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Thursday, 6 December 1973
Page: 4409

Mr HOLTEN (Indi) - The Australian Country Party joins with the Liberal Party in opposing the Bills before the House and supporting the amendment so capably moved by the honourable member for Hotham (Mr Chipp). As I have only 20 minutes in which to speak, I will not be able to cover all the ramifications of this Bill, but my colleagues from both the Liberal Party and the Country Party will comment in more detail on many points as the debate proceeds. The Bills before the House are two of a number of Bills that are necessary to implement the Australian Labor Party's health scheme. At least four more such Bills are to come before the House. It is poor government, showing a lack of regard for Parliament, that they are being introduced piecemeal, and in a vague and ill-defined form at that.

The health scheme proposed by the Labor Party is a socialist political philosophy translated into a health scheme. It is quite clear that these Bills will start to implement the following statement, which was made about a year ago by the Minister for Social Security (Mr Hayden):

The Labor Party is a socialist party and its aim as far as medical care is concerned is for the establishment of public enterprise.

Does anyone want it clearer than that? The provisions of the scheme and the obvious future intentions of the Government are completely in line with the socialist philosophy. The aim of this Government is ultimately to control from Canberra, under one huge central administration, all the hospital finance, all the hospital beds and all the doctors throughout Australia - and, of course, the taxing powers to finance this scheme. I do not consider that such an aim is in the best interests of the people as a whole. If I did think it was in their best interests, I would advocate support for the proposals. The proposals are being described as an insurance scheme. However, they are not an insurance scheme at all; they are a taxation scheme.

The 2 Bills before the Parliament are not detailed enough in vital areas, particularly in Part HI and Schedule 2 of the Health Insurance Bill. Some of the major areas lacking in detail are, firstly, the lack of definite guidelines for negotiation of agreements with the State governments in relation to accommodation and finance; secondly, the lack of precise definition of the functions of the Health Insurance Commission; and, thirdly, the lack of definition of doctors' and patients' rights and entitlements. The overwhelming evidence available to me and to the Country Party indicates that a wide range of organisations and individual people oppose the health scheme put forward by the Government. In fact, there is relatively little evidence of any organisational or individual support for the scheme, particularly amongst people who have studied it. These include people who are outstanding in the medical and economic fields. The medical people have indicated that thehospital proposals are vague and unrealistic; that they will not maintain the high standard of health care that presently is available in the majority of hospitals, public and private, around Australia.

The economists say that the Government has understated the total cost in the first year and also that the scheme will cost the taxpayers, collectively and individually, more than the existing scheme. It is regrettable that the Minister for Social Security constantly has attempted to refute criticisms of his proposals, whether medical or statistical, by resorting to personalities and misrepresentation. Regrettably, he has conducted a lengthy and consistent campaign of insult and denigration towards organisations and individuals, many of whom could not answer back. Probably, his most extraordinary outburst was his insinuations against Professor Pollard - a most distinguished and highly academically qualified Australian. The Minister for Social Security also has misled the House in many of his answers to questions and/ or has refused to give background statistical criteria to members of this House in order that those criteria could be compared by all concerned with estimates of the costs and ramifications of the health scheme as calculated by independent economists.

The list of people and organisations completely opposed to the whole concept of Labor's scheme is long and impressive. It comprises State governments, a wide range of medical organisations and highly qualified members of the medical profession, the hospital and medical voluntary insurance funds, the National Working Party of Catholic Hospitals, the private and community hospitals, the private nursing homes, nurses, organisations representing country medical staffs, the boards of management of many public hospitals and many other organisations, including the Freemasons Hospital, Labor's scheme will destroy the existing scheme which is recognised generally as one of the best and most efficient in the world. It will lower the standards of health care for the majority of Australian families. It will increase the total cost of health care for the majority of taxpayers. It will reduce freedom of choice and the availability of doctors, particularly in the hospital area. It will increase dramatically the cost of health care in Australia to the Government - that is, the taxpayers - particularly as the scheme progresses.

The Minister has refused to give any cost estimates beyond the first year of operation. An independent estimate of the cost structure of the proposals shows that the Government has underestimated the cost of the scheme in the first full year by a very large amount and that the total cost of the scheme in that full year will be $3 82m more than if the present scheme is continued.

Mr Lloyd - How much?

Mr HOLTEN - It will cost $382m more than if the present scheme is continued. This estimate gives the lie to the Minister's statement in the White Paper that the cost of Labor's scheme will be approximately the same as would have been the case under the existing program. After 3 years the Labor program will be costing - this is an independent estimate - up to $2,500m a year or about $800m a year more than the present scheme.

Further disastrous disadvantages of Labor's scheme will be that it will jeopardise the future of religious, private and country hospitals. It will result in the over-use of the services of doctors' and hospitals. The Minister has misled the House by constantly stating in his answers that the House would be in a position to debate the ramifications of the whole proposal when the legislation was before the House. However, the true situation is that he is bringing the Bills which are necessary to put the whole scheme into practice into the House in a piecemeal way. The position now is that the Bills relating to the levy on taxable incomes, the levy on workers' compensation and third party insurance, the Bills setting out the terms and conditions for the voluntary health insurance funds and the Bill relating to privacy and confidentiality of information are not available to the House at all. The Parliament and the public are therefore in no position to assess the full effect of the overall scheme, but enough data is available to show that it just does not compare with our present excellent health program.

There is a strong body of opinion, and it is shared by members of the Country Party and the Liberal Party, that it would be far easier and more practical to continue to make progressive improvements to the present scheme in which there is a co-operative partnership between the Federal and State governments' voluntary insurance, doctors and the Australian citizen. The main areas which could be considered for change in the present excellent scheme are: The establishment of a standing full time committee to regularly review and fix fees for the 4000-plus medical procedures and services for benefit purposes; the upgrading of services to the pensioners; increased hospital finance; alterations to the subsidised health benefit scheme and an improved method of enrolment of eligible people - although it is maintained by many knowledgeable people that virtually no person in Australia is denied medical and hospital treatment no matter what his financial position may be and no matter whether he is insured or not. I personally have had hardly a complaint about the existing health scheme in the IS years I have been a member of this Parliament, and I know my colleagues in the Country Party have had a similar experience. The present scheme is good. There is absolutely no need to destroy the whole structure.

Other areas which need to be reviewed are some para-medical services. I have questioned many people, people in the category of the man in the street, about Labor's proposals and the existing scheme. Their reactions are in line with the 1973 gallup poll which showed that 5 out of 6 States strongly opposed Labor's scheme. In Western Australia 29 per cent supported the scheme. In South Australia the figure was 35 per cent, in Queensland 39 per cent, in New South Wales 41 per cent and in Tasmania 42 per cent. The State in favour Victoria, had 54 per cent in favour of the scheme. So much for the mandate that the Labor Government says it has to bring in this health scheme.

I turn now to country areas. The overall picture for country hospitals if this scheme is introduced is frightening and depressing. I illustrate why by summarising some of the comments conveyed to me by people engaged and experienced in the country hospital field. They indicate that the country people should not have a bar of this scheme. I speak with particular reference to Victoria; members from other States will deal with their States of course as conditions differ from State to State. It is apparent from the Deeble-Scotton report that there is a great deal of ignorance of the very large amount of good work done in country hospitals by the ordinary general practitioner, without specialist assistance and intervention. The White Paper perpetuates a situation that all medical thinking is trying to change in the interests of better patient care, and in country hospitals the new scheme will impose a bad new system which has not arisen to date. Specialist help is already readily available in most Victorian country areas when it is needed.

In the White Paper lip service is paid to the ideal of continuing patient care or freedom of choice in paragraphs 4.19 and 4.22 by the implication that patients will be able to have continuity of attendance by their own doctor, that is, freedom of choice. But the last sentence of paragraph 4.22 shows that patients will have no guarantee whatsoever of freedom of choice because the final decision on which doctor can practice in a hospital and what he does in that hospital rests with the hospital authorities. Therefore there is absolutely no guarantee whatsoever that a patient, including a lady having a baby - the White Paper mentions that specifically in paragraph 4.22 - will have any chance of having continuity of care from his or her own doctor. There is no guarantee at all. Funding of hospitals is planned to be a joint 50-50 CommonwealthState responsibility, but with the Commonwealth in practice eventually exercising overall control because of the financial set-up. The extra cost to country hospitals will be astronomical. The benefits to which a salaried employee is entitled - and the basis will be salaried or sessional, but salaried in particular - are well known. They are regular hours of employment, payment for overtime, extra loading for nights and week ends, and payment while on annual leave of 6 weeks a year. The list is virtually endless. There are many other factors.

Further, it has been estimated that to replace one specialist surgeon who is on call all the time on fee for service in the country areas and to provide the same cover under a salaried scheme 3 or 4 surgeons will be needed to be employed at the hospital, for example the Wangaratta Base Hospital, to cover all the items listed and to provide a 7 day a week 24-hour service. The cost to the country hospitals in that position is frightening and the staff position will be chaotic. In country areas it is foreseen to be impossible to provide sufficient skilled staff to provide a 24-hour 7 days a week service plus some fair method of remuneration for surgeons and physicians who are on call for emergency cases. In fact, the effect of the Labor Party's scheme being implemented will be to create a tremendous shortage of staff in every area of medical care. The Deeble-Scotton report and the White Paper have given no consideration to that matter at all.

I will talk now of freedom of choice in more detail. The basic assumption in the foreword of the White Paper which needs testing is the statement:

The freedom of people to choose the type of hospital care they want and their right to the ready availability of medical services are fundamental principles of Government policy.

Where is this spelt out in detail in the Bills? Nowhere; there is not a sign of it. From reading this and other sections of the White Paper it would seem that the only freedom of choice with respect to hospital treatment is a choice between treatment as a public ward patient or as a private ward patient.

The main thrust of the Government's policy is towards hospital patients being treated by practitioners employed on a sessional, salaried or contract basis. Practitioners of course charging fees for service have no guarantee, even in treating private patients, of access to public hospitals. The most serious omissions from the Health Insurance Bill 1973 - which is one of the Bills under discussion - are guarantees of patient choice of medical practitioners, the type of accommodation with respect to treatment as hospital patients and the omission of any such guarantee of choice of medical practitioner from the Heads of Agreement in proposed schedule 2.

The Minister says that his scheme will be cheaper for 3 out of 4 families and 7 out of 10 single people. I question this. I do not think it will be cheaper for any single people.

On the figures supplied to me as at IS August 1973, the estimated cost of health insurance to a man on $70 a week is 62c a week; under the new scheme it will be 88c a week. It costs a man earning $120 a week 52c a week as at 15 August 1973 and under the new scheme his cost is estimated at $151 - 3 times the present cost. This is a single person. So where does the Government get the idea that its scheme will be cheaper for 7 out of 10 single people? People also lose the right to claim the health insurance costs as a tax deduction. Many Commonwealth car drivers tor example, will be worse off. Such a driver now pays $133 for private ward accommodation for himself and family. He earns $8,000 a year taxable income. With a levy of 1.35 per cent on taxable income he will pay $108 a year for public ward accommodation - only $25 less than for a private ward. He will have to pay an estimated extra $130 a year to have the private ward entitlement that he has now, so he will be $105 a year worse off. In addition he will lose the tax deduction which is probably worth $30, so a Commonwealth driver here in Canberra could be $135 a year worse off, and this is only in the first year.

Take a man on $11,000 taxable income, for example, a married journalist. He now pays $133 a year for a private ward. With the 1.35 per cent levy he will be paying $150 a year for a public ward, so he is $17 worse off straight away and only has entitlement to public ward accommodation. Then he will lose the tax deductibility on the $150, that is, $75. So he is $92 worse off. Add to this the $130 it is estimated he has to pay to get back his private ward right and he will be $222 a year worse off. If his wife is working they will be paying a hell of a lot more. So how can the Labor Government maintain that the average man will be better off? I suggest that it is misleading the people.

I raise another matter about costs. Previously a man has been able to have an operation and all the associated procedures at a cost of no more than $5. Two lines in the second reading speech altered this altogether. Each of the 6 procedures could now cost $5.

Is .this scheme going to cost the average person less? Of course it is not. No wonder people are saying that Hayden is a health hazard. In view of the costs I have quoted, let the Minister do what he has refused to do to date and make available to the House the statistics which show that his scheme will be cheaper for 3 out of 4 families and 7 out of 10 single people. To Mr and Mrs Average Australian I say: You have a very good national health scheme at the moment. It is not worth destroying and replacing it with a theoretical scheme which will be of far greater cost to us all, reduce our freedom of choice and put us all under the medical control of a socialist government.

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