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Wednesday, 12 December 1973
Page: 2731

Senator RAE (Tasmania) - I think that the Minister for the Media (Senator Douglas

McClelland) wishes to inquire whether we are going to have a cognate debate on the Health Insurance Bill and the Health Insurance Commission Bill.

Senator Douglas McClelland (NEW SOUTH WALES) - I suggest that for the sake of convenience, because orders of the day Nos. 6 and 7 are inter-related, the 2 matters be debated in a cognate fashion and, if it is the wish of the Opposition, that separate votes be taken on the 2 Bills.

The ACTING DEPUTY PRESIDENT (Senator Marriott)-Is leave granted? There being no objection, leave is granted.

Senator RAE - This means that we will have a cognate debate on the Health Insurance Bill and the Health Insurance Commission Bill. These Bills are part of an overall scheme put forward by the Government as its health scheme. There are at least 4 more Bills which are not before the Senate at the moment but which are to be introduced, according to the Government, in the next session to complement these Bills as part of the entire scheme. Therefore one of the problems that we have in dealing with these Bills is that we do not know even at this stage- undoubtedly the Government does not even know at this stagewhat the total scheme involves. We do not know what is involved in the passing of this legislation because there are other Bills to come with which we are as yet unfamiliar.

With the full agreement of the Opposition I announce that we are opposing the passage of these 2 Bills. I state at the outset that we realise the consequences of this action. As the Liberal Party spokesman on health, the honourable member for Hotham, Mr Chipp, said in the debate in the House of Representatives, notwithstanding the fact that the Prime Minister (Mr Whitlam) and the Minister for Social Security (Mr Hayden) have threatened a double dissolution if we oppose this legislation, we believe that it is our duty to act in the interests of the people of Australia. The real question is how best to improve the standard of health care in this country. That is the question we face- not threats by the Government, not what may be regarded as the antics of a paper tiger, or not regarded in that way depending upon one's view of the credibility of the Government at the moment. Probably the Government's credibility is at an all-time low but I leave that matter aside. If we approach the question as I have suggested, and that is how best to improve the standard of health care in Australia, I think we can look to the average Austraiian. I think that we can look at the way in which he has expressed his view.

There has been a wave of revulsion in this country against the proposed health scheme. Seldom has there been such a wave of feeling manifested in a community as there has been at the attempt by this Government to nationalise, to take away the right of choice, to take away a good, satisfactory scheme and to impose against the will of the people something which will be not as good but which will cost a lot more. How indicative of the extent of the reaction of the people of Australia is the fact that I have received from Tasmania, for presentation in the House of Representatives, certain petitions. Because of the importance of the matter I sought -

Senator Gietzelt - You would be joking, senator.

Senator Milliner - Have you been talking to a state school committee?

Senator RAE - Mr Deputy President,I do not intend to respond to interjections. I just take the opportunity to mention that. There are burblings coming from the opposite side of the chamber. I intend to continue my speech. I was saying that this wave of revulsion in the community is demonstrated by the fact that I have had forwarded to me from Tasmania petitions signed by 23,500 electors in Tasmania alone. Over 10 per cent of the total number of voters in the State have been prepared to sign petitions which were forwarded to me so that I could arrange for the presentation of those petitions in the House of Representatives. Therefore, I asked the Leader of the Opposition, Mr Snedden, to present those petitions. Petitions containing 21,000 signatures have been presented. He will present petitions containing a further 2,500 tomorrow, as I understand the position.

Let us look at another indication of the attitude of the people of Australia. Perhaps it represents a small area only, but I think it is quite significant. It was handed to me by Senator Bonner with a request that I simply mention it. A poll was taken at the instance of the Darling Downs Electors Association in the area serviced by the Toowoomba 'Chronicle'. It ran a vote on the national health scheme. That vote sought an indication of whether people favoured the compulsory national health insurance scheme proposed by the Government or whether they favoured the existing voluntary health insurance scheme with minor improvements. The result was that 8 people voted for the Government's health scheme, and 185 people voted against it. Maybe that is not indicative of the full strength of the opposition to the Government's health scheme because it comes only from the Darling

Downs area. Let us look at the other petitions which have been presented to this Parliament. Throughout the session it has been rare for a day to pass without petitions being presented in this chamber on behalf of Australians who are concerned at the Government's proposal, who are concerned to see that the Parliament is aware of their feelings and that the Parliament will be responsive to their feelings. The assurance which I give on behalf of the Liberal Party of Australia is that we are responsive to the feelings of the vast majority of Australians who are revolted by this attempt to reduce the standards of health care in Australia.

Before talking about the Bills in great detail, let me remind honourable senators of something which is proposed to be taken away. The Bills will take away the existing health scheme and will replace it with something which I will discuss shortly. Our scheme, the scheme which exists at the moment, is a scheme which, in the interests of the preservation of a free society and of the right of choice and the freedom of choice of doctors, hospitals and health insurance, allows every Australian the opportunity to exercise that choice. How important that right is to so many of us. What more important time in our lives do we want to be able to exercise our choice to be treated by the person in whom we have faith than when we have an illness of when we have an accident? How important that right is to the average Australian has been shown by the reactions to this proposal which would take away that right of choice.

We see the importance of the preservation of flexibility in administration and the importance of a degree of competition which the Government in one breath pretends to support but which it does everything it can to reduce. We think that there should be a degree of competition between doctors, hospitals and health insurance schemes, all of which are conducive to development, improvement and provision of the best possible services at the lowest possible cost. We believe that health care must be reasonably available as a right. We believe that it is a government's duty to ensure that there is adequate health care available and that the right may be exercised by each Australian. So we have as our aims that the present Liberal scheme be improved where necessary. There have been improvements from time to time in the past. No scheme is perfect. No one is able to perfect something which does not, at any stage in its use, require a little maintenance. We agree that there are some areas of the health scheme which require maintenance. But we do not see them as justifying the throwing out of the whole of the scheme which has worked well, which has worked satisfactorily in the mind of the average Australian and which, we believe, will ensure that adequate health care is available as a right to all Australians, with an exercise of their right of choice and with a reasonable degree of flexibility.

We see it as necessary to consider the pensioner medical scheme and the subsidised health benefits and for them to be incorporated into the present national insurance arrangements to ensure that all benefits accruing to pensioners and low income earners are available under the scheme. We see it as desirable that there should be basic health care insurance coverage of the maximum number of people in this country and that it should be readily available for those people. We see as essential the survival of the independent health insurance funds for all health services, including paramedical services. We see it as desirable that there should be appropriate deterrents to the abuse of the health scheme. Human nature being what it is, there is always the possibility that a scheme will be abused. We see it as desirable that steps should be taken to prevent from taking place abuses which come to light. We see it as desirable that neither doctors nor patients should be in a position to abuse the scheme. If there have been abuses in the past, if there may be abuses in future, that is not justification for scrapping the whole of a substantially successful and acceptable health scheme. We see it as desirable that there should be an annual determination of medical fees which is not binding on all medical practitioners but, as in the past, it is desirable that all should endeavour to comply. If doctors wish to see a situation in which there is a freedom of choice and in which there is an opportunity for competition, it is their duty to ensure that they comply with the annual determination which would be fixed by an independent tribunal comprising representatives of government, consumers and the medical profession, under the chairmanship of an independent person. That tribunal would fix annually the fees payable in respect of the services provided by the medical profession.

We see it as essential that there should be a retention of private hospitals, although we recognise that in areas there are needs for upgrading some of the standards in some of the hospitals. We hope that the Government is paying attention to ways in which that can be achieved rather than taking steps to prevent the continuation of private hospitals. As I shall outline in a few moments, that is one of the effects of the Bills. We see it is desirable that there should be a continuance of private nursing homes, including those which are conducted for profit and those which are conducted by charitable institutions on a non-profit basis. In this area there is some necessity for improvement of the control of admissions, the control of discharges and the rehabilitation of persons who are in those homes. But to endeavour to limit them and take them away is something which I believe the Austraiian people do not want.

We see it as desirable that the decentralised domiciliary care services should be extended, as should the services of day hospitals. I think it is important for us to remember that where there is variety and opportunity we have a much greater chance of being able to serve the interests of the people, because people are all different. We cannot have the approach of peas in a pod, the approach of saying that everybody must do this or do that without finding out whether a large number of people will be unhappy. That course does not suit everybody and if aged people are unhappy the tendency is that they die. What will is there for people to get better? What will is there for elderly people to live in circumstances into which they are being forced to go when they would not choose such circumstances for themselves. Naturally we see that it is desirable that people should, so far as possible, be kept in their own homes and that domiciliary services or day hospitals should be provided for their treatment. We believe they should be able to live in the surroundings in which they have resided by choice during their lifetime.

We see a large number of grounds upon which the Bill should be opposed. It is clear and beyond doubt that the scheme will lower the quality of medical care in Australia. We see public hospital wards, which are already full, being unable to cope with the extra burden of all the people who are eligible for admittance without any means test and who wish to avail themselves of that opportunity. If people are required to pay by taxation extraction for the services of a hospital and for a bed in a public hospital ward, are they likely to say, 'I want to pay again over and above', or are they likely to say, 'I have paid for this and I wish to exercise my own right '?

Senator Gair -They will be paying for something that they are already getting for nothing.

Senator RAE -Senator Gair interjects and says that the people will be paying again for something that they are already getting for nothing, which no doubt is a matter of considerable importance to the people of Queensland. I can point out that the likely effect on public hospital wards is that there will be a greater demand on already limited accommodation. The net result will be longer waiting time. The net result will be the lowering of the standard of services provided. The net result will be that more people will be dissatisfied and more people will be dead. What will happen? We will find that the people with a lower income and seriously ill people will have to compete for beds where they now have them by right. At the moment the wealthier people in the community tend to pay for the private or intermediate wards because they can obtain insurance. But when we find that they have already paid a situation will arise in which people whom the Government pretends it is trying to help, the disadvantaged and lower income group within the community, will be having to compete with others against whom by and large they did not in the past have to compete.

As has happened in so many other countries that have introduced this type of scheme, the waiting time will become longer. We will find that for non-urgent cases an appointment can be made for several years hence if one wishes to go on with whatever operation was recommended. Otherwise, vastly increased rates will have to be paid for the services to be made available. In relation to the private hospitals, the Minister has the discretion to decide how many beds will be declared public so that these private hospitals are at the discretion and mercy of the Minister. We find that the Minister under clause 34 can provide for a supplementary daily bed payment at a rate fixed by him. The net effect, as was explained in detail in the debate in the other chamber, almost invevitably will be a reduction in the number of private beds available and an increase in the number of public beds available in what used to be known or are presently known as private hospitals. These private hospitals will be forced to hand over beds because of the effects of the introduction of this scheme.

The effects of the introduction of the scheme will include the fact that fewer people will want private beds and more people will want public beds. There will be partly empty private hospitals which will be forced in fact to make some of their beds available to the Government's scheme as beds in public wards. Once the private hospitals are forced to do that, the Minister has the absolute discretion as to how many of the beds will be made public. We will find that the private hospitals will have a very short life. The private hospital system has served the interests of the community and the interests of the provision of a degree of choice to those in the community who wish to exercise it. We will also find that in public beds in private hospitals patients will not be able to exercise a choice in relation to their doctor. They will not be able to say that they have a particular preference for a doctor and that doctor is the one from whom they would like to have treatment. We will find also that if the number of private beds declines so will the ability of medical specialists who now provide many honorary services on top of their own private practice. There will be a decline in the number of specialists. Specialists will either have to become salaried doctors at public hospitals or work on a sessional basis in public hospitals.

There are other undesirable developments in medical care in Australia. I have outlined some of the effects if this Bill is passed. There will be clearly a reduction in choice. There will be clearly a reduction in the standard of care available to the Australian people. One of the side effects of this Bill is clear. It is a manifest first step towards the nationalisation of health care in Australia. Let us have a look at some of the other aspects. I turn firstly to costs. We have had many somewhat curious estimates as to costs. We have found that the Minister and his advisers have had to review the costs on a number of occasions. It is now said that there will be a 1.35 per cent supertax on all taxpayers. I wish to make it quite clear so that there is no misunderstanding that this is not just a matter of there being payment for medical care in Australia out of the taxpayers' funds to already existing funds. It is a matter of the provision of a new imposition on each and every taxpayer in Australia.

Every person who pays tax will be required to pay a 1.35 per cent supertax subject to certain limits. The taxpayers will have to recognise that large amounts of their already paid tax funds will also be going to the provision of medical and hospital care. The effect of all this will be the payment of an extra $80 to $125 for a family man in Australia if he wishes to have the coverage which is at present available to him for private wards. The outcome will be that members of the average family in Australia who would like to exercise a right of choice and be able to go, if they wished for one reason or another, to a private ward will receive that service only upon the payment of virtually double the present costs. It is also interesting to note that for each $1 raised by the tax, $1.28 will have to be paid out of Consolidated Revenue during the first year, which is estimated to increase to $1.50 in the second year, and I remind honourable senators that that is in addition to the 1.35 per cent super tax. So we will find that the total cost will be quite astronomical. Although the Government has claimed that the new scheme will be no more expensive, it is a little hard to accept this when one looks at the history of gross costing errors made by the Minister and his staff in the past. I am sure honourable senators will remember the embarrassing confessions before the recent medical fees tribunal about the rather huge error of many millions of dollars which was made in calculating costs.

Faced with that situation, let us see just what the Government can say to confirm its calculation of the cost of its scheme. So that the Government can give some thought to that, I refer to an interesting study that was conducted by an economic and market research firm, Phillip Shrapnel and Co., which recently carried out a detailed costing of the present and the proposed health insurance schemes. The conclusion which that company reached was that the Minister had underestimated the cost of the Government scheme by nearly $300m in the first year. It estimated that the Hayden scheme would cost $380m more than the existing scheme in the first year, and that the cost will escalate sharply. I am quite confident that the average Australian finds costs escalating quite sharply enough as a result of the other actions of this Government without having forced on to him a huge escalation in total costs of a health scheme which has been partially worked out and many times altered; a scheme which can be described only as unsatisfactory to the Australian people and which will reduce the standard of health care whilst increasing the costs of health care.

The present health insurance scheme covers about 90 per cent or 92 per cent of the population. Mr Hayden 's estimate is that 87 per cent of the Australian people are now covered by health insurance, but I think if we consider what I will say we will see that that is not a correct estimate. At present, 79 per cent of the Australian people are covered by private health insurance, 10 per cent are covered by pensioner medical services, and approximately 3 per cent are covered by subsidised health benefits. There is nothing to confirm the view that it would be possible to get 100 per cent coverage. The figures in relation to the English experience show that the percentage there is about 94 per cent or 96 per cent. So perhaps the difference between those who are covered under the present scheme and those who would be covered under the Government's compulsory scheme is somewhere between 2 per cent and 4 per cent. But is it necessary that the present scheme should cover only 92 per cent of the Australian population? That is not so. We believe that alterations can be made to the present scheme which will increase the percentage of people covered by it. The Government's proposal is to take away the freedom of up to 92 per cent of Australians, who now voluntarily insure with the fund of their own choice or who are covered by other aspects of health care, and to compel them, by a taxation mechanism, to insure, up to standard hospital ward care level in what can be described only in the terms which were used in many of the debates on this scheme as a monolithic Government insurance fund.

In other words, to cover for insurance purposes between 2 per cent and 4 per of Australians, the Government will destroy the right to free choice of 92 per cent of Australians. The Liberal Party, as I have already indicated, does not in any way attack or oppose the concept of maximum insurance cover. If Mr Hayden wishes to direct attention towards covering the uncovered, he would have our full support, but instead he is attacking the freedom of choice of Australians and upsetting the arrangements made and approved by an overwhelming majority of the Australian people.

Another aspect, I think, deserves attention. The new scheme will mean that Government departments- Government bureaucrats- will have to handle about 90,000 claims a day. Presumably this will involve a massive increase in the total number of public servants. It will mean that this matter is conducted on the same basis as the public service in other areas is conducted. Who, looking at that, can claim and establish that health insurance can be provided more efficiently and at lower cost than it is provided by private funds, by private enterprise? The experience all over the world is that where government takes over the provision of a service the cost of the provision of that service tends to rise. It is clear that there will be less efficiency, less competition, and less service if there is only one government national fund into which people are required to contribute by a compulsory tax extraction. That is hardly in the interests of the preservation of a free society, in the interests of economy or in the interests of providing the maximum standard of health care to Australians. But as well as that we see things such as the threat to privacy. We will have a vast nationwide computer data bank storing medical information on all Australian people. Whilst we do not allege that the Minister will knowingly divulge information, it is clear -

The ACTING DEPUTY PRESIDENT (Senator Marriott)- Order! The honourable senator's time has expired.

Senator Laucke - I wish to move for a short extension of time to enable the honourable senator to complete his speech.


What does the honourable senator call a short extension?

Senator Laucke - Less than 5 minutes.


Senator Douglas McClelland (NEW SOUTH WALES) - On the understanding that it is no longer than5 minutes, yes. (Extension of time granted.)

Senator RAE - I thank honourable senators. I was just referring to the threat to privacy by the introduction of a vast computer bank containing the medical history of and information on all Australian people. Whether or not this is the intention of the Minister or the Government, the idea of the medical records of the entire community being stored in one vast governmentowned and controlled data bank is abhorrent to most Australians. There is in the Labor proposal a number of things which the Opposition would support. These include increased financial assistance to public hospitals, the enabling of visitors to Australia to participate in the scheme by payment of a premium, special medical benefits for unusual or complex medical procedures, the right of doctors to appeal against decisions of committees of inquiry, increased payments to private hospitals, the integration of pensioners into the scheme, and the entitlement of pensioners to the same benefits. I indicate to the Government and to the people that, if the Government were prepared to introduce these provisions as amendments to the present health scheme, the Opposition would support them.

But this Bill in its present form and with its associated proposals will clearly do the following: It will lower the quality of medical care for Australian families; it will increase the total costs for the Government and thus for taxpayers; it will increase total costs for the majority of taxpayers, because they could only maintain the present quality of their health care by additional heavy commitments for private insurance; it will reduce freedom of choice; it will jeopardise the future of religious, private and country hospitals; and by design and intent it will be the first stage of nationalisation of health and medical care in Australia.

I believe that we speak on behalf of the vast majority of Australians. No attitude has been made more clear in recent times than that of the Australian people in relation to the health scheme. We propose to act on behalf of that vast majority of the Australian people who object to the Government's proposals. Accordingly I move:

Leave out all words after 'That', insert- the Senate is of the opinion that the existing health scheme is one of the best and most efficient in the world and that therefore this Bill and associated Bills should be withdrawn, because the Government's alternative proposals to the existing health scheme will-

(a)   lower the quality of medical care for Australian families,

(b)   increase total costs for the Government and thus for taxpayers,

(c)   increase total costs for the majority of taxpayers, because they could only maintain the present quality of their health care by additional heavy commitments for private insurance,

(d)   reduce freedom of choice,

(e)   jeopardize the future of religious, private and country hospitals, and (0 by design and intent be the first stage of nationalis ation of health and medical care in Australia. '

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