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Wednesday, 11 November 1959


Mr L R JOHNSON (Hughes) .- I think most honorable members enjoy the contributions made to debates by the honorable member for Hume (Mr. Anderson) and his speech to-day has been no exception. He was at a loss to-day to reconcile his attitude with that of his confreres in the United Kingdom, from where, I understand, he came some time ago.


Mr Turnbull - That is not right. He came from South Africa.


Mr L R JOHNSON - Was it South Africa? But I have no doubt that the honorable member for Hume would have considerable sympathy with the policies of the Conservative Government of Great Britain. I do not think that any member of the Australian Country Party would dispute that.

In view of the honorable member's criticism of the national health scheme I was interested to read a report published in the British Medical Journal of 26th September, 1959. The journal published an extract from the national health policy of the Liberal Party of Great Britain, which reads -

The Liberal Party's election manifesto states that . . Liberals want " better financial control of the Service," and better pay and prospects for administrative and catering staff.

The party is anxious to swell the cost of the service in this way. The report continues -

The Party supports, in the interests of national economy, the charges imposed in 1951 for spectacles, dentures, and prescriptions, but is against the extension, made in 1956, of the ls. charge to each item on a prescription. It voted against this, it is said, because it would bear heavily on old people, on the chronic sick, on patients with large families, and on those with a small fixed income.

I should imagine that the honorable member for Hume would be at a loss to know where he stands in the face of that declaration by the Liberals of Great Britain - people who may be said to have similar political beliefs to the honorable members who grace the Australian Country Party benches in this House. There is no question that the Minister for Health (Dr. Donald Cameron) has panicked as a consequence of the increase in costs associated with the national health scheme in Australia. That increase has been similar to increases that have occurred in most parts of the world. That is so in most countries where there is any government participation on a grand scale. It is the case in the United Kingdom just as it is in Australia. But there is no doubt that the Australian situation is contributed to very substantially by the inflationary situation that has been allowed to develop unchecked by this Government.

Our serious financial situation in regard to national health has been brought about by inflation and rising costs. The fact that our budget revenue increases substantially every year is often mentioned. I think that before the war it was almost unprecedented to have a budget in excess of £100,000,000, but to-day we have an estimated revenue of £1,391,000,000. In view of that increase in revenue I do not think it can be said that the cost of national health has increased unduly. It is a fair thing to say that the Government is concerned because the pharmaceutical benefits scheme in this country, which cost £7,600,000 in 1951-52, cost almost £21,000,000 in the last financial year. It is possible that the cost will rise to £24,000,000 or £25,000,000 this year. With regard to hospital benefits, the cost has risen from £7,200,000 in 1952-53 to £14,800,000 in 1958-59. That cost is a considerable drain on the national health scheme. The cost of medical benefits has increased in a similar way. I understand that in July, 1953, the cost of the medical benefits scheme was £4,200,000, but that cost rose to £7,800,000 in 1958-59.

The bill has three purposes. Its first purpose is to impose a charge of 5s. on all prescriptions dispensed under the pharmaceutical benefits scheme. This imposition will produce revenue amounting to about £5,000,000. It is generally understood that hitherto there was no charge for certain drugs. Many honorable members on this side of the House take the view that it would have been far better to provide less in the way of tax concessions if this additional £5,000,000 was needed to bolster the Government's participation in national health activities. We feel that the tax concessions will be of little benefit to the under-privileged members of the community who can ill afford to pay this charge for prescriptions.

The second purpose of the bill is to change the arrangements under which special account benefits are paid to the aged and chronically ill. I think this is highly desirable. It meets with the concurrence of most honorable members. We are pleased to see a more liberal interpretation by the Government of what is a recognized hospital. In my electorate there is a hospital maintained by the State Government for aged and chronically ill people which has not been recognized under the national health scheme and I am pleased to know that that situation will be rectified under the new arrangement.

The third purpose of the bill is to increase payments in respect of 140 items out of 1 ,000 under the schedule of medical benefits. We are told that the benefits for some classes of surgery will be as high as £60. During the course of this debate many honorable members, including the honorable member for Batman (Mr. Bird), have indicated that the proposed scale of benefits - as high as £60 - will in no way meet the actual cost of operations. A great deal remains to be done in this direction. We have been told that the benefits in respect of certain major operations will be doubled, but we have received no assurance that doctors' fees will not be increased substantially. The House is buzzing with rumours, reliably founded, that doctors are contemplating substantial increases in fees as a direct consequence of this measure.

The Opposition is not impressed with the Government's idea of a health scheme.

We consider this to be an apology for a scheme. We do not think that it compares with the scheme that has operated in New Zealand for some twenty years and which has found favour in all sections of the New Zealand community, whether they vote Labour or Conservative. In the United Kingdom a comprehensive and allembracing national health scheme has been in operation for ten years, and all political parties are giving it great support. At the end of its ten years' operation we find that not only the members of all political parties, but also members of the medical profession and distinguished medical men who visit that country, consider that the scheme is contributing in no small measure towards the raising of health standards throughout the United Kingdom.

We consider that the amendments proposed under this bill will be completely incapable of changing a scheme that is basically unsatisfactory. We consider the scheme to be inequitable and unreasonable, and we have no doubt that throughout the Australian community it is most unpopular.

The Minister, in his second-reading speech, showed some enthusiasm for this scheme that the Government has had in operation. He said -

It is, of course, a matter of great satisfaction to this Government that there has been such strong public support for the purely voluntary scheme which we initiated and fostered.

Those of us on this side of the House who have studied the bill cannot understand the Minister's reference to a purely voluntary scheme. We cannot see anything voluntary or spontaneous about a situation in which people are forced by economic circumstances to fall in with the Government's arrangements if they are to obtain any benefit at all. We do not think there has been strong public support, and, in fact, the figures indicate otherwise. A survey of the various funds has revealed that of 10,000,000 Australians only 2,700,000 are contributors to the various hospital and medical funds. This has been interpreted to mean - and I am in no position to argue with the interpreters - that 6,700,000 of the Australian people are covered as a result of 2,700,000 having contributed to the various schemes. This is because some, of course, have contributed for their families as well as for themselves. But there has been no substantial or dramatic growth in these figures. There was an increase last year of only a miserable 3 per cent, over the figure for the previous year.

We suggest that the situation can be likened to a shot-gun wedding. The position is simply that the people have not wanted this contributory scheme, any more than the Liberals in the United Kingdom wanted the contributory ls. arrangement. However, the Australian people have found it necessary to comply with the Government's wishes for economic reasons. Most people resent the fact that they are required to belong to a private organization in order to obtain the benefit for which they have contributed by way of taxation.

There are some very important reasons why this scheme cannot be considered a national health scheme. First, a large number of people have chosen not to have a bar of the scheme at all, and are not covered by the various hospital and medical funds. Then there are those who have taken less than the maximum coverage.


Sir Wilfrid Kent Hughes - What are the figures?


Mr L R JOHNSON - I have already given the House some figures in this regard. I have already indicated that there are only 6,700,000 people with any coverage at all. Of that number there would be a good proportion who have only the minimum coverage. Until a short time ago a single contributor could pay anything from 9d. to ls. 6d. a week to a medical benefits fund, while family contributors could pay between ls. 6d. and 3s. Hospital contributions for single contributors ranged between 3d. and 2s. a week, and for family contributors between 6d. and 4s. It is a fair assumption that if you pay only 6d. a week you will not get anything like the coverage that you would by paying 4s. a week. In other words, people pay to the extent that their incomes permit. No one can deny that this scheme involves a means test of the most pernicious variety. It fixes the amount of benefit according to one's capacity to contribute.

Ironically enough, we find that over the years in which the Government has had this scheme in operation, even the person contributing the maximum amount has not been fully protected against all eventualities involving sickness and accidents. Although some of the so-called life-saving drugs have been made available to those suffering from certain ailments, it has been the experience of every family that for a great variety of what might be called ordinary household complaints no remedy has been available under the scheme. Whether you have paid the maximum amount or the minimum, you have never in any circumstances had full coverage and real social security of the kind available under the schemes operating in New Zealand and Great Britain. It ls fair to say, therefore, that our scheme is a mere shadow of those which honorable members of the Country Party and the Liberal Party tend to condemn at every opportunity. There are many families which incur chemists' bills of £2 or £3 a week, even though they have been contributors to the various funds for many years. In these circumstances, no one can describe the scheme as a national health scheme.

The list of available drugs is now to be extended to cover the items in the British Pharmacopoea, and if this represents an improvement every one will be pleased about it. But the Government has also introduced the 5s. levy on prescriptions. It has done this without any mandate from the people, quite surreptitiously, in the first year after the election campaign. On whose authority has the Government done so?


Mr Duthie - The back-room boys!


Mr L R JOHNSON - Yes, the backroom boys, and there is no doubt that there is a strong reaction to this imposition throughout Australia. We no longer have a free medicine scheme, if we ever did have one. Do not forget that it is quite likely that this imposition is. only the thin end of the wedge. What might this Government do on some future occasion, in the year after an election? Is it not likely that, for precisely the same reasons as it has imposed this 5s. levy, the Government will increase it to 7s. 6d., 10s. of 15s.?


Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - And then reduce it just before the following election!


Mr L R JOHNSON - That is so. That is the way this Government has worked.

As the honorable member for EdenMonaro says, it is possible that just before an election there will be some reduction in the amount of the levy. How can this Government justify the principle of a flatrate payment for these prescriptions, which amounts to a tax on all sections of the community? It is beyond all dispute that additional revenue is required for these purposes. We of the Opposition agree that this is so. But on what new principle - or lack of principle, if you like - has the decision been made to abandon the capacity-to-pay practice in raising government revenue for these purposes? What is the reason for discriminating between the national health scheme and other social services? After all, when we think of child endowment, age and invalid pensions, widows' pensions, repatriation benefits, maternity allowances and all the other social services, we take the view that the community should contribute according to capacity to contribute. He who receives the largest amount of income should pay at the highest rate, the amount then being reduced according to a sliding scale. What is the reason for discrimination in respect of the national health scheme? Our approach to these matters hitherto has been to increase the contribution according to the increase in income, but here we have a significant departure, and the perpetuation of this novel principle - or absence of principle - will result in the rich being relieved of their obligations at the expense of the poor. The basic wage earner will contribute precisely the same amount as a company director receiving £10,000 a year.

Then we have the unsung and unheralded means test on the pensioner medical service. Pensioners who have a separate income of £2 or more, giving them a total income of £6 15s. a week, will be paying precisely as much as any member of this Parliament, all of whom are in far better circumstances. If the honorable member for Hume and those who sit opposite are happy about that state of affairs, we would like them to be vocal about it in the period preceding the next federal election. We have made our position quite clear despite the consequences of the wrath and venom of those who might dare to prejudice us as a result of our stand. We think that honorable members on the Government side have an obligation to do precisely the same thing.

People are to pay 5s. for each prescription. Where will this policy cease? Surely, if, in the Government's view there is no place for discrimination in regard to charges for national health, the time may not be far distant when we can expect an onslaught on the very basis of taxation which this country has known and come to understand for so many years. And all this about a scheme which is most unsatisfactory, anyway!

What a frail, intangible shadow of the British health scheme is represented by this emaciated form, this skeleton of a scheme which is foisted on the Australian public! Can anybody be proud of it? Is there any reason to be proud of it? Let us look at some of its most apparent deficiencies. First of all, I direct attention to the lack of any dental coverage compared with that in the scheme to which I have referred. There is no dental coverage for school children. Apparently there is no plan in the mind of the Government to introduce or initiate a scheme of this type to ensure that all Australians will have protection in this matter, regardless of their situation.

History will repeat itself. The Australian Labour Party has to take office every decade or so and pioneer legislation based on humanitarian principles and in the long run governments of the present kind reluctantly acquiesce in it. Optical services are omitted from this scheme. Can honorable members who sit opposite be proud of that? The scheme is working in other countries where a person, if he has defective vision and needs spectacles or finds it necessary to have his eyes tested, can obtain these services free of cost. Does any honorable member opposite deny that? Let the next honorable member who speaks on the Government side say whether he agrees with that or not. We want to hear whether honorable members opposite think that these people should not be allowed to participate in a benefit of this kind. Children of the low income-earners should be able to get spectacles if their eyesight is defective. They need the assistance of spectacles to enable them to do their school work properly and to earn their living when they leave school. Let us hear from honorable members opposite what they think about this omission, because so far the Government has ignored people of these circumstances completely. It is to the eternal discredit of this Government that these services are excluded from the health scheme and it is high time that the position was looked at. Australia is dragging the chain in these matters.

There is a limit also to hospital benefits. Many people think that if they belong to a hospital benefits fund they are covered indefinitely in all circumstances. But the truth is that there is a limit of 84 days - twelve weeks in twelve months - and this is very poor treatment. Who is the person most affected by this limit? It is the person who has been out of employment for a long time; it is one who has been extremely sick; it is one whose liability on his home or his car is mounting to high and very disturbing levels. But what happens in these circumstances? The attitude of the Government and of the funds is, in effect, " Our patience and tolerance are exhausted. We will give this unfortunate away. He is no longer going to be accommodated in our scheme." Where is the moral principle in an attitude of that sort? Can the Minister sit smug and complacent in the face of this situation?

The benevolence of the Government runs out in these circumstances. The milk of human kindness turns sour. It is nothing to smile about. If honorable members who sit opposite would go around the hospitals, as I do Sunday after Sunday and meet these people, they would find how difficult are their circumstances, but no extra consideration is given them. Indeed, they are denied the consideration which is extended to those who are the most fortunate.

There are those also affected by the lack of adequate provision for confinement. The period of fourteen days is laid down for confinement. A woman who is required to stay in hospital for longer than fourteen days is often one whose husband has been involved in a great financial outlay. There are such. If any honorable member goes along to the local hospital and makes inquiries he will find that the period of confinement is limited to fourteen days. Maternity costs have risen greatly. This Government has certainly failed to meet its obligations with regard to the maternity allowance. This benefit has become smaller and smaller, proportionately to the basic wage, ever since this Government has been in office. There are good reasons why people who are confined for periods of longer than fourteen days should receive additional consideration.

There are those post-maternity cases also who, because of adverse circumstances, are admitted to Tresillian, Karitane and similar nursing homes. What is happening to them? They are not generally covered by this scheme, unless the child is sick. But if the mother is sick and it is essential for her to attend at one of these clinics for advice about feeding, training and matters of that kind, or if she is a neurosis case following the birth of her child, she, too, is excluded from benefit. What is the miserable, paltry reason for picking out people of this type for exclusion?

Of course, repatriation cases are excluded from benefits under this scheme. We are told that one-third of all the claims accepted by the Government are rejected by the funds for different reasons. That is a pretty shocking state of affairs!

As to those covered by insurance, the scheme provides that where a contributor or dependant shall be entitled to recourse against third party, whether at common law or by statute or by any insurance, benefits shall not be paid. What is the reason for that provision in a contributory scheme? Why should a person be excluded from its benefits if he has taken the trouble to insure? Is the Minister satisfied about that? Will he fail to answer this point and the other points I have mentioned?

Then there are those excluded from benefits where misconduct is involved on the part of a contributor or his dependants. Who determines misconduct? It is a moot point. I suppose the fund makes a decision but it is another feature of the scheme which is a source of great aggravation to most contributors.

Another ground which precludes benefits from being paid is alcoholism and drug addiction and their effects. Why should people addicted to alcohol and drugs be excluded from the benefits of this scheme? Has any one any idea at all? Why should the unfortunate who has become subject to alcohol or drugs, the man who really needs attention, be denied? He might be a doctor or a successful businessman, but he is excluded. A tuberculosis sufferer, after the date of his positive diagnosis, is also excluded from the scheme. This is not a national health scheme.

What about those who suffer from mental diseases and disorders? There are probably nearly as many beds in mental hospitals to-day as there are in ordinary hospitals, but people suffering from mental diseases or disorders are not covered by this Government's health scheme in any way.

Then there are those in that great category who are excluded by reason of default or other technicalities. Some fail to keep up their payments and if they become unfinancial for two calendar months they are excluded. Their failure to pay may be due to sickness or unemployment and because of the Government's failure to help them with sickness or unemployment allowances they are unable to keep up their contributions and so fall out. Another group consists of those who cannot obtain benefits because of an insufficient qualifying period of two months. If they become sick within that period they cannot claim any benefits. Because of these pin-pricking technicalities, many fall by the wayside here.

Then there are those who fail to transfer from the dependant category on their seventeenth birthday. They may be ordinary, healthy, wholesome Australians but because they have not been advised by a lawyer or reminded of the need to change over from the dependant category to the single category when they turn seventeen, they are excluded from fund benefits. I know of many people who have been prejudiced on this account. There are those also who do not transfer from the single rate to the family rate upon marriage. This can have very serious consequences in respect to obstetric benefits, because these are not payable to single rate contributors.

Members on the Government side seem to think that these are things to laugh about. If they are so laughable and unimportant why have these exclusion provisions in the scheme? Many people going through times of anxiety or sickness overlook or are not financially able to meet their obligations. This is an indication of how this scheme is not comprehensive as are the national health schemes of the United Kingdom and New Zealand.

It is recognized that the Commonwealth has very limited powers on national health. The powers that it has are derived from an amendment to section 51 of the Constitution, which unfortunately arrived only in 1946 as a consequence of a referendum on the Consttiution. This was a great year for medical health. It was the year when the British Labour Government first legislated on these matters and it was the year when the Commonwealth acquired some powers over these matters. Ironically, the word " health " does not appear in the Australian Constitution. I cannot find any reference to health in any of the 62 pages of the Constitution. The States have the responsibility to provide services in respect of hospitals, mental hygiene establishments, baby health centres and the like, but they depend on the Commonwealth to sustain them financially.


Mr Anderson - They have their own taxing powers.


Mr L R JOHNSON - You had better take a bit of a lesson before you get too involved in financial matters.







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