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Tuesday, 13 November 1973
Page: 3215

Mr HAYDEN (Oxley) (Minister for Social Security) - I want to reply quickly to the points that have been made in the course of the debate on the estimates for the Department of Social Security, which has gone well over 3 hours, well beyond the time set down for this discussion. Some mention was made of aged persons accommodation. I agree with those honourable members from both sides of the House who expressed the view that there was a need to review the limit to which subsidy is paid by the Australian Government. A working party is currently assessing this matter. I had hoped to have its report by now, but there have been some complexities. I should have it fairly soon. Nonetheless, this will be only an interim report. The inquiry being conducted is an extensive one. After that inquiry is completed a policy decision will be required to be made. I am afraid that the limits will have to stand as they are until then. But honourable members will recollect that in the autumn session this year I indicated in this House that the Government was reviewing the whole concept behind the provision of aged persons accommodation. Without taking up the time of the House, I draw the attention of honourable members to a table, which I seek leave to have incorporated in Hansard.

The DEPUTY CHAIRMAN (Mr Martin) - Is leave granted? There being no objection, leave is granted. (The document read as follows) -


Mr HAYDEN - This table shows the percentage of money going towards the cost of aged persons accommodation and coming from private organisations, which is contributed by residents under the designation of residents' donations. It has increased in recent times. It has increased over the years. In the July-September period this year 87 per cent of the money being provided for those organisations was coming from contributors donations. This leaves me with a very uneasy feeling and justifies the inquiry which the Government is carrying out.

The honourable member for Mackellar (Mr Wentworth), among others, raised the important point of the situation of deserted husbands. All of us who have been associated with this matter are concerned about these people. The honourable member for Chifley (Mr Armitage) raised the point of a man deserted by his wife and left with 5 children, who receives $65 a week and pays $16 a week rent for accommodation for himself and his children, leaving $49 a week for all of them or a little over $7 for each of them. He attracts no benefit from the Department of Social Security. A woman in the same position without any other means besides income who is deserted, would attract a pension benefit of $45.45. Clearly there is an injustice here. I hope that we can do something to fix it. One of the galling things which the honourable member for Mackellar discovered, and which I have discovered, is that resources are limited but demands are unlimited. We do not really know how much it will cost. I have heard estimates varying from $9m or $10m to around $25m. Of course, this raises questions about priorities, for instance in relation to the domiciliary care allowance of $14 a week.

Both the honourable member for Chifley and the honourabile member for Bendigo (Mr Bourchier) criticised this scheme for exempting people under 65 years of age from the benefit. I know full well that there are many people under 65 years of age who have, it seems to me, a very compelling case to attract this benefit, if we apply the same objective medical criteria which are applied to people over 65 years of age. This is something that we have under review. I do not know when we will be able to act on it. I am not going to suggest that it is something which we can act on in the next Budget, for instance. A rough calculation - that is all one can do in this area because there are so many unknowns - reveals that it could cost as much as $35m or even as much as $50m if we were to provide this benefit for the whole community. We just do not know. The Government is being lectured by the Opposition on cutting down Government spending. In that climate the situation is not particularly encouraging and one wonders what support the Government would receive from honourable members opposite.

The honourable member for Mackellar raised the point about young families. I endorse his view. I think in some ways some disproportion has developed.

In this Parliament all parties have consistently expressed great concern about the needs of the aged. That concern was and continues to be justified. Much has been done but it is still not enough. More needs to be But we have not done much about families. I hope that the Australian assistance plan, which the Government is in the process of implementing, will assist greatly here. Its fostering of local initiatives and its support for services as distinct from benefits should help a lot. In fact I assert that it will help a lot. As to benefits, I would like to scrap the Social Services Act and to introduce a simplified statement of entitlement for benefits as a right, and not to categorise people into different sections as the present Act does. But we cannot do this until the inquiry into poverty is completed, because key recommendations will come, for instance, from Professor Henderson and Professor Gates, among others - they are the 2 key people in this area where benefits are concerned - and their recommendations will largely gear the direction we take in the development of future benefit rates.

I come now to the health insurance program. It is clear that there is still a great deal of error and confusion in the interpretation of what we are proposing. I would have thought that the White Paper would have assisted greatly here. The honourable member for Boothby (Mr McLeay) asked me 5 questions and I will answer them. He queried the error of $10m on doctors' fees. He queried another error in relation to individual doctors incomes on average. It is true that there was an error. By the nature of these sorts of calculations, errors do occur. For instance, from time to time the Bureau of Census and Statistics has to revise some of the statistical data that it presents. Sometimes this is because of a lag of information. At other times - not often, but sometimes - it is because of an error. If we are going to make an issue of errors, I would remind honourable members opposite of the $26m error made by the Australian Medical Association in calculating .the total cost of increased medical charges. The AMA understated the total cost by about S26m. I remind honourable members opposite also of the error of the previous Government during the 1 969 election campaign when it said that the common fee plan would cost an additional $l6m after 12 months experience. Early in the next year, 1970, after the election it had to revise its estimate and add another SI 3m to that total. Then when the Budget was brought down we found that the total cost was not about $30m but closer to $40m. So we arc all capable of making errors. If we take a comparative scale of error, this Government's errors do not happen often and they are on a much less significant scale than those of the former Government.

The honourable member referred to the number of people who are not insured. I stand by my assertion that about 87 per cent of the community is insured. I do not accept that because Queensland has free hospitalisation there is a distortion. We are comparing unlikes. People not insured who have to use the public hospital system in Queensland have to wait at outpatients clinics, with all the attendant inconveniences. That is scarcely comparable to the private insurance cover for private medical treatment. Under the Government's scheme everyone will be covered for private medical insurance. They will have the choice of obtaining treatment from a private doctor of their choosing on a fee for service basis. I think those were the main questions asked by the honourable member for Boothby.

He queried something about the estimate of cost of the health scheme made in October 1972. I can only assume that he is talking about a total costing. I remind him that, in the nature of financing, in any national obligation or public undertaking there is a growing cost burden and that the cost estimates for 1972 are not applicable this year or the following year. What is comparable is the total cost of the present private health insurance scheme plus the cost of the repatriation and local medical officer services, pensioner medical services and pensioner hospital services.

A comparative assessment shows that we will cover everyone in the community for the same total cost as the present scheme, which we assert covers only 87 per cent of the total population. Even if we were to allow the 90 per cent or 92 per cent that the honourable member for Hotham suggests are covered, there would still be more than one million people in this community who are not covered by the present system. The White Paper is very clear on this. In the last sentence of the last paragraph it says - I have said this before; I guess I could say it another 100 times and the Opposition would still be asserting otherwise - that the total net cost to the Budget, including the effect of tax deductions, will be approximately the same as would be the case under the existing health insurance scheme. So there will be no extra cost to the exchequer. Finally, I come to the comments which have been made by the honourable member for Hotham (Mr Chipp). He said that the White Paper is a farce in the sense, to be fair, that-

Mr Chipp - I said that the way in which it was being handled was a farce.

Mr HAYDEN - Yes. I was about to say, to be fair, that he said that it was a farce in the sense that there has not been any debate on it. I remind the honourable member that it was never proposed that it would be a paper for debate. We have always stated that it was our clear intention that it would be a comprehensive indication of the sort of legislation we would be introducing, that that legislation would quickly follow the White Paper and that that would be the appropriate time for an exhaustive debate on the program.

Mir Chipp - Can you guarantee an exhaustive debate or will you gag it like you gag everything else?

Mr HAYDEN - The Leader of the House (Mr Daly) is in charge of those affairs.

Mr Chipp - Why do you give such undertakings when you cannot carry them out?

Mr HAYDEN - I would regard it as an exhaustive debate, but members of the Opposition want to debate things in perpetuity. I think the honourable member will find that the debating time allowed to the Opposition will be much greater than the debating time ever allowed to us when we were in opposition. In the 12 years in which I was in opposition honourable members opposite were quite ruthless with the gag, the guillotine and any other sort of restriction or obstruction on open debate. We have been much more forebearing and much more tolerant than honourable members opposite ever were. It is just that honourable members opposite still think that they should be able to assert themselves in every way, as they did in the past.

The point about the White Paper is that it is a comprehensive statement of our intent. Several months ago we presented a planning committee report, which in the idiom of the moment has been called a Green Paper. There has been a continuing debate of several months on that report. Because of the views we gleaned from the community on the attitudes and some of the problems that the community foresaw, we have finally bought in the White Paper, which diverts in quite a number of significant areas from the recommendations put forward in the planning committee's report. I want to stress that there was a continuing debate - at times a rather vigorous one - in the community. I always thought that it was remarkable that members of the Opposition never tried to join in that debate by initiating anything in this Parliament. I ought to say, in fairness for the record, that the honourable member for Hotham was not the Opposition's spokesman on health affairs during most of that period. Nonetheless, that is a fact. The first occasion of which I am aware that any debate has been initiated here was last week. It was initiated by the honourable member for Boothby, who is a back bench member of the Opposition. No one from the front bench of the Opposition sought to join in the debate. That is not our fault. If we get the clear impression that there is not much interest - no particular alacrity - in joining in a debate we must accept it. The Opposition has to make its own way in this business. It cannot expect the Government to lay down a path of roses for it. It has to indicate whether it wants to debate the matter. The Government would have been happy to accommodate the Opposition at any time, although it has always understood the Opposition's reluctance to debate this.

The honourable member for Hotham made the point that we were disregarding the wishes of those people who are currently in private insurance by introducing a universal scheme and then, as he put it, forcing them into the universal scheme. He calls the private scheme 'voluntary health insurance'. Those are words around which a fair bit of debate can take place. There is not such of a volun tary nature in the present system of health insurance. One either joins it or does not have cover. One either pays the rates set by the present Government and, in previous years, the former Government and gets the benefits which the present Government or former Government set or one does not get anything. There is nothing voluntary about it. One cannot afford to take the risk of missing out, except in those cases - they are all too often - where one is too poor to afford the expensive nature of such insurance.

I should point out the inequity of the present scheme. One is a very generous contributor to it as a taxpayer - I say that because $2 out of every $3 that goes towards the cost of medical services comes from the taxpayer - but if one is not a member of a medical benefits scheme one gets no benefits from either the scheme or the Government. If one belongs to the scheme but goes to the outpatients' clinic of a public, hospital one gets no benefit from these funds because the medical profession has been successful in controlling the amount of the market which is covered by the scheme.

The honourable member for Hotham said that we ought to put into the present scheme the other 8 per cent to 10 per cent - his figures - who are not covered. That is the whole point of the exercise. Our scheme :s a more efficient way of raising the same total volume of money and of covering everyone in the community. It will cover them in this way at the same total cost because of the efficiencies of operation. We will not waste enormous amounts of money on commission rates and allocations to reserves. We can slash nearly in half the cost of the operation, which is about IS per cent of contributions to medical schemes merely by having a universal collection. That is something honourable members opposite never explored when they were in Government, and it is something which they ought to have explored because they may have been able to make some sort of saving grace for the present system of health insurance. All the money saved will go into improved benefits in the community. If we were to try to expand the present scheme to bring more people into it we would incur more costs, that is, we would be going beyond the cost of our universal scheme. I point jut that it has been estimated that to cover those people presently enjoying pensioner medical service entitlements with the present private health insurance scheme would cost an additional J 160m. From where are we going to get the money, especially when members of the Opposition are hectoring us on the need to cut down on expenditure?

There are a couple of other .points I want to make. One question which was asked was where were we going to get the increased public ward beds to meet the increased demand. There is, toy and large, no shortage of hospital beds in the Australian community, and there will be no increase in the bed utilisation. People will not .be rushing into hospitals to have amputations, hysterectomies, tonsillectomies or whatever they are because they are free. Those things are done because they are needed. In most cases they are done on referral. There will be a change in the pattern of distribution of beds between, say, private and public wards. But that is something which will be determined by public choice and not by imposition. The extent to which the public will be able to go into a public ward free of charge, free of means test, as a matter of a free exercise of choice indicates an expansion of choice over what currently prevails. We are making arrangements with the private hospitals and will continue to do so to ensure that there is adequate provision of public ward beds in the community.

The scheme we are introducing is cheaper, as we have asserted in the report, for 3 out of 4 families, including those in which there is a working wife, and for 7 out of 10 single people. As I have indicated, the amount of money coming from Consolidated Revenue for this scheme will be no greater, approximately, than would go into the present scheme. The ratio is not l.S to 1 in the first year, as the honourable member for Hotham suggested, but 1.28 to 1. The increase comes about because of the more generous .bed-day subsidy to the private hospitals, especially the charitable, religious and community ones which we believe have a most important role to fulfil in our society and which we will do a great deal to support. I hope the honourable member for Hotham does not oppose .that.

Finally, the honourable member for Hotham said that the contributions represent a means test. Yes, I suppose they do. One pays according to one's means - not as under the present scheme where the wealthier one is the less one pays and where the more one has a need because of one's limited income the more one pays. Secrecy will be preserved in the present scheme. I think the things that went wrong and that the honourable member for Hotham talked about relating to the Department of Health and Trans-Australian Airlines probably went wrong under his Government's administration. I am not sure about that. I will check on it. That does not change the fact that defects can happen. But the fact is that this information will be fed in on code numbers and only those who have access to the unit where the identifying number is held will be able to bring together the information that is being fed in, which will be nothing more than, for instance, 'consultation' or an item number. Therefore nothing personal will be revealed. Only those people can do it. They will be largely medical members.

If I can give the honourable member for Hotham one warning, currently I am investigating the practices of the Department of Social Security developed under previous governments of the releasing to a whole range of authorities of what I regard as very personal information by people who use the files of that Department. That report should soon be completed and when it is, I will be releasing it because I have been appalled and stunned to discover the extent to which honourable members opposite, who now say that they are concerned about the rights to confidentiality of the individual and the secrecy of personal information held in Government departments, permitted information to be released to all sorts of outside agencies. Not only law enforcement agencies but also, in some cases, even debt collecting agencies have been able to obtain information from the Department of Social Security. The extent to which this has happened is scandalous and I will be making a public statement about it. This happened under the previous Government.

Mr Chipp - Mr Chairman,I raise a point of order. What the Minister for Social Security just delivered was a king sized smear against the previous Government and previous Ministers.

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