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Thursday, 7 May 1970

Dr SOLOMON (Denison) - Before I say, fairly briefly, what I really want to say in this debate I should like to assure the honourable member for Hunter (Mr James), who I think interjected earlier, (hat unfortunate as it may be this side of the House is devoid of members of the medical profession. Those who have the appellation doctor' in front of their names have it in areas other than that of the medical profession, most of whom are bachelors of that particular profession. Much has been said in this debate, and at the tail end of such a discussion it is unlikely that any absolutely new contributions can be made.

So I want to put I or 2 personal points of view and, as far 'as I can, to summarise and perhaps to some small extent simplify some of the lines that have been running through the debate during the last several hours, including yesterday.

First and foremost I think it should be stated that the concept of this Bill is protection of ali members of the public against embarrassing medical costs, that is, to make possible for all members of the community access to proper medical care in whatever areas of illness they unfortunately find themselves. There are a few obvious elements in this particular situation. First, of course, is the Government, which is initiating the procedure; then there is the Opposition; then the medicos and then the health funds. 1 have listened with some interest, not entirely throughout the debate but almost so, to what members of the Australian Labor Party have had to say on this matter. I have listened particularly to the contributions of most of its 5 or 6 medicos. I hope that I do not misinterpret what they had to say. 1 have looked in vain for what I would regard as a serious contribution to the solving of any problems which may exist as between the proponents of this scheme, who in one way or another are most if not all the people on this side of the House, and the medical profession in one or other of its various forms.

We have heard a number of useful humanitarian contributions from the honourable member for Scullin (Dr Jenkins) and others, on which I commend them. But the question at issue is the Bill before the House. I think we can agree that there are some basic differences in philosophy. Most importantly, this Government does not adhere to a philosophy of socialised medicine or something approaching that whereas other people quite properly hold, even though they like to call it by other names, that no matter what is the cost everybody shall have exactly equal access, despite the reality or otherwise of need, to medical services. Nobody could dispute that in an ideal community it would be marvellous for people willy-nilly to indulge all their inclinations in this regard. I have even, I think, gone on record as indicating a general interest in the fact that no member of the community should be unduly discriminated against. At the same time I would say that most of what I have listened to from the other side of the House, as on other occasions, has been argument advanced by a counsel of perfection looking for an ideal society. That, perhaps, is not a bad thing in itself, but the means by which we get there is of some interest.

It seems to me that, if the philosophy is that we should implement this concept , in every field right across the board, we legislate for equality - if that is what we want to call it. If in doing so we deny any individual access to incentive, even if the incentive is an incentive to look after himself, then we get towards a situation, as the honourable member for North Sydney (Mr Graham) put forward very clearly last evening, that approximates the situation under the nationalised medical scheme in Great Britain. It is pretty hard going for any individual to say that he can summarise the rights and wrongs of the nationalised medical scheme in Britain. We have I sort of testimony in the large number of British doctors who are resident in Australia and who are practising alongside our native born medicos because, in many cases, they could no longer stomach the socialised medical scheme of Britain. I do not think that can be denied by anyone in or out of the profession. That does not necessarily make them right, but it makes fairly imposing evidence for that point pf view. Within the last dozen years I lived for about 2i years in Britain and certainly my personal observations would lead me to lend my support to much the same assessment as that of the medicos who have emigrated to Australia. Whether or not it is a ghastly scheme, to use the words of the honourable member for North Sydney, I am not quite sure; but certainly it is a highly involved scheme which involves a great deal of waste and which I would not like to advocate here.

During this discussion much has been said about why the Government scheme, useful as it might be - it was conceded that it does not go far enough - does not embrace the philosophy of members of the Australian Labor Party in respect of things medical. A lot has been said about taxation, about the little man on a low wage and so on. Quite frankly I just could not understand the relevance of some, though not all, of it. There has been a great plea for equality of treatment - again, I think the honourable member for North Sydney drew attention last night to what the honourable member for Barton (Mr Reynolds) had to say about this - on the ground that anybody who is on a lower wage than somebody else will not do as well under this scheme, or I might add any similar scheme, as the chap who is earning a lot and therefore gets more back because of his higher rate of taxation. I regard this as being absolutely irrelevant in the sense that it is not a criticism of the Bill before the House.

Surely if a person is in a position to pay little in taxation he cannot expect to get back a lot in reimbursements, whether it is in respect of a medical scheme or anything else. This would be putting the cart before the horse. The important thing is what the person pays, not what he might or might not get back depending on his total level of income. The honourable member for Scullin is shaking his head. If we carry that particular argument to its logical conclusion, I suggest we might argue that honourable members who are entirely dependent on their salaries as members of the Parliament might pay one-half or onequarter of the air fares or bus fares that those members pay who are still in receipt of private income, perhaps quite substantial private income. We might argue that there should be graded bus fares according to the level of income. That is the logic of this sort of proposition if we carry it past the point at which it is convenient for members of the Opposition to leave it at this stage. In that sense the argument is nonsensical, because the operative factor is that the initial payments are within the ambit of anybody, whatever is his income. It is clear enough in black and white in the Bill that persons on low incomes will not be placed in the position of having to pay basically for similar services that other people get.

Attention has been drawn to the fact that the Bill embraces the prospect of an increase in contributions from 60c to 75c. This has been spelt out as though we are talking about dollars, or perhaps even hundreds of dollars. I know that there are people on low incomes, some of them in my electorate, and I am related to some not in my electorate. We are talking about a tiny figure - the price of a beer or of i packet of cigarettes a week. To dress this up as a blatant infringement of the rights of the lower income members of the populace is to draw a red herring across the trail and certainly is not a significant criticism of the Bill.

The honourable member for Capricornia (Dr Everingham) drew attention, among other things, to the operations of the Blue Cross organisation in America. If I remember his words aright, he was favourably disposed to the sort of situation which could obtain here under such a scheme. For a short period when I was travelling in the United States I transferred to the Blue Cross organisation, which is vaguely allied to our organisation. The transfer was at enormous expense, but it was necessary because of the colossal cost of medicine in the United States. I wonder whether this again is a sensible criticism of the legislation we have before us. That is, of course, not to draw attention to the same member's inclination to discuss the pitfalls of smoking and the cancer that may be derived therefrom, which was hardly relevant to the matter before the House.

Obviously some features of this Bill are lacking in terms of a counsel of perfection or probably not even that sort of counsel. A number of paramedical matters will not be covered by the Bill as they have not been covered before. Various members of our electorates are making submissions on matters such as geriatrics, hearing, the necessity for therapy and aids, and so on. It can reasonably be said that these are things which need to be looked at. As I understand it, these matters have been looked at and I would imagine that they will continue to be looked at.

An integral part of the scheme proposed in the Bill - I am sure the House is already aware of this so I will not go into it at any length - is the referral system as between general practitioners and specialists. Unlike some of my colleagues who are decidedly sanguine about this matter, I am slightly less so. I would prefer to wait until the details become apparent when this scheme is put into operation. One can assume that it could operate successfully. However, we have to see that it does operate successfully. 1 for one would suggest to the Minister for Health that, as he well knows, he will need to keep it constantly within his purview. It could well be that the scheme will not operate as we want it to if we do not work with the goodwill of the medical profession. It can only be said that it will operate properly with the goodwill of the medical profession.

Members of the medical profession are tradesmen of a high order who are not unaware of the need for goodwill. It is true that some infinite details are not spelt out in the Bill, despite its length, and I think it is a reasonable proposition that the medical fraternity would understand that, as I have heard the Minister explain on more than one occasion, the Government is introducing this Bill with absolute goodwill and is prepared to remedy any minor or marginal problems which may arise, as they tend to do under the operation of a new scheme of this magnitude.

I would like to make some small mention of the medical profession, perhaps at some slight risk. The medical profession has long been held by some people to be as effective a trade union as has ever existed in this country. Until the last few weeks I was of that opinion. It now appears however that the medical profession, which is comprised very substantially of men of goodwill and men of hard labour, has not been as cohesive a trade union as in fact we suspected it was. The general practitioners are somewhat at variance with the specialists and may probably continue to be so in one shape or form. A question of status is involved. Nobody stands in higher regard in the community than do members of the medical profession. It may be somewhat salutary to mention that in very few, if any, other countries of the world does the medical profession enjoy such prestige and even mystique as it does in Australia. I think that most members of the profession are aware of this. Certainly I have acquaintances in the profession who would readily admit that.

I would suggest that the status of the medical profession results not so much from what it achieves but basically from an often very uncritical acceptance by the Australian public of the standing of the medical profession not only in its own sphere but in relation to all sorts of allied matters in which its members are frequently quite inexpert. At the same time - I would like to make my position clear - I do not for a moment suggest that the role played by medical men in the country is not one which is almost without peer and which is above the level of importance of any other calling. Th: public tends very much to believe that the medical profession stands almost on a pinnacle of its own because it deals most personally, if not personably with the public day by day.

So it is absolutely important that the medical profession should understand that the introduction of certain problems within its own ranks, particularly those that exist between the 2 wings of the profession, the general practitioners and the specialists, are not problems which it is fair to lay at the door of the Government, the Opposition or anybody who may be the proponents of this Bill and who wish to sec it passed in its entirety. The Bill has been before the House for some little time now. It is up to the profession to iron out such problems as those which either it was not previously aware of or which were not sufficiently crystallised for the profession to begin to look at. I refer to such things as lists of common fees and the differentials as between . general practitioners and specialists. So I would make a strong plea to those of the medical profession who feel inclined to blame their problems on the scheme. These are the sorts of problems on which I commented earlier and on which I received very little enlightenment from our medical friends on the other side of the House. I would like to see them accept the Government's proposition with the utmost goodwill and not try to resolve their internal problems within the confines of this Bill and the discussions relating to it.

Although the matter has been referred to on a number of occasions before, in fact in glowing terms on several occasions, I would like to commend the Minister for his engineering of this operation. The trials and tribulations attending upon it have not been insignificant. Preparing the Bill for presentation lo the House has been a rather protracted preliminary exercise. One would hope that because of the widespread, in fact universal, operation of this scheme as far as the public of Australia is concerned any problems will be resolved in the greatest possible amity and understanding for the general benefit not only of the community but of the medical profession and anybody who is touched by it.

Last but not least, I would like to say that the position of the general practitioner is one which, despite the small criticism I made a few moments ago, I regard as absolutely crucial to the continuing operation of medical services in this country. I am a little apprehensive that some members on both sides of the House, and certainly on this side, think that the trends elsewhere in the world towards a diminution in the number of general practitioners are perhaps not significant enough because they have not been given expression here. But 1 suggest that with the lack of other evidence we must take note of trends of this kind particularly where they are related to similar societies in the western world.

We should take all possible steps within the confines of this Bill, or elsewhere for that matter, to see that the foundation of the medical profession's operation is sound. I refer to the general practitioner, the family doctor, who is often the recipient of many confidences. Apart from his expertise he has to deal with a great deal of the assumed medical problems. I. think many members of the profession will readily admit this. 1 do not say this is any derogatory sense in relation to their more expert operations. But a large proportion of the cases which come to genera] practitioners have some sort of psychosomatic content. They deal with things which the community does not wish to pay a specialist to attend to until they have been apprehended in the first instance by the general practitioner. So anything in this Bill or elsewhere which would work towards weakening the general position - I do not mean status as such - and operation of general practitioners would in my view be a bad thing.

That is not to say that we should not look critically at the general status of the members of the medical profession. They should be earning their status along with everybody else. But it is important that we do nothing to undermine that position. In that regard the complexities of the relationship between the general practitioner and the specialist, and those who seem to fall in between somehow, were discussed earlier in this debate and I do not wish to traverse that subject any further. I commend the Government on this Bill and I hope that we manage to put it through with as much expedition as possible. I am sure that the general benefit to the community will become obvious when the scheme begins to operate.

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