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Wednesday, 14 September 1983
Page: 790


Mr COLEMAN(6.05) —We are dealing with a package of measures that is basically a disguised deceit. Medicare purports to give us a simpler, cheaper, more efficient and more equitable health arrangement than we have now. In fact it will be none of these things. What it will do is simply advance the cause of nationalisation of health care with all that that means in terms of poorer and more expensive services for the patient. It is very important to be clear on this. At the moment the Minister for Health (Dr Blewett) is acting the role of the good fairy distributing free goods and services in a time of economic distress with no mention made of the bill which the taxpayer and the patient will have to meet later-sooner rather than later-and no mention of the debasement of health services threatened by the Government's scheme.

The present health arrangements, which are to be changed, involve a balance of public sector hospitals, doctors and insurance, on the one hand, and three fundamental private sector institutions on the other. The first of these private sector institutions is the private insurance funds-some 38 funds throughout Australia-which employ over 8,500 people and which have provided efficient services for over 30 years. The second is the private hospitals which provide 21 per cent of the hospital beds in Australia and in which independent doctors do most of their work. The third is the independent professions, primarily the medical professions, doctors and specialists, but also physiotherapists, chiropractors and so on. Together these three constitute an effective and efficient alternative system of health service sometimes complementing and sometimes competing with the public sector. It is not perfect. There could be more competition among the funds, for example, and there is the problem of medifraud and overservicing, but these problems can be dealt with without overthrowing the whole system.

The Bill before the House, however, is an all-out assault on this private and alternative system. The Government's aim is to dramatically reduce the role of the private funds and the private hospitals, if not to eliminate them, and to reduce the role of and ultimately eliminate private fee-for-service doctors and replace them with doctors in government service and on government salaries. The Bill is a giant step towards the nationalisation of health services. Let us take the voluntary insurance funds first since they are the financial pivot of the private and alternative system. Under Medicare many of the funds will close down . They will no longer be permitted to handle medical insurance since the Medicare one per cent levy is to replace that. In a word, Medicare forthwith nationalises medical insurance. The funds will not even be allowed to cover the gap between the government subsidy and the actual fee charged by the doctor. Some 60 per cent of the voluntary funds' business will be taken over by the Government, by Medicare, and, as an immediate result, some 5,000 employees of the funds will lose their jobs.

The hostility of the Minister and of the Government to the voluntary funds is great indeed. The Voluntary Health Insurance Association of Australia proposed that the Medicare scheme go ahead as announced, with one exception, that is, that the funds be agents for the Government, for Medicare. They have the expertise, the equipment and the staff. This would be a practical, cost- effective, flexible and convenient arrangement and it would save 5,000 jobs. But , of course, the Minister did not want that. He wanted to knock the funds over. So, with the help of the Australian Democrats in the Senate, he rejected the proposal and is proceeding with his plan. Even in relation to hospital insurance the Minister in his campaign against the voluntary funds is misleading people into thinking that the Medicare levy in effect covers everything and that hospital insurance with the funds is unnecessary when, of course, for private hospitals or for choice of doctor it is necessary. Many people will drop out of the funds and those remaining will therefore have to pay higher premiums, with the probability of more dropping out. No doubt this is what the Minister hopes will happen. He is determined to destroy the financial basis of the private sector, of private non-government health care.

Let me turn to the second basis of the efficient and effective private or alternative system of health care-the private hospital. One in five hospital beds in Australia is in a private hospital. Private hospitals complement the public system by handling a type of operation and service largely not provided by the public system. They are usually community hospitals, far more conveniently located in the suburbs and provincial centres than the great public hospitals. I have nine of them in my electorate. They have long been an established part of the Australian way of life. But in the eyes of the Labor Government they are based on the voluntary principle of independence and as part of the move towards nationalisation they too must go. How is this cause to be advanced?

Firstly, Medicare will not apply to private hospitals. The levy simply does not cover private hospital accommodation. To be covered for that a patient will, as well as paying the levy, have to take out hospital insurance with the private funds. But the compulsoriness of the levy means that fewer people will use the funds and the premiums will probably rise-a further disincentive. Incidentally, the Minister for Health is also misleading the public about the costs involved. He has said that a mere $5 a week will be enough to insure for private hospitals . Yet, as the honourable member for Mackellar (Mr Carlton) has pointed out, at $ 40 a day for a bed for six days and $200 for theatre charges, a patient would be over $400 out of pocket with the $5 cover. However, the whole Medicare campaign is based on disinformation.

As the voluntary funds weaken and people drop away from membership there will be a drop in occupancy of private hospitals as people move to public hospitals. Private hospitals will cease to be financially viable, staff will be retrenched, services will be cut or hospitals will close. This is the way that I am sure the Minister hopes things will go, the way he has planned it. Even in the meantime, before Medicare is established, the Government is moving against private hospitals. The insurance funds have been instructed to reduce the benefits payable to patients by 40 per cent. So that patients can still afford to come to the hospitals-and I have had many cases brought to my attention in my electorate -fees will have to be reduced. The Government has also ordered an 18 months freeze on the benefits payable so that the hospitals suffer a two-pronged attack ; reduced benefits and increased wages at the same time. How can hospitals survive this, even before Medicare is introduced?

Let us turn to the third target in the Minister's attack-the medical profession and the fee for service regime. The key to the Minister's offensive is bulk billing and the making of bulk-billing more or less compulsory. I say ' compulsory', because if one practitioner in a community bulk-bills, that is, offers the so called 'free' service, the other doctors will be under great pressure to follow suit or lose their patients. I am sure the Minister is planning and looking forward eagerly to a system in which the overwhelming majority of doctors bulk-bill; that is, are paid by the Government. Once that is established, the profession loses its independence and its morale and it is an easy step to complete government control and nationalisation with all doctors working for the Government on government salaries. Further, bulk-billing-the so called 'free' consultation-debases the doctor-patient relationship as patients tend to demand unnecessary services and doctors are tempted to overservice, subject to the computerised medifraud squad. It is also relevant to note in this respect that clause 18 of the Bill brings the Minister, and consequently the bureaucracy, directly into the making of medical decisions. So let there be no mistake about it. The future of the medical profession is in danger under Medicare.

What will be the general result of Medicare? The medical profession will be yoked to government with bulk-billing. Patients will lose their freedom of choice of doctors and hospitals. Their relation with their doctors will be degraded by the illusion of free consultations with a consequent demand for unnecessary services on the one hand and overservicing on the other, the whole system to be policed by computer surveillance and bureaucracy, and moving with increasing speed into full nationalisation. Private hospitals will collapse and those that survive will be weakened. Public hospitals will be overburdened. A third of the people will pay more for a reduced quality of service and taxpayers will meet the disguised cost of free surgery visits and free public hospital beds. All this will destroy the existing system which, while not perfect, is effective and whose defects could be sensibly corrected. This system gives priority to individual choice, independent professions, independent hospitals and independent insurance. It will be replaced with government control and the certainty of reduced quality of health care.

To put it another way, we have in this Bill a vast shift from private arrangements to government control. That is why the measure can properly be called one of nationalisation. There will be fewer jobs in the private sector, fewer decisions made by individual patients and less finance in the private sector. For the taxpayer there will be a colossal increase in government spending-some $1.7 billion, taking into account the increased payments to the States to make up for what their hospitals will not get from the private insurance funds, the removal of the rebate for health insurance payments and the Medicare levy.

As for the levy, it is obvious that at one per cent it will not pay for Medicare. The levy will raise $1 billion whereas the scheme will cost the Commonwealth and the States $8 billion. The levy is really part of a conspiracy. The real reason for it is not to pay for Medicare-it cannot-but to fiddle the consumer price index so that, since the levy will not be included in the CPI, the CPI will come down and give a false idea of real rate of inflation. All those from pensioners on whose income is linked to the CPI will find that, since the CPI will come down as a result of the Medicare swindle, their incomes will go up less than expected. Their costs will go up, but not their CPI-related incomes at the rate expected. We have seen how the public and the unions reacted to the Government's superannuation lump sum tax rip-off. When the facts are in and when the public sees the levy for the conspiracy that it is, it will be equally outraged.

I said at the beginning of my speech that Medicare purports to give us simpler, cheaper, more efficient and more equitable health care arrangements but it does not. How can it be simpler when it is plainly more complicated for those who want more than the minimum Medicare cover and who will have to deal with both Medibank and a private fund? How can it be cheaper when the Minister admits that one third of people now insured will pay more under Medicare and when it adds $1 ,700m to taxes in a year? How can it be more efficient when it undermines the competitive position of insurance funds and private hospitals and when it makes Medibank a medical insurance monopoly with all the inefficiences of monopolies? How can it be more equitable when it starts with the sacking of 5,000 staff in the private sector, ends with a police state approach to doctors by doubling computer surveillance equipment, and is built on the lie that by removing the one per cent levy from the CPI the cost of living is reduced with the result that pensioners will be robbed of the indexed increases to which they would have been entitled? The real medifraud in Australia today is the Minister.