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Thursday, 12 November 1959

Mr WARD (East Sydney) .- We have heard a most extraordinary explanation from the Minister, an explanation which obviously will satisfy no reasonable person. The honorable member for EdenMonaro (Mr. Allan Fraser) gave the absolute facts. Of what use is it for the Minister to say that it is left to the discretion of the States as to what they do?

What the Minister says in effect is that the Commonwealth Government wants its pound of flesh, and does not care whether the State Government bears the expense from its ordinary revenues or takes it out of the pockets of the patients. Anybody with experience of the administration of hospitals not only in New South Wales, but anywhere in Australia to-day, knows of their difficult financial circumstances. This Government and the Minister are fully aware that what they actually did at this conference between the officers of the Commonwealth Department of Health and the New South Wales Department of Health is to hold a gun at the heads of the State officers and the State Government.

What we want the Minister to tell us, whether or not this document came from the source which was indicated originally, is whether the patients in the hospitals are to be charged the fee. Are they to meet this additional impost? It is not sufficient for the Minister to say that the patients are going to be provided with a wider variety of drugs than is available under the scheme at present. Let us examine what is the purpose of imposing this pre- scription fee. According to speeches from the other side of the chamber the Minister and the Government have acted in this matter as a result of an opinion that there is a great deal of waste in the administration of the health scheme. Where does the waste occur, and how does the Government propose to prevent it? If the patient has to find the 5s. as he will be obliged to do under this new scheme, who will be excluded from getting the benefits of the scheme itself - the medicines and drugs required? No person who can get a prescription written by a doctor and can pay the 5s. will be excluded. The person who will miss the benefits of this legislation is the person who cannot afford the 5s. Consequently, the Government is penalizing the poor. It is imposing further suffering upon these unfortunate people.

The honorable member for Bradfield (Mr. Turner) said that this would be a great benefit to pensioners. Why does he not explain how he arrives at the conclusion that a person receiving £6 15s. a week, if he is receiving the full rate of pension, plus additional income of £2 a week, can afford to pay for his prescription? As the honorable member for Eden-Monaro pointed out, many pensioners will have to pay 10s. a week or more because they will probably require at least two prescriptions. The Government recently increased the pensions of these poor unfortunate people by 7s. 6d. a week, but now it is grabbing back 10s. a week by imposing this additional charge upon them. How, possibly, can the Government or its supporters say that the provision of this legislation will not adversely affect the pensioners?

Let us examine the circumstances of the ordinary member of the community who, on many occasions, should be receiving hospital treatment as an in-patient but cannot afford to enter hospital. He has to attend the out-patients' department of a public hospital as a consequence. Under this scheme the Government says that even in the case of a person attending an out-patients' department attached to a public hospital, either the State government or that patient who is seeking medicines or drugs has to bear this additional fee of 5s. I think that is an outrageous proposal.

Let us return to this famous document. The honorable member for Eden-Monaro said -

The Commonwealth is now demanding that every hospital patient must pay the new tax in future, whatever his means and whatever ward he may be in. . . . This means that unless State governments bear the cost themselves, a new charge will now have to be imposed, probably for the first time in hospital history, on patients in public wards, for drugs which have never previously been charged as extras in public wards.

That is a statement in the speech of the honorable member for Eden-Monaro which was not adequately answered by the Minister. There is one rather significant feature about this proposal. If the cost of this scheme, in the opinion of the Government, has now become excessive, it has become excessive because certain members of the medical profession have written prescriptions for people who were not in need of them, therefore boosting the cost of the scheme. Why has not action been taken against members of the British Medical Association who offend rather than impose this penalty upon the unfortunate pensioner? But that is what is happening now.

I understand that the chemists are to be conscripted into this scheme. It is interesting to recall that in 1946 when the people of this country decided to vote additional powers to the Commonwealth Parliament for social services, the provision was included that there was to be no form of civil conscription. But the chemists are to be dragooned into this scheme whether they like it or not. They are to be given the responsibility of collecting this fee from the patient. The honorable member for Lilley (Mr. Wight) said that if a chemist, out of compassion, decided that one of the people applying for this assistance could not afford this 5s., he need not charge anything at all. But if he does it too frequently, according to the honorable member for Lilley he then faces disqualification from the whole scheme. He cannot give medicine away even out of compassion for an unfortunate person who cannot pay.

We are told that this scheme is too costly. When we deal with increases of this type we have to recognize that a proportion of the cost of the scheme is due not to the fact that more prescriptions are being written so much as to the fact that the cost of drugs and medicine has risen enormously. The chemists' prices are regularized, but not those of the manufacturer, the wholesaler or the importer of drugs. The Government will probably say that it has no power to control importers of these important drugs; but what the Commonwealth Government should do is to extend the activities of its own Commonwealth Serum Laboratories and aim at the day when they will be able to produce and provide all the drugs required in this country. It would be interesting if the Minister were able to give figures as to the increased costs from the manufacturers' and the wholesalers' point of view of the medicines provided under this scheme. I say that the Government is not tackling this question as it should be tackled.

The honorable member for Mallee (Mr. Turnbull) said that it was the policy of the Labour Party to care for the citizen from the cradle to the grave. What is wrong with such a policy? I take it, from his criticism, that he does not believe in such a policy and therefore he does not believe in seeing that the Australian community is provided with the best health services that science can provide. I say quite frankly, as a member of the Labour Party, that I hope to see the day in this country when we will have a completely free health scheme, including the cost of hospital treatment and the provision of necessary medicines. Both these services ought to be completely free. If a person has the misfortune to fall ill why should he be penalized on that account? But that is what is happening to-day.

Many unfortunate people have been made absolutely bankrupt as a result of serious illness befalling themselves or some member of their families. That position should be reversed and whatever science can provide by way of curative treatment for these unfortunate people should be made available to them without cost. No reasonable person in this community would hesitate to pay whatever tax was required to make this possible but would feel that in so doing he was making a contribution of a worthwhile nature, and indeed be thankful if he never found it necessary personally to receive any direct benefit from such a scheme.

This clause is the most objectionable feature of this legislation. Many members on the Government side have offered criticism of this particular provision. The honorable member for Mallee even said he was considering voting against the Government. I know that on one previous occasion he did vote against it and was subsequently reprimanded by the Great White Father. I am afraid that he will never repeat the offence again.

Mr Turnbull - That is not true.

Mr WARD - The honorable member will have the opportunity very shortly to show whether he still has the courage to vote against the Government when he believes that it is wrong.

The CHAIRMAN - Order! The honorable member's time has expired.

Mr. THOMPSON(Port Adelaide) 15.131. - We have heard a lot of strong talk concerning payments for hospital treatment and so on, but the main matter before the committee at present is the amendment of the honorable member for Eden-Monaro (Mr. Allan Fraser). Its purpose is to strike out proposed section 87 which makes provision for the payment of a fee for each prescription. I cannot quite follow the language of the bill on this matter. The proposed new sections lay down that the fee of Ss. must be paid but when I read sub-section (2.) of proposed section 87 I find this statement - . . an approved pharmaceutical chemist or an approved medical practitioner may, in respect of each supply by him of a pharmaceutical benefit (including each repeated supply) charge the person to whom the pharmaceutical benefit is supplied an amount not exceeding Five shillings.

According to that, there is nothing to show that the person has to pay 5s. The chemist may charge an amount " not exceeding 5s.". But clause 16, sub-section (1) (b) of proposed section 92a, provides that - the approved pharmaceutical chemist or approved medical practitioner will not follow a practice of supplying all or any pharmaceutical benefits to all or any persons without charge or for a charge that is less than the maximum charge that he may make without contravening section eighty-seven of this Act

One part of the legislation says that the chemist may make a charge not exceeding 5s., while another part provides that if he does not charge 5s. he can have his approval cancelled in respect of that particular charge. I do not know why these provisions have been inserted in this way.

Then we come to another point that is rather interesting. Sub-section (2.) of proposed new section 87 contains the provision that the chemist may charge an amount not exceeding 5s. Then sub-section (3.) provides -

Where an approved pharmaceutical chemist or an approved medical practitioner supplies a pharmaceutical benefit in accordance with a direction included in a prescription in pursuance of subsection (5.) of the next succeeding section, the maximum amount chargeable in accordance with the last preceding sub-section is, in lieu of Five shillings, an amount ascertained by multiplying Five shillings by a number equal to the minimum number of occasions of supply that would have had to be directed if the medical practitioner had prescribed the same total quantity or number of units of the pharmaceutical benefit by way of repeated supplies.

This simply covers the particular case in which a doctor, instead of prescribing, say, 100 tablets on six different occasions, decides to prescribe 600 at the one time. In that case the 5s. is multiplied by six and the patient must pay 30s. It is obvious that there is a good deal in this legislation that can be misunderstood.

Then I turn to sub-section (5.), which says -

Sub-section (1.) of this section does not prevent an approved hospital authority from charging, in respect of the supply of pharmaceutical benefits to a patient, not being a pensioner, receiving treatment in or at a hospital, amounts not exceeding the sum of the charges that the patient could have been required to pay in accordance with subsection (2.) of this section if he had obtained the pharmaceutical benefits from an approved pharmaceutical chemist upon a prescription or prescriptions directing the supply of the maximum quantity or number of units applicable under a determination of the Minister under section eighty-five of this Act

Sub-sections (1.) and (2.) provide that the chemist may charge up to 5s. for each prescription - although, I repeat, it is provided elsewhere in the act that the charge of 5s. is mandatory. Then sub-section (5.) deals with hospitals prescribing drugs, not necessarily at the direction of a doctor or a chemist. There is nothing to prevent the hospital from charging patients 5s. for each of such prescriptions. I am not going to argue about what has been put forward by the honorable member for Eden-Monaro (Mr. Allan Fraser). From what the honorable member said it appears that the opinion of the New South Wales Department of Health is that the charge of 5s. is mandatory in such cases. The sub-section I have read out, however, merely provides that there is nothing to prevent a hospital from making such a charge.

I do not want to confine my argument, however, only to these particular points. I do not want to argue the question whether the proposed charge is a form of tax, or whether the chemists will become tax collectors. I do not altogether agree with the attitude of the chemists in this respect. If a prescription costs £3 and the patient pays the chemist only 5s., the chemist knows that he will get the remaining £2 15s. from the Government, whereas in the present circumstances a patient may not be in a position to pay. I want to suggest, however, that many people will be called upon to pay the, 5s. charge, or multiples of 5s. if there is more than one prescription, at a time when they are least able to afford to pay.

This proposal to make a flat rate charge for all prescriptions is nothing new. I remember many years ago, when I was interested in friendly society dispensary work, that some members of the society felt they should impose a charge for all prescriptions, so that people would not waste the medicine. Members of the society were paying regular contributions, and they received their prescriptions without further charge. A small charge was made for each prescription to prevent any such wastage. I argue to-day along the same lines as I argued at that time. I believe that when a person is sick he is least able to pay for these things, and that is not the time to impose extra charges on him.

We on this side of the House are not opposing this proposal simply because it emanates from the Government side. All honorable members know that in 1947 or 1948 the Labour Government brought in a scheme providing for absolutely free medicine. We know what happened to it. On instructions from the British Medical Association the doctors sent back the books that had been provided and would not write out prescriptions in the required manner. We fought at that time to provide medicine absolutely free, and the object of the amendment of the honorable member for Eden-Monaro to-day is to make medicine absolutely free.

Mr Wight - The only free medicine under the Labour Government's scheme was that contained in a limited list.

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