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Wednesday, 28 March 1984
Page: 814

Senator GRIMES (Minister for Social Security)(4.55) —In speaking on this motion I shall come to the specific items mentioned by the shadow Minister, Senator Messner, but I wish first to take up a number of points made by Senator Reid. In raising these matters it is clear that Senator Reid does not understand the situation either as it now exists or previously. She may have unwittingly-I am sure unwittingly-put fears in the minds of patients, particularly on the subject of privacy. As Senator Reid said, an account is submitted on which is an item number, that being a number on the schedule referring to the list of schedule items which are produced and have been produced for many years. The second gives a brief description of the service. That is the crux of the matter which Senator Reid clearly does not understand. It is a description of the service. It is a short consultation or a long consultation, but it is a technical procedure. It is not a description of the disease or illness. It is nonsense to suggest that in this provision the Government is suddenly opening up everybody's medical records to anybody who wants to look at them. It is an unnecessary scare tactic and should not be raised.

Let me remind the Senate of what happened under the old system, and indeed will still happen under the voluntary health funds. People take their accounts to those voluntary health funds and they then pass through many hands in those funds. Hundreds of those funds have existed in the past. There was no guarantee of privacy there at all, no guarantee that they would not be passed round everybody in the office. There was no computerisation in most of the offices, with the protection that such a system gives. Large piles of records and papers, patients' records and bills, used to be kept in the back offices of all those voluntary health funds. There was no question from Senator Reid or any other member of this place that the potential for a breach of such privilege existed in those circumstances. But now, because Medicare has been introduced and because the Opposition has an ideological objection to it, the Senate is treated to nit-picking complaints such as it has heard this afternoon.

Typical of those complaints was Senator Reid's objection to the lack of gap insurance. I am always fascinated to hear the Australian Medical Association complaining about such a matter. Under the old Medibank legislation, that Association violently opposed gap insurance. It did not want it because it felt that there should be a patient moiety, some amount of money which the patient should pay so that he or she recognised it was a professional service. It is only under Medicare, only after the Australian Labor Party and the present Government introduced the Medicare system, that the Association suddenly makes this extraordinary turnabout on gap insurance. The reasons for not having such insurance have been clearly explained over and again by Dr Blewett and by everybody who has been involved in this debate, and I shall not again go into details. I find the matter of public importance raised for discussion quite extraordinary. It states:

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

I find that is an extraordinary matter of public importance for a Minister in the previous Government to bring up.

Let us go briefly over the history of health insurance in this country. I think it is worthwhile to do so. The fuss really started back in 1968-69 with the previous Liberal-Country Party Government of that time, which became very much aware that all was not well with the health insurance system of this country. Therefore, it set up the Nimmo Committee of Inquiry into Health Insurance. That inquiry came up with the following findings, roughly: First, there were too many voluntary health funds; secondly, they were inefficient; thirdly, too many people in this country were not covered by health insurance; fourthly, it was expensive; fifthly, the health insurance funds were getting up to all sorts of tricks with buildings and planes and other things and misusing the funds provided to them by patients in the community. The funds were not providing the service they said they would provide, nor were they providing the service across the whole spectrum of patients in this country. As I said before, large numbers of people were not covered.

Mr Gorton, the then Prime Minister, and his Minister for Health did not think much of the situation exposed by this inquiry and said that the Government would do something about it. At that time I was in private medical practice. I remember the kerfuffle over the suggestion by the Prime Minister of the day that his Government would have to do something about health insurance. The fuss went on in a big way because the medical benefits funds at that time were controlled completely by the medical profession. There was the extraordinary situation of 10 or 12 directors were doctors and another 10 were not doctors but were picked by the people who were doctors. There was no election, no consumer representation or anything else. A great campaign rose up against Mr Gorton and the then Liberal-Country Party Government. It did nothing about health insurance .

Eventually, in 1972, the Labor Government was elected with a clear mandate to introduce a national health insurance scheme in this country funded by a levy on taxable income to provide basic health, hospital and medical cover for the sick and citizens in general of this community. We were going to introduce a scheme just like the Medicare scheme. Again, all hell broke loose. I was here for the second half of that 1972-75 period. I remind honourable senators of what happened. First of all, the Opposition obstructed that legislation. We had a double dissolution and a Joint Sitting. The legislation went through in the Joint Sitting but the Liberal-Country Party Opposition at the time opposed, of all things, the levy to pay for the system. The Bill to introduce the levy was one of the Bills used by that infamous character, Sir John Kerr, in calling the double dissolution in 1975.

After the double dissolution, what did the Liberal-Country Party Government do? It introduced exactly the same piece of legislation to impose a levy which Senator Baume and others had opposed in this place when in opposition. It said: 'We will reform the health insurance system in this country. We will introduce a health insurance scheme which is fair to everybody, which is affordable by the community and which will be accepted by the community'. From 1975 to 1983 we had six health insurance schemes. I was the Opposition spokesman on health in this place over those years and every year I used to debate the latest amendments to the National Health Act and the Health Insurance Act. At the end of every speech I made in the second reading debates I said: 'I will see you here again next year because this will not work. It is unfair and unworkable'. I was right every time. For six years we had new schemes over and over again. Every year the Minister for Health, whoever he happened to be at the time, said: 'I feel a new health insurance scheme coming on'. Those Health Ministers would trot to the Parliament with the lastest scheme which it was claimed would make all the changes, all the differences, and would introduce what they said would be, in the words of this motion, 'a simple and fair' health insurance scheme.

None of those schemes worked because the Government of the day was completely under the thumb of two groups: A small section of the medical profession and a section of the voluntary health insurance funds who believed, as apparently do some people on the other side, that medicine in this community is best provided through what they call a free market. I remind honourable senators that what is involved in most people's concept of a free market in this community is a situation in which the seller has full knowledge and the buyer has full knowledge. They can therefore compete as equals in the community. That rarely applies in the area of health services. First of all, in most cases the patient, the buyer, cannot decide whether to have the service then and there. The patient cannot put off the service. Patients want the service because they are ill. They have no choice. Secondly, in general, they have no knowledge. They do not have expertise in the area. The seller, the medical practitioner, has all the knowledge.

In every civilised country, governments-whether conservative, social, democratic, democratic social, liberal or whatever-have had to interfere in that so-called free market process because the simple fact of the matter is that the best and fairest way to deliver health services in the community is to recognise that none of us can predict when we will need those services or the extent to which we will need them. None of us can say that we will never need a health scheme or that we will never need a doctor. None of us can say that we will never get run over by a bus, get a myocardial infarction or any other illness. Thus, the best way to fund the health insurance scheme is through the community rating principle. The best way, not the most perfect way, we have to fund it in this country is to impose a levy which is based as much as possible on people's capacity to pay; that is, through a levy on taxable income. If people want extras on top of that, if they want the capacity to go into private hospitals where, as is the case in some hospitals in Melbourne, wine is served with meals and other fancy provisions are provided, they can insure for that on top of the basic health insurance scheme which is provided for all citizens in the country on the basis of capacity to pay. I hope it is provided to them also on the basis of their needs in this area.

That is a fair health system. That is the sort of system we wanted to introduce . It is the system we tried to introduce in 1975. After a couple of months it was not persisted with by the new Government which came in at the end of 1975. That Government in the next seven years demonstrated a profound incapacity to introduce a health insurance system which was understood, which was simple and fair. In 1983 the present Government was elected with an absolute, clear mandate to do what for years we had explained we would do when we were elected; namely, introduce a health insurance scheme which was universal, which was funded by a levy on taxable income and which, in fact, was fair. That is what we have.

That system has only just been introduced. Of course, there are some teething problems. No one suggested that there would not be, although I suggest that those teething problems are much less than many of us would have thought. It is an example of the success of the scheme, not its failure that the Opposition, in introducing this matter of public importance which is supposed to be entirely critical of the health insurance system as it has existed for the last couple of months, makes these sorts of complaints: Complaints about the procedure for issuing receipts, to which Dr Blewett and the Health Insurance Commission have made some changes in response to the community's reaction; complaints from Senator Reid that on her payslip the one per cent levy is clearly shown, yet on her secretary's it is not. They are complaints about procedural matters. There are then the usual shibboleths which demonstrate that some things in this Parliament never change. The first one was expressed by Senator Reid when she said that we are nationalising the medical profession. How on earth can we nationalise the medical profession by introducing a health insurance scheme which maintains the fee for service systems, which maintains private practice, and which in fact provides for the assistance of funding of private practice in this community? How on earth can that be described as nationalisation of the health scheme? How can it be described as the creeping socialism that Senator Reid talks about?

My time, in essence, has almost run out. For the Opposition to raise a matter of public importance which talks about the failure of this Government to introduce a national health insurance scheme which 'is simple and fair' after two months of operation and produce only nit picking criticisms demonstrates cheek and gall, not constructive criticism of the existing scheme.