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Wednesday, 13 October 1971
Page: 2286

Dr CASS (Maribyrnong) - In the brief time available to me, I should like to deal with the whole concept of the national health scheme, since the Bill that we are discussing is the National Health Bill. Very briefly, the view of the Australian Labor Party is that it would be far more efficient to have a completely integrated scheme with the public hospitals, in essence, being the pivot of regional organisations of hospital services from which the specialised medical care would flow. Around these regional organisations would be satellite hospitals in areas where people live and where the general practitioners could be organised in health centres. By this integration of services, the cost of hospitalisation in the large public hospitals can be reduced.

Waste occurs because people are admitted to hospitals for admittedly specialised medical care requiring facilities which are available only in large public hospitals. The point is that the time they need to be in these institutions is much less than then now spend in them. They could spend probably half the time they now spend in these expensive beds.

Let us take an operation like a gastrectomy or a cholecystectomy or some other serious operation which should be performed in a large public hospital. With a normal recovery, after 3 or 4 days, or maybe a few days more for gastrectomy, the crucial stage is over and most of the intensive care supervision has ceased. But at the moment the patient sits and languishes in a bed that costs perhaps $30 a day while he convalesces before he is discharged to go home. What should happen is that be should at that stage, probably half way through the period of hospitalisation, be transferred to a convalescent bed in one of the satellite hospitals where he is nearer his own family and nearer his own general practitioner so he can get back to the care of his general practitioner where he ought to be. He would then vacate a highly specialised, expensive hospital bed. Even if it is only 3 days sooner he has saved for the community 3 days of highly expensive hospitalisation.

The next question that is thrown up at us of course is: Where will you find the money? The answer is: In the same place you get it from right now - out of your pockets and mine. The point is that we all pay for the health service. Partly the Government pays, partly benefit funds pay and partly patients pay. But let us not fool ourselves. The Government contribution comes from the taxpayers' pockets. The benefit fund contribution comes from the benefit fund contributors' pockets, that is from the same persons who have paid the taxation. The private fees come from the- individuals who happen to be sick. They are ordinary members of the community, the people who pay the taxes and pay the benefit fund contributions. So stop fooling ourselves. The money comes from your pocket and mine. It does not come from up above.

All we are suggesting is a reallocation or redirection of the money from your pocket and mine to the doctor and to the hospitals. At the moment it goes via the benefit fund organisations for a start. What does that cost us? For the privilege of belonging to over 100 different benefit fund organisations it cost us in the administration costs of those organisations for the year 1969-70 a sum of $12m - sheer waste, just to keep the wheels of the benefit funds going. In the same year these so-called non-profit organisations amassed a surplus - they call it a surplus because we must not call it profit; they are non-profit organisations - of $8. 8m. In addition, from the reserves they have invested because they have been amassing not profits but surpluses for all the years they have been going - I would guess they are well over $70m now - they received last year $4.8m. So in 1969-70 our funds, from the stage the money left your pockets and mine, passed through the benefit fund organisations and reached the hospitals and the doctors had dropped by the sum of $25.9m.

That is where you will get the money. You do not have to tax people more; just eliminate the inefficiency. You would collect the same amount of money through the Taxation Office through a national health insurance fund based on taxable income, which is what our policy is, just by changing the print on the back of the taxation form. You do not have to employ one extra person in the Taxation Office. You would collect the money in the same way as you collect the ordinary taxation revenue, without any additional expense *o the community. You would save enough money to pay directly the fees patients now pay to the public hospitals. So straight away you could eliminate the burden of fees which we inflict on the poor individuals who happen to be sick. In other words because of the way our present health scheme functions we punish the people for being sick by charging them fees. Instead we should all be insuring, by means of a national fund collected via taxation, by regular payments to the doctors and hospitals as they need them so that the service is there for the crisis occasion when we become ill. It is of no good being expected to pay when you are ill. It would be much more intelligent to pay smaller amounts while you are well and are earning. Surely that is social justice.

In essence the point about the Labor Party's scheme is not, dear friends of the Government, that we are proposing an enormous additional expenditure - not at all. We have not said that doctors should be paid more, God bless them. We have not said, although there is a good case for it, that the nursing staff should be paid more. We have riot gone into that one. Accepting the present rate of pay for nurses and the present administration costs of hospitals, what additional funds are Government supporters talking about when they ask: 'Where is the money coming from?' Who for? Not for the doctors, not for the nurses, not for the administrators of the hospitals, not even for the drug firms and the medicines they provide. So who are we supposed to be finding the extra money for? It is all a figment, of the imagination. There are no extra funds involved at all.

The Labor Party scheme would save funds because it would save the gross inefficiency which now occurs simply in the transfer of the funds from your pockets and mine to the dispensing services, the doctors and the hospitals, and all the associated people. For these reasons I suggest that the present scheme is grossly wasteful of national resources. It costs us far more than other schemes which offer much more to people. Schemes in Britain, Sweden, many of the Western nations and in Europe involving far more salaried medical services and far more national organisation of hospital services provide better service and do not cost more. They cost less than our service costs. In fact our medical service is one of the most expensive in the world. It rates not far below that of the United States of America. On the other hand many of these national schemes which involve salaried medical service cost less and yet the results in terms of the quality of medical care are better as judged by such things as the infant mortality rate and illness of children, which are very sensitive barometers used to measure health services in underdeveloped countries and so on. Using these barometers, our services are inferior to many of the services which members of the Liberal Party scorn simply because they are in essence socialised medical services. I say to them: You are wrong. Face the facts. It would be less expensive and we would have better quality medical care if we adopted the Labor Party's policy.

Clauses agreed to.

Clause 4 (Interpretation).

Mr Swartz - 1 suggest that the clause be considered by paragraphs.

The DEPUTY CHAIRMAN (Mr Hallett) - Is it the wish of the Committee to consider the clause by paragraphs? There being no objection, that course will be followed.

Paragraph (a).

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