government that private health insurance premiums rose 100 per cent.

Senator Herron —One hundred and forty-four per cent.

Senator CROWLEY —That is very interesting because you came in and said it was not that and you were quite wrong. Senator Herron, I do urge you to be accurate because, if you have to come in here and correct it a number of times, it is not helpful to the debate. What you and I should be able to agree about is that the cost of private health insurance now means that it is well beyond the affordability for most families. It is not at all assisted by your government's decision to offer $600 million a year by way of rebate. That has done nothing to stem the flow from private health insurance. One of the things that it has been associated with—and one might even be inclined to argue causal of—has been the dramatic increase in the price of private health insurance. It is just not possible for families who are doing it tough to find up to $40 a week for family cover for private health insurance. They are not going to do it, and they certainly will not do it when, down the road, there is a public hospital that covers all their needs at no further cost to them.

The way people are dealing with this is that they have realised that under Medicare they are protected from health bills. Under private health insurance, it is the only way you will get a health bill. The community are not nongs. They know that. As I explained here the other day, I had the pleasure of listening to Access Economics take us through some of the economics of health insurance and health policy at an AMA dinner in Parliament House a couple of weeks ago. The little scale was very nice. If you are an average citizen in this country, you pay your tax, you pay your Medicare levy and, if you choose nothing further, that is it—you can go to the public hospital system, you can see your doctor and so on. If you actually buy private insurance, you pay your taxes, you pay your Medicare levy, you pay your private health insurance premium and then, after you return from hospital, you pay your bills on top of that. It is just madness. Nobody—but nobody—would persist with that kind of scheme. What are people offered by way of encouragement to stay with private health insurance? You will get the doctor of your choice and you may have to spend less time on a waiting list to get access for elective surgery in hospital.

Most people recognise that, in all of our public hospitals, the standard of medical care is very high. They do not have to worry that they will be getting second-rate treatment. Indeed, our public hospitals are standard centres of good health care and most people are beginning to recognise—as I have just said, too, about obstetrics—that, very often, exactly the same specialist would provide the care for them in the public area as they would be able to choose under private health insurance. Nobody is going to suggest that public hospital care is a second-class rating. Indeed, if you are needing emergency care, intensive care or resuscitation after a heart attack, if you break a bone or a leg or if you have an accident of that sort, you invariably go to our large public hospitals and that is where the care is provided. So people know that they are covered.

People have not forgotten that, after seven years of Mr Fraser's Liberal government and five different health plans, two million Australians had no protection against health costs at all. Two million Australians had no insurance. Under Medicare, everyone does. Senator Herron, you know that, before the last elec tion, you promised everybody that you would protect Medicare because, I would have to say, even you finally got the message that the community likes Medicare.

Medicare gives the community exactly what they want—that is, protection from big bills. The real problem in the health area is that, when you are sick, you have got enough to worry about. If it is a child, parents fret, and they will continue to fret until that little one has recovered or at least a program for management of the illness is under way. If you have got elderly relatives who are sick or if you yourself are sick, you know that your main focus of worry is on their health or your own health. Will I get better? Will the pain go away? When can I walk again? The last thing you want loaded on top of that worry about your own health or the health of your relatives is the worry about whether you can afford to pay for care. Medicare took that worry away. Private health insurance has been trying to keep a piece of the action and it has been losing badly. The premiums have been going through the roof, and the government's $600 million per year to provide rebate and assistance has been completely lost in the first round of increases in the cost of those premiums.

The main argument that people use to maintain private health insurance is waiting lists. I think it is very important to place on the record, once again, the facts about waiting lists. You know, Senator Herron, in other areas you have been challenging me to look up answers to questions. I have, indeed. What is more, I have looked at your questions and some of the things you have said. If push comes to shove, I will bring them all here, but I do not want to waste people's time on that.

Senator Herron —You are now, Rosemary.

Senator CROWLEY —Excuse me, Senator Herron. What we have said all along is that the most important thing is not the numbers on waiting lists, which are very doubtful figures anyhow, but the time that people have to wait. You know—and I can get you the quotes—when you have actually said that, Senator Herron. It is very important. If we had one million people on a waiting list and each one had to wait for only a week, there would be no problem. Our concern is that 10 people might have to wait two years. That is the important thing; not the number on the waiting list but the time people on the waiting list have to wait.

I have sought an answer from the federal health department. I have asked them, for example, how many persons are waiting for surgery in South Australian public hospitals on 1 November 1997, 1996, 1995 and 1994. The answer from the department reads:

The Commonwealth does not hold this data. However, it should be noted that waiting lists are a poor indicator of hospital and health system performance which do not necessarily provide an accurate indication of the problems relating to access to elective surgery. Many hospital admissions, including elective admissions, occur without the patient ever being on a waiting list.

It goes on to say:

It is more appropriate to focus on admitting people to hospital within clinically appropriate times than on the number of people waiting at any point in time.

It cannot be said enough: the data about waiting lists is very rubbery indeed. I have heard your side of parliament in the last couple of weeks tell me that there are 50,000 on waiting lists, 100,000 on waiting lists and a good middle of the road figure of about 70,000 on waiting lists. We do not know. The Commonwealth can ring the states and ask: what are your latest figures on the number of people waiting? But they should give that away. As I remember, Senator Herron, the number of times you accused us of scaremongering about waiting lists can be exactly matched—indeed I would say exceeded—by the scare campaign run by you when you had the better reason for running a scare campaign about waiting lists.

I think it is long since past the time when we should have some reasonable discussion about health in this country. We should reasonably talk about points that you have raised on occasions and of course pick up on points that others of us have raised for years before. You know, Senator Herron, that on the whole I agree that you are pretty reasonable about this, except when you forget to answer questions. The point is that there are many people who are living longer in this country and are more likely to need surgical procedures.

There are many more procedures available to people. New technology means that we can now do many more procedures. Many more people are having day surgery, so the number of operations in hospital is dramatically increasing. Nobody in this country wants either the Labor Party or the Liberal Party, whichever is in government, to stand up and say, `We can't afford to help you.' What we might have to say is: it is going to take time to help you. But the costs of these new procedures are significantly increasing and they are very important.

One area that I think highlights this is the management of eyes. People who have corneal blindness or who have other needs for eye surgery, instead of having a one hour or three hour eye operation, can now have a procedure that will take less than half an hour sometimes but certainly less than an hour. Many more people are appearing for assistance with their eye operations. It certainly means a dramatic difference in the quality of life for people who can have their sight restored.

It also means increased costs to the taxpayers. It is about time we ask the taxpayers: are you prepared to support the costs? At the moment people are saying to us that they are not prepared to pay the horrifically expensive private health insurance, particularly when so many of them expect that they will never use it. It has passed its use-by date, Senator Herron. It is no help.

The ACTING DEPUTY PRESIDENT (Senator Calvert) —We do know that Senator Herron is here but there is also a chair here and I ask you to address your remarks through the chair.

Senator CROWLEY —Mr Acting Deputy President, I hate to think you were overlooked. I beg your pardon and thank you for that assistance. I was making the point that I think it is important that we have some facts about this matter. One of the areas that has offended me is listening to some of the monumental misrepresentations, which is a euphemism for the word `lie', coming from some people on the other side. For example, they have said that nothing under the Labor government was done to address the waiting list difficulties. The waiting list difficulties were addressed by the Labor government on a number of occasions.

One particular occasion was when former Minister Blewett provided $40 million to be matched by the states and dramatically reduced the waiting lists. Waiting lists were reduced for eye patients, particularly pensioner patients, in the Illawarra region in New South Wales. The private doctors and specialists agreed with the government that they would operate on all the pensioners and run down the numbers on that waiting list; not so much to reduce the numbers on the waiting list but to reduce the number of people who were waiting to be able to see properly and therefore get on with their lives in a much better way.

I have to say to my eternal shame that the doctors in South Australia refused to cooperate with the state and Commonwealth government and the private hospitals. They flatly refused to operate on Medicare patients in private hospitals. That, I think, is one of the real sticking points. We really have to address the main issue here. If there are empty or unused beds in private hospitals, why is it that Medicare patients are not able to access those beds? Why is it that privately insured patients have full access to our public hospitals, no questions asked. We want no hierarchy of patients according to how much they can pay. And, as I think everybody on this side would agree, that is absolutely right.

It is time the Liberal government set out to achieve justice in health care so that everybody has access, not just those who can afford it. It is also time you took a look at assisting patients instead of worrying them into further illness with the increased costs. For elderly patients in particular, the decision about section 2, the 35-day acute bed changes, is just a prime example of the mean spiritedness of this government.