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Wednesday, 14 September 1983
Page: 778

Ms FATIN(4.47) —I should like first to respond initially to the honourable member for McPherson (Mr White), who told us of his military career. Obviously, the House recognises that he must know a great deal about warfare, but I suggest that he does not know much about keeping people well and alive. I have worked in the medical field for 25 years. The honourable member defied us to show which government authorities can do better than private enterprise. I suggest that he have a look at cardiology units, intensive care units, renal units and neurological units which are staffed by public servants and by very eminent medical men and women in Australian hospitals today. In reply to the honourable member for Gwydir (Mr Hunt) and others who talk of overservicing, I suggest that while doctors' incomes depend on illness levels, in the community, and not on 'wellness' levels, there will always be a problem with overservicing. As a community, that is something that we should examine.

In joining this debate on Medicare, I wish to congratulate the Minister for Health (Dr Blewett) and the Government on the handling of this important program . I also congratulate the Australian Labor Party health policy committees which, over recent years, have had a vision for a fair, universal, equitable, simple and efficient health care scheme for all Australians. This legislation embodies one of the major policies that this Government has placed before the people of Australia and, as was said by the Minister in his second reading speech:

. . . for which a clear and unequivocal mandate was received from the Australian people.

Medicare is the largest social welfare program we have proposed. It will provide every Australian with a simple, fair and affordable form of health insurance. It is the biggest policy reform the Government will implement in its first year. The Government is returning to the basic principles of the original Medibank health scheme and this return to Medibank principles will restore equity in health contribution rates, universality of cover and simplicity and efficiency of operation. The Fraser Government produced five confusing and contradictory health schemes in the last seven years, and I suggest that Australians and Australia deserved far better than that.

Today I should like to speak about two matters relating to health care in Australia. The first is the cost of health care to the individual and his or her family and the second the notion of free choice in medicine. Medicare will make health insurance not only fairer but also affordable to every Australian. Everyone will contribute towards the nation's health costs according to his or her ability to pay. The current scheme of flat rate contribution is unfair. For example, today a family on a low to middle income can pay anything up to $1,000 per year for health cover. A family on an annual income of $40,000, $50,000, $60 ,000 or even $100,000 also pays around $1,000 a year. Whilst nearly two million people without health insurance or Commonwealth health protection are mostly low and middle income earners, the complexity of the current arrangements allows the rich to avoid contributing to the community pool of health dollars collected through the insurance system. For many of those who are well enough off to meet their health bills throughout the year, and with a range of taxation deductions available through a careful arrangement of their financial affairs, health insurance is an unnecessary waste of money. Spared the cost of insurance premiums, they also know that the majority of their health bills will be refunded through the taxation system.

In contrast to well off people, I example an elderly couple in my electorate who, after a lifetime of hard work, now receive monthly superannuation payments not much higher than the age pension. Because they are not recipients of the age pension they are forced to pay private health insurance. They contribute $900 per year to receive hospital and medical cover. If they did not do this they could face enormous health bills should they fall ill. In a fair society this elderly couple would not have to pay this exorbitant amount for health cover. Of course, after the introduction of Medicare on 1 February next year they certainly will not have to. They will pay a one per cent levy on their taxable income, just as most income earners in Australia will.

Of course, some low income earners will not pay the Medicare levy. The income threshold below which no levy will be payable is $128.80 a week for a single person and $214.25 a week for a married couple, increasing by a further $21.15 a week for each dependent child in a family. Medicare will provide the same entitlement to basic medical benefits and treatment in a public hospital to every Australian resident regardless of income. This universality of cover is obviously desirable from an equity point of view. In a society as wealthy as ours people should not be putting off treatment because they cannot afford the bills. Basic health care should be the right of every Australian.

I know from personal experience and from looking at statistics that thousands of people in Australia, and a significant number in my electorate of Canning in Western Australia, daily risk high medical bills and exorbitant hospital costs by not taking out private health insurance. They are taking a chance on not becoming seriously ill or being involved in a serious accident. They simply cannot afford to pay health insurance so they take a chance. In fact, they gamble with their health. Other Australians who are ill and in need of care decide not to consult their doctor for fear of the need to be admitted to hospital and such people have visited my electorate office. Hospitals are simply places they cannot afford. None of this should happen. These examples of financial hardship, risk with health and untreated illness all point to a fundamental fault in the current health care scheme, and that fault is the principle of user pays. As a registered nurse of 20 years standing and as a worker in preventative medicine, I have seen Australians ashamed to admit their poverty, ashamed that they carry a health care card, ashamed by their misfortune , and ashamed of what they see as handouts in the medical field. After 1 February 1984 this will no longer happen. Medicare will provide the means for all Australians to have eligibility to a dignified universal health scheme.

I now move to my second topic of discussion, the notion of free choice in medicine. It is my view that a lot of nonsense is talked about how a patient's right of free choice will be denied after the introduction of Medicare. This free choice relates to the choice of doctor. Under the provisions of Medicare a patient may freely choose his or her general practitioner, just as happens now. In fact, no one will interfere with that choice. I add as an aside that many people in remote areas in Australia never have the choice of one doctor or another. They consult the one doctor available or go without medical care. After choosing a GP a patient may need a referral to a specialist. Mr Deputy Speaker, I think you will agree that very few patients tell their GP which specialist they should see. Of course, if a patient is able to recommend a specialist, it is not Medicare which will decide whether that specialist is chosen, but the GP who makes the choice, for it will be he or she who writes the referral. All radiology, pathology and other diagnostic services provided by a doctor will be covered by Medicare. General practitioner consultations, visits to specialists, and the services just mentioned will all be covered by Medicare and freely chosen by the patient and his or her doctor. It is nonsense to suggest otherwise .

Let me now deal with hospital care, the area about which I consider that most dishonest debate takes place in terms of freedom of choice. Medicare will entitle patients in hospitals to free treatment by hospital doctors and accommodation in a public hospital. The kind of ward allocated will depend on the hospital's assessment of the patient's medical needs. Of course, that happens today in hospitals. I think it is worth while pointing out what freedom of choice in this area of health care really means. At present, even if a patient has whatever insurance he or she may want, or even if a patient pays maximum insurance, he or she rarely gets freedom of choice, if at all. Certain specialists do not operate on given days and ruptured appendixes cannot wait. Some specialists do not visit certain hospitals, and the patient's local hospital may very well be one such hospital. Doctors go on holidays, on leave overseas, and many such things. I assure this House that it is a rare occasion when a patient chooses a specialist or sub-specialist. Most often he is told who is the best man or woman for the job and he accepts that advice. Most people rely on their GP for referral, and it is the GP's choice, not the patient's.

I would like to state further that if doctors believe that the patient should have freedom of choice it can be made available, but it has nothing to do with the payment system, in this case Medicare. Doctors, if they choose, can operate on patients in hospitals as hospital patients and get sessional payments and many eminent surgeons do this today. It is up to them whether they choose to allow or not to allow patients to have this freedom of choice. This choice depends on doctors' attitudes, and in the future we may see the current attitudes change. Presently most people when ill or requiring elective surgery leave the choice of doctor and hospital to the doctor. Much of the public debate which has gone on about this choice is nonsense and scaremongering. Most people involved in such debate do not know what they are talking about or, for financial gain, wish to direct patients by suggestion.

The passage of the Medicare legislation is of the utmost importance to this Government. It is, as I said earlier, the largest social welfare program that we have proposed because it provides every Australian with a simple, fair and affordable form of health insurance. I firmly believe that Medicare will be the most popular social program of the Hawke Government and I am proud to be associated with it.