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Wednesday, 27 September 1972
Page: 2018

Mr HAYDEN (Oxley) - Last night the Federal President of the Australian Medical Association, Dr J. (Gavin Johnson, appeared on the Australian Broadcasting Commission programme'This Day Tonight' in his presidential capacity. He appeared in his official capacity, he spoke with the authority of his distinguished office and he spoke for members of the AMA. He performed 2 important services for the community. Firstly, he quickly rejected crude approaches from the Western Australian branch of the Libera! Party importuning doctors to debase their surgeries, cheapen their professional status and abuse their code of ethics by exploiting the doctor-patient relationship to disseminate Liberal Party propaganda among patients. He saw his rejection of the Liberals as a major repudiation of their despicable tactics.

In the meantime, the doleful Doctor of Philosophy and former Minister for Health without emeritus, Dr Forbes, applauded this singularly inept and offensive soliciting of doctors. In the Melbourne 'Sun' he is quoted as saying that the Western Australian branch of the Liberal Party, in seeking to have doctors pervert their ethics and exploit patient trust, had 'performed a major service' in sending the letter. What an appalling lack of taste and judgment as to the proprieties of medical practice and the doctor's special position of trust with his patient! Dr Johnson said:

It is wrong of anybody to ask doctors to use their professional privileges for political reasons.

Clearly, the AMA and the medical profession have been gravely affronted by the Liberal Party action, and the affront has been doubly compounded by the brazen endorsement of that action expressed by the former Minister for Health, Dr Forbes.

Of more importance is the second service Dr Johnson performed when he literally endorsed Labor Party policy on an important principle. He agreed that, as long as the development of any salaried medical service was based on voluntary engagement in that service by medicos, fears of such a service would not be justified. That is, he endorsed Labor policy which is substantially based on private practice, fee-for-service, preservation of the doctor-patient relationship as now but which will provide opportunity for those doctors wishing to enter a salaried service as a matter of free choice to do so. To oppose this principle is to oppose the right of choice and is to stand on the side of restriction and discrimination. Dr Johnson obviously realised this, and that is one reason why he endorsed Labor policy. The Courier Mail* today reporting on the interview led its article 'AMA In Swing Towards Labor Health Scheme' and commented in the body of the article as follows:

Dr Johnson'sstatement is seen as a significant softening of the AMA attitude to the Labor Party's health scheme.

There are other obvious reasons why he endorsed Labor policy from his position as Federal President of the AMA.

One suspects that the AMA is acutely embarrassed at the way in which our nettle grasping Prime Minister (Mr McMahon) grasps at AMA statements identifying them as Liberal style propaganda, with the result that there is a widespread public tendency for the AMA to be seen as a Liberal Party organ. This is a positive incentive to the AMA to deliver its rebuff to the Liberals. Most importantly would be the fact r.hat calm, reflective assessment has led the AMA to appreciate correctly that Labor's programme has so much that is good, beneficial and needed. The AMA would be only too well aware that the Liberals' scheme suffers from so much that is bad. lt is notorious that, after some 18 years of operation, the Liberals' scheme is st Hi ridden with anomalies. For example, a patient requiring hospital surgery treatment but not required to undergo hospitalisation attracts no benefit for the cost of surgery. An infant under 10 days o'd where the mother is also hospitalised attracts no benefits. Where both mother and infant require expensive in-patient treatment this can be a crippling cost burden for the family.

The Nimmo report of less than 3 years ago was a savage indictment of the Government's health insurance programme. No public enterprise would have survived the strident criticism of the 'free enterprise' Liberals if a thorough, impartial inquiry of the nature of the Nimmo Committee reported so trenchantly on it. Furthermore, at this late stage, key recommendations of the Nimmo report remain unattended to. The Liberals' promise to establish a national health insurance commission - a key recommendation of the report - has been buried. Means tests persist for public ward treatment in all States except Queensland. Out-patient services have not been integrated into health insurance. The $2 a bed day subsidy for Queensland's free hospitals was conceded unwillingly only after the Labor Party successfully initiated action in the House of Representatives and in the Senate to force this payment from the Government. People of religious conviction objecting to health insurance are still penalised by exclusion from Commonwealth medical and hospital subsidies of S2 a day in the latter case.

The participating doctor scheme was considered by Prime Minister Gorton but this and other proposals for reform of the scheme were single handedly defrayed by the present Prime Minister. Honorary and concessional services continue. In an effort to minimise wasteful practices the report recommended also that only one open fund be allowed to establish and maintain facilities in any one region. This key proposal has conveniently been forgotten. There are several other proposals too which have been neglected in spite of a clear need for major overhaul of the Liberals' faltering system of health insurance. One that comes immediately to mind opens up further considerations of great importance. Reserves should be limited to 3 months contribution income, according to the Nimmo report. The latest figures show an accumulation of $14Sm in reserves held in investments. If the 3 months figure were applied, reserves would be reduced by more than $90m. In fact, instead of being reduced, they jumped by $20m last year.

It is totally dishonest of the Liberals to be party to this. Contributors provide their payments to the schemes for the provision of health services yet here, unknown to them, millions of dollars of their money are being diverted for other purposes. Some of it is being misused. For example, millions of dollars are loaned to private hospitals at below market rates of interest. Contributors are being compelled to provide excessive contributions so that private enterprise can have its profits subsidised. I refer lo the. misapplication of contributors' money to fund political party campaigns. The Hospitals Contribution Fund of Australia recently produced a booklet aimed at bolstering the Liberals' campaign on health insurance. Costly overseas junkets by executive officers of funds - often accompanied by their wives or friends - are all paid for by contributors. Presently there are 20 such officials living it up at an international conference on health insurance. They stay at the best international hotels while the poor old contributor stays at home and provides the cash to pay for this lavishness. Anyway, why should 20 officials be riding this gravy train?

There should be a full and open public inquiry into the way in which contributors' money is being handled by these funds. The Government should be nailed on why it persists as accomplice to this thoroughly immoral business of funds milching contributors with excessive contribution rates so that the sort of misuse of the money I have already outlined will be ended. The community could well do with some explanation for why there has been a 194 per cent jump in the Commonwealth's subsidy for medical benefits since 1969. The Commonwealth's subsidy has gone from $49.6m in 1969 to $148.6m this year. This skyrocketing has occurred during the period of the common fee and all of its abuse by doctors. That the common fee has been a bonanza for the medical profession is undeniable. In the last 5 years doctors' gross incomes jumped 80 per cent in a period when the average weekly earnings moved ahead by only 47.8 per cent and the consumer price index by 18.3 per cent. The doctors are virtually half way to being fully paid public servants. Commonwealth support programmes through subsidies to medical benefits and financing of the pensioner medical service, repatriation and local medical officer services contribute half of doctors' incomes. That is, every second dollar a doctor earns he receives directly from the Government which, of course, collects this money from the taxpayers.

Add to this the fact that about 90 per cent of the cost of training a doctor is met by taxpayers and a fairly clear picture emerges of a professional who is heavily indebted to the public and to governments, and that is a continuing and growing indebtedness. For example, 5 years ago every third dollar of a doctor's income came from the Commonwealth; today it is every second dollar. The cost of health insurance, pensioner medical, hospital and repatriation local medical officer services will probably exceed $650m for the year just completed and that is an enormous amount of money for the scheme to stumble and bumble its way along on. Contributions will have cost in the vicinity of $350m, that is a 15 per cent increase in tax paid by contributors.

The Labor Party's programme provides for universal contributions and universal cover, for contributions to be geared to one's ability to pay. The scheme is equitable. There would be a Commonwealth bed subsidy of more than $13 a day, as the figures now stand, covering all hospital beds, public intermediate and private. The scheme would be based on private practice fee for service. Pensioners and repatriation local medical officer patients would be paid at the full rate.

The DEPUTY CHAIRMAN (Mr Scholes) - Order! The honourable member's time has expired.

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