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Wednesday, 14 September 1983
Page: 773

Mr STAPLES(4.17) —I listened with interest to the speech of the honourable member for Gwydir (Mr Hunt). He spoke of millions and billions of dollars in Australia and Canada. I would like to open my remarks in this debate by speaking not of millions and billions of dollars but of one single dollar. Last week a constituent came into my office, which is not a singular event. There are five children in this constituent's family, three of whom are handicapped. One of those children needs immediate surgery to help overcome the physical and social disadvantages of his disability. That family has an income of $294 a week. Members of the Opposition will realise that this family, on an income of $294 a week, fails by $1 to have the advantage of being classified as a disadvantaged family and hence being eligible for a health card. Had it not been for the generosity of some local doctors, the options for that family would have been, firstly, not to receive medical attention, thus continuing the family 's trauma; or, secondly, to pay out more than $50 a month from the meagre income for health insurance under the current system. I have not just made up this example. Under the current health business one does not need to resort to one's imagination to come up with stories of desperation, hardship and deterioration in people's lives and health. It is there in thousands of Australian homes all round us. It is built into the present health business.

I stress the word 'business', because what we have seen develop since 27 November 1975, when Malcolm Fraser promised to maintain Medibank, has been a breakdown of a health care system which was understood and accepted by nearly all Australians. In its place we have had forced upon us a succession of confusing arrangements that have spawned a very lucrative health business. If any government wishes to set out deliberately to create confusion, insecurity, inefficiency and opportunities for fraud and abuse it would find in the health business of the former Government's creation a near perfect model. The former Liberal Government never had and, in opposition, still does not have a health care system or program. It had a health business. Health care in a developed, wealthy nation such as Australia has no right, reason or excuse to be anything but a universal system. It should be a co-ordinated program and an efficient, up -to-date, cost-effective, cost-constraining system. That is what we will have in Medicare.

At this time nearly two million Australians are without health insurance or Commonwealth health protection. They are mostly lower middle income earners; the same people whom the Opposition, with its crocodile tears and matters of public importance, pretends to be protecting. It did not protect these people in its time in office-those dark ages of Fraserism. It did not protect the troubled family that I spoke about at the beginning of this speech and the thousands of others like them. It did not protect, by the complexity, confusion and inefficiency of its scheme, the half million other people who are entitled to a government concession card but who are unnecessarily paying for private medical and hospital insurance from their meagre incomes. It did not protect the aged people suffering in sub-standard, rip-off, so-called nursing homes. It did not protect the people who had to defer medical treatment because they could not afford to pay $50 a month for insurance. It did not protect the taxpayers from overservicing and the blatant frauds such as rent-a-patient, doctor kickbacks and the unnecessary radiological and pathological procedures. It did not protect the doctors from an inefficient system for the payment of bulk billing accounts and from the mammoth bad debts that come from the current system. But the sad joke is that the Opposition, because of its hang-ups on 'private enterprise-no matter what the cost', and because of its blind adherence to the perpetuation of the golden rule of Liberalism, which is that whoever has the gold makes the rules, it has not worked out a health care system of its own of any credibility to put to the Australian people.

For the edification and enrichment of the Opposition I will highlight the cost advantages and efficiencies of Medicare. The Australian electors do not need Medicare explained to them very much at all. They understand and embrace Medicare as they understood and clearly embraced the original Medibank. The Australian Labor Government has a very clear mandate from the Australian electorate to implement Medicare. This time the obstruction in the Senate of 1974 and 1975 will not hinder its implementation or efficiency. First of all, let us get rid of the ruse that provision of universal health care will encourage overuse of health services. There was an increase in the per person use of medical services in the Medibank years. There was a similar increase in the year before Medibank. There have been similar increases in the years after Medibank, clearly without regard to whichever system was in operation. There does, however, seem to be a correlation between the number of doctors, the number of services delivered and the usage rate. It is suppliers, not users who are the principal determinants of cost in the health business. I am sure that once Medicare is well under way we will see an increase in the number of services delivered, but it will not be because people are using the system just because it is there. It will be because there are thousands and thousands of people in this country who have had to defer medical and hospital procedures because they have not been able to afford private health insurance or because they have not had the dubious advantage of being classified as disadvantaged.

The Medicare program contains real, effective cost control measures. It is important in any large socio-economic program as fundamental as a health care system that resources are allocated according to the needs of the people, not just to those who can afford it. We have to ensure that the health dollar is spent on providing the health service to the person in need of the service, not to supporting the inefficient private health insurance industry, fraudulent practitioners and boarding houses which masquerade as nursing homes.

By not allowing gap insurance for medical services the Medicare program actively discourages the practice of charge above the schedule fee. At the moment, on average, 28 per cent of patient billed services are billed above the schedule fee. The highest incidence of charging above the schedule fee is in respect of consultations with general practitioners and specialists. Approximately 36 per cent of these services are charged above the schedule fee. In 1980-81 the fees charged for non-pensioner patient billed services were $20, 500,000 above the schedule fee for those services. In 1983-84 this represents $ 27m. Delays in payments of bulk billing accounts will be reduced under Medicare in the new improved system from the absurd six to eight weeks which operates now to one to two weeks because of the simplified, streamlined computer operations and single fund operations. I can hardly wait for the flowers and letters of thanks and congratulations which will come in to my electorate office from all the grateful doctors in my electorate who are now complaining about the delays in the payment of their bulk bill accounts. Doctors and hospitals will have their bad debts virtually removed overnight from 1 February 1984. Medicare will reduce their overheads and administrative costs.

Mr Hunt —The doctors will love it.

Mr STAPLES —They will love it. The efficiency of the Medicare control systems will mean a greater surveillance of medifraud. Medifraud has been around for years but one could not say that the former Government bent over backwards to do much about it. Considering the millions of dollars it costs Australians-apart from the moral argument-one would have thought that the former Liberal Government would have been a bit more active in stamping it out, but I suppose they were too busy stamping out tax evasion and tax avoidance. Medicare and this Government are prepared to tackle the greedy self-seekers in this nation head on . So it is no wonder that these people are trying to organise what opposition they can. Categorisation of private hospitals will overcome more of the obvious wastage of the current health dollar. Let us face it: Many of these so-called hospitals are really only nursing homes, but they are paid the same rate as acute care hospitals which have intrinsically higher cost structures. It has been a free ride for far too long.

The claim has been made that Medicare will not improve the nation's economic health. Let us look at a few salient facts. At a time of severe economic stringency the Medicare program will provide at far less cost to the consumer a comprehensive health care system. A family on average weekly earnings currently paying health insurance will save about $10 a week. That saving will be reflected in the consumer confidence of the nation. The obvious increase in family cash disposable income will help stimulate demand in our economy which is starting now on its road to recovery. While on that road to recovery I am sure that the Opposition will remind us that we have to clamp down on wages, so let us look at the statements of the National Economic Summit Conference communique. In recommendation 48 we read:

The Summit notes the announced health policies of the Government and believes that it is imperative that at the Commonwealth level a stable system should be introduced as a matter of urgency.

Further, we read:

The unions reaffirm their commitment that they will accept an offset in wage increases on account of the health insurance scheme.

Five months after that, on 5 August, the President of the Australian Council of Trade Unions confirmed this view in a joint statement with the Minister for Health (Dr Blewett) in reference to recommendation 48. They said:

This was a unique and important commitment on the part of the unions, as the ACTU believes that Medicare is integral to any successful Australian wage fixative system.

This joint statement, endorsed by the ACTU, continued:

Medicare, which will reduce the cost of health cover for most Australian families, is viewed by the trade union movement as vital in reducing Australia's inflation rate.

Clearly, there is an acceptance and co-operation of the union movement. Clearly, there is a mandate from the Australian electorate to implement Medicare. The benefits to the nation of a simple, yet comprehensive, cost-effective and universal health care system are quite obvious. It was obvious to the authors of the Hospital and Health Services Commission paper in 1978 entitled, 'Paying For Health Care' who pointed out that under Medibank:

. . . it became immediately apparent that the goal of basic universality had been achieved with remarkable administrative efficiency.

There are no two ways about it; After seven years of dismantling of Medibank, after seven years of a worsening health care situation, we are entering into a new era in health care for all Australians. Medicare will provide universal basic health care for all Australians regardless of the size of their bank account. It will provide security, simplicity and administrative and cost efficiency for this nation. The major advantages of Medicare are unashamedly directed at the long suffering public. Medicare is vital to the regeneration of our national health, and it is not an exaggeration to say that it is vital to our national recovery. When Medicare comes into operation on 1 February 1984 the family about which I spoke, which is suffering because of an application to it of the arbitral standard of an excessive $1 a week, will be a hell of a lot better off.