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Wednesday, 9 May 1984
Page: 1795

Senator HAINES(10.33) — When Senator Peter Baume first indicated that he would seek disallowance of the Australian Capital Territory Medical Services Fee Ordinance and the Health Insurance Regulations (Amendment) I must confess to being a little puzzled since, as he said, they seemed to be a non-issue. However, I am no more imbued with divine wisdom and knowledge than anybody else in this chamber, I imagine. I at first assumed that this debate was going to come on last night, when I was not going to be here, and I drafted some notes for Senator Macklin headed: 'You will have to listen to what Baume has to say by way of justification'. I apologise to Senator Baume; I did draft these notes in a hurry and did not put in the honourable senator's full title. Having done that, I said to Senator Macklin: 'Your only real response should follow certain lines'-which I then set out-'unless he produces outstanding evidence that there is a hidden problem'. So what I asked Senator Macklin to do was what I in fact have come into the chamber today to do; that is, to listen to Senator Baume's debate, prepared to hear and absorb any argument he introduces that is compelling enough to have us make a decision one way or the other on what he readily admits is a non-issue.

Having listened to Senator Baume, and I was here for the entirety of his debate , it seems to me that he has not produced anything which indicates that this is an issue, that there is any hidden agenda or any hidden threat. Instead, according to the notes that I made while he was speaking, and my handwriting is not terribly good here, he has admitted that all that is being done in the ordinance and the regulation is to restrict certain things to certain diagnostic services and to radiology. However, he did go on and express on several occasions that he was concerned-and I respect his concern-because he believes it to be a prelude to moves against other occupations. He said that at the beginning of his speech and he reiterated it at the end. I can only say to Senator Baume that, of course, those will have to be taken as they come. But I point out to the honourable senator that it took a long time between a Liberal government imposing price control on another profession, namely, on pharmacists, and a Labor government imposing it on some doctors.

That is a point that I do not think was made terribly clear by Senator Baume- that it is only some sections of the profession which are having a restriction imposed upon them; namely, those people who are practising, or whatever doctors do, on private patients in public hospitals. So I would have to say that I cannot understand why the Government is doing what I believe is, wittingly or not, an action which will embarrass the national body of the Australian Medical Association by attempting to force it, in a sort of third-hand way, to renege on an agreement it made with the Government and which it said, through its National President, Dr Lindsay Thompson, was to be adhered to until the Penington Committee of Inquiry into Rights of Private Practice in Public Hospitals reports when, as I understand it, both parties will have another look at the matter. From indications that I have seen in newspapers and heard from individuals, it is likely to mean that they will adhere to whatever that Committee puts forward.

If Senator Baume has any doubts at all about the attitude of the AMA, I refer him to the letter dated 9 April 1984 a copy of which, as a courtesy to me, the AMA sent to me. It was signed by Dr Lindsay Thompson and was sent to all members of the AMA. I do not know whether Senator Baume is still a member of the AMA, notwithstanding the fact that he is not a general practitioner, honourable or not as that profession may be, and practising or not in his own specialty, but if he is not--

Senator Peter Baume —Yes is the answer.

Senator HAINES —Right-then not only would Senator Baume have received a letter as a member of the AMA but also I presume he would have been sent a copy by Dr Thompson in Senator Baume's capacity as health spokesman in the Senate.

Senator Peter Baume —And as a friend.

Senator HAINES —Indeed, and as a friend I am sure. So he should have three copies which means that he ought to know that the letter catalogues what Dr Thompson calls 'the gradual retreat of the Minister'-that is, the Minister for Health, Dr Blewett-'in the face of the determination of the profession to resist '. I must say that the determination of the profession to resist certain plans that the Government originally had for it was formidable indeed and, I would say , should operate as a model to any profession which is setting out to resist unsavoury moves by a government of whatever persuasion. In that letter Dr Thompson said:

At an early stage a guideline placing a ceiling on the private practice earnings of salaried doctors and limiting the earnings of private practitioners was withdrawn.

Also subsequently withdrawn were guidelines laying down a Commonwealth scale of facility charges, a requirement that all accounts be raised by the hospital and that money received be handled and applied in a prescribed manner. Authority over these matters was returned to the states.

With doctors stating firmly that they would not sign new contracts, the Minister announced an inquiry into private practice in public hospitals under the chairmanship of Prof. David Penington, Dean of the Faculty of Medicine at the University of Melbourne. After negotiating greatly improved terms of reference the A.M.A. agreed to participate. The enquiry committee consists of three medical practitioners, one of them nominated by the A.M.A. The enquiry is expected to take at least six months.

Furthermore, Dr Thompson went on to say:

There is no longer pressure on doctors to sign contracts acknowledging the Minister's powers under Section 17.

As a result of these concessions made by the Minister, under considerable pressure and justifiable pressure from the AMA, the two, shall we say, warring parties, held further talks. The end product of those, according again to the AMA's Federal President, was that the Minister agreed to:

1. Delete the 46 miscellaneous services--

Again I am quoting from Dr Thompson's letter-

from the list of prescribed services, thus limiting the area of contention.

2. Set up a working party with the A.M.A. to prepare a joint submission to the Penington inquiry to recommend:

(a) Formal consultative mechanisms between the Government and the A.M.A. on the guidelines under Section 17

(b) appropriate arbitration/appeal procedures in the event of non-agreement on the quantifiable elements of the guidelines.

The Government had previously agreed to accept any recommendation of the enquiry on consultation and appeal.

With no possibility of gaining any further concessions at this stage, the Federal Executive Committee of the A.M.A. agreed on April 6, 1984, to recommend to doctors that they cease industrial action.

In effect, what Dr Thompson pointed out in his letter was that a position has been achieved where the unfettered powers of the Minister to dictate the terms under which doctors will provide hospital services with no avenue of appeal can now be effectively curbed by further negotiation of details along an agreed path and that, as he said, 'The onerous terms the Minister sought to impose have also been neutralised for the present'. Most importantly, however, this letter contained an extremely telling sentence or two relating to the matter before us today. At the bottom of the first page of the letter Dr Thompson wrote:

The Minister has refused to budge on his one remaining guideline-that the prescribed services must be charged at or below the schedule fee. However, the refusal of doctors to sign contracts agreeing to this, forced him to make arrangements with the States to impose the condition for him. It was an empty gesture, for almost universally and for many years, diagnostic services in public hospitals have been charged at or below the schedule fee. I have agreed to recommend that this should continue pending the outcome of the Penington inquiry.

I repeat for the benefit of honourable senators that last sentence which came from an honourable man who has worked very hard for his organisation and its members. He said:

I have agreed to recommend that this should continue pending the outcome of the Penington inquiry.

Having read that letter I do not think it is unreasonable to expect that I was surprised that Senator Baume went ahead with this action. I could only assume that he had found something awful in the ordinance and the regulation that I had missed. In fact, there is nothing untoward about it. There is nothing in there that Dr Thompson had not agreed to recommend should continue pending the outcome of the Penington inquiry.

Senator Peter Baume —I think he recommended that the practice should continue, not the ordinance.

Senator HAINES —That, unfortunately, was taken out of his hands by Senator Baume 's action. Had he allowed this to continue as it had continued to date there would be no problem. The only remaining regulation, the one we are debating today, imposes an already existing condition, namely that the requirement that no more than the schedule fee be charged for certain prescribed items relating to some diagnostic services and radiology should continue. There was no cause for concern and there was no opposition, as I have just indicated from this letter, coming from the AMA to the requirement that this should continue until the outcome of the Penington inquiry is made public. I certainly would have assumed that Senator Baume would have known from comments that I made in February this year that, having taken away the unfettered powers of the Minister and given them to the Parliament, which is a fairly standard practice in all legislation and departments, we would not be a party to ambush actions. I made it quite clear to Dr Repin and Dr Thompson and, indeed, to a gentleman whom I also assume is a friend of Senator Baume's-that is, John Best-that, while the Government did not try to impose anything on the medical profession that was not already existing, it would as a matter of honour--

Senator Peter Baume —Dr John Best, a real doctor.

Senator HAINES —A real doctor or not, a pleasant enough fellow. I said that we would not be party, as a matter of honour, to preventing the Government from governing-the Liberals always told us when they were in government that Oppositions were not supposed to do that-providing, as I said, that it did not go outside the status quo. As every official of the AMA goes to great pains to point out, and as Dr Peter Hughes reiterated in a letter to me dated 4 April 1984, the Government has produced no examples of doctors charging more than the schedule fee in the Australian Capital Territory for such diagnostic and radiotherapy services. The Government is not asking those medical practitioners with private patients in a public hospital to do anything other than what they are already doing. Senator Baume certainly summed up the matter when he said it was a non-issue. I would go beyond that and say that what he is undertaking is not only a pointless exercise--

Senator Peter Baume —I think I said it was an issue, but a non-problem.

Senator HAINES —If Senator Baume checks, he will find that he said it was a non- issue. Certainly it is a non-problem. I will not argue the semantics of it. I do see, quite seriously, that wittingly or unwittingly it will serve as an embarrassment to members of an executive who are honourable men and who stated quite clearly that, pending the outcome of the Penington inquiry, they were prepared to recommend that the existing situation continue. That existing situation relates to the charging of fees at or below the schedule fee. There appears to be no significant charging of more than the schedule fee for the prescribed items contained in the regulation. All that the ordinance seeks to do is to bring the Australian Capital Territory into line with other Australian States and that does not seem an unreasonable step. The real problem seems to lie in another issue raised by Dr Hughes in the penultimate sentence of his letter to me, the one that I referred to earlier, which states:

The Government states that it wishes to prevent doctors charging more than the schedule fee, but as it hasn't demonstrated that there is a problem in this area , it clearly has another reason for such legislation.

Presumably, that other reason relates to holding the schedule fee at the 1984 level for the next 100 years. If this is the case their fears should be--

Senator Walters —Is that what he says?

Senator HAINES —No, that is not what he said in the letter. What he has said to me privately and what other members of the medical profession have said is that they fear that the schedule fee, covered as it is in a regulation, will be artificially restrained, that reviews will no longer be held, that there will be no increases in the schedule fee and that in five, six, seven, 10, 20 or even 100 years time, members of the medical profession will find that their incomes have been severely curtailed. If that is the case, if that is what they fear, I would have thought that their fears should have been allayed somewhat by the fact that there have been two rises in fees in the last few months, the latest of which was a 9 per cent increase announced only last week.

If the AMA's real concern is that there is in existence no official or regular review of the schedule fee-I think that is a justifiable complaint on its part- all I can say is that it had seven years in which to convince the previous Government to establish the necessary machinery. Either it did not argue very persuasively or it did not make any attempt so to do. In any case it is not a matter of relevance in this debate. What is relevant is that the ordinance and the regulations that we are debating do not require any more of doctors in the Australian Capital Territory than is already required of doctors in other States . Furthermore, the regulations require nothing of doctors with private patients in public hospitals, it would appear from Senator Baume's speech and from information I have been able to glean, that the majority of them are already charging no more than the schedule fee for certain diagnostic and radiotherapy services. Senator Baume has certainly not convinced me that there is some hidden element in all of this to impose on doctors anything other than things which they have already imposed on themselves. In conclusion, all I can say is what must have been made patently apparent in my preceding comments; that is, that the Australian Democrats can see no purpose in supporting the disallowance of regulations and an ordinance which do not go outside a practice which is almost universally adopted by the people on whom they are being imposed.