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Thursday, 6 December 1973
Page: 4422


Mr STALEY (Chisholm) - It is a strange thing that the Minister for Health (Dr Everingham) who has just spoken should complain about the Opposition's using the example of Britain or Canada or any other country. The reason why it is not the slightest bit strange for us to use the example of Britain is that the Labor alternative health scheme is based on the British and Canadian health schemes. It is not something that has grown out of indigenous Australian experience, practice and reform. If honourable members opposite want an authority for that, I refer to a discussion I had with Dr Deeble when I put to him the question: 'Would you say that it was a fair characterisation of the Labor scheme to describe it as an amalgam of the British and Canadian health schemes?' He said: Yes. I would regard that as a fair characterisation'. So, let us have no more of the Minister for Health or anyone else saying that we are drawing red herrings across the path because we are talking about what has happened in Britain to the kind of scheme the Government wants to introduce in this country.

With every day a new delight opens up. We had the Prime Minister (Mr Whitlam) at the Press conference - at which, as the Opposition spokesman said, the Prime Minister was trounced by the Leader of the Opposition (Mr Snedden) in the debate on the prices and incomes referendum - making it absolutely plain for the first time that he will completely control doctors' fees if he gets the power he seeks in the referendum. Is it not interesting? He will control doctors' fees, but he is not willing to say that he will control the wages and salaries of the rest of the Australian community. That is one of the things that make his whole approach in the referendum such a farce. He is not willing to say that he will control any incomes but doctors' fees - the fees of the hated doctors. One thing I have deplored about the way in which the Labor Government and some of its friends have conducted the debate is the way in which they have involved themselves in hate-mongering against so many people in our community. I admit that they have had to put up with too much in the way of unfair tactics from time to time from some people, but that does not excuse them of the lack of decency with which some of them became involved in the House.

I also note another wonder of which we heard today. It is extraordinary how these things come out only bit by bit. The Minister for Health foresees the Australian health pattern as it emerges as leading to the situation where Australians will be treated by private practitioners in only 10 per cent to 20 per cent of cases. He has said that we will go in the direction of Britain and the Soviet Union in that area. An alternative scheme is being put up by the Labor Party. There is in Australia a scheme that has been reformed significantly over a number of years. It is a scheme which has had imperfections but which as a result of the reforms it has undergone during recent years, is widely regarded as one of the very best in the world.

During a recent trip to the United Kingdom I described in detail to many people involved in health care there the scheme that is practised in Australian health care now, and the response I received was: 'You would not dream of moving from that kind of health care to the system we are trying to practise in this country, would you?' I said: 'No, we would not, but tragically the Labor Government is trying to force this scheme on to the Australian community'. One of the saddest features of the British health scheme - this is a great warning to anyone in Australia who talks of a Government takeover or a great extension of Government financing in the health system - is that if the Government becomes deeply involved in this area other people will move out of financing health care.

In the United Kingdom less is expended on health care than is expended in Australia in total. In the United Kingdom the total private and government final consumption expenditure on health represents 4 per cent of the gross domestic product. Australia expends 5.7 per cent of the gross domestic product on health. So, we as a country expend far more now, before we move to the kind of proposals that are enshrined in the Labor Government's scheme.


Mr Fisher - And achieve far more for it.


Mr STALEY - Quite. The Australian Labor Party's alternative scheme forces everyone into one Government fund by means of a compulsory tax levy. It lures and seduces the private hospitals into the Government's hands, with immense consequences to patients and doctors. It strikes at the heart of the doctor-patient relationship through the lure of bulk billing and free treatment. It is not, on the face of it, inexorably free treatment, but the lure of free treatment undoubtedly is there. What patient, when faced with the possibility of seeking utterly free treatment, will not fall for the lure which in the short term is attractive but which in the long term could easily cost him dearly?

The Australian Labor Party's alternative scheme provides for a massive shift from the private sector to the public sector. In all, this is so strangely old fashioned in that it represents what I describe as the mechanistic thinking of the fag end of the socialist era. Why members of the Labor Party would seek to keep this fag end alight is almost beyond belief. Why they would socialise when the community cries out for individualisation is almost beyond belief. Why they would bureaucratise when people rightly say that we should humanise is almost beyond belief. Why they would monopolise in this area of intimate human relations when they cry out against it in the economic field is almost beyond belief. Why they would take away choice in this area when they rightly talk about the right of choice in the market place is almost beyond belief.

Why, when the doctor-patient relationship is suffering under modern circumstances or losing something, do they suggest that we take away even that which it presently has? Why do they say that we should take away some of the few final threads that bind the patient and the doctor in what we describe as the doctorpatient relationship? Why when people in our community today - a modern bureaucratic society - feel increasingly powerless to make decisions that affect their own lives and when people feel distant from the decision making in society, they would take away decision making in this area is almost beyond belief.

I suggest: Why not extend the right of choice to the final few who cannot exercise the right of choice rather than take it away from all in the interests of the few? Why not extend choice, private decision making and private involvement instead of taking that away from everyone in the interests of the final few who are still not covered by the present health scheme? This is a question of the power of the patient to affect his own health care. The power and the rights of the patient are at stake in the face of the alternative Labor health scheme. If the patient is in a personal relationship and takes out a contract for health care with someone he can see and to whom he pays fees - even if it is only a little - he can see what he is receiving and he has a stake in what he is to receive. When some of the individual's resources are involved or invested in his own health care by his own choice, people are made more human and are that much better and happier people, because they are involved in these important and intimate areas of human care and relationships.

The concept of free medicine and free care can only take away the power of the patient to determine the quality and nature of his care. If we move to free care, as this scheme would have us do, we move to a situation where people inevitably become numbers on lists. People are numbers on lists in the United Kingdom. In the United Kingdom, one is on the doctor's list. This is the sort of thing that would have to happen here. One would be a number on a list. The patient's treatment would be egg-timed. The timer would be turned and out he would go. The tragedy is that people who are low down on the waiting lists and who could be waiting 2 years to 3 years to get into hospital turn to private practitioners. They take their ills to the private practitioner and they can obtain instant treatment if they are prepared to pay for it. Many of them, having paid heavily through the government scheme, of course, cannot then afford to take out further private insurance. They have not been able to afford insurance and the blow, coming as it does in the face of illness, is a heavy blow. So driving everyone more into the hands of the Government will ultimately mean that a few people who can afford it are going to do better than others. We say that the choice should be extended to all and that everyone should be given the same opportunity of private relationship and private choice.

Another most interesting feature of the sort of system that the Government is advancing for our consideration is the practice of queue jumping. Those people who have a special relationship with someone in a Government department can jump a doctor's queue by weeks or days and can jump a hospital queue by years. This is a practice which surely we would all deplore. In a prosperous community like Australia, where we have pockets of poverty but where the overwhelming majority of people are becoming more affluent, we must empower consumers to make their own decisions. In the technical area, of course, the consumer of health care is not able to know precisely the details of the specialist or technical treatment that he is receiving, and here his relationship with his family doctor is important because the family doctor is, if you like, his health broker who acts for him in the market place of health. In the non-technical area of health care - in the service aspects of care such as the choice of timing, of location, of convenience, of comfort and of attention to individual preference, things which may well have decidely important therapeutic value - the patient can learn to exercise the sovereignty of the consumer.

As I say, rising incomes are empowering more and more Australians to make decisions, are widening their resources and involving them in what we call the expectation of rising standards where they can demand better quality and more responsive personal services. The Government of course will always have to take action in areas of what we call public health. Not for a moment am I suggesting that the Government should pull out of these sorts of areas. Much of the sort of further reforms that the Liberal and Country Parties will suggest will be involved in the area of environmental and preventive services. But the Government itself - any government - need not produce, organise, manage and provide personal medical services as a virtual monopoly.

I have talked of the notion of price and of free medicine. Price is no longer the problem in Australia that it was 10 years ago. There are very few Australians now who are denied the care they need because of price. Overseas research has shown that there is very little difference these days in a place like the United States between the medical care received by the low income earner and that received by the high income earner. I suspect that this is the case in Australia. We would need to be shown that the health care which low and medium to low income earners are receiving is deplorable by contrast with the care which middle and upper-middle income earners are receiving before we would be prepared to consider some of the issues which the Government is advancing in this debate.

A further point I want to make is in the area of cost. The Australian on an average, ordinary income, whose wife works, will immediately pay more to get the type and quality of health care which presently he and his family are receiving in this country. If we take as an example the individual receiving the average taxable income which next year will be somewhere around $100 a week, and compare what he would have been paying under the present system with what he would have to pay under the Government's scheme, the compulsory tax levy .of 1.35 per cent, and, of course, the standard taxation rate which he faces in his normal tax burden, and add to that a private insurance contribution to provide him with, say, the intermediate standard ward care that he has grown used to, we would find that he would be paying at least $30 and probably a good deal more extra per annum just to receive next year what he is presently receiving. I stress that the example I have given is the family right in the middle of the spectrum in Australia. The Minister has made a great deal of an argument, without providing facts, that 3 out of 4 Australian families" would pay less under his system, but that is to say that they would pay less for what he is offering, which is standard ward treatment in a public hospital and, perhaps, in a private hospital. We say that the important point to make is that people should be able to go on receiving what they are presently receiving. They will not be able to do that without a further, costly private insurance contribution.

As I have said, the whole theme of the Government's alternative proposal is to forget what has been done over so many years in the reform of the health care system in Australia, is to foist on Australia a philosophy which, as I have described, is part of the fag end of an old socialist era, is to be immediately more costly for the average family in Australia and is in the long term to lead to a rundown in total community resources devoted to health. I say finally that governments should facilitate rather than frustrate personal sensitivity in sickness as in health.

Debate interrupted.







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