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Wednesday, 28 March 1984
Page: 808


Senator CROWLEY(4.25) — If the squabble opposite has settled down I will make my contribution to the debate on this matter of public importance. Having listened to Senator Messner and Senator Jessop I simply fail to understand what they were talking about. The Opposition has put up a matter of public importance in these terms:

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.

Senator Messner and Senator Jessop spent their time arguing that we have instituted a national health insurance scheme. So at least two-thirds of the Opposition's matter of public importance is, out of their own mouths, affirmed. I guess it could be argued that they feel the point of difference is that the scheme is not simple and fair, but from their contribution to the debate one would never know that. I would suggest that Senator Messner, who was the first speaker on this matter of public importance, clearly does not recognise what is simple or fair when he sees it. I will go on to argue that quite clearly the Opposition does not even recognise a scheme when it sees it, unless it is scheming. I think that is a terribly important point. The Opposition is devoid of any proposals in the health insurance area. When in government it spent its time dismantling and rearranging schemes, making promises and breaking them. I could hardly expect it to know a scheme, much less a simple and fair one, if it came across it, which is why I think it has put up this matter of public importance. Members of the Opposition are condemned by their own words as being unable to see the truth when it is in front of them.

The Medicare scheme is a simple and fair one. Quite clearly, it is a universal scheme. It covers every Australian. It is a matter of considerable success for the Government that now, under the Medicare scheme, every Australian is covered for health costs. That certainly compares very well with the situation that existed before this Government came to office. Under the previous scheme at least two million Australians were uninsured. Many of those people chose not to be insured because they simply could not afford the private insurance fees, even for basic cover. It is claimed that some of those people preferred not to be insured; they preferred to risk their good health. They gambled about their own health. When the gamble failed for some of those people they were in for terrible medical expenses. For whatever reason, some two million Australians were previously uninsured. Now they are covered by this simple, fair and universal system.

Both Senator Messner and Senator Jessop have claimed, almost ad nauseam, that under this scheme one is not free to choose one's doctor. That again betrays their remarkable lack of understanding of what the Medicare scheme is about. People are continuing to go to their own general practitioners as they always have. They can choose their own doctor. They can continue to see their own doctor. There is nothing in the Medicare scheme that requires that situation to be changed. The point of difference is about private doctors in private hospitals; it has nothing to do with the bulk of doctor-patient relationships which occur in the general practice area. As I have said, those relationships remain as they were. The difference is that 85 per cent of the schedule fee of the cost of a visit to the doctor is covered by Medicare; that is all. There is no interference in that area in the right of people to choose their own doctor. With those kinds of comments both Senator Jessop and Senator Messner betray their remarkable ignorance of the scheme.

What has happened in the area of general practice? I think it is fair to say-I support very much what Senator Colston had to say in this area-that since Medicare has been introduced some doctors have gone like hell to increase their fees well above the schedule fee, thus causing an increased payment by a patient for a visit to a general practitioner. It is very interesting to see the campaigns now being waged as people realise that it is not Medicare that is interfering with their health system, it is not Medicare that is interfering with their right to see the doctor of their choice and it is not Medicare that is increasing the costs; it is the medical practitioners who are upping their fees arbitrarily and without any recourse to tribunals that set schedule fees. It is a willy-nilly, arbitrary 'I will get more if I can and 85 per cent of that basic schedule fee will be returned by the Government, but I will not tell the patients what I am doing as I do not respect them enough for that'.

I regard that kind of interesting contract between doctors and patients as a complete lie to the medical profession's general claim that it wants the right to have some kind of special contractual arrangement with patients. If that is the case, why are those doctors not explaining to patients that they have increased their general practice visit fees by the amounts that they have. It is very well documented in areas of South Australia and, as Senator Colston said, it is clearly the case in some areas in Queensland too. I have it on fair understanding that it is across the country in some areas but I do not have the documented evidence to support that claim.

Another remark I have heard from honourable senators opposite is that under Medicare people will have to use the free public hospital system and they will have no choice of doctor, as though somehow the medical profession working in public hospitals is second class, awful or a kind of group to be doubted. The majority of public hospitals in this country are at pains to protect their reputation and to provide excellent care for the patients who go into those hospitals. They appoint the most competent doctors. Appointments to public hospitals are not only sought after but also fought over. It is ridiculous to think that the doctors in public hospitals are less than competent. They may in fact charge less. In fact, under Medicare no charge by those doctors will be directed to the patients.

We need to be quite clear on that. As I understand it, the majority of Australians would prefer to go to a public hospital for any matter of serious medical consideration. People requiring open heart surgery, intensive care, after-coronary care, renal units and long term fracture management go to public hospitals. It is also important to note that, when people go to private hospitals and anything goes wrong in the medical area, those patients are transferred as quickly as possible to the largest and nearest public hospital where the most adequate and competent medical services prevail.

It is a nonsense and scaremongering on the part of the Opposition to keep putting up these false arguments, these furphies. It betrays not only the Opposition's lack of understanding of the Medicare system but also its lack of understanding for the people of Australia. It is a very fair system. People pay one per cent of their income according to their means. Those who have more income will pay more; those who have less will pay less. Couples who earn below $214 a week and single persons who earn below $128 a week pay nothing. Unlike the previous scheme, above those cutoff points the levy is phased in even before the full one per cent is required to be paid. It is a very fair system. I do not know what honourable senators opposite think fair means but I think to them it means a fair go for open slather for those medical people supporting them. That is not my understanding of fair. Fair and equitable mean that all Australians have access to medical services according to their ability to pay-and good medical services at that.

I have heard it argued by Senator Messner that people are now worse off than they were previously. If one earns $500 a week, buys private insurance and private extras insurance, one probably pays the same amount as was previously paid for basic health insurance. I suppose it could be argued that if one earns $500 a week, that is a bit rough. However, there are many people in the community who do not even get within cooee of $500 a week and who would be very prepared to contribute their $5 a week Medicare levy from that salary or income. I agree heartily with Senator Colston's claim that it is equitable for those in our community who earn more or are able to achieve more to pay more. That is also what equity means. The arguments put by Senator Messner were not only misleading but also basically wrong. Again, I do not think he has understood the figures or has a basic understanding of what the Medicare provisions are.

Another very important thing about Medicare that contributes to its simpleness and its fairness is the centralised computer within the Health Insurance Commission. There is one computer now. It is very interesting to hear the Opposition's arguments against the introduction of the Medicare computer within the Health Insurance Commission and its complaints about the loss of jobs and so on, yet it happily ignored what happened to people from Medibank when the previous Government dismantled the Medibank setup and the Medibank computer. According to the Health Insurance Commission report this year, some 2,400 jobs were lost at that time, and a further 400 from within the Health Insurance Commission. I do not remember hearing Liberal senators or members at that stage complain bitterly about the loss of jobs which they were creating. I find their arguments on behalf of the poor working people at this stage without substance. I find it difficult to take their case to heart. Besides, in South Australia, where the Health Insurance Commission and the private health funds have been at pains to be reasonable, talk to each other and work things out, at the last count I believe only one job had been lost.

The other important thing about a central computer and a central collection of data is that there will be much better epidemiological information for the whole of Australia, for people in the planning and research areas and for the people trying to administer health services in this country to the best advantage of all Australians. It will also provide a much better brake and check on medifraud . I understand from recent figures that the previous estimate of $100m for medical fraud is probably a very conservative estimate; the figure is now put at nearer $200m. I guess 100 per cent error is tolerated in this area, but it indicates that some of our medical colleagues are not exactly playing fair. If they are the people whom members of the Opposition supports, I simply say again that their definition of fair is not mine.

It is very important that medical fraud be pursued. I would have thought that was the view of most Australians. The simplicity that goes with the centralised data collection of Medicare will advantage and make that more likely. The complexities, which I presume are the opposite pole of a simple system, do not belong with Medicare and ought not to be sheeted home to it. They are the problems of private funds and the many choices people will have to make when they work out which fund, which table, how much and so on.

The other part of the confusion is the doctor engendered confusion and the Opposition engendered confusion about private practice in public facilities. The debate over the last few weeks has become disgraceful not only because of the emotionalism and all of those things that the medical profession claims it does not say but also because of the very wrong information which has been given to Australians so that, if they were not confused beforehand, they certainly are now. By and large the issue of the right to private practice in public hospitals and the requirement of the Federal Government not to put any guidelines into contractural arrangements between hospitals and doctors has been grossly misrepresented. It has also been seen as though it represents the view of all doctors in the community. I understand from contacts of mine that it does not even represent the view of all members of the Australian Medical Association. There is considerable embarrassment among the medical profession about how that campaign is being run.

I turn now to the other side of why the Opposition can put up such a simplistic and puerile matter of public importance as it has today. It is because it could not recognise a good system if it saw one. The other corollary to this is that it does not have one of its own. The principal health policy of the Opposition is to dismantle anything that the Labor Government does. We have even had a difference of opinion between Opposition Leader Peacock and Mr Carlton about whether the Opposition would or would not fully or only in part dismantle Medicare. Some say they would and some say they would not and even amongst themselves they cannot agree. Certainly, the Opposition is not sure when it would do it, if it decided to do it. Given that kind of coherent approach to things it is no wonder that Opposition senators put up such a daft debate as they have put before us today.

I have a letter which was sent by Opposition Leader Peacock to all doctors, and which has been mentioned before in the Senate. His mailing system did not blink me out of the system so I was a recipient of this glorious letter. The thing that really strikes me about the letter is how Mr Peacock argued that first of all what his Government will do is to provide the best health care for individuals by removing 'the Big Brother intrusion of government into the practice of medicine'. There is a monumentally comprehensive health policy. I do not believe the Opposition has anything more to say than 'If you do, we will oppose it'. It is nothing more than the 1975 commitment-'We promise to keep Medibank, but the minute we are in power we will dismantle it'. I do not believe Australians have any reason to trust the Opposition. I do not believe they have any reason to trust that it will provide health care. It has had five schemes under Mr Fraser, none of which improved on what went before, but which did manage to get two million Australians uninsured. Medicare is simple, fair, equitable and is covering all Australians. It is all the things that the Opposition claims it is not. That is why the Opposition is protesting so loudly.