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Monday, 14 October 1991
Page: 1811


Dr BOB WOODS(3.05 p.m.) —-This matter of public importance is about a Government which is so afflicted by policy paralysis that it cannot take any of the tough decisions that it needs to take to fix up our ailing health system. The whole country agrees that the Budget was a disaster from almost every point of view. There was just one shining light in the Budget: for the first time in the whole of the Hawke Government's history, it seemed that it was steeling itself to take a tough decision with the introduction of a $3.50 charge for Medicare. One might think that that was not such a tough decision, but for the Government it was a very tough decision.

We in the Opposition had some trouble with the way the $3.50 charge was structured, but we overwhelmingly supported the thrust of a price signal to patients. For that reason, we offered bipartisan support. We said that we would support the $3.50 charge; we would make no politics out of it. We even offered to help the Government sell it. With that sort of support from the coalition, one would have thought that even a Hawke Government would be able to take a tough decision, which was really not that tough after all.

But what happened? Old Jellyback looked over his shoulder at the honourable member for Blaxland (Mr Keating), counted his support from the loony Left, decided that his job came first, rolled the Minister for Health, Housing and Community Services (Mr Howe) and agreed, firstly, to the appointment of a Caucus committee and, secondly, to this final compromise which offers the worst of both worlds. I feel sorry for the Minister. For once, he tried to do the right thing and for just a little while it looked like he was a member of the not quite so loony Left. But boy, did he get rolled. He made the mistake of trying to implement a tough decision under this Hawke Government. That is a recipe for disaster at any time but it is particularly a recipe for disaster when the job of the Prime Minister (Mr Hawke) is involved.

How bad is the system? I think the facts speak for themselves. The system is so bad that, even though most pensioners are struggling along on a very meagre income, something like 700,000 of them, according to HBHA figures, have decided to take out private health insurance. They are terrified of being left to the whims of Medicare. They cannot afford to rot on waiting lists. They cannot afford to suffer pain and discomfort in the last years of their lives. They somehow had to find that money for private health insurance. Do they get any help from this Government? Not one bit. Do they get any encouragement to look after themselves? Not a bit; quite the opposite. They get higher premiums. Each pensioner has to pay something like $200 more for his health policy because of this Government's policies, its ideology and its bigotry in the health arena.

Wastage comes in a number of areas. Perhaps the two biggest areas are, firstly, wastage in the public hospital system which this Government has done absolutely nothing at all to address. It has simply washed its hands of the matter and said that it is a matter for the States. The second area is the over-usage of medical services under Medicare. Let us not doubt that there is in fact an over-usage. For once, probably the only time in my life, I find myself agreeing with the honourable member for Blaxland who, in relation to pharmaceuticals, said that if one offers a free service, it is going to be abused.

It is Medicare funds that are being wasted. They are not available for the other things in our system; they are not available to replace broken and painful hips; they are not available to have cataracts fixed so that people can see again; and they are not available to fix other painful problems. Those services are rationed and those patients are on waiting lists for months and sometimes years on end waiting for relief from their suffering.

The Minister for Health, Housing and Community Affairs had our complete support to fix this and he wimped out. He had a bunch of jelly bellies in the left wing of his Party who said, `We can't do that; we can't charge patients. Heaven forbid!'--regardless of the fact that I gather his own telephone surveys showed that something like 60 per cent of the population supported the co-payment. So the Government has been rolled in a big way. This is one of the most humiliating defeats in the history of this Government that I can recall, and that is saying something. The Government was forced to appoint this Caucus committee--its views were known in advance and its decision was predetermined--to come up with some alternative options.

Let us look at what the committee did. It was given terms of reference which were specifically to take into account the requirement to reduce growth in medical services and to come up with the same fiscal result as the Budget.

What sorts of solutions did the committee come up with? The first one was to increase the Medicare levy. That is a loony decision, if ever I have heard one. How on earth the Government is going to cut down overusage and overservicing by increasing the levy is beyond me. But the other option--the basis for the Government's final decision--is even worse. Instead of attacking free medicine and bulkbilling, and trying to reduce overservicing and overusage as the result of bulkbilling, the Government wants to increase bulkbilling. Somehow it thinks that making more items free will actually cut down on overusage. If ever there was a case of convoluted thinking, that must be it.

Normally the thinking is that, if one makes something more expensive, it is used less. But somebody in the Labor Party seems to think that, if it is made free, fewer people will use it. It is beyond me and I think it is beyond most people with any common sense in this place; but that is exactly what the Government is proposing. I call upon the Government to explain exactly how increasing bulkbilling will cut down on overusage and overservicing and how it will achieve the same fiscal results as the Government set out to achieve. The answer of course is that it will not; it will cost another $70m. Make no bones about it, that is $70m worth of wastage.

Think what $70m could have done. Think how many hips could have been replaced, how many cataracts could have been fixed and how much pain could have been relieved. Think about the inconsistencies and the hypocrisy involved in that sort of decision. The Government has been saying all along, and indeed said it today, that a price signal was important to cut down on overusage and overservicing. But in the end the Government wimped out and took a decision which actually encourages the smallest possible price signal. Yet it had the audacity to claim on Thursday evening that this proposal was a stronger package than the original one.

The honourable member for Makin (Mr Duncan) got it right when he said that those Labor MPs who voted for it should be ashamed to call themselves Labor members--the wrong reason but the right result. Clearly, as we have said today, the Government's motivation in imposing those charges was not to improve the quality of the health system in Australia by reducing wastage. If that were the Government's motivation, it would not have encouraged bulkbilling. The Government's motivation is to squeeze more money out of health to fund its loony Left mad cities program upon which it plans to blow $800m of taxpayers' money.

We tried to find out today what this crazy fantasy is. Nobody knows, not even the Acting Prime Minister's own Department of Health, Housing and Community Services knows, as it said before an Estimates committee. It is some loony Left, half-baked fantasy, presumably dreamed up in a shower or somewhere. I think it is true, however, that all governments in their declining months have a tendency to build monuments to themselves. A better cities program is nothing more than that: it is a monument to the doomed Hawke Government.

If Government members doubt whether bulkbilling leads to an increase in services, I suggest that they read the Auditor-General's report. The evaluation made by the Auditor-General clearly indicates that there is an association between the overusage of medical services and the incidence of bulkbilling. This is not an Opposition document or an AMA document; it is a document by the Auditor-General of Australia, completely independent of the processes of government. Yet, in spite of his statement, Government members cannot accept that bulkbilling leads to overuse.

Never mind that the State with the highest incidence of bulkbilling--New South Wales--is also the State with the highest usage. Never mind that bulkbilling GPs request more pathology services per patient than non-bulkbilling GPs. Never mind that one particular Melbourne GP who switched over to bulkbilling pathology services, with no other change in his practice, requested 40 per cent more services from that pathology service in the first year. Never mind that in Tasmania, where only 55 per cent of GP services are bulkbilled, the per capita cost is $191, whereas in New South Wales, with 75 per cent, the cost goes up to $250 per capita.

The Government's own report from the Macklin inquiry indicates that patient co-payments will significantly reduce demand. Overseas data says the same thing, that patient co-payments of around 15 to 20 per cent will reduce services by the same sort of ballpark estimate. Professor Richardson indicates in that report that, if doctors are able to do so, they will make up for the reduction in their incomes by increasing their servicing of patients.

The easiest way in which they can increase their servicing and the number of items which they service is if there is no cost signal to their patients. With bulkbilling there is no minimal signal; the patients effectively sign a blank cheque for the doctor. This is happening already. Over the weekend two of the major bulkbilling clinic chains in New South Wales indicated that they will not be charging the $2.50 signal. How do Government members think those clinics will make up their losses? One thing is sure: they will certainly not be cutting down on the number of patients they see, and they will not be cutting down on how often they see them.

The Acting Prime Minister (Mr Howe) said today that he wanted to address the problem of rising levels of service and that he wanted to give incentives to provide a better level of servicing. Encouraging bulkbilling will not do any of those things. It will do the opposite; it will cause higher levels of service and shorter sausage machine type consultations. A price signal to the patient is important.

What about this $3.50 charge that the loony Left was so twitchy about? How draconian was it? Most of us would agree--even the Minister would agree--that $3.50 is not an enormous financial burden; it is about the price of a packet of cigarettes. An amount of $3.50 would neither deter someone who genuinely needed to see the doctor, nor break the bank, particularly when there were big safety nets to protect those on lower incomes. We should bear in mind that those on the lowest incomes were entirely protected by the $3.50 proposal. We are not talking about 100,000 or 200,000 people; we are talking about over four million people not paying any charge at all. But the loony Left's welfare mentality is that government is there to pay for everything. It has really run away with itself this time.

We will still support the Minister in this matter. He will not find us doing back-flips. For once he should show some backbone and some guts and do what is best for Australia, not what is best for his opinion polls. It is not too late.

I also ask the Minister whether it is true that, in spite of the fact that he has been comprehensively rolled by his Caucus colleagues and the Cabinet decision is in tatters, he had already authorised the Health Insurance Commission to spend a quarter of a million dollars on publicity for the $3.50 charge? I invite him to answer that question when it is his turn to address these issues. That quarter of a million dollars could have been spent on helping those who are sick, suffering and in pain. It means that the Minister's ego must be so strong that he could not believe that he could ever be rolled in this matter. This is an example of enormous arrogance and callous disregard, not only for his own Caucus colleagues but also for the taxpayers and the patients in Australia.

The other matter that the Minister addressed in the Budget which seems to have gone by the board for the time being is the question of doctor numbers. He repeated today that there should be no increase in the number of doctors and in his Budget statement he said that there are thousands too many doctors in Australia. He said that it is vital to restrict the immigration of overseas doctors into Australia. On that problem as well he has wimped out. It is much worse than just wimping out because, having said during the Budget that the number was thousands too high and there needed to be constraints upon the immigration of doctors, he then turned around and, if he were accurately reported, threatened the AMA and the people of Australia.

The Minister is reported to have said that unless the AMA toed the line on the $3.50 and other charges, he would flood the market with foreign doctors. If that is what he said, it is the worst example of standover bully boy tactics that this Parliament has heard of in many years. He effectively said that in order to get the AMA in line he would destroy the quality of medical care in Australia by allowing a flood of underqualified foreign medical graduates into Australia. The Minister does not worry about health standards in Australia, he does not worry about quality of health care and he does not worry about the pensioners who really need that good quality health care. The only thing he is concerned about is winning a fight with the AMA.

If the Minister did say those things, as reported, he should stand up in a few minutes and withdraw those statements and apologise, not only to the AMA but to the whole of Australia, for using the health of the people of Australia as a bargaining tool and a weapon in a battle with the AMA, because that is exactly what he seems to have done. If that is the case, he should be ashamed of himself.

What about the Minister's long term plans for the health system in Australia? For some time, professionals in the system have been saying that his long term aims are to increase government control over the health system, nationalise it and wipe out private health systems in Australia. That postulation has now been confirmed by the announcement in the Budget of practice grants and practice budgets. Practice grants mean that the Government will give a GP a lump sum and, in return, that GP will no longer rely on fee for service medicine. Anybody with any sense at all will realise that this is the first stage towards putting GPs on salary.


Mr Melham —-Hear, hear!


Dr BOB WOODS —-I am pleased to hear that the honourable member for Banks is confirming that that is the aim of the Government. Once GPs are on salary, they will have to toe the line because the Government will tell them what to do. Once we have practice grants and practice budgets, doctors are no longer working on behalf of themselves or on behalf of their patients; they are working on behalf of the Government. The Government can restrict services and constrain the number of tests and treatments. If a doctor does not toe the line and do that number of tests, the Government can withdraw or cut his practice grant. This is centralisation and it is nationalisation. I refer honourable members who doubted that this was nationalisation by stealth to the comments by Stuart Hamilton, the Secretary to the Department of Health, Housing and Community Services, in Senate Estimates Committee E on 19 September, when he said that the model for those practice grants and budgets was the UK health system. He made no bones about it.


Mr Downer —-What! Say that again.


Dr BOB WOODS —-He said that we are going down the way of the UK health system. It is a disaster. It is a system where there are no financial incentives for being efficient, no financial incentives for better quality medicine, and no financial improvements to be made in the system in terms of making the health system better. Yet the Government is now telling us that this is the way it wants to go. Its secret agenda is out of the bag. We understand what the Minister is after. It is a case of the loony Left taking over, as we always suspected. I said earlier that it was nationalisation by stealth. I think I ought to change that; there is nothing stealthy about what this Government is doing.

Let me look at the overall picture. In February this year apparently the situation was not too bad, according to the Minister. He said:

The Government has sought to manage an equitable approach to health insurance policy. It has been successful, it has been stable and it has resulted in the restraint of costs.

Fine! But, by August this year, in an address to the Fabian Society on 29 August, the Minister said:

Medicare is unsustainable.

He also said:

There are specific issues which raise concern about the sustainability of the program, the effectiveness of the health care system, and the way services are delivered.

Either the Minister deceived the Australian population in February and told the truth to his Fabian Society mates in August, which would be completely unacceptable to the people of this country, or the situation in regard to our health system is indeed rapidly deteriorating and has now reached crisis point. I suspect that both are true--that the Minister did deceive the population of Australia and that there is a rapidly deteriorating crisis. We will help the Minister create a precedent for this great country and do what is best for its people and make it even greater. (Time expired)