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Wednesday, 28 March 1984
Page: 762


Senator PETER BAUME(10.12) —by leave-I move:

That the Bill be now read a second time.

This Bill proposes to omit certain sections which were added to the Health Insurance Act 1983 and the Health Legislation Amendment Act 1983, which are the cause of the present dispute between the medical profession and the Government. The purpose of the Bill is to attempt to resolve the dispute, which is a most serious threat ever to the provision of health services in Australia. This Bill goes further than another Bill which has been discussed widely in the Press and which I understand has been introduced by Senator Haines. That Bill picks up an amendment which I moved on 21 September 1983 during consideration of the Medicare legislation. At that time the balance of Australian Democrat votes opposed my amendment and, for reasons I did not understand, the amendment was lost in the Senate. But the Democrats now recognise this error and propose not only to support but to recommit the amendment which I moved in September. That signals a remarkable turn-round by three senators but it is one which I welcome.

It is said that the road to Damascus may be trodden in different ways. The scales have now fallen from the eyes of several of the Democrats and members of the Australian Labor Party. It is a belated but welcome move. I shall be delighted to see the Liberal Party amendment of 1983 picked up, but though that amendment will improve the present situation and although it may be necessary, it is not sufficient in our view to resolve the problem before the House and the people of Australia.

The reason is that the situation facing the people of Australia has altered significantly since the Medicare legislation was introduced. A confrontation of unprecedented proportions has emerged and has been added to by the Minister for Health (Dr Blewett) confronting, abusing, traducing and pillorying the medical profession. He has done so as a Minister of the Crown in a way that no Minister for Health has ever done since Federation. In addition, that great preacher of consensus and national reconciliation, the Prime Minister (Mr Hawke), chose in the interests of national reconciliation to describe the members of the medical profession-my own profession and that of Senator Grimes and Senator Crowley; a profession which has always commanded high respect in the community-as the builders labourers of the professions. Those are hardly the words of someone genuinely interested in achieving consensus in Australia.

I want now to try to reduce to essentials the problems before us in Australia. We can, in fact, do this. Section 17 of the Health Insurance Act provides that Medicare benefits will not be payable to patients treated as the private patients of visiting medical officers in public hospitals unless the doctor has signed a contract of service in a form approved by the Federal Minister for Health. That is the first fact. This is of some significance given that 80 per cent of the nation's hospital beds are public hospital beds. The proportion is even higher if we look at beds for the provision of surgical services which would be affected by this agreement. Therefore, of course, a high proportion of the practice of surgery or the procedural specialties in Australia will fall within this provision of the Act.

The Minister has intervened in what has traditionally been a matter between doctors and the hospitals and doctors and the State governments. It goes very close to being a back-door attempt to impose civil conscription upon the profession in a way which is specifically excluded in the Australian Constitution.


Senator Tate —Take it to the High Court.


Senator PETER BAUME —I understand and accept Senator Tate's interjection. I imagine it will be determined in the High Court in the appropriate way if people wish. I am simply making an observation. Section 17 goes further than that. It gives the Minister unfettered powers to determine the acceptability of a contract, with no provision for appeal, no provision of any kind.

The Parliament's role, of course, is to approve or not approve guidelines in relation to those contracts. That is the thrust of the amendment I moved last September and which will be moved later by Senator Haines. The trouble that has arisen is that the conditions which might be included in those contracts might be totally unacceptable to one of the parties; but that party would nevertheless be required to accept the conditions and would have no right of appeal and no recourse at all. The Government cannot put its Medicare scheme into effect without the co-operation of the providers of the services. The Minister has failed at any stage to negotiate satisfactory arrangements with the doctors. That is a failure by him in his ministerial duty because no one in his right mind would imagine that he could bring in a new health scheme which will have to be delivered by one profession and not make arrangements with that profession for the satisfactory delivery of the services.

It has been the Minister's actions, backed up by his Government, that have brought on this crisis. It is a crisis which has seen a profession for the first time in its history facing a lockout from the hospitals in which it has operated . For the first time in history health care consumers in this country-you and me , Mr President-are faced with the possibility that when they receive care from their doctors they will not be able to get Medicare benefits in relation to services they receive. It is a crisis which stands to disadvantage Australians seeking health care and seeking for themselves health services.

Dr Blewett has now come forward with his own Bill. He says that it will take up what he calls the constructive proposal made by the Australian Democrats so that the guidelines of the Federal Minister can be subjected to scrutiny by both Houses of Parliament and disallowed if one of those Houses disagrees with them. Dr Blewett's memory really must be very short. The constructive proposal, as he calls it, was put up here by the Opposition last September and was soundly defeated by his colleagues and his Government. This crisis could have been partly averted had they had the good sense then to support what they think they might be supporting now. It is not enough now, in view of the water that has flowed under the bridge, to resolve the crisis.

Senator Grimes, speaking for the Government last September, described this constructive proposal as an unnecessary impediment. That was a convenient description, one which I am sure he will wish to forget now. As I mentioned, this amendment does not go far enough. It does not address adequately the clear principle at stake. It does not give to the doctors who are going to be affected by the contracts the kinds of rights of appeal and negotiation which are enjoyed by unionists in their negotiations or, indeed, are open to most people who are expected to be one of the parties to a contract. It is that matter which the doctors find so unacceptable. Further, of course, the doctors themselves are not entirely happy about a situation where the only recourse, the only right of appeal, would be not one which they could take but one which might be taken in the Parliament by third parties and which, of course, would be dependent upon the balance of power of the day.

What will the Minister do, what will the Government do if it fails to recognise the gravity of the crisis facing medical practice in Australia? If it fails to negotiate openly and constructively to resolve that crisis the delivery of some routine services may break down, especially, as I say, if doctors who have refused to sign the contracts but who are still willing to work are locked out of hospitals. The fact is that the services required by the Australian public will be placed in jeopardy. Unless the Minister is willing to import large numbers of doctors, unless he brings into this country doctors from other countries, it will be necessary for him to win round the medical profession of this country to be the agents to deliver health services under his Medicare scheme. The Minister must understand that that is what is necessary. It is for that reason that we have proposed this Bill. The Minister will not be able to import doctors in some specialities. He has no option but to find a way of dealing with doctors in Australia in such a way that they can join his scheme with a sense that there has been due process and fair dealing.

The argument revolves around a matter which is not central to the introduction of Medicare. Medicare, after all, is a matter of health insurance payments. This issue does not relate to health insurance payments. It relates to the circumstances under which doctors in Australia will be willing to deliver services within the Medicare framework. The argument is not central to the introduction of Medicare. It is an attempt to move towards the conscription of the medical profession and it is quite inconsistent with any ideas of national consensus. What the Government has done is destined to prolong the bitterness between an honourable profession and a Minister of the Crown and that is not in the best interests of people. It is for that reason, in the interests of everyone-the public who consume the services, the Government which has a national responsibility and the doctors who provide the services-that we have sought to introduce this Bill. This legislation is a genuine attempt to find a circuit breaker, to find a way of reducing the tension for a period to allow negotiations to take place.

Currently an investigation is under way under the chairmanship of Professor David Penington to examine the options which might provide for the Minister some way of renegotiating the arrangements. That inquiry will report in due course. But in the meantime we have a government and a profession in direct conflict, with the Australian public caught in the middle. Because Professor Penington's inquiry is under way, because it will report and because there is a need for a circuit breaking exercise, in the meantime we have proposed a Bill which will remove the offensive provisions from the Act. We have introduced the Bill on the basis that the parliament can come back, re-examine the matter in the light of what Professor Penington says and then put into place instead of these provisions some new provisions which in fact we hope will allow the Medicare scheme, which is now the law of the land, to be introduced without the bitterness and confrontation that we have at present.

I say again, that if the issue of payment were central to Medicare's operation there might be a different situation but it is not central. It does, however, prejudice the rights of ordinary citizens. Any doctors who continue to work but who refuse to sign contracts because the contracts are unsatisfactory may find that their patients cannot draw Medicare benefits for the services which have been provided. The only reason they may not be able to draw the benefits is that their doctors have not signed unsatisfactory contracts. Therefore, I have proposed that we should proceed to examine this Bill to see whether it provides a way of reducing bitterness, of breaking the enormous confrontation which has existed and giving some prospect of getting matters back to a negotiated and reasonable settlement.

First, we think that this Bill is such a circuit breaker. We think it will reduce tension between the Government and the profession, always assuming that it is the goal of everyone in the Senate to see that tension reduced. Secondly, it would cover adequate arrangements for the period until the Penington report became available. At that stage we would hope that cool heads and considered judgment would allow us to propose some longer term solution in the interests of medicine and the Australian consumers. What this Bill is not about is more or less money for individual doctors. That is a furphy which the Minister has raised in an attempt to confuse the issue and denigrate the profession.

Let us put on record that most existing contracts provide for the charging of schedule fees. They provide for hospitals to collect facility charges. They provide for maxima on personal earnings. They provide that the fees represent only gross earnings and that the doctors receive less. There is very little monetary effect for most doctors in what is at issue. What the dispute is about is the principle that a Minister of the Crown should not have the unfettered power to impose contracts unacceptable to one party, to present them on a take it or leave it basis and to move towards civil conscription of the profession by the back door. To resolve this issue will require some skill and sensitivity- more, I might say, than has been shown to date. We would like to play our part in trying to assist the Government to come towards the resolution of this issue and, in the short term, to work towards a lowering of the quite extraordinary tension which exists.

One final word: The stakes in this matter are very high. The medical profession has never, in my experience, been as united on an issue as it is on this one. Doctors will not sign non-negotiable contracts. That may be good or bad; but it is a fact. They will not sign them. The Government has to find a way to break this impasse in the interests of Australian people. If the doctors are then excluded from the hospitals in which they have worked this will represent a lock out of doctors by the Government and the States. It will sour relations even further between the parties and it will create bitterness which would last for years and years which, I submit, would not be in the interests of doctors or the parties themselves.

I think that support for this Bill would provide an option which might lead us to a reasoned resolution. It would provide, at least for a short term, a cooling off. It would get us through the interregnum until the Penington report came down. It would provide for the possibility of compromise and for the easing of a situation in which a large and honourable profession has lost its faith or trust in the Minister of the Crown to whom it relates. We need a procedure to allow that trust and confidence to be restored. On that basis, I commend the Bill to the Senate.

Debate (on motion by Senator Grimes) adjourned.