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Wednesday, 27 September 1972
Page: 2022

Mr GILES (Angas) - The nation as a whole can be proud of the work done by the previous Minister for Health, Dr Forbes, on behalf of patients throughout this country. We have a scheme that is second to none in any nation of the world today in that it combines responsible government expenditure on the one hand with efficiency of service on the other. The existing scheme offers to the individual a high standard of medical and hospital service, together with freedom of choice of doctor, hospital and benefits fund, at a moderate residual cost to the patient. For the first time for some time we have an alternative Labor scheme that could well be the legislative skittle of the next election. It is something that is quite easy to knock over and I maintain that it is quite easy for the Australian people to understand all its implications.

Mr Bury - It will be very difficult to pay for.

Mr GILES - That is one of the very factors I was about to mention. The alternative Labor Party compulsory scheme - a giant stride towards fully nationalised medicine - eliminates freedom of choice of benefits fund, provides only for public ward coverage, aims to destroy private nursing homes and private and independent hospitals, and, as the honourable member for Wentworth (Mr Bury) just implied, it will cost the majority of people substantially more for a less effective service. Its main goal is finally to eliminate the private general practitioner and to substitute only salaried doctors. As the previous speaker the honourable member for Prospect (Dr Klugman) said, it would encourage overspending in comparison with any overseas country such as the United Kingdom. If the truth be known, the United Kingdom would dearly love to be able to alter its scheme which has cost so much in committed funds.

This scheme, as I have said, has built in freedoms which 1 maintain are vital to both the individual patient and to the doctor as well as the nation. Contributions to medical and hospital benefit funds are tax deductible. The patient is free to choose between government and private hospitals and nursing homes. His freedom of choice at all levels is a spur to competition of services. This is a factor in which the Opposition does not seem to be interested and does not take into account at all. We on this side of the chamber say that this is a vital guarantee - it has proved to be so - of high standards of service to the community. Where competition is destroyed, medical standards can and probably would fall with a corresponding degree of suffering to the patient. To the pensioner the scheme provides free general practitioner treatment, either in the surgery or at home. In complete contradistinction to the schemes of some other nations, it provides free public hospital treatment, free pharmaceutical benefits, very substantial benefits in nursing homes, home nursing services and the provision of hostels and homes for the aged.

This morning during question time we saw another example of the Opposition's refusal to have a bar of the voluntary benefits organisations. I would remind the House, as the Minister for Immigration (Dr Forbes) who is sitting at the table did this morning, of the comments of the Nimmo Committee in relation to this matter. The Nimmo Committee reported as follows:

The Committee found no support at all for the often expressed view that the number of different organisations adds to the cost of the scheme. We examined the operations of a large number of friendly society and closed funds and found their service to contributors was extremely good and that they had been the most successful organisations in keeping management expenses within proper limits.

Families with incomes not exceeding $51.30 a week are eligible for free health insurance. In other words, under the present scheme a family with an income of $51.50, which is equivalent to $2,678 per annum, but n>i exceeding $54.50-

Dr Gun - They are eligible but they do not have it.

Mr GILES - Of course, that is a quits inane and stupid remark and it is not the sort of remark that the majority of the Australian people are interested in. 1 am referring to the ultimate end of the scheme which looks after those on deprived incomes.

Dr Gun - No, it does not.

Mr GILES - It does, lt looks after those on deprived incomes. If the honourable member has interviewed as many people as I have who do not realise that these facilities exist, he would not make that remark. The third category is those on incomes of $51.50 a week but not exceeding $54.50 who pay one-third of the normal contribution. Families with incomes between $54.50 and $57.50 are asked to pay twothirds of the normal contribution rate for medical benefits coverage and public ward charged. In contradistinction to this, for the first time for a long while we have a scheme that appears to be more firmly spelt out by the Opposition than has been the case at previous elections. What do wc find? We find, as I have conveyed already, that it would be a costly scheme, it could have inferior services and certainly a great destruction of individual choice, whether at the patient level, the hospital level, the nursing home level, or any other level that could apply. The primary source of funds for the scheme appears to be a nev. and compulsory levy, which moves upwards from month to month, on all taxable incomes.The scheme has an escalation clause built into it without any ceiling, as was made quite plain by a recent Labor Party pronouncement on it. Other levies are proposed which I will not mention. As I have mentioned, there are various aspects of limitation of choice within the scheme.

However, one thing that does concern me is that throughout Australia today there are 96 independent hospitals - that is, private, religious and charitable hospitals. Many of these are staffed at very low operating costs and they provide a total of 7,356 beds. To replace those beds, in capital costs alone, would cost at least $220.7m, I am informed, quite apart from subsequent increases in running costs. In addition, if we look at private hospitals we find that they provide 7,030 beds. The 261 nursing homes provide 9,445 beds and, again, these are run by religious and charitable organisations. One day all of these facilities may be replaced, but ! maintain that not one sensible thinking person would consider doing away with them when there is still a shortage of the very facilities that we are discussing.

Because of the limited time I have left, I would like now to deal very briefly with ALP policy in relation to salaried specialists, because this is the key to the antagonism which today is spreading through medical circles throughout the country, and certainly throughout my own State of South Australia. I think it is doing so because we got the first indications from the Dunstan Government in South Australia as to what probably will happen in relation to Labor Party thinking in relation to this matter. In the Adelaide Hospital today the seething mass of medicos are up in arms, particularly the younger ones, because they doubt whether the huge amount of work that they have put into their training over perhaps a 9-year period will be warranted; or whether they will be salaried on their present scale somewhat below the average of the community if it is worked out on an hourly basis for work. So I say that the ALP policy is that all doctors at public hospitals shall be salaried. The Labor Party is opposed to fee for service hospitals, and this means that all medical specialists who depend on access to hospitals and their equipment will be nationalised. Recently in South Australia a top thoracic surgeon, perhaps the best in Australia, was asked to give a high proportion of his private salary to the government-run hospitals for the use of the hospitals' facilities. No account is taken of the fact that for about onetwentieth or one-thirtieth of his time he gets by far the majority of his salary and that the nominal pay as an honorary in these hospitals is not up to the standard one would expect for a world famous surgeon. Already these things are becoming apparent and they are a warning to the rest of the medical people and the patients in this nation that Labor is determined to upset the present scheme, with all the efficiency that is built into it and the proper care and concern given by doctors for the welfare of their patients.

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