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Tuesday, 10 November 1959

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) (Monaro) . - This bill proposes four principal changes in the national health scheme. First, it increases medical benefits on 140 items out of a total of about 1,000; secondly, it widens the definition of hospitals recognized under the hospitals special accounts scheme; thirdly, it very greatly extends the list of pharmaceutical benefits; and, fourthly, it institutes a charge of 5s. in respect of each prescription dispensed under the national health scheme.

The Australian Labour Party is not opposed in general terms to the first three of these proposals, although some features of them are open to the widest criticism, as we shall show. But, to institute a charge of 5s. for each prescription, especially for the health-giving and life-saving drugs that have been provided free for the past eight years is a backward step. It is a clumsy device which will not eliminate wasteful and excessive prescribing, and the Opposition will divide the House for the purpose of eliminating this 5s. charge from the bill.

The Government's national health legislation is always much more notable for what it omits than for what it provides. The bill is a further example of a wrong set of health priorities. It is - this goes without saying - another full-scale British Medical Association production. The B.M.A. has dictated the whole of the Government's national health scheme so far and - very clearly from this legislation - it is still doing so. On this, there is only one thing to say: The B.M.A. is certainly a very worthy organization, but its interests are not identical with the interests of the people of Australia, and the Government has no right whatever to act as though they were.

Thus it happens that, while the costs of the scheme are mounting tremendously, the provisions essential to any true national health scheme are still lacking from the Government's scheme. It is indeed a reflection on the scheme to-day that almost half the total cost of it is for drugs and medicines and that very soon, according to the statement of the Minister for Health (Dr. Donald Cameron), more than half the total cost of the scheme will be for drugs and medicines.

At the same time, no adequate provision is made for things to which a Labour government would give very high priority in a national health scheme. For instance, we wish to see real and practical encouragement given to arrangements for group services by medical practitioners, to be rendered either on a per capita or a salary basis. We want to see far wider provision for salaried medical services in sparsely settled areas, and the provision of funds to subsidize medical and nursing services in country areas generally. A Labour government, in contra-distinction to this Government, would give very high priority in a national health scheme to establishing a national hospital service and to restoring the system which existed under the former Labour Government of providing hospital treatment in public wards completely with- out charge and completely without means test. Similarly, a Labour government would seek to extend the system of salaried services by specialists in public hospitals so that patients in all wards - private, intermediate and public wards alike - especially patients requiring operations, would have the option of using the services of these salaried specialists without any charge. They would have available the services of men who would have no other interest in rendering that service than the health of the patient to whom they were administering.

Mr Anderson - Like what other country? What other medical service are you comparing it with?

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I am sorry, I cannot understand you. I wish I could; I would like to reply to you.

Optical and dental services for children under sixteen years of age and aid for the deaf are other proper features of a national health scheme which a Labour government would encourage. Further features should be active steps in preventive medicine, in research and in medical education. All these features are completely lacking from the Government's so-called national health scheme. However, I do not have time to deal further with those matters at this stage.

In explaining the bill, the Minister set out that the largest increase in medical benefits will be for major operations. In some cases, Commonwealth benefits will be doubled to a maximum of £22 10s. and the total of Commonwealth and fund benefits may reach a maximum of £60 as against the present maximum of £30. That is all very well as far as it goes, but what assurance is there that the doctors will not increase their fees accordingly? Absolutely no such assurance is given by the Minister. Is the Government not prepared to take any practical step to protect the interests of the patients, the contributors, and the taxpayers? Has the Government sought any arrangement with the B.M.A. - if it has, we have no inkling of it - or any guarantee at all from that body that, as a condition of the provision of this further Commonwealth benefit, there will be no further increase in medical fees? The history of medical benefits in this country is that any increase is almost immediately swallowed up by increases in medical fees. If that is so, the only ones to gain are the doctors, and the taxpayers and the fund contributors are alike at a loss. In not taking steps to provide safeguards, the Government is ignoring its responsibilities to the people.

Mr Thompson - And to the taxpayers.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - That is so. In a letter I have received, the Latrobe Valley Hospitals and Health Services Association, a very important organization in Victoria, has this to say -

From past experience and from present indications, it does suggest to us that this Bill, supposedly having the motivating conception to improve the financial position of the Registered Organization and at the same time, bringing the Benefits nearer to the level of present-day costs has, in fact, the very decided flavour of being a " Doctors' Bill ". There is a very apparent resistance among Benefit Organizations that, unless some arrangement is made, or assurance given by the B.M.A. that there will not be any increase in Doctors' Fees, then the value of the Benefits to the Contributors will disappear.

The letter continues -

Reasons for believing that Doctors will increase charges are -

(1)   One Public Officer of an Organization has already reported that attached to an account for Claim was a statement " on and after 1st January, 1960, consultations and visits will be increased ".

(2)   It is rather significant-

The Minister has not told us of it - that the Department of Health has issued the following circular during the past week: -

Since the inception of the medical benefits scheme, established policy has been that fund benefit for general practictioner attendances must not exceed 7s. 6d. for surgery consultations and 9s. Od. for home visits. It has now been decided that organizations may, if they so desire, amend their rules to provide a fund benefit up to a limit of 10s. Od. for such consultations and visits.

What does that presage except an increase in the fees to be charged by doctors? This, I understand, is the first indication that this proposal has been put forward. The letter goes on -

The combined organizations have unanimously rejected the proposal. Both Western Australian and South Australian organizations have also rejected the proposal.

The letter concludes in these terms -

It is becoming increasingly apparent that with the introduction of new benefits with their necessary accompanying increase in subscriptions, the average wage earner is being "priced" out of both hospital and medical benefits.

Finally, documentary evidence has been produced to me of the padding by doctors of their accounts. I know that that is a practice which the majority of doctors will repudiate, but the evidence is here that some doctors are certainly engaging in it. The letter states -

We have in our possession a doctor's account attached to which is a note by the doctor which reads, " Deduct £1 for local anaesthetic if not in hospital benefit association or a lodge ".

The point, of course, is that a local anaesthetic does not carry a refund as it forms the very basis of a consultation.

In dealing with medical benefits, this bill perpetuates the obnoxious system against which the Opposition has been protesting repeatedly, namely that in order to qualify for payment of the Commonwealth benefit, a contributor must belong to a private association or society - a provision of which my friend, the right honorable member for Cowper (Sir Earle Page) may be proud but which we consider to be entirely wrong in principle and politically immoral. Indeed, in some cases although an individual does not, and cannot, qualify for any benefit whatever from the private society to which he has to contribute, he is compelled to contribute to it in order to attract the Commonwealth benefit - an amount that is paid from the public Treasury. When the Australian Labour Party is returned to office it will most certainly abolish iniquitous provisions of that kind.

Mr Drummond - And abolish the system, too.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - We will not abolish the system; we will improve it. It is noteworthy that the Minister, in his second-reading speech, apparently was deliberately vague in his references to the proposed increase in fund benefit to correspond with the proposed increase in Commonwealth benefit: We have been told what the increased Commonwealth benefit will be, but the Minister has been extraordinarily vague about the additional amount that contributors will have to pay to the societies, and the additional amount that the societies will make available to the contributors.

The Opposition welcomes the amendment to the bill which will extend the list of hospitals that will be recognized for the purposes of the hospital benefit special account plan. According to the Minister, it appears that this amendment will wipe out a very serious anomaly to which I, and other members of the Opposition, have previously directed attention in this House as a cause of quite tragic hardship and injustice. The anomaly was that hospitals catering principally for permanent patients were not recognized as hospitals to which benefit would be paid from the special account. In effect, it meant that hospitals catering for people most seriously ill, people for whom the general public hospitals could no longer provide treatment which might restore them to health, but who were most desperately ill and were, therefore, transferred to these special hospitals, were shut out from any benefit whatever under the special account plan. We have brought this matter to the attention of the Minister on previous occasions in this House, and we welcome the amendment which he has now proposed to correct the anomaly.

The most controversial provisions of this bill are those which deal with pharmaceutical benefits. The Government's proposal is two-fold. First, it proposes to enlarge the general list so that, to use the Minister's words, it will cover practically the same comprehensive range as the pensioner list covers, namely, the range of drugs covered in the British Pharmacopoeia, with such additions as are recommended by the Government's own expert advisory committee. Secondly, the Government proposes to authorize - in fact, to compel - chemists to charge 5s. for each prescription, the penalty clause being to the effect that if the chemist does not make the charge he will be disqualified from operating under the National Health Act in the future. To justify this charge, the Minister has pointed to the soaring costs of pharmaceutical benefits and to the necessity to place some curb upon that mounting and astronomical sum. Certainly, the cost has mounted astronomically, particularly in the last three or four years, but equally certainly the changes now proposed by the Minister will not, in fact, place any curb whatever upon that rise in costs. The Minister has indicated the way in which costs have risen. In 1951-52, the first full year of operation of the scheme, it cost £7,600,000. By 1956-57, the cost had risen to £11,700,000, and after that it began to race away - so much so that in the last financial year the figure was £21,000,000, while this year it is expected to be about £25,000,000 for drugs and medicines alone on a restricted list. The Minister has stated also that the cost is soon likely to reach £30,000,000 for a restricted list unless some curb is imposed.

The Minister, in his speech, completely soft-pedalled the factor that is mainly responsible for the increased cost of the scheme, namely, the uninhibited, wasteful and excessive prescribing by some doctors. Nor does the Minister propose by any word in the bill to place any curb whatever upon doctors who engage in those practices.

The Minister's speech in this respect is most interesting because he appears to have backed away completely even from the most guarded references to this subject in the Budget speech of the Treasurer (Mr. Harold Holt) and in the Minister's background notes which were circulated at the time when the Budget was introduced. Indeed, the Minister has been at pains in his second-reading speech - as though he has been slapped over the wrist and compelled to make some apology for his earlier statement - to say that it is not to the discredit of any one that there has been so much prescribing of expensive drugs without regard to their cost to the taxpayer or to their real need in the circumstances. If the Minister really believes that; if he really believes that it is not to the discredit of any one that this position has arisen, then he must stand alone in the medical profession in Australia. I doubt whether any honorable member in this House has spoken privately with a doctor without being told in the strongest terms of the doctors' condemnation of the prescribing practices that have been adopted by some of their colleagues.

The official journal of the B.M.A. has been most outspoken on this subject. The Minister, although in his second-reading speech he has eaten his words, said in the background material to which I have referred that the object of the proposed alterations was " to remove the present economic pressure which results in prescriptions being channelled to expensive free items ". Later, in the same background notes, he used some very revealing words which were not contained in his second-reading speech. He said in these background notes -

One factor of some importance is that when a new drug becomes a pharmaceutical benefit it is almost immediately very widely prescribed by doctors without any inhibition as to cost . . . and the trend is continually to increase Government prescribing and decrease private prescribing.

Yet where in the bill will you find even the slightest proposal to place a curb on the uninhibited doctors? The answer, of course, is nowhere.

The Minister himself has declared that if the trend towards a steep rise in prescribing under the National Health Scheme is not arrested it will lead to the taxpayer being called upon to meet a drug bill of £30,000,000 a year with disastrous effects upon the entire national health service, both because of the unnecessary burden imposed upon the taxpayer and of the eating up of financial resources which could be used for some of the vital improvements in a national health scheme, which I indicated earlier in this speech. Yet the Minister still proposes to do nothing about it in any way which would be effective, because apparently he dare not tackle those doctors who are abusing their trust and bringing discredit upon an honorable profession. No curb of any kind on their uninhibited practices is proposed, but instead the wild leap is taken of placing almost every drug upon the national health list and of imposing a Ss. fee for every prescription - which certainly affects the patient and certainly affects the chemist, but has no effect whatever upon the doctor. So the free medicine scheme has gone!

Mr Hamilton - Was there a free medicine scheme under Labour?

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - Yes. there was a free medicine scheme under Labour, and it had the utmost co-operation and support of the Pharmaceutical Guild of Australia. But that scheme was destroyed as a result of a political plot between the British Medical Association and the Liberal Party.

Let us look at the present position as the effect of the Minister's proposals becomes clearer. First, it is clear, although the Minister has carefully refrained from saying so, that soon there will be practically no private dispensing in Ai"*"* The

Government will pay for the lot, less the charge of 5s. on each item. Now, what is this? This is almost nationalization of medicine and pharmacy by a Liberal Government, and what nonsense it makes of all the arguments which were used to destroy the Chifley-McKenna free medicine plan! It will be remembered that this plan was the original concept of an Australian national health service, on the basis of an extemporaneous dispensing of a very wide range of drugs and medicines. The B.M.A. objected to the idea of a formulary, and had the loud support of every Liberal member of this Parliament.

Mr J R FRASER - And of the Australian Country Party.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - Quite so. But as the Australian Country Party is an appendage of the Liberal Party, it is not necessary to mention it every time. The scheme was successfully challenged in the High Court, but historically the truth is that the original free medicine scheme was torpedoed by an alliance between the B.M.A. and the anti-Labour parties in this Parliament. It was stated at that time, of course, that there must be no limitation on the doctor's right to prescribe whatever drugs he saw fit. That was put forward almost as a sacred principle. Now we have the Minister blandly saying in his second-reading speech -

In any scheme conducted by the Government there must necessarily be some limitation of the range of drugs- and pointing out that no doctor will have an unfettered right to prescribe under the National Health Scheme.

The Chifley-McKenna scheme was destroyed because it placed some limitation upon the right of the doctor to prescribe whatever drugs he saw fit - the right which the Minister himself now says no government could ever give to any doctor. To replace it, the Page scheme came into being. It provided a limited list of life-saving and disease-preventing drugs.

Sir Earle Page - A very good list.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - Exactly! A good list, but still a list. The B.M.A., of course, eagerly embraced the Page scheme because the restricted list was called a list and not a formulary. And now the B.M.A. is equally willing to accept the enlarged scheme, with the enlarged list, which is, after all, still a formulary. The Page scheme provided a bridgehead over which old-established manufacturers, and numerous new ones, came into the scheme with a wide and ever-increasing range of new proprietary lines. As the Minister has admitted, as soon as any new drug was placed on the pharmaceutical benefit list the doctors began immediately to prescribe it very widely and without any concern for the cost to the taxpayer. No wonder the cost of the Page scheme soared.

Certainly a proportion of these proprietary drugs, supplied by manufacturers of long experience in therapeutic science, were of value in the field of health. Unquestionably they must have saved the nation much money - though the Government has never told us how much - by providing for earlier diagnosis and treatment and for shorter stays in hospital, and so greatly reducing absences from work. But equally certainly some doctors have grossly abused the scheme from the day it started until to-day.

Mr Cleaver - They are a minority.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - It is hard to say. I would certainly like to think that that is correct, and I believe that the standards of the medical profession are high enough to justify the honorable gentleman's statement. But the tremendous soaring costs of the scheme make it necessary to place some curb on this extravagant and wasteful minority who are using the scheme for their own special purposes in building up their own practices against those of their more conscientious colleagues. The B.M.A. in its own journel, " The Medical Journal of Australia ", published an article headed " Anti-biotics Amok ", which made it plain beyond doubt that some doctors were abusing the scheme. Since that article was published the cost of the scheme has skyrocketed, and even the Government now recognizes the need for some deterrent to unnecessary prescribing. Of course anybody who had the figures would recognize that need. But the singular fact is that the Government should think, or pretend to think, that this can be done by imposing a tax or levy or charge or impost, or whatever you care to call it, for every prescription written as a general pharmaceutical benefit. The 5s. has to be paid by the patient and collected by the chemist. But neither the patient nor the chemist decides the writing of a prescription. That is the sole prerogative of the doctor, and one searches this legislation in vain for any sign of sterner disciplinary action or penalty upon these uninhibited doctors.

The Government's attitude is all the more remarkable, and is all the more clearly dictated by its fear of the power of the B.M.A., in that it cannot have been formed in ignorance of the final report of the Committee on the Cost of Prescribing set up by the Minister for Health in the United Kingdom. This expert committee, headed by Sir Henry Hinchliffe, put forward a series of detailed and far-reaching recommendations to deal with the problem of wasteful and excessive prescribing. It clearly recognized the necessity, and it set out precise proposals for medical training, both undergraduate and post-graduate, including systematic instruction of general practitioners in pharmacology and therapeutics because, the committee pointed out, the average practitioner is now completely unable to judge the validity of the makers' claims for the many new drugs now produced.

Not one of those most important recommendations by this committee which studied the whole subject in Britain for many months has been given, apparently, the slightest attention by the Government. Further, this expert committee, while defending the doctor's right to prescribe the drugs necessary in his judgment, recommended, first, the provision for doctors of up-to-date information about new drugs and preparations and the results of clinical trials; and, secondly, the tightening of disciplinary measures to deal with excessive prescribing. Particularly, the committee recommended severe penalties for excessive prescribing where doctors prescribed extravagantly in order to attract patients. This is exactly the problem which we have to face in so many parts of Australia.

In addition, the Hinchliffe committee made a series of most valuable recommendations for providing doctors with the results of clinical trials of new drugs - how important that is - for assisting general practitioners in habits of good prescribing, for educating the public and for enlisting the co-operation of the drug industry and of the retail pharmacists.

Altogether, that report is a historic document, lt cannot possibly have been unavailable to the Minister. Yet the Minister's second-reading speech, dealing with this very problem, gives not the slightest indication of the adoption - or even the consideration - of practical recommendations of this kind. Indeed, it is as though the Minister had completely set aside all other proposals in favour of his pet idea of the new prescription charge. The fact is that a prescription charge is the one thing against which the Hinchliffe committee firmly set its face. This committee of experts - of noted medical men - in the United Kingdom, which studied this problem for months, said -

The present prescription charge is a tax which, besides stimulating the wrong incentives, has proved disappointing financially . . .

The committee added that consideration should be given to the desirability of abolishing the prescription charge altogether if agreement could be reached with the medical profession for some voluntary action on its part to limit excessive prescribing. So I say deliberately that, in the light of all the available facts and evidence, the Government's proposal as now put before this House appears to be a halfbaked crazy scheme which cannot possibly achieve its professed purpose of curbing excessive dispensing.

Of course, regarded simply as a new tax for the purpose of gaining revenue for the Treasury from the people of Australia and those who can least afford to pay this tax, the proposal must be very convenient indeed to the Government, because it imposes the whole responsibility for collecting the tax, estimated to bring in over £5,000,000 a year, on the 4,000 chemists of this country.

The Minister has been unable to announce to the House any agreement with the Federated Pharmaceutical Services Guild, and the fact is that no agreement with the guild has yet been reached.

There appears to be a very sharp contrast between the way in which the Government deals with the British Medical Association and the way in which it deals with the pharmaceutical guild. When the guild first met the Government on this matter, a comparatively few weeks ago, the Government told the guild that the Government had no constitutional power to enforce the collection of the 5s. fee. Its airy attitude towards the chemists was, " Collect 5s. yourselves if you can". But the Government insisted that it would deduct 5s. from every payment to a chemist for a prescription item, whether or not the chemists succeeded in collecting the fee. If the chemist collects the 5s., it comes off his claim to the Government at the end of the month. If he does not collect it, he is still compelled to deduct it from his own claim on the Government. In other words, it is a compulsory discount.

In this bill, some attempt has now been made to reinforce the position of the chemists by rendering them liable to disqualification under the National Health Act if they do not succeed in collecting the 5s. on every prescription.

Mr Wight - That is a distortion.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - No. The bill states plainly that if a chemist does not collect the 5s. fee he will be liable to lose his approval under the National Health Act. In other words, he will be disqualified, as I have said, from operating under that act. I do not think that is a distortion. I think it is a statement of fact.

But that, of course, will by no means solve the chemist's difficulties, especially when he is dealing with some one who has been accustomed to obtaining the drug or the medicine free for years and who simply cannot afford to pay the new tax of 5s. on every prescription every time it is made up. The feeling cannot be avoided that the chemists of Australia are being made to suffer by this Government because they dared to offer their co-operation in the Chifley-McKenna free medicine plan. Indeed, I think it must be said, to the credit of the pharmaceutical profession of this country, that its members have played the game with governments throughout on national health schemes. They have recognized the authority of government and they have done their best to co-operate with governments of all political colours. They have honorably discharged their duties under the scheme, and in doing so they have performed a notable service to the people of Australia.

We think it utterly wrong that, in the fixing of their rates and conditions under the new scheme, the chemists should be at the mercy of a departmental committee, on which they have representation certainly, but which has a departmental chairman, so that, whenever the decisive vote is given, it is given for the department and against the chemists. The Opposition strongly supports the view stated by the Leader of the Opposition (Dr. Evatt) in his policy speech for the last general election that the chemists are entitled to an independent chairman or arbitrator in the fixing of their rates and conditions under the national health scheme.

Mr. Speaker,the Minister made no mention in his second-reading speech - I particularly direct the attention of the House to this fact - to the hardships which the new 5s. charge for each prescription will undoubtedly impose. He pointed out, quite correctly, that the pensioner scheme will continue to be free, but he went on, entirely incorrectly, to speak as though no pensioner would have to pay the new 5s. tax or fee. The fact is, of course, that under the iniquitous 1955 amendment of the National Health Act every pensioner whose income exceeds £2 a week is denied a pensioner medical card, and consequently is denied the benefits of the pensioner medical scheme. So that he will have to pay the full 5s. in future every time he goes to the chemist to have dispensed a prescription which, for the past eight years, has been free to him.

Mr Pollard - Scandalous.

Mr Barnard - He will have to pay it out of £4 15s. a week.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - Yes. In other words, the new tax will have to be paid by all old and ill people in Australia whose income is £6 15s. a week or more - that is, £4 15s. a week plus £2 other income. This will undoubtedly impose an almost impossible burden upon many of those in the lowest income group. For many old people and invalids, what the Government now proposes will far more than absorb the recent 7s. 6d. a week pension increase. I think it is a disgraceful thing.

This, also, I bring to the special attention of the House: In the Budget speech made by the Treasurer (Mr. Harold Holt) an assurance was given that arrangements would be made to avoid the special hardship which would otherwise be endured by patients requiring regular repeat supplies of particular drugs. The Treasurer gave an assurance that that position would be met. Whether it is met or not I do not know, but it is disturbing to find not even that assurance in the Minister's second-reading speech. I ask him now to remedy that omission in this House before this debate closes. If that is not done, people who are old and ill, and who require regular supplies of a particular drug in order to maintain their health, will find themselves placed in an impossible position, because they will be required to pay 5s. every time they have the prescription made up.

Mr Cope - Who introduced the bill imposing the means test on pensioners?

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I think it was the present Minister, although I am not sure. I hope I am not doing him an injustice.

Sir Earle Page - I introduced it.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I do not think they will quarrel with each other about it. I can understand both of them being ashamed of it.

Before I conclude, Mr. Speaker, I have time to give one further illustration of the very ruthless way in which the Government intends to operate its new scheme. I think that this will be disturbing to honorable members generally. Again, the Minister told the House nothing whatever about this. Nevertheless, the fact is that the Commonwealth is now demanding that every hospital patient must pay the new tax in future, whatever his means and whatever ward he may be in. It is no use the Minister denying this because I understand that the Commonwealth has already, in writing, informed various State governments of its determination in this respect. This means that unless State governments bear the cost themselves, a new charge will now have to be imposed, probably for the first time in hospital history, on patients in public wards, for drugs which have never previously been charged as extras in public wards.

Mr Pollard - Outrageous!

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - It is outrageous, as the honorable member for Lalor says. Similarly, a new and additional charge will have to be imposed upon outpatients in public hospitals. For them, in the past, drugs have generally been provided at cost, or less than cost, and in many instances no charge at all has been made. But now the Commonwealth Department of Health has served notice on the State governments that, in future, this practice must cease. The poor must be made to pay to the last penny.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - That is a pure flight of fancy.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I declare this to be based on an official statement by the Department of Health, in writing.

Mr McMahon - Produce your evidence.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - The evidence is on the files of each State government n Australia. If the Minister for Health will check with his own department, he will find that what I am saying is true. If it has been done in error, and if the Minister has not been sufficiently careful as to the actions of his department, let him now correct the situation because it is a disgrace to this or any other government.

Mr Hamilton - You have only been making insinuations.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I am not making insinuations. I am making a direct statement that the Commonwealth Department of Health has officially informed the various State governments that, from now on, it requires the payment of 5s. in respect of each prescription dispensed in a hospital to be met by the hospital patient whether that patient is in a public ward, an intermediate ward or a private ward, or is an outpatient. If the State government chooses, itself, to meet that cost, the Commonwealth Government will still require the State government to make the payment.

Mr McMahon - That is totally untrue.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - All right. Then it is an issue of fact between us. I assert that there is an official instruction.

Mr McMahon - Produce your evidence or do not make the statement.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - I am basing my argument on an official statement issued by the Department of Health to the various State governments. I can understand the Minister and the House being disturbed about it.

Mr McMahon - I am trying to help you to be accurate.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - If my statement is untrue-

Mr McMahon - You should apologize.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - If it is untrue, 1 will most certainly apologize. But I know the facts. I have them on the highest authority. I challenge the Minister to go back to his department and to produce for the benefit of this House the actual document, signed by the Commonwealth Department of Health, that has been sent to the various State governments.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - That is a distortion.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - The Minister does not say that it is false. He says now that it is a distortion. I say that it is a fact. The Minister said first that there was no basis for my statement. Now he is admitting that there is some basis.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - I said that it was a flight of fancy, and so it is.

Mr ALLAN FRASER (EDEN-MONARO, NEW SOUTH WALES) - We can carry it no further than that to-night. It is not a flight of fancy. It is a fact and I challenge the Minister to examine the records of it in his own department.

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