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Wednesday, 1 December 1976


Dr CASS (Maribyrnong) -The honourable member for Berowra (Dr Edwards) commented earlier in his contribution that there is no such thing as a free meal. I agree. Of course there is not. He spent a lot of his time then trying somehow to prove in some devious way that there might be such a thing. He made the point, I thought that the whole thrust of the Government's plan was to decrease the cost on public funds and hence reduce the cost to taxpayers. Bully for the Government. That is perfectly correct except for one problem: Taxpayers unfortunately in this country happen to be people. People get sick. People still have to pay their medical bills. Theoretically it is the Government's claim that taxpayers may not pay so much now, but I will dispute that in a moment. What the people do not pay via their taxation they still must pay out of their pockets when they are sick. I agree that there is no such thing as a free meal. The honourable member has juggled the figures.

Let us examine the total cost. It does not matter a damn to the average citizen really whether he pays via his taxation or out of his own pocket. If die sum total he pays for health services is more now than what he was paying when we organised the scheme he is losing. The Government has imposed a levy. It was claimed that the Government did not believe in increasing taxes, that it wanted to reduce the cost to the taxpayers and so on. So the Government imposed a levy. That is not a tax, but no one can escape it. Everyone has to pay it. Whether it is called a tax or not is irrevelant; it is a tax. The levy was the clever way adopted by the present Government to increase taxes. It did that without saying that it was its intention to increase taxes. The rub is that the levy is less socially equitable than the direct taxation system that was used by the Labor Government to raise a similar sum of money. This Government has imposed a levy on taxable income. I will not go into it here. Honourable members may work it out with a pencil and paper. The figures will not show -


Dr Edwards - The Labor Government proposed a levy.


Dr CASS - That is right. Thanks to the idiocy of the then Opposition Parties, we were able to adopt a socially more equitable approach which involved funding from taxation revenue. That was the mistake of the Opposition Parties, not of the Labor Party. The present Government has reverted -


Dr Edwards - But the levy was as the Labor Party proposed.


Dr CASS - I agree that what the Government has reverted to is the same as our original proposal with the exception that the levy has been bumped up considerably. But the Government's scheme is less socially equitable than the system that the Labor Party was successful in introducing.

There are further deficiencies. One is the ceiling. The ceiling is a burden on the poor, because it tends therefore to lower the contributions that the rich must make. The cover or the opt-out provisions again favour the rich as against the poor. If we take these aspects together, given that a set sum of money must be found- we are not arguing about that factor at the moment- whatever that sum is, this Government's system ensures that more of that money required for the scheme comes from the poorer section of the community than from the richer section of the community. That is not social equity; that is not helping this Government out of its present economic mess. It is making the situation worse. Let us come to the crucial question -


Dr Edwards - We are helping the needy.


Dr CASS -The Labor Government helped the needy. Those who were needy were covered by us. Everybody was covered by Medibank. Do not come up with that nonsense. The Government has simply made the situation worse for those who are a bit above the needy line but well below the rich line. The actions of this Government have made the burden much more difficult for those people. Let us look in real terms at the total cost to the community of this Government's health scheme. Let us look at taxation charges, benefits payments to the private funds and what a person must pay from his or her pocket. Let us sum all of these payments together. What then is the effect of the intervention by this Government? I suggest that it is disastrous.

I make that claim, first, in terms of business efficiency. The Medibank computer was able to handle, at 4 per cent administrative cost, all of the claims for medical benefits and hospital benefits that came to it. Some hospitals benefits claims still went through the private funds. So, in that period when Medibank was doing much of the job of the private funds, the administrative costs of those private funds were still at approximately IS per cent while Medibank 's administrative costs were approximately 4 per cent. That does not smell like inefficient government service. Despite that fact, this Government is now forcing a large proportion of the community out of Medibank, away from the organisation with overhead administrative costs of 4 per cent into the arms of private organisations with overhead administrative costs of IS per cent. How, may I ask, does that save money, given that the doctor or the hospital concerned still has to receive the same amount of money in the end? In other words, the taxpayer or citizen must find 10 per cent more to pay the same bills under this Government's system.

I turn next to the bulk billing arrangements. Under Medibank, our Government provided bulk billing arrangements so that, for the poorthat is, those who could not afford the payments -or for those doctors who were prepared to bulk bill and were not bothered to charge any moiety, which is the beautiful term used and which means a mark-up for the doctors, there was a facility by which charges could be levied directly on Medibank. A great deal of administrative nonsense was saved. A doctor who bulk billed did not need to send accounts to patients. There was no necessity for claims to be made for rebates. All of this was done simply by a doctor sending an account to Medibank from which he received a cheque in payment. This Government has changed that system. Medibank is still in existence. But this Government now permits those doctors who bulk bill also to charge their patients the balance, that is, the difference between the bulk billing payment and the doctor's fee. Under our scheme, a doctor who bulk billed was not able to charge that balance. This Government allows that practice. One does not need to be terribly clever to know what will happen. Most doctors will use the bulk billing facility when they think it suits them and it pays them. In addition, they will charge the patients the extra portion of the bill. So, most doctors in my view will charge the difference, which is 15 per cent, allowing for the fact that there is an 85 per cent rebate on the common fee -


Mr Hunt -The gap is $5.


Dr CASS -They will charge the gap, or $5, whichever it may be- that was the figure under the Labor Government also- with the result that whatever was the saving that we achieved under our scheme, represented by the difference between what a doctor received by bulk billing and what was the common fee at that time, will be an additional charge imposed upon doctor's patients. I repeat that this will arise because in my view- and I am sure practice has shown this to be the case- most doctors will charge the gap. What is worse, some doctors are even charging pensioners in this way. Fortunately, not all of them are doing this. I do not believe that most doctors are in that category. But there are some unpleasant members of the medical professions who are using this loophole which this Government has provided them. They are now charging pensioners who must find whatever money is needed to meet the gap.

I move from that aspect to consider what seems to be the whole point of this exercise, that is, to enshrine and to boost the whole concept of fee for service medical practice, and to guarantee its survival. In his second reading speech on the relevant legislation, the Minister for Health (Mr Hunt) when dealing with this aspect said that the Government was taking this action to ensure that private medical practice would survive and in the ope that the Government's action would encourage the doctors therefore to provide the equivalent of what were once honorary services to hospitals. This is not happening. The doctors are not taking the bait. The doctors are demanding payment. In more and more cases, they are demanding fee for service payment in hospitals. They are greedily grabbing at all of the fee for service facilities that have been provided by this Government's distorted Medibank plan. I have claimed, and often claimed, that that is what bumps up medical costs.

In this respect, let me quote a survey to demonstrate my claim. I know that we are not Americans but we are people. I do not believe that doctors in Australia are fundamentally different from doctors in America. I do not believe that people in Australia are fundamentally much different from people in America. A study was carried out recently on contrasts in health maintenance organisations and fee for service performance. A whole group of these organisations were analysed in this study which was reported in the Social Security Bulletin of May 1976.

In essence, first of all a check was made on the claim that all healthy people belonged to health maintenance organisations. The study found that there was no significant difference between patients belonging to health maintenance organisations and the general community. The same number of chronically ill patients were found in both areas. The study checked on whether people who contributed to health maintenance organisations were more health conscious. The study found that this was not so. The levels in either group seemed the same. What were the differences? Hospital care is the area where all the operations are done and to which the large bills are attached. Hospital use was two-and-a-half times lower in group practice plans where doctors were on a salary compared with hospital use by doctors working on a fee for service basis. There is the answer to the problem. The surgical rate of group practices and salaried doctors was half the rate where doctors wanted fee for service. Anywhere one looks, at whatever time one tries to analyse the figures, the claim that if people have something seemingly for nothing and therefore the sky is the limit is found to be nonsense. A patient cannot operate on himself; he cannot write his own prescription. The patient depends on his doctor for these things. The only freedom that the patient has is to visit his doctor. If there is too much medical care, too many drugs prescribed, or too many operations undertaken, that is the direct responsibility of the doctor, encouraged by the fee for service technique. That is what this Government is encouraging. I assure the Minister that costs will soar enormously.

Mr DEPUTY SPEAKER (Mr Lucock)Order!The honourable member's time has expired.







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