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Wednesday, 14 September 1983
Page: 746

Mr MacKELLAR(12.24) —We have just heard a typically idiosyncratic speech from the honourable member for Prospect (Dr Klugman). I always welcome listening to the speeches of the honourable member for Prospect because he does bring a flexible mind to bear on the problems which confront the Parliament. I would agree with a lot of what he says. He says that fee for service is bad in itself; I do not necessarily agree with him. He does admit that there should be some sort of restraint on the escalation of costs by the introduction of a patient moiety, and in that he agrees with the Opposition's point of view.

He then treated us to a dissertation on the excesses of various surgical procedures in various parts of New South Wales. Of course, the Government's scheme does nothing in any way to combat this problem. I believe this has to be combated from within the profession itself. A very effective and thorough peer review system obviously would have some effect in this area. Of course the training of the medical graduates will have a great deal to do with solving this problem. Certainly-and I agree with the honourable member-in some areas it is a problem. But the Government's scheme-I point this out again-does nothing to correct that problem. The honourable member said-I think I heard him correctly- that the Federal Australian Medical Association agreed with the Medicare proposals. That, to my knowledge, is not correct.

Dr Klugman —It has not criticised them.

Mr MacKELLAR —It has criticised them in a low key way and the honourable member for Mackellar (Mr Carlton) pointed out exactly why. It was because the doctors have experienced the jack-boot of the present Minister for Health (Dr Blewett) and they are frightened of what can happen in the future. And quite rightly they have a degree of concern about that. The honourable member for Prospect did say that he believed there was an excess of private beds. If there is an excess of private beds now, let me assure the honourable member that the Government's scheme will certainly put an end to that, because if this scheme stays in operation for too long there will not be any private hospitals left. What we will have is an escalating and ever-increasing demand on the expensive public hospital beds and a diminution of the private hospital system much to the detriment of the people of Australia.

The honourable member also mentioned-and I make some allusion to this-that he believed that we should be looking at things like health maintenance organisations. I agree that we should. The Opposition's position is that our scheme would maintain sufficient flexibility within the health provider services to allow health maintenance schemes to operate in Australia. Again, the monolithic scheme proposed by the Government does not allow this flexibility, this experimentation. It is a typically socialist, monolithic answer to a very difficult problem.

Mr Saunderson —That is why it is so good.

Mr MacKELLAR —That is why it is so good. It is a typically socialist, monolithic , bureaucratic-ridden scheme; ipso facto it is good. What a typical response. In the introduction of this Bill, we see the absolute cornerstone of socialist thinking in this country. I would not be as unhappy about it as I am if I could see in it any benefits in health care to the people of Australia. This scheme simply brings about no increase in the quality of health care to the people of Australia. It simply does not. In fact, over the longer term, it will lead to a diminution of the very high standard and quality of health care available in Australia at present. If honourable members disagree with that assertion, they should ask the people of England or the people of Canada. The Canadians are luckier than the people of England. They can go south of the border to get high quality health care. If we introduce this scheme, in my view and in the view of a whole host of other people, in the longer term the general high quality of health care in Australia will diminish.

We see an almost manic obsession on the part of the Australian Labor Party to re-introduce Medibank-or Medicare as it is called now-in this country. Obviously it is a matter of great concern to the coalition and to a very large percentage of the population, because we all remember the cost explosions, the unnecessary operations and the greed associated with the open-ended system introduced originally by the Whitlam Government and called Medibank, now to be introduced again and called Medicare. It took the coalition many years to pull back the costs of health care caused by the spending during those Whitlam years. I do not believe there is any denying that apart from the name change to Medicare, this is really Medibank Mark II. The Minister for Health admitted this in his second reading speech when he said:

The task facing the Hawke Government is thus much the same as that faced by the Whitlam Government, and I am proud that our solutions are much the same.

The Minister is proud that his solutions are much the same. What sort of answer is this for the health care system if the Minister intends to use the example- and a very poor example it is, I believe-of Medibank as the scheme that is best for Australia? It is obvious, as the honourable member for Mackellar has pointed out, that this Government has learned nothing from its past mistakes. In fact, it has wheeled out the same tired academic crocks from the Medibank days and told them to implement a universal scheme which it is to call Medicare. Has the thinking of those advisers changed from the Medibank days? Not a bit. They have just been waiting for another chance to take their ideological dream of nationalisation of the health system one step further.

Since coming to power a little over six months ago the Labor Government has been fundamentally dishonest in its approach to the taxing of all Australians. It has indexed excises and increased sales tax. That slug will now come every six months. The Government has ceased the rebate on health insurance, breaking its concrete promise-of course we are used to the breaking of promises by the Hawke Government-and has thereby increased the financial burden on many Australians. Next February we can all look forward to a new tax being introduced to pay for Medicare. Call it by any other name, it is just a new tax. Considering the number of tax increases that have occurred under this Government , one wonders when the wealth tax that the Prime Minister (Mr Hawke) has already talked about will be introduced.

Mr Chynoweth —Wait for it.

Mr MacKELLAR —'Wait for it', the honourable member said. I am glad that he has now acknowledged that the wealth tax is in the pipeline. Perhaps he can tell us when it will be introduced. I am glad he has acknowledged that we have a wealth tax coming up as well as all those other tax increases. When the Australian Labor Party unveiled the Hayden health plan in February last year I described the scheme as misleading. I also stated that the estimates of cost were so inaccurate that it was best described as an attempted confidence trick on the Australian people. On the figures available to me in March of last year it was shown quite clearly that if the Labor Party were genuinely to use an income tax levy to recover the real cost of the scheme, that levy would have to be set as high as 1.2 per cent. 'Not a bit of it', says the present Minister. He said at that stage that it would be 0.75 per cent. He said: 'We will not need any more than 0.75 per cent'. The figure is up to one per cent already. Where will it go from there? As the honourable member for Mackellar pointed out, even that disguises in a very misleading way the real cost of health care in this country.

Any shortfall in the cost of Medicare will lead to higher taxation. We will all be worse off. If the costing is wrong the only way in which that shortfall can be made up is by the provision of less health care or by the raising of more taxes from the people of Australia. If this occurs and more and more money is poured into the system we will be in the same position as in the Medibank days when the schedule benefits were paid exclusively by a government agency funded by taxpayers. That is exactly what the new scheme will do.

I will mention some of the aspects of the introduction of Medibank mark I. That saw a great change in the proportion of health expenditures borne by the public sector. That proportion rose from 62 per cent in 1974-75 to 72 per cent in 1975- 76, and the Federal Government bore the largest share of 48 per cent. National health expenditure accounted for less than 6 per cent of gross national product in 1973-74 but it jumped to 7.7 per cent by 1975-76. Commonwealth Government outlays on health services jumped from 7.7 per cent of total Budget outlays in1973-74 to 13.5 per cent in 1975-76. It was a time when the Labor Government kept pouring in money and complaining vigorously about the inflation that resulted. I think it is utterly plain to everyone that the escalating costs of the introduction of Medibank were absolutely beyond the imagination of the people who introduced the scheme and were certainly beyond the capacity of this country to pay in the longer term. As I have said, if this blowout occurs again it is obvious that either the levy will have to be increased or Consolidated Revenue will have to be used to prop up the scheme.

Let us look further at what happened with Medibank I. In 1973-74 56.62 million medical services were carried out. In 1974-75 the number was 64.03 million, an increase of 13.1 per cent over the previous year. In 1975-76, the first year of Medibank, there were 82.26 million services, an increase of 28.5 per cent over the previous year. That is the effect of introducing a scheme such as Medibank. I believe, as the honourable member for Mackellar has already pointed out, that the reintroduction of the Medibank system will lead once again to the over- utilisation of medical services and to more provision of services by the medical profession than is necessary. That can be combated in various ways, as the honourable member for Mackellar pointed out, but none of them will lead to effective and efficient health care services.

The defect of the previous system and, by all appearances, this system, was the temptation which it provided to those concerned with the provision of health care to overservice patients and thus generate higher costs which inevitably must be borne by the taxpayer. The position is further aggravated when universal cover is provided by a single tax-financed government agency which in effect becomes the dominant source of income for doctors in private practice. Another problem which comes to mind in the introduction of Medibank is the desire of the Labor Party to number everybody by issuing them with a card. Mr Deputy Speaker, I am sure you will recall the introduction of Medibank Mark I and the farcical nature of the introduction of the Medibank cards. Cards were issued to people who had been dead for many years and to people's pets. Cards were misused by overseas relatives of Australian residents who came to this country solely for the purpose of having expensive operations, and of course the cost of that misuse was borne by the taxpayer.

I note with interest that this rather generous attitude to visitors to Australia has been carried over by the present Labor Government. It seems rather generous to me that visitors who have approval to stay in this country for six months should receive the benefits provided by the tax of permanent residents of this country. I recall the influx of people into Great Britain from other European countries simply to take advantage of the free health care which was available there.

Dr Charlesworth —Ha, ha!

Mr MacKELLAR —The honourable member for Perth laughs about it. The fact is that it occurred. People from overseas added to the queues of those seeking to use the services that were available in Great Britain. It was no cause for laughter on the part of those people who were disadvantaged by it.

Dr Charlesworth —You are suggesting it is going to happen here.

Mr MacKELLAR —I am suggesting it should not happen here and that it could happen here with the Government's introduction of this scheme. The fundamental aim of the coalition was to ensure that all Australians had proper access to health services of high quality at a cost which the individual and the community could afford. Our other objectives were: A pluralist approach to health care delivery; preservation of freedom of choice by both providers and users of health care; small government; acceptance by the State governments of their proper role in planning for and providing efficient and economic health care services; encouragement of responsible use by payment of a personal moiety; protection of the needy; encouragement of the private sector; and the fostering of a sense of responsibility among the providers of health care.

These objectives are what the coalition stood for when it introduced its health scheme in 1981. I believe that it was a successful scheme. Obviously, as the honourable member for Mackellar pointed out, there were some defects but they could quite easily have been remedied. It was a scheme which was acceptable to the public of Australia and which the Labor Government now intends to dismantle. We should ask: What does the Labor Party stand for and, in particular, where does it stand in relation to the health care of Australians? We know that the Labor Party stands for big government. It obviously stands for higher and higher taxes. It stands for a denial of choice and a distortion of Commonwealth and State priorities. When it comes to health care Labor stands for universal, compulsory centralised, monopolistic government schemes.

The danger of centralised government agencies is that they can be impersonal and insensitive to the needs of individuals. I am concerned at the possible unemployment in the voluntary health insurance area, and I am pleased that the Minister has seen fit to give employment preference to employees of the private health funds who seek employment with Medicare and who are affected by the introduction of the new program. It is an empty promise but, nevertheless, he made it. I trust that some of his compassion in this matter will rub off on his Government agency when it comes time to handle the health problems of the community.

Another area where I must also congratulate the Minister is his decision not to revert to the open-ended hospital cost sharing arrangements which were in vogue during the Whitlam Medibank era. I note that the Minister said:

The Government believes that the States should have the major role in planning the total health services available in the community.

The coalition is firmly of the belief that the States should fully accept their constitutional responsibility for the provision of health services and determine their own priorities as to how funds should be allocated to the different parts of the health system. Yet, for all the Minister's words, I can see nothing in his second reading speech which guarantees that health care decisions will not be brought back to the bureaucrats in Canberra as they were during the Whitlam years. The Minister pointed out the benefits of Medicare to the States and he singled out for special attention the State of Queensland. I wonder why he mentioned Queensland? Perhaps it is because there is an election in Queensland on which he thinks he may have some influence. He said:

. . . Queensland is the only State Government which has its overall health funding situation improved by Medicare.

That, of course, is an absolute nonsense. The original offer made to Queensland was $63m and its population is 2.45 million. In South Australia, where the population is 1.33 million, the offer was $78.7m and in Western Australia, with a population of 1.35 million, the offer was $69.9m. Of course an extra $35m has been found for Queensland since the original offer. But on a population basis the original offer was nowhere near a fair one. One could perhaps question the motives behind the highest increased outlay of $20m to Western Australia now that that State is controlled by Labor.

The one per cent levy in Queensland will provide residents of that State only with access to a private medical practitioner as hospital treatment is already provided free through the State's own tax system. Queenslanders will now find that the one per cent levy would be more than they had previously paid for health insurance to cover themselves for visits to the doctor. Rather than being better off, they are worse off. With the coalition's tax rebate on health cover which, as I mentioned earlier, was ceased by the Government on 1 July, single persons could have taken out a health insurance policy for $1.75 each week to cover themselves for visits to the doctor. Under the Medicare levy they will pay a minimum of $2.50 per week. Not even the mathematical gymnastics of the Minister will convince Queenslanders that they are better off paying more. Obviously married couples who are both working will be hit hardest because they will pay the levy twice. This will cause additional hardship to young couples saving for their first home amongst other things.

The current Minister for Health, when he was in Opposition, took great delight in knocking our health program, saying that it was confusing. I do not believe that it is anywhere near as confusing as the particular proposition that has now come before us. The Labor Party has had seven years to work on a policy. The present policy was announced over 19 months ago. But, after six months in government, the Labor Party is still not in a position fully to explain to the people of Australia what it all means. I believe that the public are confused. A number of people are fairly concerned about what will happen to their freedom of choice, what will happen in terms of the delays they may experience and what will happen in the general provision of the wide variety of health care services currently available to Australians.

It is clear that this scheme, which is a gross deception, will put a grave strain on public hospital services, leading inevitably to queues and delays. It will be a major burden on the nation's economy and will grow substantially in cost year by year, unless services and facilities are curtailed, and it will inevitably lead to higher taxation. The Minister has described his scheme as ' simple, fair and affordable'. It obviously is nothing of the sort. Like so many of the Labor Government's statements and policies, it breaks promises. Its performance will in no way live up to its description when it was put to the Australian people before the last election.

Debate interrupted.

Sitting suspended from 12.45 to 2 p.m.