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Tuesday, 10 November 1959

Mr THOMPSON (Port Adelaide; [9.58.]) (Mr. Deputy Speaker, in discussing this bill, I should like to say that I have views which differ from those of quite a lot of honorable members. I believe that this bill is intended by the Minister for HealthDr. Donald Cameron) to improve the present health scheme, but, at the same time, I must say that it does not do what we on this side of the House think a national health measure should do. The honorable member for Eden-Monaro (Mr. Allan Fraser), speaking this evening on behalf of the Australian Labour Party, put forward the objections that we raise to many of the provisions of this bill and to what he has termed the inequalities and unfairness of some of these provisions. Those inequalities will continue if we go on in the same way we are going at present, Sir.

I have always given credit to the right honorable member for Cowper (Sir Earle Page) for the work he has done to bring into being a national health scheme that could be improved in order to make it a great scheme to serve the interests of the people of Australia. But that scheme is not being improved in the way I should like to see it improved. To-night, I do not intend to go into all the clauses of the bill and I do not intend to take that red book which the right honorable member for Cowper has been speaking about and read extracts from it. I want to refer to one matter which I happened to hear broadcast to-night on the 7 o'clock news. I suppose that this would be some of the latest information that we have. In that broadcast it was stated that, in the United Kingdom, nearly half the taxes collected are spent on the welfare state. The broadcast stated the proportion of money spent on defence and it was interesting to note that in spite of the huge sums spent on battleships, fighter planes and all modes of warfare, defence expenditure is much below the welfare state expenditure. I think it was said that between 8s. and 9s. of every £1 of taxes collected is being spent on the welfare state.

Mr Anderson - Dreadful.

Mr THOMPSON - I remind the honorable member that this heavy expenditure on the welfare state in the United Kingdom is not being incurred by a Labour government. There has been a Conservative government - a Tory government - there for years past and it was returned recently with the biggest majority that it ever had. That is the Government that is spending nearly half the taxes on the welfare state. So if the honorable member for Hume says that it is dreadful to do, he disagrees with both the Conservatives in England and the Labour Party in Australia. 1 was pleased at one statement made by the right honorable member for Cowper near the end of his speech when he spoke about raising money for mental institutions of the States. He referred to the taxation that we imposed in order to raise about £10,000,000 for the States. He implied that, in his opinion, we could impose taxes in order to finance a proper health scheme. That is the view of the right honorable member for Cowper who, as Minister for Health, brought into being the health scheme with which we are dealing tonight.

Mr Drummond - I think that your inference is wrong.

Mr THOMPSON - If my inference is wrong I cannot see the significance of the remarks of the right honorable member for Cowper when he showed that, by taxation, we can do things to help the States which they cannot do themselves. The inference, in my opinion, is that we should finance these things, if necessary, by taxation.

The honorable member for Werriwa (Mr. Whitlam) was asked by a Government supporter where a Labour Government would find the money to pay for the things that Labour advocated, and he said that it would find the money in the same way as the Government of the United Kingdom and the Government of New Zealand were finding the money - by taxing the people. As I have said before, I would not have reduced taxation as the Government has reduced it this year. I would have used that £20,000,000 for the benefit of the people. The few shillings that the man at the bottom of the salary scale gets, and the few pounds that the man at the top receives represent such a small part of their income that they would not have worried very much if they had not received the reductions.

Mr Bandidt - Would you increase taxation?

Mr THOMPSON - I would be prepared to increase taxation in order to give to the community those things that are necessary. I have always understood - and Labour contends - that taxation is the medium by which you can adjust the income of the country to the needs of the people. I would use taxation, without any qualms whatsoever if I had the power and authority, to give a fair distribution to the people. The Government believes in that principle also because the man in receipt of a high income is taxed at a higher rate. Income taxation is levied in accordance with the capacity of people to pay.

I was rather amused by the remarks about not recognizing the increased costs to the medical profession. This bill proposes a big increase in the amounts payable to one member of the medical profession - the surgeon. The general practitioner who looks after the family will get no more from the Government and the approved society. He receives 6s. from the Government for every visit to or by a patient. Then he also gets a matching contribution of 6s. from the society.

The question has arisen as to why the surgeon is being given an increase. I do not know what the actual figure is but the right honorable member for Cowper said that we had complained about doctors getting a 20 per cent, increase in their fees. Whether that figure is right or not, I do not know, but if the doctor is charging 20 per cent, more to visit a patient is he not entitled to get 20 per cent, more on the 6s. that the Government is paying? No mention is made of that. Mention has been made of operations, anaesthetics, &c, in respect of which some increases are proposed.

It has been suggested in this debate that the original health scheme contemplated that 80 per cent, or 90 per cent, of the patients' medical expenses would be met. When the scheme came into operation, 6s. was paid by the Government and 6s. by the approved society, making 12s. towards the doctor's fee. At that time, in my State at any rate, the doctor's fee was 15s. In other words, the fund and the Government paid 80 per cent, of the doctor's fee and the patient the other 20 per cent, plus his contribution to the approved society. Now many doctors are charging 17s. 6d. or £1 instead of 15s., but the patient still receives only 12s., no improvement having been made in the reimbursement of general practitioners' fees. The extra payments proposed in this bill are to be made to the specialist.

The honorable member for Cowper contended that we are not doing as much for the specialist as could be done. He said that New Zealand had lost some of its specialists to countries where they could get a higher fee for their work. Under the bill, there is one anomaly with regard to the specialist. If a man is ill and considers that he should see a specialist he must first see a general practitioner and pay him 15s. or £1. I do not know whether the Department of Health or the Minister has ever given consideration to this factor, but the position is that if a patient goes straight to the specialist he does not get as much from the fund as if he first sees a general practitioner and is referred to a specialist. That is a matter that should receive further consideration.

I wish to quote two examples of the fees doctors charge. One man of my acquaintance saw a doctor and was asked to return for a further examination. When he did so the doctor told him that he needed an immediate appendectomy. The fee was £21 for the doctor performing the operation. The patient received a total of £11 5s. from the fund - not much more than 50 per cent, of the cost of the operation. The patient also had to pay the assisting doctor £3 3s., receiving back from the fund £1 10s. The patient paid the anaesthetist £5 5s. and received from the fund £2 5s. In that case the patient paid a big share of the cost of the operation, despite the fact that he had already made contributions to the fund. I am not saying that the doctors did not do a good job - they did. I am merely showing what the costs were. In another case a lady had to have her gall bladder removed. The operation took one and a half hours and cost £41 19s. The lady received from the fund a total of £22 10s. In addition, she had to pay for the assisting doctor and the anaesthetist. It will be seen that the patient in that case had to bear a fairly high proportion of the cost of the operation.

When this scheme first came into operation I addressed many members of friendly societies and told them that although the Government proposed to pay varying amounts for medical services, it did not propose to tell the doctors what they should charge. The Labour Party came up against the same thing when it put forward a health scheme. The Labour Party said that there should be a schedule of charges, but the doctors would not agree. But the Government sets out clearly a schedule of fund benefits. I think that doctors should state the charges for their various services. We on this side of the House believe in that. We have said it before and we say it again. If the taxpayer is to pay a bill for anybody he should know beforehand what he is to be charged. If a member of the Australian Country Party goes to Melbourne or Sydney to buy a new machine he wants to know the price of the machine so that he can work out whether it is a fair price. But the Government says that it cannot tell the doctors to produce a list of their charges although it agrees that it can give a list of the benefits that may be obtained by patients. If the Government can do that why can it not say what is a fair thing for the medical profession to charge?

I wish to say a few words about the pensioner medical scheme. I believe that the great bulk of doctors are good, honest men. But some of them, for example, if attending a woman may suggest that they should also examine her husband, who is also one of their patients, at the same time. Two fees are then charged. That kind of practice is pushing up the cost of the service. I think that the Department of Health tries to control that, but it is very difficult to control. In some cases, a doctor may visit a man more often than is absolutely necessary.

Let me deal with the proposal to charge 5s. for prescriptions issued under the pharmaceutical benefits scheme. When the honorable member for Werriwa was speaking, the right honorable member for Cowper interjected and said that although the increase in the cost of prescriptions would be 5s. in Australia, compared with 1s. in England, the increase of1s. in England was in respect of each ingredient used. Honorable members may be surprised to know that a person will be very lucky to get away with a prescription under this scheme for a mere 5s. I understand that in future doctors will not be able to write more than two prescriptions on one piece of paper, in which case a charge of 5s. will be made for each prescription. Will the Minister say whether that is correct?


Mr THOMPSON - I have had many years' experience with dispensaries and friendly societies. I remember that one of our dispensaries in Port Adelaide once told me that it had to charge for ingredients that were not listed in the British Pharmacopoeia. If a doctor wrote out a certain prescription, and we in the dispensary made it up from the two or three drugs necessary, the patient could have it free. But the doctor does not do that; he specifies a proprietary line made up by a manufacturer. When we give the patient those tablets or powders made up by the manufacturer we have to charge him for them.

We had an idea at one time that many people were wasting medicine because they were getting it free. I say " free ", although they paid so much a quarter all the year round in order to obtain the medicine when they wanted it. I know that my wife paid in for about 30 years and never had 10s. worth of medicine. I suggest to the Minister that when he is considering the question whether dispensaries should be compelled to charge their members 5s. for every prescription, he should remember that those members pay so much a quarter, and very often they make those payments for years without getting any medicine at all. They are entitled to work together, just as in any co-operative society, for the benefit of one another. I understand the dispensaries are prepared to consider charging some fee, but that they want to give consideration to the amount that has been paid in by the individual member in his subscriptions throughout the year. I quite agree that if an outsider comes to the dispensary he should be on the same footing as a person who goes to a private chemist.

The honorable member for Fawkner (Mr. Howson) said to-night that the chemists feared competition from the friendly societies, particularly in Victoria and South Australia. I do not know whether the honorable member is aware of the fact that some years ago the South Australian Government introduced legislation to prevent dispensaries opening up any more shops. We have very big districts with powerful friendly societies, but we cannot open up dispensaries in those districts because of that State legislation. I suggest, therefore, that there is not much to fear in this regard, because the friendly societies are confined to the number of dispensaries that they had six or eight years ago.

I want to say that the dispensary movement has been a wonderful benefit to members of friendly societies. I have been connected with them for many years. My late father was the first president of the dispensary society in my electorate. It can be seen that I have had intimate knowledge of the growth of this movement, and I know of the great benefits that the movement conferred when dispensaries were badly needed. I am not condemning the chemists in any way, because I know that there are fine men in private practice as pharmacists.

Mr Howson - But the Labour Party wants to get rid of the friendly societies.

Mr THOMPSON - No, it does not. We believe in co-operation, and that is a system of co-operation. I have never heard of any one in my party wanting to get rid of the friendly societies. Every member of my family is in a friendly society. The honorable member for Kingsford-Smith (Mr. Curtin) has just informed me that he has been in one for 40 years. Do not say that we want to get rid of the friendly societies, because it is simply not true. We do not want to do anything that will interfere with the proper functioning of the dispensary movement, side by side with the private chemists. I am not trying to put one on a higher plane than the other. They have both done fine work, and I think that work should continue.

At the present time the only pensioners who obtain the benefit of free medicine are those who hold a pensioner medical card, and this charge of 5s. for each prescription will constitute a great hardship for many others. I refer particularly to single men and single women, whether they be persons who have never married, or whether they be widows or widowers. If such a person applies for a pension and has an income of more than £2 a week he cannot get a medical card. If his income is £2 a week and the pension £4 15s., then he receives in all £6 15s. a week. From this he has to pay rent for a room, or, if he owns a house, he has to pay the costs of maintenance. I do not think, in either case, it is fair to suggest that such a person is in a position to pay as much as the ordinary person in the community, and if we on this side were in government we would see that such a person was given some relief. The honorable member for Werriwa (Mr. Whitlam) mentioned, by way of illustration, a certain drug which he said costs £2 6s. a bottle. I know that it was costing £2 a bottle some time ago in my own State. That was for, I think, 100 tablets. Charges such as this constitute a heavy burden on pensioners and others who have to meet them. The pensioner who holds a medical card is relieved of this burden, but not the pensioner who is not granted a card.

Mr Bowden - The charge will be reduced to 5s. under this legislation.

Mr THOMPSON - The honorable member says that the charge will be reduced to 5s. and I have to admit that that is correct. The charge for quite a lot of these prescriptions will be reduced to 5s. However, we on this side of the House do not believe that a charge should be made at all.

I have very little time left at my disposal, and I want to say a word about hospital benefits. Honorable members on this side believe that every person in the community should be entitled to the same payment for hospital treatment, whether he is in an approved society or not. The Government professes to believe in a voluntary scheme; yet it says that if a person does not voluntarily join an approved society the most he can get by way of Commonwealth contribution towards his hospital fees is 8s. a day.

If he wants the further Commonwealth benefit he must be a member of an approved society. The Opposition believes that the Commonwealth benefit should be paid to everybody, irrespective of whether he is in a hospital fund or not.

I know that the Minister is trying to get over some of the difficulties with regard to unrecognized hospitals, and I appreciate the problems that he is facing. We know that some of these places are really nursing homes for old people who have no one to look after them. They are not real hospitals, in a way, and yet they accommodate many people who would be in public or general hospitals, if they could gain admission to them, getting treatment that they are receiving in the nursing homes. The Minister has said that provision will be made so that if a person in one of these institutions can show that he is suffering from a complaint that would normally gain him admission to a general hospital, and that the institution has the necessary facilities to treat him as he would be treated in a general hospital, then he will be granted the benefit. I am glad that this provision is being made.

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