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Wednesday, 11 November 1959

Mr TURNER (Bradfield) .- The honorable member for Bendigo (Mr. Clarey), like all members of the Opposition who preceded him, extolled the virtues of a nationalized health scheme and condemned the health scheme that has been proposed and carried into effect by the Government. The right honorable member for Cowper (Sir Earle Page) has already pointed out in the course of the debate that the Commonwealth Parliament does not have the power that would enable it to put into effect a nationalized health scheme, even if it wished to do so. The gaps in the Government's scheme have been grossly exaggerated by all Opposition members. For example, there has been no word of praise of the scheme which has largely eliminated and will ultimately eliminate completely tuberculosis in this country. That is a very great achievement.

Mr Pollard - You inherited it from the Labour Government. What are you talking about? Why don't you wake up?

Mr TURNER - This Government has had to provide the money for it and that scheme has -been a tremendous success. Now there is another scheme, and I think that the honorable member who has just interjected will noi deny that this was not inherited from the Labour Government. I refer to the very vigorous measures which were taken by the Government to deal with poliomyelitis. I presume that the Opposition will not deny credit to the Government for that achievement. They were two great scourges with which the Government has dealt.

The scheme instituted by the Government is very well fitted to our circumstances, and I should like to quote a few words from a book written by Mr. Walter Hagenbuck in 1958 called "Social Economics". He referred to the choice that the British Government had at the time it instituted a nationalized system. He said this -

Could not the gaps have been filled by an extension of health insurance? . . .

He went on to refer to other methods which could be used, and stated -

Would there not still have been a useful field for private practice and voluntary hospitals, to offset the dangers of top-heavy organizations, political influence, and restricted freedom which sometimes arises in comprehensive national institutions? The answer is probably: Yes, had it not been for the experience of the war. It was that experience which prepared the ground for the acceptance of the national health service proposed in the White Paper of February, 1944. The danger of air attack necessitated, during the war, a nationally organized system through which medical services and equipment could be immediately applied where they were most needed.

He also said -

Distinctions, real or imaginary, between different classes of people, became meaningless in face of air-raids. . . .

And again -

All this was of tremendous importance at a time when post-war reconstruction was widely regarded as a job which would command the same national solidarity as had the task of winning the war.

He clearly envisaged that at the time the British Government decided to institute a national health system, it could equally, and with certain other advantages, have instituted a scheme of health insurance such as we have in Australia. The reason the British Government made the decision it did was due entirely to the circumstances of the war, involving air raids in the United Kingdom. Those circumstances do not apply here, and the system that we haveinstituted is the one that is more consonant with our traditions, our customs and theform and practice of our health system.

The honorable member for Bendigo, again like all other members of the Opposition, while giving no credit to the Government for the gaps that it has filled in the scheme of national health, has thought of a large number of other free services that might be provided- The honorable member for Hughes (Mr. L. R. Johnson) this afternoon thought of a great many more.

It is easy for any member of the Opposition, for any member of this House, for any member of the public and for any person with a little imagination to think of 101 ways in which more free health services might be provided. Why are not these services provided? They are highly commendable; why are they not done? In 1956, the Guillebaud Committee in the U.K. was appointed - to review the present and prospective cost of the National Health Service.

At the end of its report, it made a comment which is very relevant to our situation or to the situation of any country contemplating a health scheme, or, indeed, any other expenditure. It said -

It is clear that the amount of the national resources, expressed in terms of finance, manpower and materials, which are to be allocated to the National Health Service, must be determined by the Government as a matter of policy, regard being had to the competing claims of other social services and national commitments, and to the total amount of resources available.

Of course, we could improve the national health scheme in many ways with the expenditure of large sums of money. Of course, we could improve housing condi tions or defence arrangements and many other matters, if we had unlimited money. But the task falls on every government to allocate limited resources. I believe that the Government has obtained the best value for its money by expending it in the way that it has on the present health service. I do not propose to say any more on that matter. The scheme is a good one. It has, I think, been accepted by the people and they are glad to have it.

The honorable member for Bendigo then spoke about the failure of the Government to provide by this bill for those inmates of benevolent homes who might for a time have to be placed in the infirmary attached to those homes because of real illness. Had he read the speech of the Minister for Health (Dr. Donald Cameron) he would have read this paragraph -

The new definition will in addition provide that individual patients in homes which are not eligible for recognition will be entitled to payment of special account fund benefit, when they can establish, first, that they were suffering from an illness or injury requiring the treatment of the kind provided in public hospitals; and, secondly, that the treatment provided was of a standard substantially equivalent to that which they would have received in a recognized public hospital.

In other words, if an inmate of a benevolent home is for the time being placed in the infirmary attached to that home and is receiving what amounts to hospital treatment, a special application can be made for the patient to receive the full hospital benefit.

The honorable member for Bendigo complained of the imposition of the 5s. charge for medicine. What appears to be overlooked by members of the Opposition is that this is not a 5s. charge that is imposed and has become a new burden on the people; the fact is that they will benefit from it. Formerly, they were paying more than 5s.. The result of this scheme will be that the Government will in fact be handing out more money for drugs than it did in the past and, of course, the public must get the benefit of that. They are not being compelled to pay 5s. when they paid nothing before; they are being permitted to pay 5s. when formerly they would have had to pay much more. Therefore, I cannot agree with the honorable member for Bendigo that this is a great imposition on the people. Indeed, it is precisely the reverse.

He is on firmer ground when he speaks about those people who are precluded from the benefits of the pensioner medical service because, in addition to their pension, they have an income that exceeds £2 a week. Those people who just fail to qualify for the pensioner medical service are in very poor circumstances. This means test was imposed in 1955, and as inflation in the interval has marched on to the extent of approximately 12 per cent, the limit of £2 should be increased to at least £2 5s. merely to keep pace with inflation, quite apart from whether one regards the £2 as having been a reasonable figure in 1955. So the honorable member, although he did not draw the conclusion that I have drawn, is on firmer ground when dealing with this subject.

I have not the time to pursue his arguments any further. He, like other honorable members opposite, had a great deal to say about the impositions upon pharmacists. The Minister is in negotiation with them, and I believe that some satisfactory arrangement will be reached. The honorable member for Bendigo complained that pharmacists are in a minority on the committee that, advises the Minister in relation to charges. Somebody has to decide these matters, and I suppose the honorable member would not expect that the pharmacists should write their own cheque.

Mr Clarey - No, but I want an independent arbitrator.

Mr TURNER - The honorable member wants an independent arbitrator on the committee. That may be a reasonable proposal, but I think that we should wait until the negotiations are concluded. We may then find that agreement has been reached.

Having referred to the speech of the honorable member for Bendigo, I now pass to some of the matters that I hope to mention in the time that remains to me. This bill does several things. It makes certain amendments to the medical benefits scheme. It increases the Commonwealth contribution to the funds of the medical benefits organizations by £425,000, and it does it in such a way that increased payments will be made on 140 items that appear on the relevant schedules. For instance, in respect of major surgery the benefit payable to the contributor will be increased from £30 to £60. For a very good reason I congratulate the Minister on having done this. When participating in the debate on the amending legislation on 23rd September, 1958, I urged that the benefit payable for major surgery should be increased, and I am gratified that it has now been done.

In 1954-55 the Commonwealth contribution towards the cost of doctors' bills was 30.9 per cent, of the total account. Through inflation, this proportion fell to 28.5 per cent, in 1958-59. Had the proposed additional contribution of £425,000 been made in the financial year 1958-59, the proportion would have been restored to 30 per cent. It is evident, therefore, that the increased amount that the Commonwealth will now make available will restore the Commonwealth contribution towards the cost of medical accounts to the proportion that existed at the inception of the scheme. I believe that the Government is restoring the proportion in the best possible way, that is, by providing increased benefits where they are most needed, because we all appreciate the high cost of major surgical operations.

I wish to deal now with the criticisms that were made by the honorable member for

Eden-Monaro (Mr. Allan Fraser), who led the debate for the Opposition. He said that the proposed increase would be gobbled up by the doctors. What I have to say may not be a matter of very great interest to honorable members, but I have approached this aspect in an entirely academic spirit in an endeavour to find out in a purely scientific way and without any desire to find one answer rather than another, whether in fact the doctors, since the inception of the scheme, have gobbled up the Commonwealth contribution. I can prove to the satisfaction of the House, or to the satisfaction of those honorable members who choose to read what I say, that the medical profession has not exploited the public purse. Of course, particular instances would be no basis for making a judgment. How then does one assess the increase in doctors' charges? The total amount paid to doctors by fund patients in 1954-55, which was the first full year of the operation of the scheme, was £13,584,716. That figure rose to £27,309,455 in 1958-59. Of course, that does not mean that fees have doubled. They have not. The number of fund patients has increased greatly in the interval. The primary contributors to the scheme in 1954-55 - of course a secondary group benefited, namely, the families of contributors - numbered 1,665,524, and this figure increased to 2,666,984 in 1958-59. Can it be assumed that exactly the same increase was evident in doctors' services for each patient during that period? Of course, it cannot. On the average, in 1954-55, 6.215 services were provided for each patient, and in 1958-59 the number of services was 6.487.

Obviously the relevant matter that must be taken into acount is the increase in the average cost per service. In 1954-55 the average cost was £1 9s. Id., and by 1958-59 it had risen to £1 12s. 9d. That represents an increase of 12.6 per cent. However, a correction must be made to meet the decline in the value of money in the interval. The Statistician's C series index rose from a figure of 2,678 in 1954-55 to 3,024 in 1958-59. This represents a rise of 12.1 per cent. I have come to the conclusion, therefore, that doctors' fees rose by 12.6 per cent, and the value of money declined by 12.1 per cent. Clearly, fees have risen by no more than the decline in the value of money. There has been no exploitation by medical men.

The honorable member for Eden-Monaro made a charge that has been bandied about by other honorable members opposite. The figures that I have given are a complete refutation of that charge. If honorable members opposite are not interested in the honour of the medical profession, I am. However, the Commissioner of Taxation should make a study of this matter and submit a report each year similar to the report that he submitted in 1955-56 in relation to the earnings of various professional people,, including medical men, for the year 1952-53. If the commissioner were to do so, charges of this kind would not be made, and it would be evident that these insurance funds are not being exploited.

Now I pass on to the second matter with which the bill deals - hospital benefits. This measure extends full hospital benefits to patients of institutions formerly excluded under the definition of " recognized hospital ". Again I congratulate the Minister on this matter, because it was one that was taken up with the Minister by a number of members on this side of the House. It is a matter about which I myself have spoken in the House, and I am glad that the Minister has seen fit to correct the position.

The honorable member for Eden-Monaro, who led for the Opposition in this debate, took for the Opposition the whole credit for this amendment to the law. Now, Sir, let us get the facts straight and put them on record. Some one may even read them. The fact is that the Opposition knew nothing about this proposal until they heard some rumours that honorable members on this side of the House were concerned about it and were seeing the Minister about it. The Opposition then put on a debate in the House which clearly showed to anybody who listened to it, or read the report of it, that they did not know what the matter was all about. However, the honorable member for Eden-Monaro, in the course of this debate, claimed the credit for this amendment - credit which belongs, like the credit for so many other improvements and reforms introduced in this Parliament, to the back benchers on this side of the House who do the job that the Opposition should be doing.

Mr Whitlam - Were you responsible foi abolishing free hospital treatment?

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