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Wednesday, 12 December 1973
Page: 2737

Senator O'BYRNE (Tasmania) -The Health Insurance Bill 1973 which is before us is one of the most important measures that have been introduced by this Government. The Government was given a mandate to introduce this legislation because of the great need that exists throughout Australia for such a scheme. The figures quoted by Senator Rae mean that at least one million people throughout Australia are not covered under the existing so-called health scheme. Senator Rae said that the Government proposes to do away with the private health insurance scheme. However, I would like to remind Senator Rae and other honourable senators opposite, as well as members of the Australian Medical Association and other medical people, particularly those associated with the current health scheme, that the Commonwealth Government has to pay more than $300m a year to keep the private scheme going.

I have here some of the propaganda that is being pushed out by the organisations that have a vested interest in the perpetuation of the current scheme. It shows the great hypocrisy of so many of these so-called ethical people who are barraging private patients with propaganda in their surgeries. The purpose of this piece of propaganda is to give 13 reasons why the women of this community should say no to the Government's proposed health scheme. It contains a whole pack of half truths which verge on lies. Medical practitioners have been trying to push this propaganda, spreading fear and scare amongst the people. They say that the Government's scheme will cost more. They know very well that for the greatest proportion of people in the community it will cost less and, as I mentioned, the community has been paying $300m to the present scheme over a long period of time- since the scheme was introduced. But that has never been mentioned in the propaganda. Someone has to finance the present scheme, and if the Commonwealth were to withdraw the assistance that it has been giving the present scheme would be impossible to administer and to finance. I would like the people of Australia to know this quite clearly.

The first point that is made in this propaganda which gives 13 reasons why you should say no to the scheme is as follows:

The Federal Government's scheme to replace voluntary health insurance with a compulsory, tax-financed scheme is a creation of men- not doctors, mind you, but male academics and economists.

This document was published by the Voluntary Health Insurance Association of Australia. I would like to know whether the doctors themselves might have a vested interest and a financial interest in this scheme. But the point is that they are exhibiting themselves- I do not know whether they are discriminating against themselves as being males- as chauvinists and probably prigs. But I do not see how they can differentiate before themselves and male academics and economists. The publication says that the Government's health scheme will cost the family more. But most Australians will pay less. That is the fact of the matter, despite all the propaganda put out by the doctors. Most Australians will pay ess for health insurance under the new scheme. I want to stress the untruths that have been pushed out to the public of Australia. Of course, the doctors are in a very privileged position because they have had university training. Many of them in the earlier day of this campaign were saying: Look at the money we have spent on our training'. But they were trained at universities which are financed by the taxpayers. Many of the privileges that they get in the community are subsidised.

Senator Gair - You are making it free today.

Senator O'BYRNE - Of course. If we look at those who received scholarships that are financed by the taxpayers, many of whom are humble working people paying a proportion of their incomes towards these scholarships- possibly they pay a higher proportion than the fat cats and the tall poppies- we will probably find that many people in the medical profession have been subsidised by them. I would like to mention in passing also that in my view a section of the medical profession has been most unethical, because 40 per cent of the doctors of Australia are working for government instrumentalities; they are working for the Australian Government, for State governments and for local government authorities. Yet the pressure and the emphasis has been on this grim hand of socialism that will be placed on the doctors if they become involved in a scheme such as this.

I am being quite candid when I say that many of the agitators are those people who have left the national health scheme in England. A propagandist usually has some sort of an ersatz Oxford accent or a primed up Yorkshire accent. Such a person has come out to Australia because he realises that there is a wonderful harvest to reap here, with the wide spectrum in which they can work. Of course, we have in Australia also this very substantial subsidy which is paid by the Commonwealth Government to the private scheme. But the levy to be imposed under the new scheme is based on capacity to pay, which means that it is based on one's taxable income after allowance has been made for children and educational medical and other expenses. This will mean that the new scheme will be cheaper for three out of four families. These are the facts. Yet all the propaganda that has been pushed out is a broad generalisation.

Senator Little - Three out of four families is not a fact, on your own figures.

Senator O'BYRNE - Three out of four families will be better off under our scheme, including families in which there is a working wife. The scheme will be cheaper for seven out of ten single people. The Government applies the same principle to such a basic thing as health as it applies to education. We have been trying to tell the people of Australia, particularly honourable senators opposite, that we look on education as being the right of every Australian citizen, of every Australian child, from the kindergarten right through to university. What is more noble an ambition than to see one's children properly educated. One does not have to use much imagination to apply our policy in relation to education to health. What is more important than having an Australia-wide health scheme which is available to everyone. The scheme is being opposed but on the basis of Senator Rae's figures one million people or more- possibly many more- are not covered by the present scheme. He reduced the proportion to 87 per cent. This propaganda put out by the Voluntary Health Insurance Association uses the words: 'If you are a working wife', in an effort to scare the housewives in the home. There is no doubt that a tremendously delicate relationship exists between a doctor and his patient. This is particularly so in the case of the housewife. But how can a doctor maintain that trust which a woman patient has in him when out of the doctor's own sponsorship comes these half truths and this scare campaign that has been spread around the country over the last two or three months?

The propaganda sheet states that it will be harder to obtain a hospital bed. I would like to remind honourable senators opposite, particularly some of those who have been very vocal in advancing this scare campaign, that of all the Opposition to the Government's proposal that relating to hospital care reveals the greatest hypocrisy and the most naked protection of privilege and vested interest. The Government's proposals are clear and unequivocal. They ensure that every Australian will be free to choose treatment without charge in a public hospital, including all necessary medical treatment by doctors appointed to the hospital staff. Can anyone contradict that? No one can contradict it because honourable senators opposite and those who have been briefing them know very well that that is the truth. The Government is confident that doctors of the highest reputation and competence will seek appointment to both the full time staffs and the visiting staffs of hospitals and that the treatment of patients who choose this care will be of the highest quality. The anachronistic honorary system will be replaced by salaries, sessional fees or contract payments at rates ranging over $30,000 a year for senior specialists. At the same time the Government's program allows any patient to choose between being a private patient in either a public hospital or a private hospital and to be provided with full medical benefits against the fees of doctors treating him as a private patient. Can anyone contradict that? Yet the tenor of the propaganda has been to try to contradict that.

In public hospitals, private patients will be liable for fees of $ 1 5 a day in intermediate wards and $22 a day in single rooms. To those who immediately raise to cry of 'discrimination', let me point out that similar differentials now exist in public hospital charges and that these will grow even larger in the future. In Victoria present charges are $20 a day in public wards, $30 a day in intermediate wards and $40 a day in private wards, giving an overall differential of $20 a day. For patients in private hospitals, the Health Insurance Commission will pay $16 a bed-day direct to the hospital, leaving patients to meet amounts equivalent on average to those charged for similar accommodation in public hospitals. Private insurance will be available and the Government will ensure that favourable rates are offered to people who maintain a continuity of cover. The Government will meet the full cost of the treatment of patients without charge in those charitable and religious hospitals which wish to accept such patients, and will do so without any infringement of the autonomy and independence of these hospitals. Can anyone on the Opposition side contradict that? That is implicit and explicit in the proposal.

The program will provide security and a high standard of care for patients, offer substantial financial relief to the State governments, establish for the first time a direct Australian Government responsibility for hospitals, and greatly simplify both the collection and distribution of funds for their support. What has the Opposition to say against this program? Nothing, except to defend the vested interests of certain doctors and private hospital proprietors and to appeal to privilege in the advocacy of private hospital care. Senator Rae seemed to be more concerned with the well being of a few affluent private hospitals as he was with the private schools. He was very concerned about the private schools. He was conspicuous by his absence from any of the state schools in Tasmania. His time is always spent looking after the more prosperous schools. No wonder he was so well briefed. The honourable senator seems far more concerned with the well being of a few affluent private., hospitals than with the great public hospitals which provide over 80 per cent of all the hospital treatment in this country. Where does Senator Rae think that the most skilled medical work is performed, the most complex equipment provided, and the medical and nursing staff of the future trained? Certainly it is not in the private hospitals where, despite their comfortable if not luxurious accommodation and high fees, there are not even resident medical staff to care for patients in an emergency.

Which group of patients does the honourable senator consider to be in the greatest need? Is it that group in the single rooms of private hospitals or that group in the wards and the outpatient departments of the public hospitals which the last Government ignored and neglected for 23 years? The Opposition's affection for private hospitals and its neglect of public hospitals are in exact parallel to its attitude to schools. In both cases, it is an elite and not the overwhelming majority of the Australian population which is favoured. But Senator Rae says that the great majority of Australians want the old scheme.

Senator Rae - You take us to a double dissolution on it and see whether I am right.

Senator O'BYRNE - The honourable senator will be double disillusioned when he sees the electors next time as he put up such a poor show in running to water in regard to the Schools Commission Bill. The truth of the matter is that the Opposition has no desire to allow the members of the Australian community any real freedom to choose the type of hospital and medical care they want. What it wishes to preserve is a system in which everyone is liable for hospital fees and under which means tests are used to compel all but pensioners and the very poor to take insurance sufficient to cover treatment and accommodation as private patients. What is voluntary about a system which imposes charges on everyone and will pursue even those who qualify for public ward treatment for the debts which they incur in preserving their health? It is certainly private, with all the concealment of information which this implies, and it certainly supports the incomes of the medical profession admirably, including the Pitt Street farmers. But as a so-called voluntary system it is an expensive farce.

The Government's program is, on the other hand, both equitable and liberal in every sense. Through agreements with the States any person admitted to a public hospital will be free to choose to be treated as a hospital patient or as a private patient. The Australian Government will meet 50 per cent of the net cost of operating public hospitals, including the cost of paying doctors for the care of hospital patients. The State governments and hospital authorities will continue to be responsible for operating public hospitals within a system which must surely meet all of the Opposition's desires for co-operative federalism. Without this assistance, the States could not for long avoid savage increases in hospital fees and even with much higher charges their budgets could not alone bear the cost of the increasing complexity of modern hospital treatment. The free hospital system in Queensland must, for example, be seriously threatened if costs continue to increase at the current rate of nearly 20 per cent per annum. We have never heard anything of the inflationary possibilities that are confronting these private schemes. Of course, all that honourable senators opposite want to do is to beat the Labor Government at any cost. The opportunists in our community have had their wings seriously clipped since the Labor Government has been in power.

The previous measure before the Senate was a tax avoidance legislation. Many people who have been hovering around the perimeter of this country and using Noumea, New Caledonia, Norfolk Island and the New Hebrides are tax dodgers finding loopholes. The same principles apply in regard to a policy like this. We are closing the loopholes. We hope that the Austraiian public will be given a fair deal and that this will mean all Australians and not a selected few. The Government recognises valuable the contribution which private hospitals, particularly the religious and charitable hospitals, make to the health care system. They offer both a range of choice to patients and a vocational satisfaction to those who work in them. The $16 a day which the Government will pay for each patient in a private hospital will leave the patient to bear no more, on average, than for the equivalent accommodation in public hospitals. Private insurance against these fees will be much less expensive than opponents of the scheme suggest. The Government will see that insurers offer insurance to all present members on the same terms, without discrimination according to age and health status and without limits to the period of coverage. It will require, as a condition of registration, that the health insurance funds use their already excess reserves to underwrite this commitmentthe only way in which they will ever be used for the benefit of their members. The resulting rates will be such that it will be cheaper for a family receiving the average income and below to enter a private hospital than it is at present. Those who attack the Government's proposals on the ground that they will make private hospitals the preserve of the rich had better think again in the light of the facts. Compared with the present system, they will be much more accessible to low income people. It will cost a single pensioner, for example, only about half of the amount which it now costs him to insure for private hospital care. In the limited time available, let me deal with two other aspects of the Government's proposals. The first involves the staffing of public hospitals and the so-called choice of doctor issue. I want to nail one lie that has been disseminated throughout the community by various people who have their own interests at heart; that is, the statement that a patient will not have the right to choose his own doctor. There will be absolutely no change. A person will be able to go to his local doctor or, if he needs to do so, to his local clinic, at which he does not always have the choice at present as to which doctor attends him. Pensioners will have a wider choice of doctors from whom to choose. They will not have to go to the doctor allocated to them, as was the case under the previous Government's scheme. One will have the choice of selecting one 's own private doctor, as has been the case in the past. There has been a very concentrated attack on this aspect of the Labor Government's scheme. But every doctor and every health insurance contributor knows that there has never been any threat to the right of people to choose their own medical advisers.

It has been highly offensive to me on going to my local doctor to find the wall of his surgery plastered with propaganda that I knew was untrue and to see him collecting petitions, the wording of which I knew to be untrue, to send to this Parliament day by day and then to have my letter-box and my private account assailed with propaganda that I knew to be untrue. People who traditionally have been the most ethical and looked up to group in the community have been virtually degrading themselves because they have been caught up in the political pressure that has been brought to bear to try to get revenge for the fact that there was a change of Government on 2 December of last year.

I have dismissed the outrageous untruths that have been circulated by opponents of the scheme about patients being forced to attend certain nominated doctors or being restricted in their right to be referred to specialists in private practice. They are lies and always have been lies. The new medical benefits program follows the same principle as the present scheme, namely, that every patient has a free choice of doctor, both general practitioner and specialist. But a principle of both schemes is that full specialist benefits are not payable unless the patient has been referred. Both recognise that the patient is in no position to judge the merits of different specialists and choose the one most expert in his ailment. I pause there to say that any person who is in his right mind would take the advice of his medical adviser and go to the specialist to whom he was recommended. Who would go to someone different from the specialist to whom his medical adviser advised him to go?

The choice is in fact exercised by the referring doctor. This is precisely what the Government proposes. It intends, in discussion with the States, to extend as far as possible the number of doctors appointed to the staffs of public hospitals for the treatment of patients who choose free treatment and to make arrangements for those patients to be referred directly to staff doctors where appropriate. In midwifery, the Government will encourage hospitals to appoint general practitioners to their staff and will treat their patients as hospital patients without charge. The suggestion by a section of the medical profession that the quality of care will decline if doctors are not free to charge fees to hospital patients is unworthy of the profession and a slur on both the professional competence and the dedication of the 40 per cent of doctors who work for salaries at present. What is more important is whether doctors are to take a real role in the public hospitals and follow their Hippocratic oath by being collectively responsible for the quality of patient care for all, or whether these great institutions are to be simply workshops in which public capital and public operating funds are used to underwrite the doctors' private practice incomes.

Finally, there is the so-called bed shortage about which the Opposition expresses such hypocritical concern. In total there is, of course, no bed shortage. The most recent World Health Organisation statistics show that Australia has the third highest ratio of hospital beds to population of all the developed countries. Australia has 20 per cent more beds relative to population than Canada and 27 per cent more than the United Kingdom. But there is a surplus in the country, as a result of the pork-barrel politics of the Australian Country Party over many years, and a shortage in the cities reaching scandal proportions in the medically deprived western suburbs of Sydney and Melbourne. It is, of course, only the public ward beds which are in short supply, not the private beds or those in private hospitals.

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