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Wednesday, 19 April 1961

Dr Donald Cameron (OXLEY, QUEENSLAND) . - in reply -

Mr. Deputy Speaker,the debate on this bill has ranged very widely over the whole of the National Health Act. 1 do not intend to traverse the entire field through which the debate flowed, but shall confine myself largely to the bill. However, to begin with, I should like to say one or two things. Honorable gentlemen opposite have had a great deal to say about the deficiencies which they allege exist in the act and about various alleged anomalies to which they have directed attention, but it is a fact, as I think the Deputy Leader of the Opposition (Mr. Whitlam) pointed out, that all that this bill deals with is a few rather minor amendments of the principal act. When there is occasion again to make major amendments of the National Health Act, I shall be fully prepared to debate all the major amendments which then come under consideration. At this stage, Sir, I should like to say that although honorable gentlemen opposite have been very keen to point out what they regard as deficiencies in the present act, they should not forget that when this Government took office, there was no national health service at all, with the exception of a scheme for some totally inadequate payments to hospitals - a scheme under which every hospital in the country was going bankrupt.

Let me now come to the bill which the House is considering, Mr. Deputy Speaker. The first of the amendments which, it will make to the National Health Act deals with the definition of " contributor ". Speaking of that amendment, the honorable member for Eden-Monaro (Mr. Allan Fraser) said that he believed, and that the Australian Labour Party's policy was, that it ought to be unnecessary for any one to be a contributor to an insurance organization in order to receive Commonwealth benefit.

Mr Pollard - Hear, hear!

Dr Donald Cameron (OXLEY, QUEENSLAND) - Let me just point out to the honorable member for Lalor something that I have pointed out in this House before: The inevitable result of enacting legislation to make such provision would be to destroy the benefit organizations and to nationalize the entire provision of benefits under the National Health Act.

Mr L R Johnson - That would give the people the benefits to which they are entitled, and that is the main thing.

Dr Donald Cameron (OXLEY, QUEENSLAND) - Honorable gentlemen opposite are in favour of the nationalization of health services. We understand that.

Mr Pollard - What would be wrong with it?

Dr Donald Cameron (OXLEY, QUEENSLAND) - A great many people in Australia think that there would be a great deal wrong with it. The plain fact is that the Australian Labour Party is once again confirming its intention to nationalize health services in Australia if it ever has an opportunity to do so.

I now go on to deal with the special accounts. I do not think that I need to discuss all of the amendments to be made to the principal act by this bill. I think that some of them are quite well understood. A great deal has been said about the special accounts to-day. In fact, one clause of this bill provides for limitations on the total benefits provided under the special account procedure. In spite of all that has been said in this House from time to time about the operation of special accounts with respect to hospital benefits, there is apparently still a good deal of misunderstanding among honorable gentlemen opposite about what happens to patients who are transferred to special accounts.

Mr Pollard - There is no misunderstanding at all.

Dr Donald Cameron (OXLEY, QUEENSLAND) - I am talking about hospital benefits. If a contributor is transferred to a special account, he is not really put at a disadvantage. In fact, in many instances, the contributor is given an advantage, because he is still entitled, if he incurs hospital expenses, to benefits equal to those provided in the table to which he belonged, provided that those benefits do not exceed the hospital charge. That is to say, if he is insured under a high table and he goes into a hospital where the charge is equal to the benefit for which he is insured, he is entitled to receive benefits at that rate. If he goes into a hospital where the charge is lower than the table under which he is insured, it is true that then he only receives benefit equal to the hospital charge. But when he has exceeded his maximum benefit period, then, instead of going down to no fund benefit at all, as he used to do before-

Mr Thompson - That is after 91 days?

Dr Donald Cameron (OXLEY, QUEENSLAND) - Yes. In those circumstances he then receives indefinitely payment at the special account rate until the end of twelve months and he can then return to the maximum rate for which he is ensured. There is really no disadvantage suffered by the introduction of special accounts; on the contrary, a great many people have been advantaged.

Now let me come to the questions that have been raised in connexion with the Pharmaceutical Benefits Advisory Committee. My honorable friend, the honorable member for Isaacs (Mr. Haworth) asked for some explanation of our putting more doctors onto the advisory committee. The reason is a quite simple and very good one. It is that, with the introduction of the great many new drugs and preparations in recent years, we feel that it would be an advantage to have a wider range of therapeutic experience represented on the committee. Therefore, it is proposed to increase the number of doctors on the committee.

The Deputy Leader of the Opposition (Mr. Whitlam) made many complaints about very little. He complained that the names of the committee members were not divulged. The attitude which I have always adopted, and which I have made plain in answer to questions in this House before to-day, is that, while this is not a secret committee and the names of the personnel are not secret, these gentlemen are engaged in a busy practice and discharging very onerous duties - and they are onerous duties - and I do not think it is fair for their names to be broadcast and made public so that they might then be subjected to all sorts of pressures to have other drugs put on the list. This is especially so as they act in an unpaid capacity. If either members of the medical profession, members of the public, or honorable members of this House consider that other drugs should be placed on the list, it is perfectly easy for them to make approaches to either the Director-General of Health or myself and their requests will be considered.

The Deputy Leader of the Opposition went on to say that, there had been great delay in the inclusion of drugs on the list. There is a delay, and for very good reasons. I say nothing against the research that is done in the laboratories. It is necessary. Indeed, I pay tribute to the organizations and companies who carry it out. But the real criterion can only be, not the research carried out in the laboratory but the result of therapeutic experience, and it would be quite wrong if every new drug which was tested in the laboratory was immediately assumed to be suitable for clinical use. Only clinical experience can tell us whether it really ought to be on the list or not. For that reason alone, some time must elapse between the development of a new drug and its inclusion on the list.

Another reason is that if we were changing the list every few months we would have both the medical profession and the pharmaceutical profession in confusion. Every time a new drug is put on the list, or taken from it, all doctors in Australia must be notified, all chemists in Australia must be notified and arrangements must be made about pricing. A whole series of complicated arrangements has to be made, and it would simply make confusion worse confounded if, every couple of months, we were suddenly to add to or subtract from the list. In the interests of proper dispensing, proper diagnosing and commonsense, we do not do that.

The Deputy Leader of the Opposition referred to other matters. Let me say that they were minutiae in the general scheme of things. He had a great deal to say about them, but most of them do not really matter at all. For instance, he complained about the dates on which the committee met and when I said it met. The committee does not hold a great many formal meetings, although, of course, the advice of the committee is available to the Minister almost at any time. It was perfectly true for me to tell the Deputy Leader of the Opposition that drugs are not removed from the list without the advice of the committee. Of course, it is true to make that statement. I hardly think that it is worth my while bothering to go into the other objections that have been raised about what State Ministers have said to me and what I have said to State Ministers. The plain facts are that the answers which I have given to the Deputy Leader of the Opposition have been quite true and no amount of rhetoric will put them into any other kind of context.

Reference has been made to-night to finance for hospitals. After all, there is a Federal Constitution under which the States are the bodies responsible for hospitals. There is not one State in the Commonwealth which would for one moment agree to the Commonwealth assuming any responsibility for its hospitals or for the management of those hospitals. If they charge pensioners who are in their hospitals, that is the business of the States. The Commonwealth Government does not force them to make the charge. But it is a fact that the payment made directly by the Commonwealth Government by way of Commonwealth benefit and Commonwealth additional benefit in the last financial year amounted to approximately £18,500,000. The fund benefits attracted by the payment of those Commonwealth benefits amounted to another £12,000,000. So, directly and indirectly, the State hospitals received something like £30,000,000 last year as a result of the operations of the National Health Act, a great deal of it being paid directly by the Commonwealth Government. To say that the Commonwealth Government starves the State hospitals for funds is to create a quite false impression. Not only do the State hospitals attract to themselves this amount of money because of the operations of the national health service, but they are free to allocate from all the payments and reimbursements from Commonwealth funds under the Commonwealth and States financial arrangements whatever funds they wish to their hospitals. To attempt to shift the burden of hospital debt on to the Commonwealth's shoulders is an exercise which we all understand, but which, in fact, has really no substance.

Question resolved in the affirmative.

Bill read a second time, and committed pro forma; progress reported.

Message recommending appropriation reported.

In committee (Consideration of Administrator's message):

Motion (by Dr. Donald Cameron) agreed to-

That it is expedient that an appropriation ot revenue be made for the purposes of a bill for an act to amend the National Health Act 1953- 1959, and for other purposes.

Resolution reported and adopted.

In committee: Consideration resumed.

Bill - by leave - taken as a whole, and agreed to.

Bill reported without amendment; report adopted.

Bill - by leave - read a third time.

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