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Tuesday, 23 September 1958

Sir EARLE PAGE (Cowper) .- It is very difficult to have much respect for the crocodile tears of the honorable member for Grayndler (Mr. Daly), who spoke about the co-ordination of State and Federal health activities. When the Australian Labour party was in power, it rejected my suggestion that a referendum be held on the question of health, with the object of its being made a matter for the Commonwealth and States concurrently, so enabling cooperation to take place in the widest possible field. That suggestion was rejected in this Parliament by the leader of the government at that time, and the proposition was not submitted to the people. I consider that had it been submitted it would have been approved, and we would not now have any of these difficulties that have arisen since, with all sorts of propositions being dragged up before the High Court.

The second matter to which I wish to refer is the question of age pensioners and their medical treatment. The Labour party held office, off and on, during a period of 40 or 45 years. It is true that sometimes the periods of Labour government were short, but at one time Labour was in office for eight years. But during any of those periods did Labour members ever mention publicly the question of free medical treatment for pensioners? No. The matter was not raised in this Parliament, and it was not raised elsewhere in Australia, until the provision for it was brought down by this Government when I was Minister for Health. What has happened since? The figures show that age pensioners have had over 20,000,000 medical visits, either in the surgery or at home, which have been paid for by the Commonwealth Government to the tune of some £17,000,000. In addition, an amount of £9,000,000 has been provided for their medicines, which are of a much wider range than is the ordinary list of drugs provided for the general public. Therefore an amount of £26,000,000 has been found for a purpose that was never mentioned by the Labour party when it was in office or when it was seeking election.

My mind goes back to this time three years ago. Parliament was coming to an end, and I brought down a National Health bill, which was finally passed through this House unanimously, without a division. The main speakers on behalf of the Labour party, the main speakers on behalf of the AntiCommunist Labour party, then sitting in this corner, and the main speakers on behalf of the Government all praised the generosity and value of this scheme and said that they did not think its fundamental principles would be altered, although amendments to improve it might be made now and again. That was Labour's attitude three years ago. What has happened since?

I congratulate the Minister for bringing down an amendment which will make a very generous contribution in cases of chronic sickness and pre-existing sickness, and to people who are getting old and have the ordinary ills of age. What has made this possible? It has been made possible by the experience gained through the operation of voluntary health insurance over the last eight years. The insurance schemes have grown to a degree with which there is no comparison anywhere else in the world. We started, I suppose, with 10 per cent, of the population insured. To-day, in New South Wales, over 70 per cent, are insured. Who are the other 30 per cent.? About 10 per cent, are age pensioners, bringing the total to 80 per cent. Another 5 per cent, come under repatriation services, making 85 per cent. Some of the remainder are handled by the State, and a number of others are in mental institutions. As regards the latter, the Labour government decided that they should not be allowed to receive the age pension. That provision is still in existence; it has never been changed. I do not know whether it is right or not, but Labour put it into the legislation. Labour therefore should not cry very much about the fact that everybody in the country is not able to benefit directly from the proposed provision.

What is now being done by the Minister for Health is possible only because we have gained wide experience over the last few years. I think that is a very wonderful thing. Let us consider the case, not of poor pensioners, but of the better-off pensioners to whom the honorable member for Grayndler referred. Those are married couples who, jointly, may have incomes of up to £7 a week in addition to their pensions. That is an additional income of £350 a year. An investment of £7,000 at 5 per cent, would1 be necessary to return that income. If they pay ls. a week into an insurance fund, they will get all these benefits, as well as the benefits they get from other insurances. Therefore, I think that the honorable member for Grayndler shed crocodile tears in relation to this matter. Over 700,000 pensioners and their wives are being provided with free medical treatment. They are not being dealt with similarly in any other part of the world on a fee-for-service basis. The pensioner knows that the Government is paying for the service and that he can, as he does, demand from doctors full treatment. It is not such treatment as pensioners got in the old days, when it was largely a matter of charity, and they used to go furtively into the surgery. Now they take their places in the same way as does anybody else. The doctor knows that he will be paid because of the agreement between the Government and the doctors. A similar arrangement is made with regard to medicine. The pensioner does not have to stand in a queue now. Thousands of pensioners have told me that for the first time they have not felt bemeaned when they have sought medical advice or treatment. That is because of the way they are being treated now.

This legislation had to come. Some of the medical and hospital benefits funds were approached and they agreed to take a risk in relation to members with preexisting ailments, and they have been doing so, as the honorable member for Port Adelaide (Mr. Thompson) knows. The honorable member applauded this proposal. The friendly societies agreed to insure those with pre-existing ailments. Other organizations said they were willing to insure a person even though he had a pre-existing or chronic ailment, but they would not pay benefits for the treatment of those ailments for two years. They would, however, pay benefits in respect of other ailments. Under this legislation people who insure will receive benefits for any ailment after a period of two months has elapsed. The Government has set up a system of special accounts, and if the contributions of a member are paid to the special account, the Government will guarantee payment for his treatment.

This service will be cheaply administered because it will be handled by experts. Nobody is more capable of dealing with this scheme than are the friendly societies and approved organizations. They have had experience of managing huge undertakings which run into millions of pounds. Every year more than £20,000,000 is paid out in hospital and medical benefits, and overhead expenses amount to no more than 15 per cent. They have built up reserves against the time when bad epidemics may sweep through the country. If that happens, there will be no danger of these funds not being able to meet their commitments.

The bill will still further strengthen these bodies. The Government says that it will take the risk for them in the future. All that the Government asks in return is that the scheme should be administered by some body that knows something about the problem. Why should we need a department to handle this scheme?

One reason why my 1928 proposal failed was that I was trying to get the States and other organizations to join forces with me in order to reduce administration costs so that they could better be borne by the people. "The Economist", of 5th July, 1958, points out that because the national health scheme in England was administered in an extravagant way, certain shortages appeared. Where did those shortages appear? " The Economist " states -

The first place where shortages were seen was in general practice, in the excessively large numbers of patients on some doctors' lists. But the shortages were felt more severely still by two sections of the population that, before 1948-

That is, when the Labour government brought in the national insurance scheme in Britain - had received priority treatment.

Before the advent of the national insurance scheme in Britain, the two classes of persons that received priority treatment were the aged and chronically sick, and school children in need of dental care.

On 29th June the London " Sunday Observer " contained an article from its medical correspondent, stating that the national health scheme had improved hospital treatment, but that general practitioners were being forced out of business, and within ten years the general practitioner would cease to exist. It does not matter how good our specialists may be, if they do not get their patients early from the general practitioners it may mean that the patients suffer months of sickness instead of weeks, or less. In some cases by the time the patient reaches the specialist his condition may be inoperable. I have had brought under my notice dreadful cases in families which pay their doctors only lis. or 12s. a year for looking after the whole family. In such circumstances it is almost impossible for the doctor to give that personal service to his patients that is necessary to make a health scheme work properly.

I am 'glad that the Minister has adopted the course that he has chosen with regard to the administration of this scheme, and particularly for his decision to maintain the fee-for-service system, which can be handled only by organizations such as have been developed in Australia. Our health organization challenges comparison with any voluntary health insurance organization in the world, and I have seen most of them. It compares more than favorably with other government insurance organizations. Under this scheme, the Government is saving a substantial amount in administration expenses, which can be devoted towards helping other very necessary projects. The number of people insured will increase. Elderly people will be able to insure for less than it would otherwise cost. Aged, infirm and chronically sick people will receive greater benefits from the scheme because of the removal of the means test. The real basis for benefit is sickness and need. The opposition should realize that this national health scheme is a huge voluntary insurance scheme that has no means test except in connexion with special services rendered by members of the British Medical Association. The association says that it is not justified in rendering special service to persons in receipt of more than the basic wage. It wants to know where the line will be drawn. The association fears that ultimately the family doctor will go out of existence, as has happened in other countries. The family doctor, as the Minister will agree - he has been one, as I have - is the foundation of all good medical treatment.

I praise the funds for having a flat rate of contribution, a practice adopted by the friendly societies. One of the great advantages of getting the friendly societies into this undertaking in the beginning was that they brought with them more than 100 years of experience in this field. The friendly societies said that they believed they could handle this scheme for everybody. They fixed a certain rate for a single man, and a certain rate for a married man irrespective of the size of his family. Now these voluntary organizations, with the experience brought to them by the friendly societies, are able to keep the scheme going. Unfortunately, an effort has been made by the Victorian Government to alter the set-up. I implore honorable members, whatever their political faith, to stick to the flat-rate principle. The older a man gets the more likely is he to succumb to illness. This bill makes the personal family medical care, by the fee-for-service-system, the essential part of the scheme from birth to death. We have applied it to the pensioner medical service, and that is one of the reasons why there had to be the discrimination that has been talked about, the bulk of the fees are paid by the combined contributions of the voluntary organizations, and they maintain a very close watch.

The other matters raised have been answered by actual facts of history and do not have to be dealt with in words any more. Because of the basis of personal service by the medical profession a close partnership has been established between the insurance organizations, the medical and pharmaceutical professions, the hospital systems and the people themselves. It is worth while remembering that when we came into existence as a government, the hospital system throughout Australia was practically bankrupt. The whole yearly expenditure of the previous government was between £6,000,000 and £7,000,000. But last year, close on £50,000,000 was found by the Federal Government. In fact, during the eight years this Government has been in office, something of the order of £270,000,000 or £280,000,000 has been injected into the national health system in Australia. Any one who visits almost any large centre of population anywhere in Australia will see new hospitals going up.

The methods by which tuberculosis cases have been handled in hospitals equipped especially for their treatment have been so successful that many of these hospitals are able to take patients for general treatment. This is an indication of the extraordinary way in which the tuberculosis plague has been cleared up. Whereas in 1949 the death rate from tuberculosis was something like 26 per 100,000, to-day it is only six per 100,000. The number of patients entering hospital for treatment for tuberculosis to-day is very much lower than it was in 1949 as a result of the expert methods of diagnosis now used.

But as well as that, the Commonwealth Government has made available to the people of Australia £66,000,000 for free pharmaceutical benefits, including expensive antibiotic drugs. There is no question of the existence of this gift to the people. Actually, it is more a restoration to the taxpayers of their money than a gift. By this expenditure it has become possible to shorten from fourteen days to ten days the length of time people stay in hospital. This reduction of four days makes possible a saving of millions of pounds. If 1,200,000 people enter hospital each year and their hospital costs are £4 a day, the shortening of the stay in hospital means a saving of between £16,000,000 and £20,000,000 a year.

In addition to that, because many people can go to see a doctor without cost and no longer have to worry, as they used to do, about what the doctor's fees will be, they now receive an early diagnosis and treatment and return to work earlier than formerly was the case. This means that the whole work force of the community is in better health. This sum of between £250,000,000 and £270,000,000, which has been spent in the last eight years on health, has been repaid several times because of the reduction in lost time through sickness by workers. The reduction in the time patients stay in hospital makes beds available more quickly and is equivalent to increasing the size of the hospitals. This has enabled more patients to be treated and is almost the same as building new hospitals to accommodate them.

The Commonwealth Government has contributed, in all, £11,000,000 for the provision of free milk each school day to 1,200,000 school children over the last seven years. During that time the Government has paid out more than £45,000,000 for attacks on tuberculosis. Another £10,000,000 has been handed to the States for the purpose of trying to increase accommodation which the State health authorities believe is a basic requirement to improve treatment for the mentally sick. We regard these patients as being sick.

But that is only a part of what the Government has been doing. Six or seven years ago, the Government sent Dr. Bazeley to the United States of America to study poliomyelitis. He returned to Australia and put his knowledge into practice, with the result that Australia was the second country able to embark on a nation-wide campaign to immunize children and adults against poliomyelitis. Honorable members are well aware how successfully this has worked out in Australia. The incidence of poliomyelitis attacks has been considerably reduced.

Furthermore, the Government has spent a great deal on medical research. The government of which I was a member established the National Health and Medical Research Council in 1935, which has been responsible for a great deal of research. The Government has assisted individual research men also to go all over the world, to gather knowledge and to bring it back to Australia. Honorable members are aware of the work of men like Sir Macfarlane Burnet and the contribution he has made to medical science and treatment in this country. These are some of the things which the Government set out to achieve and for which it deserves the highest commendation.

The Minister should be complimented very highly for the skill and wisdom which he has displayed in his administration of the national health scheme. Great credit is due also to voluntary organizations for the extraordinary work they have done during the eight years in assisting the Government to minister in many directions to the health needs of the people.

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