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Wednesday, 14 September 1983
Page: 844


Dr EVERINGHAM(1.30 a.m.) —My colleague the honourable member for Burke (Dr Theophanous), who sits on this side of the House, has just pointed out that when one provides medical insurance, medical benefits and hospital benefits one is not conscripting or socialising anybody. The power given to this Parliament under the provisions of the Constitution which enables it to monopolise health insurance was given to it by a referendum of the Australian people, and was backed by the Australian Medical Association and the Menzies Government; that is, the power to provide health benefits and health services to the Australian people. It is the same sort of power which the Tasmanian Government sought when it wanted to monopolise energy production in Tasmania. It is the same sort of power that governments use when they want to monopolise any service that they consider should be monopolised in the public interest, whether it be services in relation to railways, Qantas Airways Ltd, the hydro power authority in Tasmania or the Snowy Mountains scheme.

There are plenty of examples of public monopolies in the public interest. Governments of both colours have seen the wisdom of monopolising such things. In fact, when Sir Earle Page brought in the original pre-Medibank subsidy for private fee for service practice he did not say: 'We had better allow people to have 100 per cent cover'. He said the opposite to that. He said that a moiety should be provided by the patient. The clause we are debating provides for that. The patient will provide some of the cost of his health care. Sir Earle Page said that we should be helping those who help themselves, which is going a lot further than we do. The honourable member for Denison (Mr Hodgman) seems to think that he can take this matter to the High Court of Australia and have it thrown out. I can assure him that it will not work that way. The beauty of this system is that it preserves the right of every doctor to charge the patient any moiety he likes. He can charge the patient nothing above the benefit so that the patient pays no moiety at all or he can charge the standard fee which will be met by the Government in cases of hardship. In the case of the person who is up for $150 a year of gap or the patient moiety, that cost will be met by the Government. But if the doctor envisages that that is not enough of a deterrent- the 15 per cent gap-the doctor can charge patients above the standard fee. Even when gap insurance was widespread in this country doctors were doing that because they did not believe in their services being free of charge at the point of service.

There is no way that this legislation is introducing any new principle. There is no way that it is introducing any principle that has not been argued for by the AMA and other medical interests. In fact, the medical organisations which have most condemned and opposed Medibank and Medicare have argued for this very principle-that one should not cover 100 per cent of fees. This proposition was put to the Australian people at election time. They have given us a mandate. Nothing in the post-war history of Federal Parliament has been so acclaimed as the Medibank scheme and now Medicare. Another interjection from the honourable member for Denison suggested that people will regret it and that they will have to pay for their unwisdom.


Mr Spender —They will find out it is not free.


Dr EVERINGHAM —Of course, nothing is free, but there are things that are free of charge at the point of service. Opposition members should talk to their colleagues in Queensland who run what they call a free hospital system. Of course, there is no free lunch. Of course somebody pays for it. But it is free of charge, free of fee, at the point of service. That is what is meant. That is all that is meant by the term 'free hospitals'. It does not mean that it drops from the sky like manna from heaven. No sensible person suggests that it does. I wish that that sort of inane comment would be dropped from the debate.

There are many ways in which Medicare will improve on the Earle Page concept of medical insurance and the five steps towards restoring the Earle Page scheme which occurred in seven years of Fraser Government. In that period, the then Government gradually eroded almost everything that Medibank had provided to the Australian people except the cover for pensioners which we brought in. The Earle Page cover for pensioners was about two-thirds of the standard fee. Most doctors joined that scheme and agreed to treat patients for that concessional payment. They then objected to the liberalisation of eligibility for pensions when the tapered means test came in. So a limit was put on the amount that a pensioner could earn and still get medical benefits. Under the Liberal Government, before Medibank, those patients who were eligible for pensioner medical services without means tests were allowed free services under that scheme only if the service was provided by a general practitioner and if the service was either a consultation or a visit. If the doctor was treating a fracture, giving an anaesthetic or performing an operation, there was no medical cover for the pensioners for that specialised care by general practitioners or specialists.

Medibank gave pensioners the same benefits as insured patients. It gave them entry to medical services on the same basis as the rest of the community. We are carrying that a little step further and asking the doctors to put everybody on the same basis as pensioners. The doctors will earn a reasonable return. If they want to charge a patient extra, they may do so. It is up to the doctor and the patient to arrive at a private practice free enterprise agreement on what the fee involved will be. That is free enterprise. Nothing in this system will stop that happening. But the Federal Government has been given the power by referendum by the Australian people. This Government has been given a mandate to implement its Medicare policies and to do what we are doing tonight, that is, to provide a monopoly of public service to apply to every Australian just as we have a monopoly on age pensions, on State railways and on all kinds-


Mr Howard —Telecom.


Dr EVERINGHAM —Yes, Telecom and Australia Post.


Mr Howard —And some of you would like a monopoly on education for the States, wouldn't you?


Dr EVERINGHAM —We have done more for the private education sector than our predecessors. Private schools were better off during the Whitlam years with the money we gave them when there was an education crisis in this country. The major complaint of the private and public schools was that Liberal-National Party governments had let them run down. We restored decent funding to them. We have done it again in the Budget this year.