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Wednesday, 28 March 1984
Page: 801


Senator COLSTON(3.34) —I was absolutely amazed at the gall of Senator Messner in submitting this matter of public importance to the Senate for discussion. I will read the terms of the matter of public importance because it is important that we know what we are discussing. It states:

The failure of the Minister of Health to honour the Government's commitment to institute a national health insurance scheme that is both simple and fair.

I reject the word 'failure' in that matter of public importance. The MPI would have been much better if it had been submitted in this way:

The congratulations due to the Minister for Health in honouring the Government' s commitment to institute a national health insurance scheme that is both simple and fair.

I waited for some time while Senator Messner was speaking to find out how he would support this matter of public importance. I waited in vain. I conjured up an image of a Scotsman trying to defend the abolition of bagpipes.

It is necessary to look back to some aspects of health insurance in Australia over the past nine to 10 years if we are to discuss this matter of public importance. I go back to 1975 when the Labor Government was in power. At that time the Labor Party introduced the original Medibank scheme. Unfortunately for us as a party it was not introduced until mid-1975. Although it was not introduced until then, public acceptance of that scheme was quite evident within the first few months of operation. We know that at the end of 1975 we had a rather unusual election campaign. By that time the Labor Party was not in power and we had a caretaker Prime Minister, Mr Fraser. Mr Fraser knew how well accepted Medibank was at that stage and he very clearly said to the Australian people in his election campaign speech that he would maintain Medibank. Many of us can remember seeing him do this on television. I suppose some members opposite actually saw him make this promise in person. He said that he would maintain Medibank. The promise was not matched at all by performance. We know what happened after than. Medibank was emasculated over the years that followed and there was such a manipulation of health insurance schemes that people became confused. The only thing that was maintained was the name Medibank. It was maintained as a private health insurance scheme.

While we were in opposition we were not prepared, as a Labor Party, to see health insurance in Australia go the way it did without putting up an alternative. While we were in opposition we planned a new scheme based on the previous Medibank. The new scheme, as we know, is known as Medicare. We put a lot of effort into the planning of the new scheme. During the planning stages it was obvious that a new health system for Australia was absolutely necessary. The Fraser Government had created chaos in our system of health care. There were continual changes leading to public confusion. There were five basic changes to the health insurance scheme in Australia under the Fraser Government. It became almost an annual ritual in this chamber to see a new change brought forward. I was here from 1975 and I remember that every year but one a new system of health insurance was introduced by the Fraser Government. No wonder the people were confused!

The new system that we planned while in opposition was well publicised. Even before the early election was held in 1983 we publicised our system so that people would know exactly what we had in mind and they accepted what we had in mind. In the election campaign in 1983 we spelt it out in even greater detail. I will read parts of what was said in Mr Hawke's policy speech of 16 February 1983 . Under the heading 'Health' he outlined originally the unsatisfactory situation which existed early in 1983.

One of the big factors in the decline of the living standards of Australian families over the last seven years has sprung from one of the most notorious of the Fraser Government's broken promises-the promise to maintain the universal health care system. There have been five confused and confusing schemes put in its place. It has reduced health care standards and directly raised inflation. Further, the Fraser Government has placed intolerable burdens on the hospital systems of the States.

Then Mr Hawke went on to note what the Labor Government would do. He said:

The Labor Government will return to the basic principle of the right of all Australians to health services according to their medical needs.

He made some mention of the details of the proposed Medicare scheme. He said:

Labor's new Medicare program involves simply the replacement of the present crippling health fund contributions by an income-related levy of one per cent on taxable income.

It is history that the Australian Labor Party was elected to be the Government and the introduction of Medicare was put into its planning stages. On 1 February this year Medicare started to operate. Considering that this Government had been elected less than 12 months prior to the introduction of Medicare, it was a remarkable achievement by the Health Insurance Commission to get Medicare operating by 1 February. Credit should also be paid to the hard work and dedication of the Minister for Health, Dr Blewett, in getting Medicare up and running on 1 February.

Now that Medicare is up and running-it has been up and running for nearly two months-it has been well accepted by the Australian people. There have been some teething problems but in general it has been running smoothly. One would almost expect that there would be some teething problems given the massive operation that is required in running Medicare. Six and a half million services were processed up until 26 March. Throughout Australia 265 offices are on line to the central computer in Canberra. In addition, there are 70 agencies. The level of payouts up until 21 March this year was $112m. When one has an operation such as that, I suppose there would be some teething problems, but these have been overcome and we now have a smoothly running scheme. Medicare is now in place.

Despite what was said by Senator Messner, Medicare is a simple and fair scheme. Despite the urging of the Australian Medical Association, some medical practitioners do bulk bill their patients and these patients find that Medicare is an extremely simple system. The system contrasts with the schemes offered to the Australian people by the last Government. Those schemes were complex and inequitable. Those people who missed out on adequate health insurance and therefore adequate health care were the less affluent in the community. That situation has been overcome.

I find that one disappointing aspect of Medicare is that some medical practitioners in Australia are simply not playing the game. I would like to mention some aspects of that. Medical practitioners, like most other people in the community, expect workers to receive only award wages-the wages that are awarded to them by the Australian Conciliation and Arbitration Commission. However, apparently what is good for the workers is not good enough for some medical practitioners. They are willing to have their profession heavily subsidised while they are training as well as when they are in practice. We as a government are willing to provide that subsidisation. But some of the medical practitioners are not willing to curb the cost to their patients. I am not referring to all doctors but I am referring to a substantial proportion of them.

Over the last couple of weeks I had a number of complaints referred to me about members of the medical profession charging above the schedule fee. Schedule fees are set by the Medical Benefits Fees Tribunal. Medical practitioners are able to argue their cases before the Tribunal. It is not compulsory for medical practitioners to limit their fees to the level set by the Tribunal but if they do not they cause difficulty for their patients. If they do not they are not taking the same action as they expect workers throughout Australia to take in regard to wage decisions awarded by a tribunal or a commission.

Because of the complaints that I received, I undertook a survey last week of 70 general practitioners in the Brisbane and near Brisbane areas. The 70 general practitioners in the survey were chosen on a random basis. The survey threw up some interesting results. The schedule fee for a standard consultation in Queensland is $12. By a standard consultation I mean a consultation of 5 to 25 minutes. It is interesting to note that 73 per cent of the doctors in this survey charged above the schedule fee of $12 for a standard consultation. The average fee was $14 rather than $12. Fees of $14 were quite common. One doctor in the survey charged $16.

It seems to me that it is obvious many medical practitioners do not realise that a visit to a doctor does not mean that the only expense is payment of the doctor's fee. Usually a visit to a pharmacist is required. Usually the cost of one national health script is an extra $4. Quite often one will go to a medical practitioner and then spend at least $10 at a pharmacy. These are the sorts of financial difficulties that people find when they go to a medical practitioner who charges well above the schedule fee and then have to go to a pharmacist to buy scripts costing at least $4 and perhaps up to $10.

When I reported the results of this survey the President of the Australian Medical Association in Queensland, Professor David Wheedon, claimed that the survey was a waste of taxpayers' money. In fact, he said I was being mischievous . In my opinion the good professor was talking humbug. For Professor Wheedon's information, the survey cost less than $20 and was money well spent. If I have matters brought to my attention by my constituents I have every intention of investigating those matters. No senator worth his or her salt would be content simply to warm a seat in the Senate chamber and I do not intend to do that. The survey that I undertook was well worth while.

Today I received a letter from the Secretary of the Metropolitan General Practitioners Group of the AMA in Queensland. As a copy of this letter has been sent to Dr Blewett and Mr Carlton I should not feel inhibited about mentioning it in part. It urged me not to stir up public opinion against general practitioners in future. For the Secretary's information, I do not stir up public opinion against general practitioners but if general practitioners are not prepared to play the game they will be responsible for the opinion that the public develops about doctors.

I would like to look at that survey in another light. I have mentioned that 73 per cent of the doctors surveyed charged above the schedule fee. Looking at this matter in another light, it is significant that over one-quarter of those surveyed charged no more than the schedule fee. If they can do that, why cannot their peers? It is obvious that some medical practitioners, like some honourable senators opposite, do not want Medicare to be the success that it is. They will do everything they possibly can to scuttle the scheme which has now been well accepted by the Australian people.

The matter of public importance which has been submitted to the Senate for discussion talks about the failure of the Minister for Health to do something. The Minister for Health, Dr Blewett, was a driving force when we were in opposition in having the scheme that is now called Medicare brought into the planning stages. He was certainly aided by a number of people in the Australian Labor Party, but without his driving force we probably would not have had it in a ready-to-go situation when we came into power. The matter of public importance talks about the Minister's failure to honour our commitment to introduce a national health insurance scheme that is both simple and fair. The people of Australia are finding it a simple and fair scheme.

The previous speaker in this debate, Senator Messner, made the claim that we said that the Medicare scheme would 'be cheaper for everybody'. We did not say that the scheme would be cheaper for everybody. We knew that it would be more expensive for people on high incomes. Why should not the scheme be more expensive for persons on incomes like mine and those of honourable senators opposite? Why should it not be more expensive for those who have very high incomes? It certainly is more expensive for me and for those opposite. But we did not say that the scheme would be cheaper for everybody. It is misleading to say so. For the majority of people it is a better scheme in terms of financial consideration. All people find it simple and fair. What is inequitable about making those on higher incomes pay more than those on lower incomes? There is nothing inequitable about that: there is nothing unfair about it.

The matter of public importance that was put to the Senate for discussion talks about the failure of the Minister for Health to honour the Government's commitment to institute a national health insurance scheme which is both simple and fair. That is absolutely absurd. I repeat that I reject the suggestion of failure. I suggest that the matter before us should have read: 'The congratulations due to the Minister for Health in honouring the Government's commitment to institute a national health insurance scheme that is both simple and fair'.

Debate interrupted.