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Tuesday, 23 September 1958

Mr THOMPSON (Port Adelaide) . - Mr. Speaker, I am pleased to have an opportunity to discuss this measure. I for one have heard the opinions of many people about the advantages of a medical benefits scheme. First of all, I should like to say that I entirely disagree with the suggestion made by the honorable member for Bradfield (Mr. Turner), who preceded me, that benefits should not be payable in respect of the first £10, or some other amount, of the fee for a service. The real value of this scheme, Mr. Speaker, is not to the person who can afford to pay 100 guineas for an operation. Its real value is to the person who cannot pay one or two guineas without great hardship, and the easing of the burden for those people has been one of the greatest benefits derived from the medical benefits scheme.

The right honorable member for Cowper (Sir Earle Page), who was formerly Minister for Health, spoke this afternoon about what the friendly societies have done. He mentioned the flat rate of payment for each society member. I happen to have been closely associated with friendly society work all my life, and I know that, before the upward trend in costs and wages that we have experienced over the last twenty years or so, we in South Australia had an agreement with the British Medical Association on this matter. On a number of occasions, I discussed it with representatives of that body when an alteration of the arrangement was desired. Under that agreement, for half a crown a quarter for a single man, and 6s. 3d. a quarter for a married man, full services were provided by the medical profession. This did not include the cost of medicines. Later, the British Medical Association decided that it was not prepared to continue under the flat-rate arrangement, and the friendly societies battled with the association for a long time in an effort to retain the flat rate.

Ultimately, it was decided to terminate the agreement, and an arrangement for a fee for each visit, similar to that in respect of pensioners under the Pensioner Medical Service, was entered into. The various friendly societies then introduced a fund comparable with the insurance fund that we have at present. A member of a friendly society had to pay into the medical fund a given sum each week or each quarter, and he received from the fund a refund on much the same scale as provided in this scheme. So, although the former Minister for Health introduced the scheme, its foundations were really laid by the friendly society movement. Of course, membership of the friendly societies' fund was restricted. A person could not join such a fund if he was more than 40 or 45 years of age; the age varied a little with the different societies. A person also had to be a member of a friendly society before he could join the fund. Very strict tests were applied to people who wished to obtain the benefits of these funds.

When this national health scheme was introduced, I saw that a difficulty would arise in approved societies in being able to fix contributions at a sum that would meet commitments. I must say that the Minister has dealt fully with those phases of the scheme. The payments to any insurance scheme, whether life insurance or other insurance, are worked out by the Public Actuary on the basis that a given sum must be contributed before benefits can be paid. Friendly societies have not been able to increase the sick or funeral benefits until the actuary was satisfied that the contributions would be sufficient to meet the commitments. In my own State, in one instance when we tried to increase the benefits, we found that we had to increase the contributions slightly. The honorable member for Bonython (Mr. Makin) has given us the overall figure of the amount that may be in hand. I am not speaking now of mutual societies formed to provide medical benefits only, but of friendly societies that operate not to make profits but merely to obtain sufficient to meet expenses. Even in those cases, contributions had to be increased to meet the cost of increased benefits. The friendly societies were able to help some chronically ill people to a certain extent, but one thing was left, and I am very pleased to see that this bill attempts to meet this point. I refer to the limit on the number of visits to a doctor for which a chronically ill person could receive payment from a fund. The special fund which will be established under this bill and which will be guaranteed by the Government will help those cases, as well as elderly persons.

Members of friendly societies who are over 65 years of age have asked me what they should do. If they depend solely on the pension, I have advised them to cease paying into insurance funds and to rely on the Pensioner Medical Service. I have told them that under the Pensioner Medical Service they receive free medical attention and free medicine, but if they were to pay into an insurance fund they would receive only the contribution of the society and the Government towards the cost of the medical practitioner's visit, but would not get any payment for medicine. This Government has not provided for free medicine; therefore, aged persons will not join an insurance fund. I say to the Minister that not many persons over 65 years of age will join the special fund provided by this bill, because those who are entitled to do so would prefer to receive benefits from the Pensioner Medical Service. However, the special fund will be of benefit to those who are not entitled to the Pensioner Medical Service. 1 wish to join issue for the moment with the right honorable member for Cowper. When speaking to-day he said that, from the British Medical Association's point of view, a married couple receiving £15 15s. a week should have no need of the Pensioner Medical Service. He has taken the greatest amount that a pensioner couple could receive, but I shall take the lowest amount. A single person receiving a pension of £4 7s. 6d. and other income of £2 2s. a week, making a total of £6 9s. 6d., out of which he pays rent, would not be entitled to the Pensioner Medical Service. I am sorry that this means test has not been eased. I feel that the number of people with income of more than £2 a week who are receiving a pension would not be so great that it would adversely affect the Pensioner Medical Service. When this service was first introduced, any person receiving a pension, even if it was only 5s. a week, was entitled to the benefits of the scheme.

I admit that the Pensioner Medical Service has filled a need for many pensioners. However, there seems to be a conflict of opinion in relation to pensioners receiving the benefits of this service. A pensioner suffering from, say, a heart condition or some other serious condition, is told by a doctor that a drug is available which would relieve his condition. When he goes to the chemist to have the prescription filled, he finds that the doctor has prescribed a proprietary line which is not on the list of free drugs and which would cost, say, 25s. or 30s. The pensioner may not be able to afford it, and he does not know what to do.

I have often had people in this position come to me. All I can do is to give them the answer that has been given to me by the department. If I ask the Minister about the drug that the doctor has said a person must have - I give all credit to the Minister; I do not blame him - he will say that the expert committee which considers whether a drug should be included in the free list has determined that something else will fill the bill and this drug is not necessary. People are forced to buy drugs that they cannot afford simply because their doctors say that they must have these drugs and not other drugs which are on the free list. Such a person may say to his doctor - a member of the British Medical Association - that he has approached his member of Parliament on the matter, that the member has taken up the matter and has been told that the authorities say that there is a drug on the free list that can be used in the place of the drug advised by the doctor. The doctor may then say to the patient, " That drug will not do. You must keep on with the other". The patient is then forced to pay for the drug that is not on the list.

Recently, there was brought before me the case of a person who, on medical advice, was using a drug not on the list, for which he had to pay. Finding himself unable to continue paying for the supply of the drug, he discontinued its use and began to use the drug on the free list which was said to be its equivalent. His health immediately deteriorated. That was his contention to me.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - But the equivalent drug must be adequate to meet the purpose.

Mr THOMPSON - There will always be a difference of opinion. That is one of the difficulties in relation to the pensioner medical service. The real bone of contention with pensioners is not that they are unable to get free of charge the drugs that they themselves think they should have, but that they are unable to get free the drugs that their doctors say they must have. I do not know whether the problem can be surmounted. I, for one, do not think that we should give doctors complete freedom to prescribe any drug that they like on the understanding that the Commonwealth will pay for it, when the use of that drug may not really be necessary. I admit that difficulty. As the Minister has told honorable members in answer to questions, it is not for him to decide whether or not a drug should be placed on the free list. The responsibility for that decision resides in an expert committee. That, however, does not alter the fact that on the one hand we have doctors telling pensioners that they must have certain drugs, and on the other hand we have the department telling pensioners that they may not have these drugs unless they pay for them. The committee is responsible for such decisions, and I do not blame the Minister for them. But I say that this is a difficulty that must be overcome. I do not know how it can be overcome, but until it is overcome we will have the problem with us. I would say to the British Medical Association-

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - It has nothing to do with the British Medical Association.

Mr THOMPSON - Nothing to do with it! Well, if it has nothing to do with the British Medical Association I cannot understand it, because it is a case of doctors prescribing for pensioners drugs which are not on the free list. If they do so while there are drugs on the list which would do as well, and for which the pensioner would not have to pay, there is something wrong there. As it is, the pensioner is between the devil and the deep blue sea. His doctor says he must have a certain drug which is not on the free list, and the department says that if he has that drug he must pay for it himself. In many instances pensioners are paying for drugs that they cannot afford. As I said before, there should be some help for people who are unable to afford to help themselves. We are putting on them a burden which they are not able to bear.

I do not want to say to the Government, to members of the public or to anybody that I think that the pensioner medical scheme meets all requirements. The Labour party has its policy in regard to a pensioner medical service. We have put it in the past, and we will put it again when the time comes to do so. But at the moment I am not dealing with what the Labour party intends to submit as its policy in this respect. I am dealing with the way in which the present scheme fails to meet the position.

Sitting suspended from 6 to 8 p.m.

Mr THOMPSON - I wish to direct my attention now to the hospital fund benefit that is provided in the bill. I remind honorable members that the provisions for medical fund and hospital fund benefits are kept separate in the bill. The Minister for Health referred to two special funds for those over 65 years and for chronic cases and I presume that when he spoke of a special fund, he actually referred to two funds.


Mr THOMPSON - Well, I do not know how that arrangement will work out because there are two separate funds and members of the societies can pay either to a hospital fund or a medical fund.

Dr DONALD CAMERON (OXLEY, QUEENSLAND) - I am sorry. I misunderstood the honorable member. The societies can work out their arrangements as they wish.

Mr THOMPSON - There will be two funds, then. In connexion with the hospital fund, one of the fundamental differences of opinion between the Australian Labour party and the Government relates to the differentiation in the provisions approved by the Government. Under the original hospital legislation which was introduced by the Chifley Labour Government, the government paid 6s. a day towards everybody's hospital bill so long as the patient was in an approved hospital. The people did not have to contribute to a hospital fund. That daily allowance was later raised to 8s. a day. Then this Government introduced a scheme under which a person who insured himself for hospital treatment up to £2 2s. a week would get an extra 4s. a day. That meant that two sections of the people obtained hospital benefits. There were those who could afford or were prepared to pay into a hospital fund to get 12s. a day and those who did not contribute to a hospital fund and who received 8s. a day. Several years ago, the Government altered the scheme again and provided that if a person was contributing for £6 6s. a week he would get an extra amount.

The Opposition believes that everybody should be treated alike. There should not be any differentiation between one section of the community and another. I have here the scale of charges and benefits formulated by the National Health Services Association of South Australia which includes most of the big friendly societies. This scale shows the old rates and the present rates of contributions and benefits. They refer to a family member. If a contributor paid 6s. 6d. a quarter, the fund benefit was £2 2s. a week and the contributor received an extra 4s. a day from the government. A contributor who paid 13s. a quarter or ls. a week under the old rate received £4 4s. from the fund and £4 4s. Commonwealth benefit, a total of £8 8s. Those contributors get nothing additional now but if they pay, instead of 13s. a quarter or ls. a week, an amount of ls. 6d. a week, the fund benefit is £6 6s. and the government benefit jumps from £4 4s. to £7 a week. Therefore, a family man who is able to pay the higher amount by way of insurance gets the greater benefit from the Government by way of subsidy.

I should like to say here, in reply to the honorable member for Bradfield (Mr. Turner), that if a family member, instead of paying 13s. a quarter for a benefit of £4 4s., pays £2 12s. a quarter, he gets £16 16s.. from the fund and £7 from the Commonwealth, or a total of £23 16s. a week. On this side of the House, we disagree entirely with that great differentiation. If the Government is going to help anybody with hospital payments, everybody should have equal treatment. There should not be what is, in effect, a means test so that the higher benefit goes to the person who contributes the most.

Mr Turner - I was talking about medical benefits and not hospital benefits.

Mr THOMPSON - The honorable member said he represented the middle class. Personally, I represent all classes but I am interested mostly in those in the lower income groups who need most assistance. I say to the honorable member that the people he says he represents would not have much difficulty in arranging to insure themselves against sickness to get the greater benefit. I know that they would not get the subsidy that the honorable member mentioned but, again, that is where the Opposition differs from those on the Go.vernment side.

The honorable member for Bradfield said that the Labour government did not attempt to do anything. When Senator McKenna was Minister for Health, the Labour government introduced a proposal for the government to pay half the medical fees. That was comparable with this arrangement because a contributor pays into a fund to get more than half from the fund, so he receives less than half from the Government. The difficulty the Labour government met was this: We believed that when an arrangement was made for the Government to pay half the fees, there would have to be a scale of charges. Honorable members opposite were opposed to that scale of charges, but the Health Act provides all sorts of rates of payment for operations up to £11 5s. by the Government and £11 5s. by the fund. The honorable member for Bradfield quoted a payment of £30 for an operation. It means that the Government would pay £11 5s. and the other £18 15s. would be paid by the approved society.

Mr Turner - The honorable member completely misunderstood me.

Mr THOMPSON - Well, the honorable member said that £30 was the maximum, and the most you can get from the Government is £11 5s., so the remaining £18 15s. must come from the fund. I assume that the approved societies can increase the amount of contribution to provide for higher benefits. There is nothing to stop them from doing so and raising the present scale, but I do not want to labour that point. I feel most strongly that all persons are not being treated alike. Supporters of the Government might claim that they will be treated alike if they join a fund. But some people are not able to become contributors to funds.

I do appreciate very much the introduction of a guarantee to those people with chronic complaints. A great benefit will result, not so much to the person who is over 65 years of age as to the younger person, who is now limited as regards the number of visits in respect of which he may recover from the society. That number will be unlimited. That alteration will be a great help to the man who suffers continually and is involved in constant ex penditure. I do not know whether the societies or the Government have worked out the costs necessary to give effect to these proposals, but it is a step in the right direction to be able to say to the people, " No matter what your health may be, whether you are chronically ill, or whether you are suffering from a complaint you had before you were insured, there is to be no limit. You are to get those refunds so long as you are involved in that expenditure." This bill goes a certain part of the distance towards achieving what we on this side of the House have advocated - the inclusion of everybody in the scheme, whether they be sick or healthy, young or old. The young and the healthy will not be penalized, because the increased cost, if any, is to be met by the Government.

The Government is doing something which we have long advocated and which should be done. I am not sure of the extent of the guarantee for hospital treatment after the society's contribution is exhausted. It seems to me that the Government will guarantee the standard payment of 36s. a day. If a person is entitled, in the terms of his insurance, to receive from a society £16 16s. a week, and his illness continues beyond the maximum time prescribed for payments, I take it that the Government will guarantee only the standard rate of 36s. a day, and not payment at the higher rate.

I do not desire to keep the House any longer. I ask the Minister to consider the matters that I put forward on behalf of pensioners before the suspension for dinner, and to examine whether it is not possible, perhaps working in conjunction with the British Medical Association, to get doctors to prescribe, where possible, drugs that are available to pensioners without charge. I explained earlier that if drugs prescribed are not on the relevant list, the pensioner cannot get them free.

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