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Wednesday, 28 March 1984
Page: 798


Senator MESSNER(3.16) —The point of the matter of public importance is to draw attention to the Government's failure in recent times to implement its most essential promise for which it has claimed great credit since coming to power; that is, the institution of a simple and fair health insurance system. Amid the smoke and dust of the last few weeks, as the Minister for Health (Dr Blewett) has become embroiled more and more deeply with the doctors and other people who are interested in the welfare of the needy and the sick particularly, there has been a confusion of the real aims of the Government in establishing, as it has, this nationalised system of health insurance. The introduction of Medicare on 1 February was against the background of one of the world's most effective and efficient health schemes already operating in Australia. It previously offered a mixture of public and private health care, with freedom of choice for those who sought it. We are witnessing the destruction of that system in favour of a scheme whose inadequacies are now painfully obvious to all and which suffers from deficiencies which it has been claimed by its creators were its greatest benefits. Those are the questions of simplicity and of fairness.

Firstly, let us consider what the Minister's obvious objectives were in establishing Medicare. We note that he has adopted the so-called salami approach to the problem of attacking first the position of diagnostic specialists, no doubt with the object of then proceeding to attend to the problems of other types of specialists, particularly surgeons, and so on through a whole range of medical practitioners down to general practitioners, so as to establish eventually a totally socialised health insurance system. In the process we have witnessed in the last few weeks the lock-out of diagnostic specialists operating in hospitals provided by governments in various States. I remind the Senate of the intentions of the Minister, which he spelt out quite clearly in August last year in a speech to the Doctors Reform Society, when he said:

. . . It was agreed at the July Health Ministers' Conference that attention to these problems should be initially directed to the area of diagnostic services, with the intention to move more broadly in due course.

I do not think now that any of us could have any doubt about what was meant by ' more broadly'. Clearly the Government has instituted its procedures and practices here to establish a more comprehensive health scheme based on nationalisation of the interests of practitioners, certainly on a basis broader than that of diagnostic specialists. The point that has to be made here quite clearly is that the subjugation of the medical profession is in force through the establishment of a socialised system of health insurance which is aimed not at improving the health care of individual Australians but of establishing what is basically a commitment to an ideological principle which is quite foreign to a system that has served Australia well in previous years.

Let us examine what Medicare really means. It is supposed to cover people generally for basic health cover, both for medical expenses, as to 85 per cent of the cost, and as to public hospital coverage. That does not mean that all the services required by people in times of medical need are going to be covered by the basic cover. Indeed, there are many gaps in that, as we already know. The Government has encouraged us to take out private health insurance in order to cover those things not provided by Medicare. In relation to public hospital care we know that we have no choice of doctor. We can take only the doctor who is provided by the State hospital system. The fundamental element of freedom of choice that applied previously has been abolished.

All of this has been brought to us by virtue of the impact of a one per cent tax levy, which will apparently be the contribution by individuals in place of what was previously paid in the form of health insurance. That one per cent levy on taxable income, which will affect everybody, is going to bring in some $1, 000m in a full financial year. One must consider what proportion of total health care costs will be covered by the levy. As the total cost of health care throughout the nation is in the region of $8,000m, clearly the levy, which will raise only $1,000m, will leave uncovered seven-eighths of the cost of health care. That $7,000m cost which will not be paid for by virtue of the levy must be found from other sources. Those other sources are the taxpayers of Australia. In other words, extra taxes will have to be exacted to cover the costs of health care as a result of Medicare.

That is not the only source of the future cost of taxation. As we know from our experience during the period when Medibank applied, there will be increasing usage of the system and, consequently, the cost of health care will rise from that source as well. The cost to the individual will be felt most in the months ahead. One has only to be reminded of the Government's actions in May last year in the mini-Budget and later in the course of the introduction of the Budget itself. The Government abolished the tax rebate which was available to credit against health insurance costs, of which every family that paid health insurance had the benefit. In aggregate throughout Australia that rebate amounted to some $600m for Australian families. That rebate has now been abolished, and the cost will be borne by the community when people come to pay their taxes in the current financial year. In addition no longer will people be able to claim as tax rebates the cost comprising the gap between the full medical expenses and the claim made to Medicare. That also will be added to the total cost of health care.

The Minister for Health said that as a result of Medicare two-thirds of Australians will pay less than they are now paying. If that is right-and we must take the Minister's word for it-it will leave only about half the population of Australia to pay more than is now being paid. The reason is that under the pre- medicare health arrangements some 20 percent of the population paid nothing. The people in that category were the very poor, pensioners, Aborigines or people generally classified as disadvantaged. Therefore, it can be readily understood that as a result of Medicare about half the Australian population will be paying more to meet total health insurance costs. This is quite contrary to the point made by the Government, in seeking to justify the introduction of Medicare, that it will be cheaper for everybody. The reason put forward, and the way in which it has been explained to the community, is that purely and simply people will only have to pay that one per cent levy. As we have demonstrated, that goes nowhere near meeting the total cost of the nationalised health insurance system. The rest will have to be found from taxation. On that basis the statement that it is to be a cheaper health insurance system is unjustified.

There will also be effects in terms of equity on various groups. For instance, two-income families will pay twice the levy for the same level of health insurance which they might otherwise have received. People will not be able to arrange the insurance through their private health insurance companies to meet the gap between medical expenses and rebates available from Medicare. There is to be a ceiling of $150 on patient contribution for medical bills over a 12- month period. Presumably doctors will be encouraged to direct all their patients to the bulk billing system, but are to accept only 85 per cent of the scheduled fee as full payment. The point that arises is that there will be no freedom of choice for the patient to select his own doctor or a private hospital. Indeed, the system will work very much in favour of orienting people towards acceptance of public hospital facilities rather than the private hospital system. One must wonder what will be the effect of that if private hospitals go out of business, and the resulting pressure on the public hospital system will have to be met by the Federal Government.

One can envisage the need for extensive capital expenditure to build new hospitals or perhaps to extend old ones to meet the extra costs. In addition to these items, and apart from the costs I have mentioned, people will need to insure themselves against all the ancillary medical costs that are not now covered in the basic insurance offered by Medicare. Indeed, people will need to buy that unsubsidised insurance at a deal of expense to themselves and their families. For those reasons there are extensive problems in the system that go to the core of the establishment of Medicare. The claims that it is both simple and equitable fall to the ground when one is aware that half the population-not some small proportion of relatively well off people-will pay more as a result of this new health insurance system

There is no doubt that the system will promote a higher level of usage in the community, which can only lead to further costs and therefore to higher taxation . Many other problems associated with the new system will affect individuals. I have already dealt with a number of those matters. Perhaps one of the most significant is the question of simplicity, which again the Government claims will be one of the major features of the new system. As I have pointed out, instead of people being able to go to a one-shop health insurance company to cover all their needs for hospital, basic medical and ancillary insurance, they will now have to go to two shops. In fact, insurance for Medicare will cover only the most basic medical insurance. All other areas will have to be covered through a second private insurance operation.

How can the claim of simplicity apply when there will be only 300 Medicare offices in Australia compared with the 1,000 private fund offices that are now operating? How will people be able to get quicker service through Medicare than that which they obtained through the private fund system? Obviously those people who are insured with Medicare and who live in remote areas will be severely disadvantaged. How can that be called either simple or equitable? It is pretty clear that even the lowest cost of private health insurance will amount to about $5 a week on top of the Medicare levy. That will have a significant impact on families. Perhaps in order to thoroughly understand what the Government is claiming in this matter we should examine what has happened in recent weeks in the processes adopted by the Minister for Health, Dr Blewett, to implement the program of Medicare. Clearly he has been operating in cahoots with State Ministers in seeking to achieve the coercion of doctors to accept his system.

This has been the case particularly in my State of South Australia in recent times when the State Minister for Health, Dr Cornwall, in a rather horrifying set of circumstances sought to bring to account one particular diagnostic specialist in Adelaide called Dr Peter Humble. We have seen the use of most extravagant and outrageous language against Dr Humble on the part of the State Minister in order to justify his particular stand and that of Dr Blewett against actions which Dr Humble himself thought were quite justified in withholding his services in a particular situation in Murray Bridge. I think that is one of those witch hunting situations that arise from time to time. It caused enormous concern in Adelaide at the time and caused the Adelaide News to write in its editorial as follows:

What is beyond argument is that, in his intervention in the Medicare row, the Minister-

that is, Mr Cornwall-

was intemperate and displayed a startling lack of judgment.

The article goes on to make the point that that was just part of a series of other misjudgments made by the Federal Minister, Dr Blewett, in regard to the implementation of the system.

I finalise these remarks by referring to what has happened with nursing homes in recent months. The new Medicare arrangements have sought to change the funding arrangements for nursing homes and hostels. There has been a change from what was previously known as the 60-day rule to the 35-day rule. People who receive long term care can be insured only for a maximum period of 35 days. This has caused a great deal of very genuine confusion amongst families. Elderly folk who have been confined to hospitals for periods far longer than the 35 days have suddenly found themselves in need of a bed in an elderly person's hostel. Of course, these beds are not easily available. Indeed, there are considerable waiting lists for those beds. Yet there has been no flexibility on the part of Medicare beyond certain points to provide insurance for people in those circumstances. Indeed, people in very difficult situations have tried to find beds for elderly folk who, of course, beyond question are in great need. These people perhaps suffer from senility or are in very indigent circumstances and are unable to be moved very quickly to alternative accommodation.

The assertions made in the matter of public importance put down for discussion today can be most clearly and substantially supported by the position of the elderly. The point is that the elderly have certainly not done well under Medicare and the arrangements which are flowing from it at present. As the people of Australia are now finding, Medicare will provide an alternative system of health insurance in this country with which very few people clearly identify. It is not something to which we are accustomed. It is aimed at the socialisation of health care in this country and it is creating unprecedented confusion and confrontation within the community.