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Wednesday, 12 December 1973
Page: 2707

Senator LITTLE (Victoria) - I move:

That the Bill be now read a second time.

Copies of the second reading speech are being distributed to honourable senators. I do not propose to wait for the copies to be distributed as I have no doubt that honourable senators will be able to follow what I am saying. The purpose of this Bill, expressed in its simplest terms, is to remove all barriers to the provision of a first-class health care cover to every Australian regardless of means. It also aims to preserve the dignity of the Australian people, their total freedom of choice in medical and hospital care, their personal privacy and to maintain the present quality of Australian health care which is recognised as being as high as any existing in the world. The decision to submit these amendments to the present National Health Act was made to solve the crisis that emanates from the proposals to dismantle the accepted scheme and replace it with one arousing hostility and causing predictably much higher costs to many subscribers.

The present Act has operated with general cooperation by all sections of the medical and health professions but has revealed serious deficiencies in its cover and operation. The present scheme disadvantages some people in the community, mainly low income earners, especially those with large families and pensioners, who presently receive what can only be regarded as a second-class health service. On the other hand there is Mr Hayden, the Minister for Social Security, the architect of the Government's proposed health scheme. The Minister sees no virtues at all in the present Act. Indeed, his principle accusation against it is: 'A million people are not covered and they are the poor people'. In the Minister's view, therefore, the current Act must be destroyed. In its place there is to be an entirely new, compulsory, tax-based health scheme, under a new nationalised health care bureaucracy.

For 12 months, the Minister has engaged in a massive propaganda attempt to bludgeon all sections of the medical and hospital professions into accepting his scheme. This he has signally failed to achieve. The past year has been notable for the continual divisiveness and rancour of the Minister's attacks on the medical and hospital professions for their failure to become willing slaves. For their part, the very people, whose professional expertise is essential to the success of any national health scheme, have expressed their continued resentment and fears of the Minister's health proposals. How on earth can the Minister expect his scheme to succeed, when he has deliberately provoked dissension with all the highly skilled groups that are required to make it work?

The average Australian is confused and apprehensive; he suffers the weaknesses of the existing National Health Act but seriously wonders whether the Minister's plan, in the face of bitter medical and hospital opposition, will not create greater problems and, indeed, lead to a chaos that could destroy him completely. This Bill is presented as a positive solution to the crisis. We seek to amend extensively the present National Health Act in order to eliminate the weaknesses in the voluntary scheme and to extend its coverage to the low-income single earner, to those with larger families, to pensioners, to newly arrived migrants and to aborigines.

This Bill clearly opts for a voluntary health insurance scheme, as against a compulsory, taxbased one. The Austraiian Democratic Labor Party believes that the present voluntary scheme, whatever its weaknesses, enjoys several substantial advantages. It is a unique 3-way partnership of patient, voluntary non-profit funds and the Government. Its costs are restrained and personal responsibility is retained, because the financial burden is partly borne by the patients themselves; cases of hardship attract Government subsidy; real freedom of choice exists in the selection of one's doctor and private hospitalsboth religious and charitable- retain their freedom to contribute substantially to a dual system of hospital care. In other words, the DLP believes that, given support by the Government and the other Opposition Parties, this Bill will provide fully adequate medical and hospital care, in which the patient is guaranteed his personal freedom and the maintenance of the present high standard of health in Australia.

We believe that the Government's divisive, unnecessary and very costly health proposals are too high a price to pay for a controversial new scheme of health cover for the 90-odd per cent of the community who are adequately covered already. It is interesting to note that, if one takes account of the free medical and hospital attention given to repatriation patients and service personnel, together with the free outpatient treatment and public ward accommodation provided in Queensland's public hospitals, or as outpatients, some 96 per cent of the Australian population has medical coverage and 97 per cent has hospital coverage.

The Minister's constant references to 'the million not covered at present' take no account of the number of people in Queensland who, because they have a free hospital system available to them, see no need to take out private insurance. For this reason, 596,000 Queenslanders have taken out no hospital cover and 550,000 have no medical insurance. In fact, if we include the 10.3 per cent of people covered by the pensioner medical service, the subsidised health benefits, the 2 per cent covered by repatriation benefits and the 0.6 per cent covered by the Australian defence forces medical care, there are at present 1,700,800 people- representing 12.9 per cent of the population- who have cover outside the non-profit medical funds. As only less than 3 per cent of the total population is uncovered at all for hospital treatment and less than 4 per cent for medical care, the logical step is surely to extend the coverage of the present scheme to 100 per cent, instead of scrapping it entirely, in favour of a huge tax-based controversial national compulsory scheme.

This Bill will eliminate the need for drastic, disruptive legislation. It seeks to strengthen 2 areas of weakness in the present scheme. The subsidised health benefits scheme was originally introduced to provide cover without cost to people in the very low income groups, arriving migrants and the unemployed. Unfortunately too little effort has been made to ensure that the provisions of the subsidised health benefits scheme are kept in line with the needs of those sections of the community this scheme is designed to serve. For example, the income level at which low income earners become eligible for subsidised health benefits is below what is just in the present high inflation situation. But the subsidised health benefits scheme has further gross inadequacies. It does not, for example, cover single low income earners. It disregards the special problems of large families on low incomes, because assistance is pegged to family units of 2 persons. It makes no provision for automatic adjustment to meet the problems of inflation. It is unnecessarily cumbersome and costly in its administration. Under clause 16 of the DLP Bill the subsidised health benefits scheme would be widened to include single people on low incomes. The tapered assistance to low-income beneficiaries would be discontinued and full assistance provided to all eligible persons, whose eligibility would be determined by the number of dependants in the family, as recommended by the Nimmo Committee. Our Bill would also streamline the present complex administrative arrangements for the subsidised health benefits scheme by replacing the Commonwealth reimbursement of benefits and substituting the payment of contributions to the fund of the subsidised health benefits scheme beneficiary's choice. Clause 13 provides that waiting periods for all subsidised health benefits scheme beneficiaries would be waived in respect of medical and public ward benefits, and the beneficiaries would continue, should they wish, to insure themselves for hospital benefits, in excess of the public ward level, at their own expense.

Finally, under this Bill, the Commonwealth would enter into negotiations with the State governments for an alternative arrangement to the subsidised health benefits scheme which would be more suitable to the special needs of tribal Aborigines. The DLP believes that pensioners should enjoy the same type of medical care as is enjoyed by the rest of the community. At present, the pensioner medical service is limited to general practitioner services and provides no cover for the full range of services which insured patients and subsidised health benefits scheme beneficiaries enjoy. It is, in fact, a restricted and second-class medical service. Any pensioner who seeks a surgeon of his or her own choice, by electing to go into private or intermediate hospital accommodation, is automatically excluded from all benefits and has to carry the whole cost of the hospital and medical bills. On the other hand, any other low-income person receiving subsidised health benefits may go into private or intermediate hospital accommodation and incur only the difference in cost between his public ward entitlement and the hospital charges. He is also covered for medical benefits. This is a gross injustice that should be remedied.

A major objective of this Bill, which is contained in clause 6, is to end this situation by phasing out the pensioner medical service and bringing those pensioners who desire it under the extended provisions of the subsidised health benefits scheme. Despite the Minister's claim that this move would disadvantage pensioners, our Bill would provide low-income pensioners with the opportunity of upgrading their health care to the level of that enjoyed by all other members of the community. Under the present pensioner medical service the Government is bulk billed' by participating doctors. By replacing this system with the 'reimbursement system', over-servicing and over-utilisation would be effectively contained, with consequent savings to the Government. State hospitals would also be assisted by the inclusion of pensioners in the subsidised health benefits as they would receive the normal daily bed charges for pensioner patients in heu of the current $5 per day.

One problem unresolved by the present and previous governments has been the unpredictability of medical fees. The resulting openended commitments have created great problems in the financial management of national health schemes. Medical fees and charges are not simply of concern only to the medical profession. Medical benefits and the accountability of governments are also involved. This Bill, in clause 24, provides for the establishment by the Minister of a Medical Fees and Benefits Advisory Committee, which at its establishment and, at intervals of not more than 3 years, shall inquire into and make recommendations to the Minister concerning the basic Commonwealth medical benefit, and, in respect of each State, the fund benefit and the specified excess that in the opinion of the Committee are reasonable, in respect of the professional services, to which the items in the Schedule relate.

The Committee's Chairman shall be a Presidential member of the Arbitration Commission and, of its two other members, one shall be appointed by the Minister from a panel of three submitted by the Australian Medical Association and the other from a similar panel submitted by the Voluntary Health Insurance Association of Australia. For inquiry purposes, this Committee may seek the assistance of 2 doctors as assessors, nominated similarly by the AMA and the VHIAA. The Government's interest would be preserved by the fact that it would have the last word on whether Commonwealth or fund benefits would be increased, and the people would be represented by the Chairman. Existing machinery already provides for a registration committee to approve benefits, and the Commonwealth itself has the right to decide what the matching benefits shall be.

I stress that the DLP is prepared to be quite flexible as regards the Committee. We would consider, and indeed welcome, suggestions from the Government and its health experts on ways to improve the Committee's functions and composition. The Bill does not attempt to deal in great detail with the areas of paramedical services and health provisions for the elderly, invalids and semi-invalids. We offer this Bill as a practical solution of the present health impasse. We invite both the support and constructive criticisms of the Government and the Opposition parties. We hope that the Government, through its professional advisers, would offer suggestions on how best to extend its cover to the specialist fields I have mentioned.

I have not attempted at this stage to discuss the costs involved in the DLP's scheme. Obviously, any attempt to ensure that all Australians receive adequate medical and hospital cover must cost more than the present system. But our Bill has been carefully costed. This reveals, as I shall discuss at a later stage of the debate, that its financial implementations would be significantly lower than the Minister's own scheme. At this stage, I wish merely to explain the Bill 's principal features and to stress its purpose, which is to provide adequate health cover to all Australians, especially the elderly, the under-privileged and the disadvantaged. I invite the support of all parties in the Senate to enable this BUI to go forward as the real solution to the on-going health debate and the health crisis which faces Australia today. I commend the Bill to the Senate.

Debate (on motion by Senator O'Byrne) adjourned.

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