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Wednesday, 11 November 1959

Sir WILFRID KENT HUGHES (Chisholm) . - The honorable member for Hughes (Mr. L. R. Johnson) has hardly done credit to the name of his constituency. He has lashed himself into a passion of frustration because the Government's health scheme has proved to be most successful, when compared with the efforts of his own party. He worked himself into a synthetic frenzy about all sorts of conditions of men who are not included in the scheme, and finally lost himself in complicated verbiage; he was not quite certain where he was going, or what the scheme was doing. The fact is that the Government and the Minister for Health (Dr. Donald Cameron) can congratulate themselves on having established what is acknowledged to be, if not the best, then one of the best health schemes or a health scheme second to none in the world. The right honorable member for Cowper (Sir Earle Page) introduced the scheme, and we should all pay a very great tribute to him.

I cannot help but be slightly amused to hear the honorable member for Hughes and other members of the Australian Labour Party say that we should adopt everything that has been done in the British scheme. They object very strongly to the prescription charge of 5s., but if they had taken the trouble either to listen to the right honorable member for Cowper last night, or to investigate the British scheme, they would have known that it was Mr. Bevan who instituted the charge of ls. for a bottle of medicine. In other words, the Labour Party in England tried to put a brake on the rising costs of the scheme by adopting methods similar to those now being adopted by this Government. The charge did not work in England, and I do not believe that it will work here. I am much amused, therefore, to find the Australian Labour Party criticizing this provision, but advocating that we should follow the British scheme, when it was the Labour Party in England that introduced the principle.

I am interested, and also faintly amused, to find that we are, apparently quite inadvertently, now proposing amendments to the pharmaceutical benefits scheme which I believe are totally unconstitutional because of an amendment moved by our Prime Minister (Mr. Menzies) when he was Leader of the Opposition. Placitum (xxiiA.) of section 51 of the Constitution states -

The provision of maternity allowances, widows' pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), benefits to students and family allowances:

I know quite well that when that provision was included the intention was to ensure that there would be no civil conscription, whether of pharmaceutical benefits or medical benefits. However, the Minister made quite clear in his second-reading speech that this 5s. charge .is to be compulsory, because if a chemist does not make the charge, his licence will be taken away. The Minister said -

As a breach of a condition of approval makes a chemist liable to have his approval terminated the legislation gives full effect to the Pharmaceutical Guild's expressed request that the charging of the fee should be mandatory on chemists.

It seems to me that this very definitely amounts to civil conscription. I am quite certain that the Government is doing this inadvertently. If we were in Opposition, I would say that the Government was taking a long step down the road to nationalization of the pharmaceutical industry by stealth and deception, but I am perfectly certain that the Government is not doing that, but is acting inadvertently. Because of this principle, I am not happy with the bill.

I approve of what is being done with the medical benefits, because the Government is extending them. I am very strongly in favour of, and congratulate the Minister on, the amendment which allows those suffering chronic illnesses to come now within the scope of full medical benefits. I know that the area of medical benefits is being very considerably extended and, therefore, I wholeheartedly agree with the Minister and congratulate him on what he is doing. But I must confess, as an old parliamentarian, that I would have liked this to be done a little more effectively and Parliament taken more into the confidence of the Minister on what will actually happen with regard to costs and fees. We have not been given any figures. I suppose that somebody will say that we can search them out in some records somewhere, but, when we are asked to deal with these amendments, I think that the figures should be in the Minister's second-reading speech. We have not been given any information as to the results of the operations of medical benefit insurance companies. I understand that some of them have built very large reserves; others may not have done so. But in any case, very little attempt has been made to estimate accurately what the increased costs will be and what the effect on the insurance fees will be. As a sort of rough estimate, the increased rate of contribution might be 3d. or 6d. in certain cases. I suggest to the Minister that the House would have been considerably assisted if more details of the results of the operations of these medical benefit insurance companies had been included in his speech. He said -

Before the plan comes into operation on 1st January next, every contributor will be able to get exact information from his own organization regarding the cost of insuring for the new benefits.

I should think that 99.9 per cent, of contributors would not be sufficiently au fait with the situation to make a special visit to their organization to find out what the cost would be. I certainly hope, therefore, that the organizations will send this information to their contributors, despite the increase of Id. in postage. However, I do not want to spend much time discussing medical benefits. As I say, the Government is to be congratulated on what it has done. One result in Melbourne of the hospitals benefit scheme is that a large number of private hospitals have come into existence and there is now a surplus of beds in public hospitals. That is very good. When the honorable member for Hughes was throwing his criticisms around in a broad, open-handed way, he forgot to mention, for instance, that tuberculosis had been practically eradicated as a result of the action taken by the Government under the previous Minister for Health, the right honorable member for Cowper, and the present Minister for Health. He forgot to mention all sorts of benefits that have been derived from the scheme that the Government introduced and has very successfully operated.

I am not at all happy with the pharmaceutical benefits aspect of the matter. In the first place, I think that if it were tested it would be found to be unconstitutional. But leaving that aside for the moment, I do not think that the main purpose of the amendment will be achieved. Again, may I refer to the speech that was made by the right honorable member for Cowper who is far more experienced in these matters than any other honorable member in this chamber, and I am only sorry that there was such a thin House last night when he made his speech. Although he was not overseas on official business, he investigated the working of insurance and health schemes in other countries, and particularly in Great Britain. He said that he had had a long interview with the DirectorGeneral of Health in Great Britain, and he went on to say -

The Director-General told me that unfortunately that-

That is, the charge of ls. for every ingredient in every prescription - did not stop the rising bill either ... I believe that the method we adopted of providing hospital benefits and medical benefits by voluntary insurance should be adopted in regard to medicine also. I believe that chemists throughout Australia should organize themselves, as the medical profession has organized itself under the medical benefits scheme.

I agree entirely with the right honorable member for Cowper and with the honorable member for Paterson (Mr. Fairhall), who supported him. I believe such a proposal to be the only solution of the problem which has arisen with respect to free medicine. I direct the attention of honorable members to the fact that the charge of 5s. is for one unit in a prescription. The prescription may be for pills, a lotion or a medicine which contains other drugs. Thus, there may be three items in the one prescription which will attract a charge of 5s. each so that the patient will have to pay 15s. for one prescription. Why should this 5s. charge alter the existing position in any way? A doctor may feel that his patient would probably need only drug A to cure him, but because the patient will not have to pay for it, he may prescribe drug B which is much more expensive and will perhaps work more quickly than drug A. What difference will it make if the 5s. relates to drug A or drug B? In cases where expensive drugs are prescribed indiscriminately, the 5s. fee will not make any difference to the rise in the cost of the scheme.

Furthermore, it will not be easy for the chemists to collect their money, particularly chemists in country areas. In passing, might I ask the Minister to encourage his officers who are responsible for administering these schemes to exercise a rather more sensible outlook than they have in the past. I know of a case in which they returned to a chemist a prescription which had been dated by the chemist and by the patient at the time when it was made up and when the medicine was handed over, but which had not been dated by the doctor when he made it out. Apparently he had forgotten to put the date on it. The prescription went through all the channels from the chemist to the department, and then went through the same channels in reverse to the chemist with the request that he have the doctor date it. That sort of thing does not engender confidence in any scheme. I know that such a practice is not general, but I should like the Minister to inform certain people, who apparently do not understand very much about administration, that they should try to avoid such stupid actions in the future.

Friendly societies, particularly those in Victoria and South Australia, have been operating dispensaries in competition with members of the Pharmaceutical Guild. If there is to be a prescription fee of 5s., why should the present arrangement between the friendly societies and the guild be disturbed? Why should there be any distinction? If a friendly society finds that it has to pay the 5s., it can increase its subscriptions to cover it, but why make a distinction between one set of pharmacies, or dispensaries, and another, whether the proposal is unconstitutional or not? It is no good saying that there is a difference between the closed shops and the open shops. I know the Victorian friendly societies act, and the closed shop can become an open shop quite easily. Already in one district in Victoria one man is accepting new members on a subscription of 6d. a month, or some such infinitesimal sum.

Mr Thompson - Is not the dispensary member taking up a voluntary insurance?

Sir WILFRID KENT HUGHES - If you are to have all voluntary insurance, all right, but if you say that there shall be a compulsory fee for every prescription, why differentiate? I am not against friendly societies; I am all in favour of them. It is wrong in principle to make something compulsory on one person and not on another. To date, the friendly societies have not been carrying the 5s. fee. They have fixed a fee for their voluntary insurance which excludes the 5s. Therefore, why not make the scheme allembracing, if it is to be compulsory, and say to them, "You must adjust your fees on the voluntary insurance, but must charge the 5s.".

Mr Thompson - Then for what services will the members pay the voluntary insurance fee?

Sit WILFRID KENT HUGHES.Friendly societies provide all kinds of insurances. I am not against them. I think that they have done a very good job. But why do we pick out A who sells a certain drug and say to him, "You must collect 5s. on that prescription " and then say to B, who sells the same drug, " You do not have to collect the 5s."? If there were no distinction, the existing difficulties would be overcome.

I agree wholeheartedly with the right honorable member for Cowper. I should like to see the whole thing on the same basis as the medical benefits scheme, and then the people concerned would be more careful as to the number of drugs that they have in their cupboards because, if we have to pay for something, even if it is a small fraction of the total cost, we will be much more careful than we would be if we knew that somebody else would pay the total cost.

I am concerned also that no agreement has been reached with the Pharmaceutical Guild on the new rates of charging. I know that it has been said that the act will not be proclaimed until agreement has been reached, and that it is not anticipated that there will be any difficulty in reaching agreement. I have been in Parliament for 32 years and I know that anybody who accepts such a statement in all good faith is on very shaky ground. I have no reason to doubt that the Minister has spoken in good faith, and I am not pointing the bone at him when I say that he may not be the Minister to-morrow. Governments come and go while agreements of this kind are being consummated. It is highly dangerous to pass a bill and then say that it will not be proclaimed until a certain agreement has been reached.

We on this side of the House talk about our opposition to nationalization. I know that the guild has asked for an independent arbitrator on the advisory council. But whether there is an independent arbitrator or not. I understand that the Minister makes the final decision as to prices. When a government imposes a compulsory charge and whan a Minister makes the final decision with regard to prices, we are getting so close to nationalization that we will not have to take very many more steps along that road before we haw; a socialized pharmaceutical industry. For that reason, I am against the Government's proposals on this matter.

I do not understand why, if the cost of expensive drugs falls in other countries as larger quantities are produced, that general pattern is not followed here. I ask the Minister to make some inquiries of the wholesale suppliers as to what is happening to make the pattern in Australia completely different from the pattern in other countries.

I do not want to speak at any length on this bill, but I feel, as I said earlier, that the right honorable member for Cowper and the honorable member for Paterson really put their finger on the weaknesses of this bill. I believe that they have suggested the only way to overcome the difficulties in which the Government finds itself in order to be fair to the patient, the taxpayer and the chemist. I approve wholeheartedly with the medical benefits provisions in their present form. But I do not like the proposed 5s. charge for prescriptions and I hope that this provision will be amended in committee. I hope more consideration will be given to the proposal, because it seems to me to be another case of the extension of bureaucratic control. I do not like making charges against people who cannot defend themselves in this House, so I will leave it to the Minister to have a look at this whole matter.

We are told what overseas countries did in an effort to prevent the costs of their health schemes from continuing to rise, and that the Government has decided to try the same method in Australia. The right honorable member for Cowper has proved to us that the method used overseas to keep down costs, which the Government is now to try in Australia, did not succeed in doing so. The Government now proposes to include 90 per cent, of the dispensing business under Government control as against 50 per cent, in the past, and it will not be long before the figure will be 100 per cent. This is another instance of how close we are getting to nationalization.

So I ask the Government to give the second half of the bill much more serious consideration than it apparently has had at present. I hope it will allow a full discussion on that part of the bill, in committee. Personally, I would rather have the provision postponed than amended, because I do not think that it will have any effect on Budget receipts. The Government may gain £5,000,000 as a result of this proposed 5s. charge for each unit of each prescription, but with the increase of the number of drugs on the list the cost of pharmaceutical benefits will rise well above the present cost of £20,000,000. It may rise by another £10,000,000, but let me be conservative and say that it will rise by £5,000,000. So the proposal will not benefit the Government on the revenue side in the first year, because the receipts from the 5s. charge will be completely offset by the increased cost of the larger number of drugs.

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