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Wednesday, 12 December 1973
Page: 2763

Senator JESSOP (South Australia) -The 2 Bills that we are debating tonight are probably the most significant Bills we have dealt with since the Australian Labor Party came into power. The Government's proposal really amounts to throwing out a health scheme that has been shown to be one of the most effective health schemes in the world. It has been the envy of many countries. These countries would very much like to get rid of the nationalised scheme they have introduced and opt for the scheme we have in Australia. I think this was made abundantly clear when Mr Detwiller came to Australia last year to look at our scheme. He was one of the experts in health care in Canada. Of course, the scheme we are discussing tonight is based on the Canadian health scheme. Mr Detwiller, who is a very well qualified man, said that the Australian health scheme had a lot going for it.

I recall reading a statement by Mr Potter, who is the Health Minister in Ontario, Canada, that the Government had created a monster which was in effect devouring the economy and that people would be well advised to stop this monster before it consumed the resources of the country. In Ontario, the health scheme expenses appear to be growing at the rate of 13 per cent per annum, whereas the gross national product is increasing by about 9 per cent per annum. So, it is quite clear that countries that have already established the scheme that the Labor Party contemplates introducing in Australia have regretted it and in fact envy our scheme which I believe caters for 100 per cent of the population. I venture to suggest that no one in Australia is denied medical or hospital treatment today.

The Minister in another place has tried to suggest that only 87 per cent of the population is covered by health insurance. Previous speakers tonight have said and proved that 92 per cent of the people are covered by health insurance in one way or another. I know for a fact that the medical profession still has the Hippocratic tendency to provide health care for people whether they can afford to pay for it or not. So I believe I am right in saying that the people of Australia have a 100 per cent health cover. We have decided to oppose this Bill, and I believe that we are acting in the best interests of the Australian people. The Liberal Party and the Opposition generally recognise that the existing scheme needs some attention. We recognise the fact that changing needs demand a revision of our present health scheme. I know that in certain areas the existing scheme needs a complete review, and I will say a little more about this later.

Because we believe that the proposal of the socialist Minister will mean a downgrading of the medical service and a consequent lowering of the standards of health care to Australian families, because it will destroy the existing scheme, increase the total cost to the Government and for the majority of taxpayers, because it will mean the end of private and religious hospitals, and, above all because it will mean the end of the freedom of choice of patients with respect to their doctor or hospital, we totally reject the Bill. It seems quite incredible to me in the face of this that the Government has pre-empted a decision of this Parliament and has set aside some millions of dollars to purchase a computer which will be installed to administer this scheme. I think it would be reasonable to suggest that if a referendum were held on the question whether the Government should have centralised control over the national health of the people of Australia, and ultimately control over doctors, the Government would receive an even more convincing defeat than it suffered last Saturday, when it attempted to take over control of the prices and incomes of the people of Australia.

I repeat what Senator Webster said when he referred to the utterances of the Minister for Social Security (Mr Hayden). He said that the Labor Party was a socialist party and that its aim regarding medical care was the establishment of public enterprise. I was most interested to read in a recent issue of the ' Bulletin ' a comment made by the Commonwealth Minister for Health (Dr Everingham). The article states.

Commonwealth Health Minister Doug Everingham in an exclusive interview told the 'Bulletin' last week that he saw community health centres eventually catering for between 80 and 90 per cent of general practitioners services in Australia, leaving private practice fee-for-service doctors only 10 to 20 per cent of business. Everingham said that he saw Australia moving toward the pattern in England and the Soviet Union, where only a well-off few use private doctors.

That in itself is quite clear. In my view it is indisputable that in the long term the Labor Party intends to socialise the medical profession and the hospital system of Australia. If the proposals of the Government were adopted, most people would certainly pay more. Senator O'Byrne and other honourable senators on the Government side have maintained that it will be cheaper for three out of four people in Australia. I heard Senator Little demonstrate quite forcefully and quite conclusively that this is not the case. He demonstrated that the Deeble report on health insurance differed quite significantly from the White Paper that has been brought down by the Government in recent days.

I have done a little research into this matter as well. I was interested to find that 37 per cent of all taxpayers comprise husband and wife combinations, both of whom are contributing to the family income. Almost all of the people who fall into this category would be worse off financially under the Labor scheme by paying the compulsory 1.35 per cent of taxable income. I think Senator Little spelled this out quite clearly, chapter and verse. Thirty-two per cent of the taxpayers of Australia are single, and the vast majority of these people would be penalised under the proposed scheme, because under the present scheme they pay less to a private insurance fund than their married counterparts. Of the 3 1 per cent in the latter group in which only one person in the family contributes to the family income, about half will be better off and half worse off. Therefore I think it would be fair to suggest that the number of taxpayers in Australia who will be paying more will more likely be four out of five.

I turn to the effect of the proposed health scheme on hospitals. It is fair to suggest that if the compulsory taxation levy of 1.35 per cent is applied to people in Australia, human nature being what it is, the average citizen will opt for a public bed because he will be required to pay extra to a private fund for intermediate or private ward accommodation. In fact, the additional estimated cost for 1974-75 for the average family for intermediate ward accommodation in a public hospital would be $1.25 a week; accommodation in a private ward would cost an additional $1.96 a week; and accommodation in a private hospital would cost an additional $2.50 a week. So it can be seen that this represents a considerable extra cost to those people concerned. If human nature prevails, it will mean that lower income groups and pensioners, who are now given means test protection with respect to public beds, will suffer. These are the people, of course, that the Labor Party purports to champion, but they would suffer because of the lack of hospital accommodation in the public wards. Public hospitals would quickly become overcrowded; private hospitals would become empty and would be forced to offer the Government a number of public beds in order to survive. I think it is interesting to note that the number of such beds and the rate of subsidy for such hospitals would be determined by the Minister. It is quite conceivable that a hospital with 150 beds would offer to the Government, say, 20 beds and the Minister could say: 'We need 100 beds'. This is spelled out quite clearly in the Bill. Clause 34 of the Bill states, in part:

(3)   Where the Minister approves an application under subsection ( 2 ), he shall determine the number of beds at the hospital to which the approval relates.

(4)   There is payable by Australia to an organisation to which this section applies a supplementary daily bed payment, at a rate fixed by the Minister . . .

It is quite clear to me that ultimately this would mean the death of the private hospitals and their complete takeover by the Commonwealth so that public ward accommodation could be satisfied. This is particularly significant in relation to South Australia where at the present time in excess of 40 per cent of hospital beds are provided by private hospitals. The figure is approximately 44 per cent and this, of course, gives me great concern. I recall that Dr Moss Cass is reported to have said that private hospitals and private nursing homes are irrelevant to the Labor Party's concept of a national health scheme and that the vast majority of people could easily be catered for in the public hospital sector. In view of that statement I find it quite incredible that the Labor Government should suggest that it does not want to nationalise or socialise medicine. We have clear evidence of Ministers of the present Government clearly indicating the Government's intentions. I understand the socialist motive behind what they suggest.

Referring again to hospital accommodation, the statistics show that about 70 per cent of people insure for private or intermediate ward accommodation. One does not have to be a genius to work out the effect this will have on the waiting lists for operations. This effect has been clearly demonstrated in England and in Canada where over-utilisation of the scheme has meant that in relation to special types of surgery- in particular, non-urgent types of surgery- there is a waiting period of sometimes up to several years. During the last few months we have heard much about the shortcomings of the Labor Party 's proposals, and tonight we have heard quite a bit more about them. I think it is a pity that the Government has chosen to introduce these important Bills into the Parliament at such a late stage in the parliamentary session. They have been introduced virtually in the dying days of this parliamentary session. A Bill of the magnitude of the Health Insurance Bill deserves to be discussed for several days in order to give the members of the Parliament, including honourable senators, a full opportunity to express their points of view. But over the last few months the debate on this legislation has been conducted in the public area. As a result of this public discussion the Minister has changed ground considerably and has varied some aspects of the scheme. In spite of this, it is still unacceptable to the Liberal Party.

I do not intend to say anthing further about the proposed Labor scheme at the present time. I will do my best to conclude my remarks as quickly as I can. However, I want to refer to some of the areas in which the existing scheme should be improved in the light of present day needs.

The Liberal Party has devoted the whole year to reviewing its health policy as well as its policy in all other areas. We have come to some conclusions as to the amendments that are necessary to the existing national health scheme. I want to repeat some of the things that Senator Rae has already said for the benefit of the Senate and the people who might be listening in and who are anxious to know some of the improvements which we contemplate. I suggest that the people of Australia would agree with the Liberal Party in saying that the scheme is basically a good one. We wish to consider only those alterations which would result in significant improvements in the quality of health care or its coverage or its cost, or which would simplify the administration of the scheme. We wish to see maximum insurance coverage for basic health care. We desire the survival of independent health insurance funds for all areas of insurance, including paramedical services, so as to allow people a free choice of health insurance funds.

We want to see appropriate deterrents to the abuse of the health scheme, either by patients or medical practitioners, provided that the deterrent does not make the health scheme unduly complicated and that people needing health care are not unreasonably deterred from seeking it. We want to see the pensioner medical scheme and the subsidised health benefits scheme integrated into the present national health scheme so that the benefits of the scheme accrue to pensioners and other people in low income sections of the community. We want to see a tribunal determine medical fees annually and that on this tribunal the government, the consumers and the medical profession should be represented, with an independent chairman. We have referred to many other areas. In the field of nursing homes, we want to see a co-ordinated decentralised delivery system of domiciliary care and day hospitals in order to keep people who do not want to be there out of nursing homes.

Senator Mulvihill - Who wrote the copious notes?

Senator JESSOP -A11 the members of the Liberal Party Health Committee have contributed to the preparation of this document. I happen to be a member of that Committee. I wanted to mention those points. Senator Rae elaborated on them in greater detail, and I do not want to detain the Senate with needless repetition.

However, I want to refer in particular to the provision of insurance for other professions working in the field of health care. The Senate will forgive me if I mention for a few moments the profession of optometry. Nobody can deny that optometrists make an extremely valuable contribution to the community. It interested me to read only a week or so ago that the fall of the Danish Government was attributed to the fact that one of the members of the Parliament lost his spectacles, went home to pick them up, and his car ran out of petrol. As a result the Parliament was deadlocked 86 votes to 86 votes and this forced a general election. I am sure that honourable senators appreciate what it means to break a pair of spectacles and to do without them. Perhaps even Senator O'Byrne might be considered to be legally blind if he lost his glasses. It is a fact of life in Australia that many people depend on spectacles to improve their eyesight. Otherwise, they are considered to be legally blind. I think that patients of optometrists should be able to attract some sort of benefit from the Government and from a health fund on the same basis that a benefit is attracted in regard to the medical profession.

Whether this ought to be an open-ended arrangement seems to me to be the subject of argument. But I am convinced that this profession has been neglected for too long. The previous Government recognised the capacity of the profession to refer patients to opthalmologists for specialist attention and, in fact, allowed these patients to attract a specialist benefit from the health funds. I believe that this was clearly a recognition of the competence of the profession to deal with visual treatment in the field of health care. Irrespective of the fate of the Bills before the Senate- and it is quite clear what will happen to them- I suggest that the present Government could act to overcome discrimination that appears to occur at the moment with respect to certain funds. I refer to the discrimination against the patients of optometrists in favour of the patients of opthalmologists. Under the present Act, a benefit is not payable for a refractive examination or an optometric examination at which spectacles are prescribed. There are one or two loopholes whereby an opthalmologist can enable his patient to attract a benefit. He can do this under the guise of a medical examination.

Physiotherapists also have a strong case for the inclusion in the health program as they provide primary health care. Such treatment is most important, of course, in the rehabilitation of injuries caused by accidents in industry and in assisting elderly people who suffer from cerebral thrombosis and other illnesses. I believe that the inclusion of this profession in the health program needs to be looked at favourably. I understand that although at the Scullin Health Centre, which I have visited, private doctors and one private dentist practise it has been manned by salaried physiotherapists. I am of the opinion that the concept of fee for service medical centres is something that we will have to look at. It is something that the Liberal Party supports, particularly in under-doctored areas.

Senator Mulvihill - Do you support that action by the present Government?

Senator JESSOP - I support the action where services are provided in medical centres on a fee for service basis in under-doctored areas.

Senator Mulvihill - So we have achieved something.

Senator JESSOP - I am happy to concede that in that area the Labor Government has achieved something. I suggest that fee for service private physiotherapists, private optometrists and private members of the other professions working in the field of health care ought to be included in that sort of complex. I am opposed to the principle of salaried health centres. I could say a lot more about dentistry, chiropody and other professions. I am of the opinion that if any government wants to provide total health care for the members of the community, it cannot avoid including other professions that are working in this field. I am glad to say that the Liberal Party has recognised this principle in the broad acceptance of paramedical services in the insurance plan. I look forward to further progress in that area. We are studying the economics of all these things. I have no doubt that when we finally draft our health proposals, together with other proposals, we will be able to deal very well with the challenge that has been repeated by the Government on many occasions. I support the suggestion made by Mr Snedden, the Leader of the Liberal Party in the other House, who said that we would welcome a double dissolution and an election fought on this issue. I support the amendment moved by Senator Rae.

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