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Wednesday, 29 April 1987
Page: 1995

Senator POWELL(3.45) —We are addressing a matter of public importance which states:

The hardship imposed on Australian families by the failure of the Hawke Government's health policies.

Of course, Senator Michael Baume, the new health spokesperson for a now totally disintegrated Opposition, has raised this matter of pub- lic importance today in an attempt to raise his personal profile in the health portfolio. He has shown us his colours, but I am afraid that all we have seen is a continuation of the anti-Medicare tirade of his predecessor in another place. The Australian Democrats do not condemn Medicare. Our party has consistently proclaimed our support for the principle of a fair and universal basic health cover for all Australians. We believe that a basic level of care must be guaranteed by our community to all of its members.

The problems facing our health system, like those facing our economy as a whole, speak for themselves. We will not solve them by continuing, with blinkers on, down one path proposed by the Government. We will certainly not solve them either by the so-called expenditure cuts and `user pays burden on the individual' approach of the Opposition. The fact is that we will not fix the health system or the economy by adhering to the rigid ideologies of either the Right or the far Right. To find creative, sound solutions we have to rise above the philosophical dichotomies and sensibly assess the possibilities.

The Australian Democrats acknowledge that some efforts have been made and are being made by the Hawke Government towards more effective health policies that are of benefit to the community in general and families in particular. These include the initiation of the Better Health Commission. Of course, the challenge there will be to facilitate action on its very fine range of recommendations, and perhaps for the Commission to survive and continue. There has also been the establishment of a consumer health forum. The challenge there for the Government is to use this consultative vehicle in a manner that will advance health policy in the interests of Australians, in particular Australian families. We have commended, too, the provision of a safety net for users of pharmaceutical products, which ensures a ceiling of $250 for families which find it necessary to use medication in substantial quantities. Those are some of the measures that do deserve and get some commendation from the Australian Democrats.

Of course, although the Hawke Government apparently maintains its commitment to Medicare, it is writhing painfully through the unpalatable procedure of expenditure cuts on every front. The influence of domestic and international speculators has assured the victory of the economics of the New Right, whose influence pervades the health policies of the Government and of the several factions of the Opposition. What conservative economists advocate today, as we have seen all too often over the past months, the Hawke Government seems to implement tomorrow. The circus continues with Joh, John and Ian vying to outdo each other on their promises to cut social spending by even greater margins.

The Democrats reject this approach to managing the economy and we reject it as a means of mending our health system. Reforms are clearly necessary. The cost to the community of financing health care is growing. Patients seeking elective surgery face long waits before they are treated and our hospitals cannot obtain enough nursing staff. As recent inquiries initiated by the Minister for Health (Dr Blewett) indicate, we are facing an excessive supply of medical graduates, in many ways inadequately trained, and inexcusable problems in determining whether pharmaceuticals have been certified as safe for marketing.

The health system has problems. It has empty beds in some areas, demand for beds in other areas, and beds that are inappropriately occupied, for instance, by nursing home patients. Alongside that maldistribution, we face the need to provide much more comprehensive social services to cushion the consequences of the policies of deinstitutionalisation. We have a rapidly aging population, and a rapidly burgeoning medical technology and associated health care possibilities. The resulting increase in demand for medical services is one of the problems that we face, and I shall return to that matter later.

Public health problems are associated with poverty and hopelessness in the community, both of which are on the increase. The long term stress and the effects on health of extended unemployment, domestic violence, substance abuse and child poverty are well documented. The need for better preventive health care is espoused in numerous medical and professional publications, yet we seem to lack the political will to reconsider our allocation of funding priorities to favour prevention and to acknowledge the breadth of social and environmental factors that influence health.

The problem is not Medicare, and the solution is not cutting billions off the budget. The Liberal Party proposal to fund tax cuts by more service cuts will clearly favour the wealthy, and that is the crux of the matter. Amidst all Senator Baume's rhetoric about the well being of Australian families, we need to ask: Which families? Tax cuts for high income families mean spending cuts on employment training, family allowances, tertiary education and health care. The abolition of Medicare and the widespread requirement for costly private health insurance clearly must benefit the already well-off families. The Opposition's proposal quite simply espouses a health system where the availability of care is directly tied to ability to pay. The Australian Democrats reject that user pays principle in the area of basic health care. The criterion for treatment must be medical need, not financial means. The Opposition's proposals are merely the imposition of a flat tax system, where people will pay through the private medical benefits system at a flat tax level, as opposed to the current system of the Medicare levy, which is clearly a progressive system that does not impact on low income families. It is yet again another flat tax proposal, which is matched by the Government with its flat tax imposed on tertiary students.

The Opposition's rhetoric about cutting expenditure is nothing more than a verbal smokescreen. What would follow from its policies is not a cut in health care costs, but simply a transfer of expenditure from the public to the private sector. People will not stop needing medical services; they will just have to pay directly out of their pockets, depending on their health status, rather than fairly through the tax system. The reduction in Government spending would not represent a saving, but simply a shifting of the burden through insurance premiums and to the uninsured ill.

The demolition of Medicare not only would cost the majority of Australians-low and middle income families in particularly-much more in proportion to their incomes, but also would not solve the array of problems facing the health system. Most of the problems bedevilling the system during this decade would have done so under the fifth and final Fraser scheme and under most other possible financing arrangements. Medicare is not to blame for the chronic shortage of nurses in Australian hospitals. The predecessor to Senator Baume in the shadow Health portfolio has been quoted as saying that the massive public hospital queues were a direct result of the Government's Medicare failure. That clearly demonstrates the Opposition's failure to recognise that the problem is that nursing staff are unavailable as a result of decades of exploitation of mainly women workers, who were supposed to care for the sick and dying out of the goodness of their hearts, irrespective of pay and conditions. They have, quite rightly, finally refused to continue to do so. In many ways, the health system was built on false foundations for all of the years that those staff were not remunerated in proportion to their contribution to the system. The real cost of providing nursing care would have emerged during the last few years, whichever party had been in government, and whatever health care system had been in operation.

Similarly, Medicare alone is not to blame for the alleged increase in medical servicing. In fact, it is not clear from the figures whether a significant increase has occurred. Members of the enrolled population received an average of 7.7 medical services in both the last calendar year, 1986, and the last calendar year of the fifth Fraser scheme, 1983. The practice of bulk billing may mean less disincentive to the community to undertake certain medical services, but other significant factors would similarly have contributed to that, and would have been in place whether Joh or John had led the government over that period. For instance, the availability of ever more sophisticated medical technology and media coverage of medical possibilities has contributed greatly to our health care costs, and some difficult decisions will be involved in addressing this technology-led growth in demand. The growth in Australia of medical malpractice litigation has also contributed to excessive servicing because practitioners feel compelled to cover their backs against legal action. Again, that problem is not easily answered by, or sometimes distinguished from, deliberate abuse by overservicing, and it is not addressed by the Opposition.

The dilemma that we face is that the sum of what is medically possible and individually desired is infinite demand and a potentially infinite increase in costs. Of course, it is politically unpalatable for politicians to be seen to seek to impose a limit on what the electorate wants. The truth is that the resource cake is limited, and that for every front page cute kid with a liver transplant, or every take-home baby in vitro fertilisation success, there is a trade-off. It would take courage rarely seen in politics to reassess those priorities. Yet courage, innovation, consumer consultation and an illusive balance of economic realism and compassion are badly needed, not a firing of shots from one side of the chamber to the other about who will do the best job on an ideological basis.

Both demand and supply of health services are badly askew. Minimising bed use, better policing of fraud and overservicing and the introduction of diagnostic-related reimbursement would all help. The Australian Democrats indicated last year our initial support for the development of health maintenance organisations and other initiatives that would change some of the incentives built into fee for service medicine. A workable system must exist somewhere between giving free service to everyone and the free market dream of the New Right.

The forthcoming economic statement carries with it the threat of cuts to measures directed at the health, welfare and education of Australians, which were so trumpeted by the Australian Labor Party until the Hawke Government came to power. Let us not have cuts to health care that merely transfer costs to individuals and to the State governments that carry the responsibility for managing our hospital system. Let us instead have an increase in public revenue by, for instance, abolishing negative gearing on unproductive company takeovers, eliminating transfer pricing, taxing luxury goods imports and the export of Australian money speculating against our currency and other means, to ensure that the corporate sector makes its due contribution to government revenue, in addition to that contributed by the ordinary families of this country.

The Australian Democrats will oppose deceptive and dangerous cuts in health care, from whichever side they come, but will support innovative and sensible measures to optimise the efficient provision of services to all Australian families. Above all, I want to stress the Australian Democrats' strong view that, whatever administrative, funding or care arrangements are made in the name of health policy, the overall cost in terms of money and misery will not be reduced until we, as a nation, place much more emphasis on prevention-on achieving wellness, as opposed to curing illness.

Public health promotion, education in nutrition and action to encourage healthy and safe lifestyles and to encourage individuals to make responsible decisions in their own lives, supported by community based services, will be needed to achieve a healthier population. As I said earlier, we also need to recognise the stress caused by social factors; it is not only health policies that affect people's health. Both the Government and the Opposition have a history of allowing the impact of the current economic difficulties to fall on those least able to cope, and who pay once they suffer the physical breakdown of some kind that is almost inevitable in those circumstances. Perhaps it is the case that until we have a healthy economy we will not have a healthy community. But in the meantime prevention must be stressed. Those who can pay must do so to help this economy get back on its feet again.