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Tuesday, 23 September 1958

Mr TURNER (Bradfield) .- I do not think it is necessary for me to occupy very much of the time of the House in replying to the honorable member for Bonython (Mr. Makin). I say that not in an unkindly fashion, but because I realize that he and those who have preceded him on the other side of the House must feel a good deal of chagrin when they look upon the accomplished fact that this Government has been able to devise a viable scheme of health insurance after they themselves failed signally to put into effect a halfbaked nationalized health service. One can understand their discomposure. They are in two minds, as far as I can follow them. They do not know whether to claim the credit for fathering this scheme, or whether to have no part of it, but merely to state that they framed and will again frame a far better scheme.

Mr Duthie - Is the honorable member making our election policy speech?

Mr TURNER - I may be outlining the Opposition's election policy, but I very much doubt whether it will have the opportunity to put it into effect. The right honorable member for Cowper (Sir Earle Page) well and truly laid the foundations of the present scheme, and the present Minister for Health (Dr. Donald Cameron) has built a very useful piece of superstructure on it by means of this bill. I believe he is to be congratulated on it. There certainly was a gap in the scheme as it existed previously. Under any insurance scheme it was difficult to provide for those persons who would prove exceedingly costly and who could make no very serious contribution towards the funds of the insurance organization. I refer to those who are covered by the present measure, those over 65 years of age and persons with pre-existing or chronic illnesses. The scheme devised by the Minister fills that gap. One has only to look at the detailed provisions of the bill to understand the work that the Minister has put into it. He has used a fairly simple principle in setting up special accounts in respect of these classes of persons. He has carried that principle into effect in detail and with great care. He has shown great industry in the preparation of the measure.

Now, Sir, I wish to refer to what I believe is another gap in the scheme, and one that affects the constituents whom I have the honour to represent in this Parliament. I refer to middle-class people in the middle income brackets. I do not want the Minister to think that what I am about to propose will involve the expenditure of additional large sums of money. This is always possible with certain proposals that are made, and our friends opposite show great facility in devising ways of spending more public money. However, I do not want to suggest the filling of this and other gaps in legislation by means that will involve the expenditure of vast sums of money.

Let me give my own experience, Sir, simply because I think it is typical of. the experience of my constituents. A few years ago, having insured under the medical benefits scheme at its outset, I went to the pains of working out what proportion of my medical bills was reimbursed by way of benefits. I found that I had received back from the fund with which I was insured about 35 per cent, of the total amount of the medical accounts that I had paid - in respect of my family, principally. I have come to the conclusion that the workers, on the other hand - I use the word " workers " in its technical sense, because I do not know of any leisured class in this community - receive back from the insurance organizations probably about 90 per cent, of what they pay in medical fees. I think my own situation is fairly typical, and I think the matter could be remedied.

I have before me a pamphlet distributed by the Medical Benefits Fund of Australia Limited. I see that, under table C, which is the most beneficial for the insurer, the highest benefit paid in respect of operations appears to be a total of £30 for both Commonwealth and fund benefits. It is true that the list of operations set out in this pamphlet is not exhaustive. Examples are given and, without going into detail, I simply point out that the highest benefit paid totals £30. The real problem of middle-class people is not the payment of a fee of, say, £30, and certainly not lesser fees or the odd guineas that they may have to pay for the services of general practitioners. The thing that they really want to insure against is a sudden slug of 100, 150 or 200 guineas. It is not very helpful to a person who has to have, say, a difficult cancer operation, for which the fee may be 100 guineas, to receive a benefit of £30. For this reason I have not for some years been insured with this fund, because I do not think it is worth while.

Another difficulty concerns the making of claims. A general practitioner may send in his bill for the odd guineas for the treatment of some member of one's family who had influenza or a sore toe, for example, perhaps two or three months after the event. At that stage, one cannot recall what it was all about, and one's wife also has forgotten. In these circumstances, the filling in of forms in order to obtain a benefit in respect of the general practitioner's fee presents problems. All this, Sir, is a great nuisance, and it makes the whole thing seem not worth while, because that is not what one really wants to insure against. What one wants to insure against, let me repeat, is a sudden slug of, say, 100 guineas. After all, when one insures one's house, one's concern is to insure not so much against the burning down of the laundry as against the burning down of the entire house.

I know that the Minister for Health gives great attention to the affairs of the Department of Health and is open to reasonable suggestions, and I put it to him that he might well take up with the medical benefit organizations the question of introducing another table of benefits making use of a device used in other forms of insurance - provision for a franchise. For example, an insurance company may say to the insurer of a motor cycle, if he wishes to pay a lower premium, " As to the first £10 worth of damage, you must bear that on your own shoulders. We shall not be responsible for it ". If the owner of the motor cycle is in a really big accident, and the machine is smashed up properly, he gets the insurance for the full amount of the damage, with the exception of the first £10. The same thing can be done in respect of the insurance of a motor car. An insurer may choose to pay a lesser premium and allow the insurance company to hold itself free of responsibility for the first £20 worth, or whatever it may be, of damage. I put it to the Minister, as a constructive suggestion, Sir, that he should take up with the medical insurance organizations this problem of insurance against the bigger fees for operations under an arrangement whereby the insurer would pay a premium - which is all his contribution is - similar to the premium now required under table C, and absolve the insurance organization of responsibility for the payment of a benefit in respect of small fees up to whatever limit may be considered necessary.

I know that this proposal would involve some alteration also of the Commonwealth benefit. The pamphlet that I have mentioned indicates that, for a thyroidectomy for example, the Commonwealth benefit is £11 5s. and the fund benefit £18 15s., making a total of £30. If, for that operation, or another, for which the medical practitioner's fee is, say 60 guineas, the fund paid a combined benefit of 50 guineas, clearly, the Commonwealth benefit would have to be somewhat greater than the present Commonwealth benefit. But that would not cost the Treasury any more, because, the Commonwealth would not be responsible for benefit in respect of all the little bills for general practitioner service under a table of the type that I have suggested to the Minister as being desirable. 1 have nothing more to add to that, Sir. I believe that such a table would cover the needs of a large number of middle-class people who are not catered for under the existing arrangements. I have not made enough inquiries among a large number of people - I have not had time to do so - to know whether the experience that I have had is common. That experience indicates that it is of no advantage to me to insure under the present scheme, and I assume that that is the case with many other people.

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