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Wednesday, 14 September 1983
Page: 819


Mr CONNOLLY(10.46) —the bulk billing provisions and the related matters concerning persons who are entitled to Medicare benefits covered in clause 24 and the subsequent clauses really are the very heart of the doctrinal reforms contained in this legislation. I find some difficulty in understanding how a government, which was elected, among other things, to restore employment to the Australian people-a government which promised, as I recall it, to create some 300,000 jobs, in its first term-can enter into an arrangement which it knows will cost the jobs of anything up to 5,000 people who are currently the employees of the health funds which, under this Act and, in accordance with these provisions, are excluded from being able to act as agents for Medicare, in relation to pensioners in particular. In other words, those health funds and their personnel will be limited to that section of the population. I have not heard the Minister for Health quantify those people who will be able to continue to finance their medical health coverage in addition to their contributions to Medicare.

On the other side of the equation we are told that the Governemnt proposes to employ an additional 2,500 people to cope with the Medicare arrangements. However, there is a simple time problem here. I gather that those are to be employed before December. It is quite likely that most people will lose their jobs in the funds in 1984. Therefore very few, if any, of those people will be able to transfer from the health funds to Medicare. The point made by my colleagues is also very valid. We are concerned about oversevicing. We do not believe that a relationship should exist between the doctor and patient which does not involve at least some element of a fiduciary relationship by which the patient is encouraged to consider whether the additional requirements for medical care and attention are needed rather than leave that decision exclusively to doctors, some of whom-as we have seen in relation to Medibank mark 1 in particular-felt themselves to be in a situation where they would literally delve into the mythical Pandora's box.

I agree absolutely with the observation made by the honourable member for Mackellar (Mr Carlton)-that the vast majority of doctors are honourable people who do not actively enter into either overservicing or fraud. This point was emphasised quite clearly in the report of the Joint Parliamentary Committee of Public Accounts into medifraud and overservicing of which I was chairman. Nevertheless, the empirical evidence would suggest, and I think commonsense would support, that if we are not to have a system which encourages some sense of financial restraint while at the same time ensuring that all the people in the community who are in financial distress, for whatever reason, are totally covered by a government-funded scheme, as they have been to date, the remainder of the population who are abe, to some degree at least, to finance their costs and to take out insurance should be expected to do so. The essential problem we have with this proposal is that, once again, we see this doctrinal tendency to remove from individuals any sense of basic responsibility for the manner in which they conduct their lives and the relationships which they wish to develop with their doctors and the medical profession for their health care.