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Wednesday, 14 September 1983
Page: 780

Mr NEWMAN(5.01) —I begin my contribution to this debate by taking up the remarks of the honourable member for Canning (Ms Fatin) when she began her contribution. She referred to my colleague the honourable member for McPherson ( Mr White)-a professional soldier who has campaigned to defend this country, including I presume people such as the honourable member for Canning, as have other soldiers, sailors and airmen who are just across the way. Her remarks are beneath contempt.

This is a very significant debate. It is significant because of the changes that the Health Legislation Amendment Bill and the other three measures which we are debating cognately will bring to health care delivery and the problems which , I believe, they will cause. They are bad enough, but this debate goes far beyond those issues. The debate is a necessary one and that is why many of my colleagues are joining in it. I do not think the people of Australia realise the very fundamental changes which this legislation will bring to their way of life. In the last six months this Government has carefully nurtured and projected a very conservative image. It has been very cleverly done, by devices such as the National Economic Summit Conference, by so-called consensus politics and by a soft Budget.

However, this legislation reveals the Government's true colours. It is socialist legislation, introduced by a socialist Government. As all the speakers on this side of the House have pointed out, it will nationalise a large part of the health care services of Australia. It worries me that so few people in our community realise what this Government is up to. They do not realise because so far in public comments or public debate many of the people who might speak in our community have been foxed first of all by the excellent propaganda of the Government. They have been foxed by the compliant Labor governments that exist in the States around Australia. They have been silenced by the not too subtle blackmail of people such as the Minister for Health (Dr Blewett), who is at the table. After listening to the contributions that members of the Government have made to the debate today in a naive belief of what all this means, it is clear that they simply do not understand the ramifications of the Bills which they are defending today. This legislation will change the way health care is delivered and it will change the way in which it is received. Unfortunately, it is legislation which will result in poorer health care.

Why do I say that it is socialist legislation? Let me pick out some of the characteristics of the legislation. First and foremost, it will severely limit the ability of health care consumers to choose, despite the rather specious and stupid arguments of the honourable member for Canning. A great number of Australians will be led to rely more and more on the state for their health care . Secondly, medical insurance business will be channelled practically exclusively through the Government monopoly, Medibank. Policy, administration and decision making will be concentrated in a large and centralised bureaucracy. Thirdly, doctors will be pressured and finally forced to bulk bill. Again, as my colleague the honourable member for McPherson so properly put it, eventually Australians will be totally dependent on the Government. Fourthly, private hospitals will be squeezed because of the reduction of fair competition between the public and private hospitals. Fifthly, the Medibank levy will result in a very large covert redistribution of income, and from taxpayers who are already paying large amounts of tax. Finally, there is the false representation that it is a scheme paid for by the levy when in fact, as the honourable member for Mackellar (Mr Carlton) pointed out right from the very beginning taxpayers will have to pay extra taxes over and above the levy to pay for the scheme. These are just general points about the characteristics of the legislation.

I will go into some specifics and pose some questions for the Minister because there is confusion about what this legislation means. I refer first of all to costs. It has been established by the honourable member for Mackellar that the cost to the Federal Government will be $1.7 billion, only one-eighth of which will be covered by the levy, and the total cost to the States will be of the order of $8 billion. What I do not understand is how the Commonwealth Government is going to meet the costs, to the States particularly, on the assumptions that it has made. I understand that one assumption that the Minister has made is that the cost of hospital care will average out at only about $300 per family of four . As I understand the Tasmanian costs, they will run at something like this for the financial year 1983-84: This year hospital services are budgeted at $130m. There are 420,000 people in Tasmania, so that works out at about $300 per person , not $300 per family. For a family of four the average cost is $1,200. If the Minister's calculations of costs are right, how does he marry that figure with his assertion that the average cost will be $300 per family? If my figures are correct, we have only three choices to make: The State will pay more-and that will be a burden on Tasmanian taxpayers-the Government will have to increase the levy, or the Government will have to increase taxes to cope. Perhaps more of a worry to Tasmania, other than those basic costs which I would be glad to hear the Minister clear up, is the effects of the States (Tax Sharing and Health Grants) Amendment Bill (No. 2) 1983. In the explanatory memorandum on that Bill, the Minister said:

In order to participate in the Medicare funding arrangements, South Australia and Tasmania have agreed to terminate their hospital cost-sharing agreements with the Commonwealth with effect from 1 February 1984.

The Minister must know that that statement is quite dishonest, that that is not the situation at all. As I understand it, Tasmania as late as just a few days ago but certainly in a letter on 16 August quite clearly pointed out to the Minister, to the Government, that it had not agreed to terminate that arrangement as the Bill stated. If that is the case, what does the Minister intend to do about that? How has he calculated his Budget if he does not know what arrangements he has to negotiate with Tasmania? How can he predicate any of his assertions about the levy or future tax arrangements if he does not know what he is up for in at least one State-Tasmania? Perhaps he could clear up that point as well.

The honourable member for Canning, the honourable member for Canberra (Mrs Kelly) and the honourable member for Deakin (Mr Saunderson) have all commented on the question of cost to the average income earner. The proposition that they put to us is that the average family, on average income, will have its health costs reduced to about $350. Of course, this covers only the basic provision of Medicare; it does not cover the family which wishes to insure against costs incurred in having a doctor of its choice and going to a private hospital. The Minister has said that the figure for basic hospital cover will be $5. My colleague the honourable member for Mackellar has already made it clear that on his information this could be as much as $7 or $8 a week. I corroborate that assetion. Could the Minister please clear this matter up? On what basis does he say that $5 a week is the hospital cover for insurance purposes on the basic rate? I was informed as late as several hours ago by several health funds in Tasmania that they will not be able to do this-of course it is not clear yet, because again this is an area of some doubt. It is clear from their calculations on what they do know that they will have to charge $7 to $8 a week in Tasmania. So that bears out the information that the honourable member for Mackellar put to the House this afternoon. It certainly makes a nonsense of the sort of proposition that has been put by those members I mentioned. If the average family wishes to continue to have not only cover for medical services but also proper hospital cover so that it has a choice, it will be up for about $10 to $ 12 a week.

The proposition put to us by the honourable member for Canning is absurd. She referred to a couple on superannuation paying $900 a year for cover. That is just not so and she knows it. On that basis that couple must be getting the very top insurance cover so they will also be in the same position. If they wish to cover themselves over and above Medicare the insurance cover will cost them more on top of the one per cent levy. So there are some questions in regard to costs. On the question of doctors-

Dr Theophanous —You were never any good at figures.

Mr NEWMAN —It will be answered by the Minister. We are putting it on the table; let him answer it. The honourable member may be able to answer it in his contribution to the debate. As to the question of doctors, we believe that the way in which the Government is tackling this matter is a deliberate effort to pressure the doctors to bulk bill. That means that in their practices they will be down by somewhere between 5 and 15 per cent of their income. This will be accepted by the honest doctors, I have no doubt. But for the Minister to assert that the doctors will be able to save some of this money, because of the savings that will occur from less administration, fewer bad debts and so on is just not true, because all the doctors I talk to point to the problems that they will have in administering the new scheme. Some of them now have several secretaries doing nothing else but trying to cope with the administration of the existing system, let alone having to cope with the system that the Minister will produce.

Dr Blewett —Because it will be so much more simple.

Mr NEWMAN —I am not trying to defend all the aspects of the scheme that exists. The honourable member for Mackellar pointed out some of the disadvantages of it.

Dr Blewett —That is the problem.

Mr NEWMAN —This is the problem: The administrative burden they will have, I assert, will be more than they have now.

Dr Blewett —That is utterly untrue.

Mr NEWMAN —This is what most doctors believe. It is certainly what doctors are telling me at the moment.

Dr Blewett —And telling each other.

Mr NEWMAN —The Minister is only putting a point of view, the doctors are putting a practical point of view. I would like to hear why the Minister says it will not be so. I would be very happy to hear about it. Whatever the argument is about administration, the problem that arises is: How are doctors going to make up for the 5 to 15 per cent drop in income that they will suffer? As I said, the honest ones will cope by just getting on with the job. But as the record shows- the honourable member for Canberra was talking about the Joint Committee of Public Accounts, which looked at the overservicing problem-one of the ways the doctors will cope is to overservice. They will overservice.

Mr Chynoweth —Greedy.

Mr NEWMAN —Yes, they will be greedy; but we know there are doctors like this. I wish to ask the Minister what his magic solution is for improving the situation. He has talked about $8m going into the system to detect this sort of fraud, but in the practicalities, in the nitty gritty, how will he do it? If he intends to do so by checking on the profiles that presently exist, he knows as well as I do that the profiles are available only in the case of doctors who really get into the system. Those who approach that point are not picked up at all because there are simply no ways, means or resources to chase them. Those doctors who will increase their servicing to make up for that 5 to 15 per cent drop in income will not be caught within the existing system. Again, I ask the Minister another question: What will he do about that?

I refer now to the question of public hospital use. This is fairly important. Again, as I understand it, the Minister has said that he believes that there will be a shift of around 2.2 per cent from the private system to the public system.

Dr Blewett —No.

Mr NEWMAN —That is not so. The Minister might tell us what he is calculating. As I understand it, State authorities and State governments are calculating 2.2 per cent as the accommodation they will have to make because of the shift to public hospitals under Medicare. I put it to the Minister that that is a very modest calculation. In Launceston, on checking with a wide cross-section not only of doctors but also of medical administrators and hospitals, they are calculating that the shift could be as much as 20 or 30 per cent. If this is the case how will public hospitals like the Launceston General Hospital cope?

The honourable member for Prospect (Dr Klugman) was talking about the queues which now exist in some hospitals. He was concentrating particularly on ear, nose and throat operations or perhaps plastic surgery which we all know causes queues in the public hospital system. A check this morning revealed, for example , that at the Launceston General Hospital the waiting time for such surgery as a gall bladder operation is up to two or three months while for hip operations it could be over 12 months. That is the position now. What will happen when the system gets over-loaded if the shift of somewhere between 20 and 30 per cent occurs? How in heaven's name, under the new system of Medicare, which will encourage people to make that shift, will a public hospital like the Launceston General Hospital be able to cope? There is no way it will be able to cope.

In passing, I ask the Minister what he will do about the Launceston General Hospital because he well knows that it is an uneconomic, inefficient hospital because only stage 1 has been completed. We have to move to stage 2. As I understand it, the Minister is saying that no more funds can be given to the State or that no agreement can be reached until the whole question of the rationalisation of bed space in the north of Tasmania can be realised, when his colleagues in the Labor Opposition in Tasmania are saying that there is no way that any beds can be taken away in the north of Tasmania. It is a dilemma which he has posed. I would be interested to hear today what the Minister will do about providing a local general hospital which will be able to cope with his systems. Because of the shift I have just described and because of the hospital' s inbuilt inefficiency as it is not finished, I want to know what the Minister will do about stage 2 of the financing of that hospital.

I now move to the question of private hospitals. It is said by the Opposition that the competition available between private and public hospitals will be reduced by the arrangements which the Minister will put in place. I believe that that will be so because it is a worry as to whether people will insure for private hospital cover when they realise that they will have to pay an extra $7 or $8 a week to do so. More than that, there is the question of the categorisation of private hospitals. So I ask the Minister another question which he may be able to answer and settle. He would be well aware that in Tasmania at least-but I have no doubt it occurs all over the country-a number of private hospitals and organisations are very worried about the category in which they will end up. As I understand it, the principal private hospitals in, say, Launceston will end up in category B. Are these figures correct or not? The Minister may be able to clear them up now. One hospital charges $130 a day for a shared private ward. As I understand it, if someone takes out the basic insurance cover he will get $100 from the insurance company. The Commonwealth will pay-in this case a category B hospital-$28. If that is so, what will happen to the gap which, for a medical patient will be $16 a day or for a surgical patient, $18 a day? In the case of surgery it will build up as well because of operating theatre fees.

I am just backing up what the honourable member for Mackellar said this afternoon in this debate. There is a gap of somewhere between $18 and $30 per day in a category B hospital if it charges $130 for a shared private ward. That is quite a different picture from the sort of picture painted by Government members when trying to describe what a beautifully equitable system this is. If that is true, it simply is not fair. It will certainly be a great expense on the system. There are more things I could say on this matter. Hopefully, when we get to the Committee stage, we will be able to go into some more detail. I have tried to put some of the problems which are being debated but are not being answered properly in the community.

I conclude on this point: I believe that the Government will rue the day that it introduced this new Medicare policy. I believe these Bills mean that there will be a poorer health service in this country. The levy which the Government has struck will not cope with the escalation in the years ahead. The Government will either have to increase it or it will have to increase taxes to cover the gap. I hope the Government members will read their speeches in a year or two and see the nonsense which they spoke. These are silly Bills.