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Thursday, 14 May 1970

Dr KLUGMAN (Prospect) - We now have 15 minutes left in this debate to discuss 142 pages of Schedules after having had a very short visit from the honourable member for Macarthur (Mr Jeff Bate) for the first time for some weeks to this House. There are large numbers of inconsistencies in these Schedules. In his second reading speech the Minister referred to 300 items that appeared as specialist and general practitioner items; 1 have counted 1,036 such items.

Dr Forbes - With 2 rebates.

Dr KLUGMAN - With specialist and general practitioner, S and G respectively.

Dr Forbes - You counted 1,000?

Dr KLUGMAN - It is 1,036. That is 518 separate items each with specialist and general practitioner rebates. The Minister probably got it all mixed up because he does not read his own Schedules. For example, he is not aware of the dislocation rebates for a specialist and general practitioner to which the honourable member for Macarthur referred: If in fact it is a dislocation with some complication there is a different charge and again there is a different rebate for specialist and general practitioner. In this case there would be 4 different items and not just 2. This is probably one of the very minor points as far as the Minister's lack of knowledge on this particular piece of legislation is concerned.

A point I would like to refer to in passing is the ridiculous way in which refunds in respect of anaesthetists are dealt with. This is referred to on page 38 in Part 3. lt is still related in the old fashioned way to gaseous and non-gaseous. There is no provision at all for major advances in the speciality of anaesthetics and I think in some ways the worst feature is that it relates what anaesthetists are entitled to receive to the question of whether a surgeon is a general practitioner or a specialist. If I were an anaesthetist 1 would certainly prefer to be an anaesthetist for a specialist surgeon. It would be an easier job to be an anaesthetist for a specialist surgeon than for a general practitioner surgeon. Under this legislation I would be entitled to a bigger amount of money from the Commonwealth Government for being an anaesthetist for a specialist surgeon than for a general practitioner surgeon, because the common fee for anaesthetics is related to the basic Commonwealth medical benefit for the surgery, and as there is a greater Commonwealth benefit for an operation done by a specialist I am therefore entitled to a bigger refund if I am giving an anaesthetic for a specialist.

Further, the fee charged for an anaesthetic ought surely to be related to the degree of difficulty of the anaesthetic, to the physical state of the patient and the time involved, and not to the degree of difficulty of the operation itself. I can well imagine that for an anaesthetist giving an anaesthetic for an appendicectomy on a very old person with all kinds of complications is a much more difficult procedure involving much more skill than giving an anaesthetic to a young person having an involved operation in the sense of the operation taking time, for example, plastic surgery for which the refund is much greater than for an anaesthetic.

Previously I have given examples of the vast differences in the cost of prostatectomy operations depending on whether they are done in Melbourne or Devonport. There is the difference between $100 and $200 depending on which side of Bass Strait the operation is performed. There arc 136 pages of these examples. We have not been given the opportunity to go through them in any detail. I do not propose to go through them in any great detail now but I certainly hope that the Minister and hi.s advisers will have some go at this at some stage and make it fair for the patient.

It is clear to me that again the Minister has given in to pressure by the medical benefit funds. The medical benefit funds have suggested the table of common fees. He gave this as a reply earlier in this debate when he obviously did not understand the question about psychiatrists' charges. When I asked him how he got the charges he said that they came from the medical benefit funds. The medical benefit funds just got an average charge for all specialties but did not pick out those for psychiatry. Psychiatrists were put down as 'Specialty-Special consultation, $4'. This clearly indicates that an editorial in the 'Australian Financial Review' was perfectly correct when it stated:

What started off as a serious exercise in social engineering with the avowed purpose of removing the financial penalty that occurs through ill-health, has become a battleground of pressure groups with the public left forgotten on the side lines. Where does the patient rank in the policymaking now?

The Minister for Health, Dr Forbes, who is nol even a member of the inner Cabinet, apparently interprets his position to be that of an adjudicator between pressure groups that have been institutionalised by Government machinery - listening to the health funds here, tut-tutting at the Australian Medical Association there, speaking sternly to hospitals everywhere.

He is the embodiment of what is wrong with the Liberal Government of today.

Somewhere along the way the guiding principles of Liberalism have been subordinated to defending the policies and values that have been handed down from another era.

At all costs (to the public) nothing must be done or said to antagonise the organised and vocal pressure groups.

In Australia only the silent majority is defranchised.

That is what the 'Australian Financial Review' said about the Minister and about the Liberal Government, and 1 heartily concur. As many members in this debate have pointed out, we have had the shocking spectacle of the Minister trying to implement a policy pronounced by his leader during the election campaign last October. He has had 6 months or so of meetings with the pressure groups mentioned and today and yesterday the Government has used the guillotine to railroad the whole lot through in 6 hours.

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