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Thursday, 7 May 1970


Mr BRYANT (Wills) - The honourable member for Denison (Dr Solomon) seemed to me to be shedding a general air of complacency over the whole system which has been the pattern of the last 20 years or so, since the late Sir Earle Page precipitated the present system upon us. He used such words as 'minor and marginal problems'. Minor and marginal problems in health are major tragedies and disasters for the family who is afflicted with them. The criteria upon which I am likely to examine a scheme such as this are: Does it handle this kind of disaster? Does it handle the situation where somebody has to have an air ambulance, for instance, to save a life? At a lower level, what does it do about eye care, spectacles and so on? During the course of this debate there have been ample demonstrations that it does not cover these aspects. In fact, it is obvious that the present system has failed. There are lots of people who are not in the scheme. Those who are in the greatest need receive the least possible cover on occasions. Therefore 1 believe the whole system should be changed. I look at the Bill and see that it amends the National Health Act. Perhaps we should change the name of it. lt is a national insurance system of sorts; it is not a National Health Act.

When I look at the system I ask myself: How many new hospitals will it build? How many new areas of research will it develop? How many new doctors will it train? How many new services will it supply throughout the community? How much greater security will it supply? It is not a national health system at all. It leaves so many areas of assistance to chance to be provided by municipalities. State governments and other areas of Commonwealth action. It is not a nat onal health system at all. We on this side of the House believe that what this country needs is a national health system. The honourable member for Denison, with the wisdom of Solomon, although Solomon is about 2,500 years out of date, referred to a remark made by my colleague, the honourable member for Capricornia (Dr Everingham), but he misquoted or misunderstood the honourable member for Capricornia. I do not blame him for not reading every word of Hansard, unless of course he concentrates on my speeches. The honourable member for Denison said that my colleague, the honourable member for Capricornia, had lauded the Blue Cross system of the United States. However, the honourable member for Capricornia has assured me that he said nothing of the sort. In fact he said that he thought the Blue Cross system was like the present system here - it was shot full of holes.

In fact, the schere that my colleague is advocating is the Kaiser scheme which operates on the west coast of the United States of America. The honourable member assures me that it is fully prepaid, it operates on salaried services, it has 8 million members at the moment, and it is expanding as fast as people care to join it and as fast as it can expand its services. In fact, it is giving great satisfaction to its members. In other words, it is something of the ideal to which we on this side of the House are dedicated. That ideal is that people can pay a fixed sum and get total coverage. I believe this is where we part company with honourable members on the other side of the House. I have no doubt of course that we each have the same social objectives and that we will all do the best we can to assist people who are in need and people who are stricken down by illness. However, honourable members on the other side have this continuing philosophy - I believe it is false in a modern society - that a fair area must be left to private initiative and to private schemes of this sort. The honourable member for Denison mentioned that our objective was to create an ideal society, and he gave his imprimatur to that in a kindly fashion. He seemed to think that it would not be possible to get a total coverage. Why should that be so?

Hisother philosophical point was that people should be encouraged to look after themselves. I represent one of the industrial areas of Australia where there are large numbers of migrants who wisely come to be represented in the seat of Wills. They are not the kind of people who can prepare for the contingencies of medical disasters. They are not the kind of people who can look after themselves. There are large numbers of people - I would think about 10% of this community, and it might even apply to every other community in the country - who have not the kind of expertise that- is required, who are short of money on occasions, who forget about it, who do not know at all or who cannot manage their affairs. Although there have been changes recently to take up the slack in relation to people who are below a certain level of income, this scheme still does not cover them. We live in a materialistic society. It always interests me that we can put a tremendous effort into the protection of property. If a house catches fire or a motor car crashes and bursts into flame, the first service to arrive will be the fire brigade to put out the fire. It is there on a full time basis and is totally dedicated to the preservation of property. The police will be the next to arrive on the scene to help in the protection of the property. If a motor car is involved, a tow truck will turn up too.


Mr Stewart - The tow truck will be first of all.


Mr BRYANT - First of all in all probability, yes. If the incident occurs on a Saturday afternoon or Sunday night, how long will it take to get medical services for the broken human beings? How long will it take the ambulance if people find themselves 20 miles from anywhere? This is the challenge of modern society. Whether we are dealing with people or property, are they the values which will be enshrined in this legislation? I can think of no reason at all why human beings should not receive the same service and the same immediate attention as property. That is the aim of the Labor Party in its social programmes. That is why we have a different view from that of honourable members on the other side of the House. The philosophical concept of private enterprise, of looking after yourselves, is incidental to the protection and the development of human happiness and human health. We know, of course, that this present scheme is totally inadequate. Over recent years it has been criticised extensively.

There is a multiplicity of funds - over 100 - which spend large sums of money on administration, on advertising, on putting out beautiful brochures with a form on the bottom that can be completed by those who wish to apply for membership. These schemes do not provide a total cover. Everybody in the community is not covered all the time, and there are no funds available for capital development. How are we to build new hospitals? The finance has to come from somewhere else. It would seem to me that research, the capital development of hospitals and so on would be part of a national health scheme. 1 would be willing to pay extra fees because 1 get a higher salary than other people, despite what the honourable member for Denison had to say about it, if it would assist in producing for the community a system in which one's children, wife, parents, neighbours and friends are totally covered. Those are our objectives. Within the system funds should be readily available for the development of capital work. If we can have a total involvement of the fire brigade, if education and the police services are universal, why can health services not be universal as well? Of course, there has always been the fear of cost, lt is true that health services are very expensive undertakings, that hospitals are very expensive to run, that doctors are very expensive to train and probably equally as expensive to maintain because they deserve the best resources available for the job that they have to do. ft seems to me that our society has arrived at the stage at which the effort we put into giving totality and universality to education ought to be put into health services too. The Labor Party is prepared to embark upon that endeavour. In fact, that is our total objective. lt has been said that the Labor Party's approach will create all. sorts of difficulties. Let us examine for a moment some of the criticisms that have been expressed in relation to the development of the British health system. The British health system has been the victim for some 20 to 25 years of vigorous hostility from people who have come to this country and from honourable members on the other side of the House who see in this scheme some insidious evil Socialist force which will overwhelm the good health of the community. The national health scheme in Britain was one of the great contributions to British society. There is no doubt that before the last war British health services were inadequate and their hospitals were inadequate. Honourable members may read the same documents as I have read if they want to find out the facts about this. The health of the British people on the lower incomes was at a very low level. These facts and figures cannot be gainsaid.


Mr Graham - They were never healthier than they were during World War II.


Mr BRYANT - That is right. Then they had a total national service which saw that they were all properly fed and that total medical services were available to them. The best part of their manhood was spent in the Services and they were getting a total national medical service. I am fortified in my belief about this by a quote from the Melbourne 'Age', which reads:

UK. health plan is 'misunderstood'. There is greater misunderstanding of the National Health scheme in Britain by Australians than any other people in the world.

So said Lord Hayter, who is leading the British Hospital Equipment Trade Mission to Australia, in Melbourne . . .

You don't realise that we will spend $2 1 5m on new hospitals alone this year.' 1 have heard people say in debates in this House that no new hospitals are being built in Britain. The article continues:

Our public relations have been very bad,' he said.

The honourable member for North Sydney should listen to this - and Australians aren't told how it really works.

Doctors who come to Australia from England tend to run down the scheme . . . they over compensate as they praise the good deal they get in Australia.'

The average working class man who arrives in Australia with his family is struck by the inordinate costs of social welfare in Australia both in the field of education and in the field of health, lt would pay honourable members to make a study of the advantages and disadvantages of the British medical service.

An article which I have before me points out some achievements of the British national health service. There is no gainsaying that errors and fallacies developed throughout the system. One cannot embark upon a major enterprise of that sort without producing errors. The first achievement was that it made a whole range of services from the general practitioner to the hospital available to the patient without fear of any financial burden. I ask: What is wrong with that? ls that the kind of objective that the honourable member for Sydney would reject for Australia? The second advantage was that it made regional planning of hospital services possible. I ask: Would not that be desirable in Australia? Would it not be desirable for hospitals not to have to fuss and to carry out bottle drives and make appeals to charity to fulfil their obligations? The third achievement was that it encouraged closer links between the mental and other health services. 1 ask: ls there anything wrong with an integrated health service? Fourthly, and this seems to be contrary to everything we have been told, it encouraged a better distribution of general practitioner doctors in the country by use of negative direction - by restricting entry into over-doctored areas and by offering positive incentives in the underdoctored areas. In 1952, 51% of the population was living in under-doctored areas. Today that proportion is down to 20%. Finally, it has encouraged a better standard of general practitioner work. lt is true that there are disadvantages in the scheme and that there are things that need to be altered. In some areas it has been difficult to make changes. For 20-odd years the national health service of Britain has been under constant attack in this country through the vested interests of people opposite who believe in the sanctity of private enterprise. They have been supported in this belief by the medical profession which until recently, when we on this side had an accession of liberal minded, advanced thinkers from the profession, was generally speaking a fairly conservative group in the community.

The Opposition has been challenged about its proposals, lt is said that a salaried service would be the kiss of death to the medical profession. I ask: Why should a salaried service be the kiss of death to the medical profession, if it is satisfactory for thousands of teachers and scientists and others in the community who are as highly qualified academically as any member of the medical profession? Why do they say the profession would collapse? The Labor Party believes that there is room in the community for both private enterprise and a salaried service. I believe that we will not have a total system in the community until we have such a national health scheme. The way in which it is conducted and controlled is important. Some of the problems that have not been analysed will have to be analysed. It would be desirable if on occasions like this, in across the floor debate on a piece of printed fait accompli such as the Bill, 30 or 40 honourable members could sit around the table and discuss the legislation chapter and verse and have their ideas sewn into it.

T ask: What is wrong with the repatriation hospitals? Are they not salaried medical services? Do they not supply a total national service to the fortunate people who can get into them? Is it not true that at the moment a large number of beds in the repatriation hospitals are empty? I believe that a salaried service can operate satisfactorily. The Minister said that we need a voluntary system. The Opposition believes, and it is obvious from the experience of the past, that a voluntary system in this field is not good enough, lt is the right of the person who is in serious want because of ill health or chronic disease to be attended to. The doctors have a personal duty to do this. The situation can only be resolved by some satisfactory taxation system.

A week or 2 ago my colleagues on this side of the House sent a series of 5 questions to the Minister for Health (Dr Forbes). The Minister has had a distinguished record in a number of fields. He is a man whom 1 would have expected to involve himself deeply in the system so that he knew all about the hospitals of Australia. I would not expect him to know chapter and verse that there are so many beds in I hospital and so many in another, but I would expect him to know from where the information flowed and how accurate it was. As J recall, he was asked the difference between the systems in Australia and countries like Scandinavia and Britain. He was unable to say whether the facts were as stated. Obviously, a total study of the systems had not been developed - at least, it had not been made available to the Minister - nor had he felt, perhaps in view of his political philosophy, that it was necessary that Australia should develop from within its own resources despite the inertia of the past. That only proves that there has been inadequate consideration all along the line. The Minister, the Department and the Government parties have now become hotly involved wilh the medical profession. These are shades of 1948 and 1949. The medical profession would be much better advised to become totally involved with the political forces on this side of the House. If you want to change political systems you have to take political action. It is of little use sending us all nicely - duplicated notices. People have to stand and be counted at the ballot box if they want some action. It is their duty to do so.

The question before' us is: Does the National Health Bill comply with the requirements of the community? Will it supply us with alt the desirable characteristics that are found in other national medical services? From the evidence that I have read and from those to whom 1 have spoken it seems that Britain is much closer to this ideal than we are, and much closer to it than the United States of America is. I suppose it is very dangerous at this time to quote an instance from behind the Iron Curtain. I beg the House in this instance not to regard what I have to say as a dangerous piece of fellow travelling by the honourable member for Wills. In 1964 I was travelling across Russia on the TransSiberia railway. Honourable members should try it some time. We arrived in the city of Irkutsk. My wife was ill. It was a Saturday afternoon. The guide said to us: You will need to get a doctor.' I thought of Saturday afternoons in Australia and the general attitude of Australians, that they have to be pretty sick before they call the doctor. We decided that it was desirable. Five minutes later the doctor arrived. Ten minutes later a prescription arrived.


Mr Graham - Which doctor?


Mr BRYANT - A highly qualified Russian lady doctor. I said: 'That is pretty good service. How does that happen?' She said: That is easy enough. I just dial the emergency service, 0.1.' It is probably the only place in the world, or one of the few places in the world, where medical assistance can arrive quicker than the fire brigade. I believe, and I think most of the community would, that that is a very desirable objective. They have resolved some of the problems by under-paying the medical profession. There were not many things that I saw in Russia of which I approved in general but in fact this was evidence of a social value which is totally lacking from the present system and therefore I commend the amendment to the House.







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