20th Parliament · 2nd Session
Mr. Speaker (Hon. Archie Cameron) took the chair at 2.30 p.m., and read prayers.
– Will the Minister acting for the Minister for Commerce and Agriculture state the present position in relation to the proposed reference of the fisheries dispute with Japan and Australian jurisdiction oyer the area covered by the recent legislation in relation to fisheries in Australian waters foreshadowed by the Minister for Commerce and Agriculture a few days ago?
– I am not acting for the Minister for Commerce and Agriculture. I merely represent in this House the Minister acting for the Minister for Commerce and Agriculture, who is in another place. However? I shall bring the question to the notice of the Minister for Commerce and Agriculture and endeavour to obtain the. desired information.
– I address a question to the Minister for Air. I understand that the Commander-in-Chief, Royal Air Force, Far East, has arrived in Australia for a short visit. Is it possible to issue an invitation to him to address members of this House informally while he is in Australia?
– I regret to say that it will not be possible to issue an invitation to Sir Clifford Sanderson to address the members of the House or party members because his itinerary has already been completed. I understand that he will be in Sydney for only a couple of days before he returns to Singapore. If, in future, the honorable member hears of the impending visit to Australia of any highranking officer, and he gives me sufficient notice of it, I shall do my best to bring the officer here and give honorable members an opportunity to cross-examine him.
Mr,- DUTHIE. - I address a question to the Postmaster-General which relates to the contract system that has been introduced in his department. Under what award are men paid, if they are employed by a contractor on contract projects for. the Postmaster-General’s Department? If they are paid under existing awards applicable to the PostmasterGeneral’s Department, and if the depart-, ment has . to provide supervisors’ materials, additional plans and estimates, which require time in preparation, where can any financial saving occur, especially as the profits of the contractors have to be added to the cost ? “What is the reason for the delay in accepting a tender in Hobart, though tenders closed there seven Weeks ago for a contract project?
– I cannot give the honorable member any information offhand about the awards under which the employees of contractors are paid, but I am quite sure that the men would be adequately safeguarded. Indeed, the various unions concerned would be most interested in ensuring that the interests of the employees would he protected. Beyond that, I am not able to give the honorable member any information about that matter. The fact is that very few contracts are being let by the PostmasterGeneral’s Department for the construction of lines, as we let contracts also for the’ construction of telephone exchanges, buildings, post offices and the like. So far, the contracts that have been let have proved quite satisfactory to the department.
– Has the attention of the Postmaster-General been directed to the fact that in the town and district of Walcha, due to the extensive programme for the land settlement of exservicemen, increasing pressure has been placed upon the postal facilities and the antiquated post office in that town? Oan the Minister inform the House whether there is any possibility of even temporary action being taken to relieve the situation there?
– I know that the conditions at Walcha are not all that one would desire them to be.
– Like Maroubra.
– Evidently another honorable member is not satisfied with the postal facilities in his electorate.
Following the representations of the honorable member for New England, I shall examine the situation at Walcha with a view to ascertaining whether some relief oan be given.
– Can the Minister for Civil Aviation say when it is expected that the new Hobart airport, known as Llanherne, will be ready for commercial flying operations? Can he say whether it is proposed to operate only when the aerodrome is fully completed, or whether operations will begin as soon as properly adequate facilities are available?
– I think that the main runway al the Hobart aerodrome has been completed, but provision has yet to bc made for the hangars, terminal buildings and the like. The proposals for those buildings will have to come before the Cabinet Sub-committee on Works. It is expected that if a favorable decision is given by the sub-committee, the aerodrome will be completed within about twelve months thereafter, but it will probably be some time yet before it is ready for use.
– I address a question to the Minister for Civil Aviation, which I think he should he able to answer. When is it proposed to produce the reports and balance-sheets of TransAustralian Airlines and Qantas Empire Airways Limited? Tn view of the fact that the year which the reports cover concluded on the 30th June last, can he inform the House of the reason for the delay in presenting the reports to the Parliament, in order to give honorable members an -opportunity to discuss them?
– The balance-sheets and annual reports for Trans-Australia Airlines and Qantas Empire Airways Limited will be presented to this House as soon as I receive them. I have not yet received the report of TransAustralia Airlines, but I know that it has been completed, and I have given my authority to certain matters in it. I hope that I shall have the reports of Trans-Australia Airlines and Qantas Empire Airways Limited to lay on the table, probably towards the end of this week.
– I ask the Minister for Civil Aviation whether it is a fact that Australian National Airways Proprietary Limited is about to take delivery of two DO 6 aircraft which will be placed in operation on capital city routes in Australia next month? Will these additional aircraft improve the flight schedules between the capital cities, from the point of view of both the number and the duration of flights? Is there any indication yet when Trans-Australia Airlines will place its Vickers Viscount aircraft in operation? Will these aircraft operate on capital city routes only? Has the Minister any information in relation to other new types of aircraft being purchased by airline operators in Australia?
– The first of the DOG aircraft purchased by Australian National Airways Proprietary Limited will be in operation, I think, some time next month. I do not know on what routes they will fly. That is a matter for the management of the company. I presume that they will iinprove the flight schedules between the various capital ci ties. The use to which “Vickers Viscount aircraft will be put is a matter for the management of Trans-Australia Airlines. I presume that they will be flown on the capital city routes, although this type of aircraft is suitable to land at any place where a D03 machine can land, which opens m> possibilities for country services. I do not know of any other purchases of new type3 of aircraft by Australian airline operators, except for a Heron recently imported by Butler Air Transport Proprietary Limited.
– Will the Minister for Civil Aviation inform the House whether a decision has been made to remove the automatic control device from planes operated by Trans-Australia. Airlines and other airline services? Is the Minister aware that the pilots flying these planes are deeply concerned about the decision co dispense with these safety devices? If such a decision has been made, had the Minister any say in the matter? If so. i.* he satisfied that the discontinuance of the use of these controls is in the best interests of safe flying?
– I have received no representations from the pilots or from the pilots’ association in relation to this matter. I shall try to ascertain the facts for the honorable member.
– Will the Minister for Civil Aviation state whether the major airports of Australia which handle overseas aircraft are suitable for the handling of commercial jet aircraft, such as the Comet? Are suitable refuelling facilities available? Is it anticipated that overseas airline services will be operating jet aircraft in Australia in the near future ?
– The main airports are suitable for handling Comet and other types of jet aircraft. As far as refuelling facilities are concerned, a forced fuel feed system will be installed at Mascot. At other centres the usual mobile refuelling systems will bo in operation. I cannot say when the first commercial jet aircraft will be operating in Australia. I think it will be some time towards the end of next year.
– Has the Minister for the Army been advised officially of the adoption of a standard-gauge rifle by the defence authorities of the United Kingdom and the United States of America? If he has been informed that the .30 weapon has been accepted, will he confer immediately with the Minister for Defence Production in order to ensure that the urgent work of tooling and production shall be commenced by the Commonwealth Small Arms Factory without delay?
– Many reports on the proposal mentioned in the honorable member’s question have been received from time to time, but there has been no official final decision as far as I have been advised.
– Will the Prime Minister say whether it is a fact that in Canberra the security service has its offices in the same building as the telephone exchange and telegraph office? Is it also a fact that the security service has facilities in this building for obtaining sample recordings of telephone, telegraph and teleprinter traffic? Is it true that the security service attaches tape recording machines to both official and private telephone lines in Canberra for up to 24 hours at a time and that security officers play back the recordings and make, notes of the conversations recorded on them ? Can the right honorable gentleman justify the invasion of the privacy of citizens and this breach of the PostmasterGeneral’s obligation to ensure the privacy of telephone, telegraph and teleprinter traffic ? “Will he order the security service to stop the tapping of telephone, teleprinter and telegraph circuits and direct the Postmaster-General to restore the integrity of these channels of communication ?
– Order ! The honorable gentleman began by asking about four questions, and then he asked a couple more in which he assumed the correctness of everything to which the previous questions referred. That is against the Standing Orders. Does the Prime Minister wish to reply?
– All I want to say is that the security service is vastly concerned with the integrity of Australia. Whether it has an office in Canberra I do not know.
– Well, you should know.
– Should I, indeed? If I had your army of snoopers, I would know.
– You are supposed to be the Prime Minister.
– Order ! The honorable member for East Sydney must not interrupt.
- His reference to the Prime Ministership shows the desire of the moth for the star. When I deal with the security service, I deal with the head of the service. He comes to see me in my office. Whether he has an office in Canberra, I cannot say.
– Will the right honorable gentleman ask him ?
– If he has, I shall find out where k is, but whether I shall convey that knowledge to anybody else is an entirely different matter.
– Last week, the honorable member for Hindmarsh asked me a question about the auditing of accounts at Woomera. He inquired whether the audit system in my department was satisfactory and whether there was any truth in a rumour that there were large-scale discrepancies and an attempt to cover up shortages of stores at Woomera. I want to tell the honorable member that he was quite wrong about this matter. I have had it investigated. As I told him when I replied to his question, the matter he had raised had no reference to the Department of Supply. I suggested it might have reference to another department. The construction of the Woomera establishment was a large-scale undertaking. Most of the construction work was carried out by the Department of Works, on behalf of my department. I have the permission of the Minister for Works to say that there were difficulties in his department so far as the stores recording system was concerned. These difficulties relate to the past, and nearly all of them occurred when the Chifley Government was in power. They were commented upon by the AuditorGeneral and the position has been corrected. When a very large undertaking is being pushed forward repidly as a matter of government policy, it is not uncommon that recording and accounting systems have difficulty in keeping pace with construction work. That difficulty has been overcome. I am sure the House will be glad to hear that, so far as we know, there has been no loss, to the Australian taxpayer.
– My question relates to a letter said to have been written recently by the Prime Minister of Ceylon to the Governor-General of that dominion about the playing of the National Anthem, the use of the flag and the position of the Governor-General. I ask the Minister for External Affairs whether such a letter was written. If so, was it in the terms to which wide publicity has been given?
– A communication from the Prime Minister of Ceylon to the Governor-General of Ceylon was reported in the press four or five days ago. Since then, the Prime Minister of Ceylon has said that his statement was wrongly reported and, I think, grossly distorted in the course of publication. He has issued a further statement in which, I believe, he has set at rest any doubts about what he said or meant in relation to the Governor-General, the flying of the flag and the playing of the National Anthem. He has said that the flying of the British flag and the playing of the British National Anthem will take place during the visit of the Queen and on all other appropriate occasions. He has said also that the Queen will be given a right royal welcome when she comes to Ceylon. These are matters entirely for determination by the Government of Ceylon, but I think I am in order in saying we all realize that the unity of the British Commonwealth is something that has to be preserved because anything that diminishes that unity diminishes the strength of each of the component parts of the Commonwealth.
– I preface my question, which is addressed to the Prime Minister, by stating that some time ago an announcement was made that moneys received from the sale of Japanese assets in this country would be distributed among Australian ex-prisoners of war! As it is almost twelve months since the first payment was made to the Australian ex-prisoners of war, and as the payment was stated to be a first payment, will the Prime Minister say when the next payment is likely to be made?
– I shall have a precise statement on the subject prepared, and convey it to the House.
– My question is directed to the Minister for External Affairs. Can the Minister for External Affairs say whether the Commonwealth Scientific and Industrial Research Organization is experimenting with methods to eradicate bracken? Bracken is a troublesome and persistent pest in our high rainfall areas, particularly in the Mount Lofty Ranges, and the southeastern districts of South Australia.
– The problem of how to eradicate bracken is very well known. I can well imagine that bracken is very troublesome in the honorable member’s electorate, and in many other parts of Australia as well as in many overseas countries. As far as I know, the Commonwealth Scientific and Industrial Research Organization is not now conducting any work designed to discover a method to eradicate bracken. All sorts of chemical methods of treatment have been tried in the past, including experiments with hormone weed-killers. They have all proved almost entirely negative. Work has also been undertaken in connexion with this matter in other countries, notably in Scotland, and that has proved equally ineffective. The Commonwealth Scientific and Industrial Research Organization is keeping a careful watch on work that is going on in other countries towards the perfection of chemical means to destroy bracken. At the moment, this plant cannot be destroyed except by burning wherever possible, mowing, trampling down by stock, and, in particular, by competition of pasture plants after mowing or burning. I regret that I cannot give the honorable member any comfort in respect of this matter, because research into it has come to a full stop for the time being. However, the Commonwealth Scientific and Industrial Research Organization has the matter in mind.
– I ask the Minister for Territories whether an audit of his departmental accounts in New Guinea has disclosed grave examples of excess expenditure, absence of commercial project and administrative records, increase of outstanding amounts and instances of unsatisfactory store accounts. If that is so, will the Minister inform the House of the action that he proposes to take to rectify the position ?
– I assume that the honorable member has based his question on the statements available to all members of this House in the latest report of the Auditor-General. Those statements are by no means as extensive or serious as the honorable member’s question attempts to suggest. Attention is being given to the report in the general course of administration, and any matters that need rectification will be rectified.
– I desire to ask the Minister for Territories a question in relation to the unfortunate massacre of two Australian patrol officers and two police boys, at Telefomin, New Guinea, recently. Is it a fact that the killing of these men by New Guinea natives was the result of the drowning of five carriers who were members of a previous patrol led by the late Geoffrey Harris? Is it also a fact that the promise of compensation to the relatives of the five carriers had not been honoured? Is it also a fact that the delay in considering such payments had extended over a period of four months? Will the’ Minister call for a report on the cause of this delay? Will he also instruct the officers of his department in New Guinea to deal more expeditiously with claims of this nature with a view to strengthening the goodwill between the native population and the white residents?
– May I allow myself to make the observation that the honorable gentleman has asked some questions, and then assumed that the statements contained in them are true? They are not true. I also wish to correct his use of the term “massacre”. I think that it would be more appropriate to say that two patrol officers in separate places were murdered by natives. Immediately the first report of those murders was received, an investigation was ordered. That investigation is being made by an officer with long experience. So far it lias not been established that the incident referred to by the honorable member has any relation to the happenings at Telefomin. Apparently the honorable member has taken at their face value some newspaper statements that are nothing more than surmise. The investigation has shown so far that there is no truth in any of the statements contained in the honorable member’s question.
– Is the Minister for Territories aware that in the area of Buin, at Bougainville, in the Solomon Islands, both the white and the native peoples are very short of food - I believe close to starvation level? The Minister will appreciate the difficulty experienced in growing food in this area because of the terrific rainfall. Will he immediately investigate the position and send necessary food at a reasonable price because rice is beyond the means of people in the area? Will he also investigate the possibility of securing for them the American multi-purpose food, known as MPF, which is made up in packets and is supposed to be very nutritious for people living in the circumstances of those in the area concerned?
– I have no knowledge of the rather alarming situation which the honorable member has sketched. In July last, I visited Buin, Sohano and Kieta and as I travelled over Bougainville, I formed the impression of flourishing gardens and of every one in the highly satisfactory condition of being well fed. Australian officers are stationed at a number of places in Bougainville, and I am sure that if any unusual situation had arisen since 1 was there in July they would have directed ray attention to it. In addition to the officers, a number of missionary bodies are working in the area. I feel sure that if the missionaries had noticed anything suggesting food shortage, they would have directed my attention to it. So far no shortage of food or failure of agricultural crops which might lead to a shortage of food has been brought to my notice. If the honorable member will give me such information as he possesses, I shall have inquiries made. On the question of whether we can use some patent food. I point out that our object and the general line of progress in the territories have been directed to encouraging people to try to grow their own food rather than import it. That is customary over a large part of the Territory of Papua and New Guinea.
– Is the Prime Minister aware of the strong protests that have been made, and that are still being made, against the Polish Government’s savage persecution of Polish cardinals, bishops, priests and Christian laity in Poland? Does the right honorable gentleman agree that this religious persecution is in direct defiance of the Declaration of Human Rights, in which Poland professes to be; lieve?What action, to which Australia may subscribe, can be taken through the United Nations or other channels?
– In the last few weeks I have received, and other honorable members have also received, a great number of protests from a variety of sources about the persecution of church leaders in Poland. Undoubtedly, there is a great volume of indignation in this country about that persecution. The persecution, of course, is clearly an example of the violation of fundamental human rights which unfortunately has been not uncommon in recent years in certain countries. As far as the Government of Australia is concerned, we have instructed the members of the Australian delegation to the United Nations to watch for an opportunity in debate to express the Australian Government’s abhorrence of such acts of religious persecution. The Government has also instructed the acting High Commissioner in London to lodge a protest with the Government of Poland.
– Will the Minister for Health explain why pensioners confined to approved hospitals other than public hospitals are denied the additional Commonwealth benefit of 4s. a day? Does the Minister know that public hospitals cannot cater for all the aged and invalid people who re’quire treatment and that, because of the Government’s denial of the full benefit while they are in hospital, pensioners are compelled to meet the extra cost of hospital treatment out of their pensions, and are caused acute hardship? Will the Minister take action to have the full benefit paid to all pensioners irrespective of the hospital to which they are admitted?
– The payment of the benefit to pensioners is covered by the hospital benefits agreements with the various States. The agreements do not apply to private hospitals.
– My question, directed to the Minister for the Navy, relates to the dismissal of many hundreds of workers at Cockatoo Island Dockyard, New South Wales, and the resultant necessity for many tradesmen, highly skilled in naval construction, to seek work elsewhere. Will the Minister inform the House what measure of protection will be given to apprentices to this highly skilled work, and thus allay the fears of their parents caused by the action of this Government in curtailing naval construction at this national dockyard?
– The number of employees at Cockatoo Island Dockyard is at present approximately 2,450, which is the average number employed there during 1952. For a very short period the number of workers employed at the dockyard was increased, but because of the fall-off in civil demand a number of men has since been retrenched. During 1953-54 the demand of the Royal Australian Navy will remain as high as it was during 1952-53. Therefore, the dismissals that have taken place at the dockyard cannot be attributed to action taken by the Department of the Navy or the Government. For the benefit of the honorable member I may add that I think it is true to say that what has happened is that the dockyard is no longer repairing big ships like Palana and Aorangi. As civil demand has diminished workers have been put out of employment, but I have been assured that they have rapidly found employment in other industries or other parts of the shipbuilding industry. The honorable member will know, perhaps better than any one else, because of his association with the Cockatoo Island dockyard, that apprentices are under indenture and that they will not be discharged because of the dismissal of approximately 200 employees. The standard of the training given to apprentices at the dockyard is extraordinarily high. It is recognized by the trade union movement as being almost unequalled elsewhere in Australia. If a lad goes through his training at Cockatoo Dockyard he is quickly taken into his trade and recognized by the trade union movement as a first-class tradesman.
– In view of the decision forced upon the Department of External Affairs to close the cafeteria formerly operated at West Block, Canberra, will the Prime Minister confer with the Chairman of the Public Service Board and discuss with him the need for the provision of cafeteria services for employees of the Commonwealth in this city?
– I know nothing of any decision being forced on one department by another. If I may omit that aspect of the question, I may say that if the honorable member wants to know about the cafeteria I will find out about it and inform him.
– I address a question to the Minister for the Interior. Does the fact that all Government cottages along the routes to.be traversed by Her Majesty the Queen next year are now being repainted mean that houses in other areas in this city which are urgently in need of repainting must wait longer for attention?
– I have no knowledge of the matter raised by the honorable member for the Australian Capital Territory, but I shall ascertain the position for him. I believe that he can obtain the information by telephoning the Department of the Interior. I am certain that it is not correct to say that priority is being given to some cottages in the manner mentioned by him. Probably,the work that is being undertaken is similar to that which is being carried out in every other capital city, where buildings along the route that will be traversed by the Royal Party are being decorated. In Canberra, perhaps a little extra paint is being applied to cottages along the route that will be followed by Her Majesty. I would not say for one moment that such is not so. At the same time, that work is not interfering with the ordinary programme for the repair and maintenance of houses in general in Canberra. The work to which the honorable member has referred is just something extra.
– Has the attention of the Prime Minister been directed to the report of the Bank of New South Wales to the effect that freights, particularly shipping freights, pay a very big part in the unduly high cost structure of Australia-
– Is the honorable member basing his question on a press statement which I read to-day?
Mi-. KEON. - No, it is based on the quarterly report of the Bank of New South Wales. If the attention of the Prime Minister has been directed to the report-
– The answer to that one is “ No “, if I may save time by intervening now.
– Will the Prime Minister examine the report and direct the Minister for Shipping and Transport and the chairman of the Commonwealth shipping line to reduce freights to the level that operated prior to the Minister having directed that they be increased in conformity with the freights charged by private shipping companies?
– My attention has not been directed to the report. I read as many reports as I can read. Some of them are, happily, very good, but others are quite bad.
– My question, which is addressed to the Minister for the Interior, concerns the long delay experienced by ex-servicemen when they apply for loans through the War Service Homes Division. Is it a fact that some applicants who own blocks of land and have £1,000 towards the cost of building their home have been refused a loan or have been compelled to wait for eighteen months for a loan to be approved? Is the Minister prepared to do something to remedy that situation?
– The Minister will not do a thing.
– The honorable member for East Sydney has answered the question by saying that the Minister will not do a thing. Obviously, the Minister for the Interior cannot do anything in the matter because the administration of war service homes is not under his direction but under that of the Minister for Social Services. However, I shall do something. I shall refer the honorable member’s question to the Minister for Social Services, who is not present in the House to-day, and ask that a reply be furnished.
– I direct a question to the Prime Minister.
Mr.Ward. - Make it an easy one.
– The right honorable gentleman will, I think, remember that when I directed a question to him some time ago concerning the Lady Gowrie child health centres, he informed me that inquiries had revealed that there was no justification for increasing the grant tothese centres. Is it not a fact that a select committee appointed to inquire into the work of the Lady Gowrie child health centres recommended that the grant for this purpose should be increased from ?35,000, as it is at present, to ?50,000 ? If that is a fact, will the Prime Minister review his recent decision to refuse to increase the grant in the light of the committee’s recommendations?
– The honorable member has referred to the report of a committee. I have not that report before me. I shall inquire into the matter and put myself in a position to answer the honorable member’s question.
– Can the Minister for the Army inform me whether the court martial on the payroll robbery in Japan has completed its investigations? Has the report been delivered to the Minister ? When will he lay the document on the table of the House?
– I undertook to inform the honorable member forWatson when the court martial concluded. It is still sitting.
– I desire to announce to the House that during the absence through illness of the Minister for Commerce and Agriculture (Mr. McEwen), who, I regret to say, will be away for at least a month, and the Minister for Trade and Customs (Senator O’Sullivan), who, unfortunately, is required to be away for some time, the Minister for Shipping and Transport (Senator McLeay) will act both as Minister for Commerce and Agritulture and Minister for Trade and Customs. As Minister acting for the Minister for Commerce and Agriculture, Senator McLeay will be represented by the Postmaster-General (Mr. Anthony), and the senator will also act as Leader of the Government in the Senate and represent the Minister for Defence (Sir Philip McBride) and myself in that chamber.
Presentation to the Governor-General.
-(Hon. Archie Cameron). - I inform the House that the Address-in-Reply will be presented to His Excellency the Governor-General, at Government House, at 12.30 p.m., on Thursday the 26th November. I shall be glad if the mover and seconder of the motion for its adoption, together with as many other honorable members as can conveniently do so, will accompany me to present it.
Motion (by Mr. Eric J. Harrison) agreed to -
That, until the end of the session, unless otherwise ordered, the House shall meet on each Thursday at 10 a.m. and, in addition to the days fixed by Standing Order 38, on each Friday at 10 a.m.
Motion (by Sir Philip McBride) - by leave - agreed to -
That leave be given to bring in a bill for an act to amend the Defence Forces Retirement Benefits Act 1948-1952.
Bill presented, and read a first time.
– by leave - I move -
That the bill be now read a second time.
The principal purpose of thisbillis to give members of the permanent naval forces who elected not to become contributors to the fund when the Defence forces Retirement Benefits Act became operative in 1948, a further opportunity to become contributors and so acquire entitlement to the benefits provided by the act on retirement from the permanent defence forces. As honorable members may be aware, the Defence ForcesRetirement Benefits Act 1948 gave officers or ratings of the permanent naval forces who had an entitlement to deferred pay, a right to elect either to contribute for full benefits, for limited benefits or not to contribute under the act. Those who elected not to contribute under the principal act retained the right to a lump sum payment of deferred pay which accrues until their retirement, but since exercising that right of election, certain members have realized the advantage of the benefits to which they would have become entitled had they elected to become contributors for full benefits, and have accordingly made representations for permission to withdraw the election they previously made and become contributors to the fund.
The desire of these members to acquire rights to benefit under the act on retirement, and to adequately safeguard their dependants in the event of death during service, can be readily appreciated, and as these members have accepted the service as a career, this bill will permit them to revoke the election previously made, and allow them to contribute to the fund on a full contributory basis. Each member who so elects will be required to establish his medical fitness and pay such contributions as would have been payable by him had he elected to contribute to the fund for full benefits in July, 1948. This will place him in the same relative position as others who previously elected for full benefits. Those members who require a further right of election under this bill, will have four months from the date upon which it receives the Royal Assent within which they may elect to become contributors.
The bill will also provide for a further right of election for those members who elected in 1948 to contribute for limited benefits, and who now desire to acquire rights to full pension or benefit under the act. Such members will not be liable for any additional contributions, but the deferred pay which stood to their credit in July, 1948, will be transferred to the fund and applied as contributions for fully paid units, instead of their becoming entitled to receive this amount as a lump sum in addition to a proportionate pension on retirement.
It might here be explained that personnel on limited benefits contribute to the fund for the difference between the number of units represented by their “ frozen “ deferred pay and the normal number of units based on their rates of pay for rank. If they now elect for full benefits, it simply means the transference of the deferred pay to the fund in exchange for the units it represents. The latter provision will apply, not only to naval personnel, but also to certain Air Force officers, who had the option of electing for limited benefits in July, 1948, and as in the case of those members who desire to become contributors for the first time, a period of four months is allowed from the date upon which this bill receives the Royal assent for the member to exercise his right to become a contributor for full benefits instead of for limited benefits.
The remaining provisions of the bill concern minor matters which in the course of administration or altered conditions applicable to the services have been found to be desirable or necessary and have been recommended by the Defence Forces Retirement Benefits Board constituted under section 5 of the act. I commend the bill to honorable members.
Debate (on motion by Mr. Chambers) adjourned.
Message recommending appropriation reported.
In committee (Consideration of GovernorGeneral’s message) :
Motion (by Mr.Hasluck) agreed to -
That it is expedient that an appropriation of revenue be made for the purposes of a bill for an act to amend the New Guinea. Timber Agreement Act 1952.
Standing Orders suspended ; resolution adopted.
That Mr. Hasluck and Sir Philip McBride do prepare Mid bring in a bill to carry out the foregoing resolution.
Bill presented by Mr. Hasluck, and read a first time.
– I move -
That the bill be now read :i second time.
The House will recall that by the New Guinea Timber Agreement Act of 1952 approval was given to an agreement between the Commonwealth and Bulolo Gold Dredging Limited to form a company to be known as Commonwealth-New Guinea Timbers Limited for the purpose of working the timber stands at Bulolo in the Territory of Papua-New Guinea. The text of that agreement was appended as a schedule to the act. The agreement provided for a nominal capital of CommonwealthNew Guinea Timbers Limited of £2,000,000 and by the act of 1952 the sum of £500,001 was appropriated from Consolidated Revenue as the Government’s first contribution to that capital.
Commonwealth-New Guinea Timbers has proceeded with a great deal of energy in the establishment of the mill and plant a.t Bulolo and is on the point of commencing operations. As a. result of this rapid development it was decided that a further £500,000 would be required during 1953-54 to bring the paid-up ca pital of the company to £1,500,000. Of the additional amount of £500,000 to be provided this year the Government’s share will be £250,000, and the sole purpose of the bill now presented to the House is to appropriate that amount. Provision of that sum has already been made in the budget for 1953-54.
No new principle or any point of policy is involved in the appropriation of this amount. I commend the bill to the House as very heartening evidence of the rapid progress that is being made in a great joint enterprise which should be of marked value in the progress of the Territory. I also take this opportunity to express appreciation of the way in which the company has applied itself to the purposes for which it was formed.
Debate (on motion by Mr. Calwell) adjourned.
Debate resumed from the 12th November (vide page 171), on motion by Sir Arthur Fadden -
That the bill be now read a second time.
.- This bill seeks to amend the Sales Tax Assessment Act (No. 5) 1930-1939. The Treasurer (Sir Arthur Fadden), in his second-reading speech, indicated the nature of the proposed amendments. The Opposition will not oppose the measure. However, my colleagues and I desire to take this opportunity to discuss the sales tax generally in relation to the proposed amendments. The sales tax was first introduced in 1930 by the Scullin Government when its need for increased revenue was urgent: At that time it was believed that the imposition of the tax would not have a very great impact on the cost of living or on the cost of production and services. I had the opportunity on a number of occasions to discuss this matter with Mr. Scullin when he was Prime Minister. He informed me that his Government had investigated the imposition of sales tax in Canada and that a survey indicated that in the circumstances existing at that time the greater part of the burden involved in the imposition of the’ tax would have to be borne by those in industry best able to bear it and, consequently, the full impact of the fax would not be made on the cost of living.
The tax operated in its original form until 1940, when the government of the clay, in order to obtain additional revenue, introduced the multiple rate system. However justified that alteration may have been under war-time conditions, it had the effect of making more complex the administration of the tax and of increasing the cost of collecting it. At the same time, the task of the business community was rendered still more difficult. Reports of the Commissioner of Taxation disclose that the cost of collection of the sales tax is less than that of any other class of tax. But the actual cost to the Government in this respect does not represent the final cost to the community, because the tax is imposed on the principle of self -assessment. Clearly, the cost incurred by the business community in collecting the tax on behalf of the Government is substantial. In addition to the revenue derived from the tax that cost is passed on in the prices of manufactured goods and, accordingly, is reflected in the cost of living. It is clear, therefore, that the tax. is complex and costly to collect, notwithstanding that the cost to the Government is small, and that it has an irksome effect upon the business community. Sales tax and other indirect taxes are described as regressive taxes. The percentage of their incidence varies inversely with the income of the taxpayer. An extensive survey conducted long ago in Great Britain proved that the ratio rises very steeply in the low income groups. The proportion is as high as 10 per cent.
– Order ! The honorable member appears to be engaging in a general discussion of sales tax. I point out that the purpose of this bill is merely to amend the Sales Tax Assessment Act (No. 5). There are nine sales tax acts. On this occasion, the honorable member is entitled to refer only to the bill before the House.
– That is true, Mr. Speaker, but surely the whole field of sales tax is involved?
– Not in this bill.
– I point out with respect, Mr. Speaker, that the sales tax law as a whole is consolidated. Surely, therefore, the whole sales tax field is open to discussion ?
– Order ! Since the inception of sales tax, there have been nine separate acts to cover this field of taxation. The custom is to have a general debate on sales ‘tax each year when bills to amend the nine acts are before the House. On this occasion, the House is considering a bill to amend Sales Tax Assessment Act (No. 5) 1930-1930. My ruling is that we cannot have a general debate on sales tax on this issue. Honorable members may discuss only the proposed amendments of Sales Tax Assessment Act (No. 5).
– I must bow to your ruling, Mr. Speaker, though i greatly regret it because I consider that a general discussion of sales tax would be useful at this stage. The purpose of this bill, to which your ruling narrowly confines me, is limited. It refers to two technical subjects only. The Opposition accepts the amendments for which the bill provides. One amendment refers to the payment of sales tax on goods that are imported for the purpose of being re-exported later. As the Treasurer (Sir Arthur Fadden) pointed out in his second-reading speech, the Collector of Customs, who collects the tax on behalf of the Commissioner of Taxation, has power to hold the tax for a period of twelve months and then, if the goods are re-exported, to refund it to the trader. The bill provides that the Collector of Customs shall be empowered to accept a security or an undertaking for payment of the tax. The Opposition does not object to that proposal. The second amendment is of a machinery nature. It provides for the deletion of a redundant section. We accept the bill.
– I realize that, under the terms of your ruling, Mr. Speaker, we must nOt engage in a general discussion of sales tax in this debate. I shall do my best to confine my remarks to the subject of the bill. Clause 5 provides for the repeal of section 6a of the relevant act and the insertion of another section in its place to provide that the Collector of Customs may accept a security or an undertaking for the payment of sales tax on goods that are imported for the purpose of being reexported later. Persons who bring such goods into the country are rea u 1red to provide a deposit of sales tax, which will become payable if the goods are not exported within twelve months in accordance with the regulations. I am concerned with the inflationary effect of this system of levying sales tax when such goods are not re-exported. Let us assume that a consignment of goods in this category is liable to sales tax of £100.000 if the goods are not re-exported. I have made the amount high purposely so that honorable members will be able to appreciate the effect of the system. If the ;goods are not re-exported and are sold in Australia, the ultimate purchasers pay, not only the sales tax paid in the first place by the importing company, but also an extra percentage at the rate of the margin added by the retailer to the original cost. The honorable member for Perth (Mr. Tom Burke) tried to direct attention to this anomaly when he spoke of the evils of sales tax. The margin allowed to retailers might be 50 per cent, or 33^ per cent. The percentage would be applied to the wholesale cost and the sales tax combined. This would have a severe inflationary effect on retail prices.
Reference has been made in this House already to-day to the effect of inflation on transport costs. This system of levying sales tax has a serious inflationary effect. I have said, for the sake of illustration, that the sales tax on a consignment of imported goods could amount to £100,000. That figure is improbable, but it indicates the danger of the system. I agree with the Government’s proposal to provide greater protection for persons who import such goods. The Opposition does not oppose the bill, but we wish to take advantage of every opportunity to remind the Government and the public of the spiralling inflationary effect of sales tax upon the cost of living.
– I shall reply briefly to the observations of the honorable member for Perth (Mr. Tom Burke) and the honorable member for Port Adelaide (Mr. Thompson), who spoke of the inflationary effect of sales tax. This bill will not have an inflationary effect. It refers simply to goods prescribed under regulation, such as travellers’ samples, certain goods imported for the purpose of public exhibition or entertainment, personal belongings of tourists and temporary residents, wedding presents, containers and goods imported for the purpose of being re-exported. No sales tax is payable on those items if the persons who bring them into this country are to leave again within twelve months.
– The tax is paid immediately.
– And subsequently refunded. There is no impost on the public at all. I remind honorable mem bers opposite, who have referred to the inflationary effects of the sales tax, that this form of tax was introduced by’ the Scullin Government. Therefore, when they are criticizing this imposition, they should remember that the party to which they belong was the author of it. Both the Curtin Government and the Chifley Government substantially increased the sales tax. This Government has reduced the number of sales tax classifications from four to two. Whereas previously the classifications were 50 per cent., 33^ per cent., 20 per cent, and 12-J per cent., they are now 16$ per cent, and 12-J per cent. If anybody is to be applauded for having eased the burden of sales tax, it is this Government and not honorable members opposite.
– I rise to correct in one or two sentences some statements that the Minister for the Army (Mr. Francis) has made. Of course, the honorable gentleman administers a branch of our defence forces and he is accustomed, as he thinks, to defending the country.
– I was merely stating the facts.
– The facts were unfairly and inadequately stated by the Minister. Under the Labour Government, the basic rate of sales tax was 8-J per cent. In 1949, the party to which the Minister belongs promised to reduce the rates, but the basic rate is still 50 per cent, higher than it was at that time. Instead of being 8$ per cent., it is 12-J per cent. Members of the Liberal party clearly promised to reduce the sales tax on essential items, such as furniture, but they have not done so. The rate has not been reduced, and the actual yield from the tax has increased enormously.
– Because of the greater prosperity in the country.
– The Minister apparently believes in inflation. He says the increased revenue from the sales tax is proof of prosperity. The truth is that the yield has increased because of inflation. The commodities that are bought are not intrinsically worth more than they were, but prices have risen enormously. As I have said, in spite of the 1949 election promises of the parties now in office, the basic rate of sales tax in 1 953 “ is 50 per cent, higher than it was when those promises were made and the yield from the tax has reached almost £90,000,000 per annum. This year, in spite of the over-vaunted reductions announced in the budget, the yield will be reduced by only about £1,000,000 on last year’s figure of £90,000,000. The basic rate is the important rate from the point of view of young people who need furniture for homes, and those are the people who were specially mentioned in the promises of Liberal leaders such as the Minister for the Army. When the Minister rose I thought he was about to speak on a defence subject. This is a topic that he does not usually debate.
– The right honorable gentleman should wake up.
– I am waking up. The Minister misled the House and the country and I rose to say in two minutes a few things that he omitted to say.
– The Opposition cannot deny that the maximum rate of tax has been reduced from 50 per cent, to 16$ per cent.
– Order ! The Minister for the Army has been interjecting continuously.
.- I rise to mention one or two points briefly. The Leader of the Opposition (Dr. Evatt ) took great care not to disclose that under Labour the highest rate of sales tax was 25 per cent., which is considerably higher than the maximum rate provided in the current legislation. The right honorable gentleman said also that large sums of money are being collected by way of the sales tax. Of course, large sums of money are being collected by way of the sales tax because of the buoyancy of the commercial life in this community. So far from being a thing of which we should be ashamed, it is a thing with which we may be highly delighted. The Leader of the Opposition continually refers to inflation in this House although he knows that the policy of his party, as disclosed by him from time to time, is to provide a tremendous amount of bank credit which could only send inflation flying even higher.
.- 1 should not have ‘risen in this debate except for the speech of the Leader of the Opposition (Dr. Evatt), who ostensibly sought to correct some statements by the Minister for the Army (Mr. Francis). The right honorable gentleman noticeably refrained from referring to goods from which the sales tax has been removed entirely by this Government.
– He could not .refer to that matter in this debate.
– But he did refer to like matters and I am replying to those references although the honorable member for Balaclava. (Mr. Joske), who received the call before me, has said much that I intended to say. As the honorable member rightly pointed out, greater production has increased the yield from the sales tax; but there is more to it than that. When Labour was in power, sales tax was not collected on many commodities for the simple reason that it is impossible to collect taxes on black-market, transactions. That is one of the fundamental reasons why sales tax receipts are so much higher to-day. Although it is true, as the Leader of the Opposition has said, that the minimum sales tax rate was lower in Labour’s time than it is to-day, the maximum rate was much higher than it is now. This measure should be considered fairly and free from the party political influences of which the honorable member for Perth (Mr. Tom Burke) is an obvious victim. The measure, as you have rightly pointed out, Mr. Speaker, has no relation to the general subject of sales tax rates. However, certain statements made by the Opposition had to be refuted.
– If there is to bp further debate on this measure, it must be related specifically to the contents of the bill.
.- I take it that references to matters already mentioned by honorable members will be allowed ?
– The honorable member for Mallee (Mr. Turnbull) referred to black markets and I think he should apologize for his reflection upon the record of the previous Government. The implication of his statements that sales tax could not be collected on black-market goods is most unworthy and I shall leave it with him to be judged according to his own ethical standards. One point made by previous speakers is that the revenue from the sales tax is still extraordinarily high.
– Order ! This bill does not deal with the sales tax revenue.
– It is not my intention to garnish what has already been said on this subject. Rather should I like to sub-edit it. However, I can say little that has not already been said by the honorable member for Perth (Mr. Tom Burke). My main purpose in rising was to protest against the comment made by the honorable member for Mallee.
Question resolved in the affirmative.
Bill read a second time, and reported from committee without amendment or debate: report adopted.
Bill - by leave - read a third time.
Debate resumed from the 12th November (vide page 169), on motion by Sir Earle Page -
Thai the bill be now read a second time.
– The bill proposes that standards shall be established for drugs and other substances used in the prevention and cure of illness. It is of great general importance. If the measure established a framework of standards for therapeutic substances for the whole of Australia, it would be of great significance but, as it is, it represents a step forward in the solution of the important problem of protecting the people of this country from the possible harmful effects of drugs used in the prevention and cure of illness. A great deal still remains to be done. Uniform action must be taken by the Commonwealth and the States to establish common standards for drugs throughout Australia. That could be done by a reference by the State parliaments to the Commonwealth Parliament, under the Constitution, of legislative authority to deal with the composition and standards of drugs and other substances for medical use.
The importance and. difficulty of the problem are shown by the second-reading speech on the measure of .the Minister for Health (Sir Earle Page). The right honorable gentleman has pointed* out that, in some respects, the present position is very serious indeed. He lias admitted that there is evidence to show that drugs are being supplied that do not conform to the requisite standards, and are incapable of doing the job that the medical profession believes they will do. I think everybody .agrees with the statement of the Minister that it would be criminal to allow such a state of affairs to continue through lack of appropriate action. Even in the case of life-saving drug3, to which the right honorable gentleman referred specifically, there is evidence of the necessity for a close check of standards. Under this measure, standards will be prescribed in regulations, but, in the absence of regulations, reference will have to be made to the British Pharmacopoeia or the British Pharmaceutical Codex, which provide recognized standards. I propose to give one illustration of the changing situation in connexion with life-saving drugs. In 1951, the Minister for Health said that a life-saving drug effective in treating pneumonia, typhoid fever and whooping cough had been produced in Australia for the first time. He said also that the drug, Chloromycetin, was an important addition to therapeutic agents, such as penicillin vaccines and sulpha drugs, that were being made here. He added that Chloromycetin had been accepted by the American medical profession as an important new antibiotic, and its use had increased rapidly during the last two years. That statement was made in 1951. On the 4th July, 1952, according to press reports published in Australia, the United States Food and Drug administration announced that its entire staff had begun a nation-wide survey to find out whether the antibiotic Chloromycetin was harmful and caused blood disorder. The deputy commissioner of the administration, Mr. Larrick, said that 200 new cases of blood disorder called plastic anaemia had been found since the previous Friday among persons treated with the drug. He said that some deaths had occurred, and reports of more deaths were coming in. At the same time, the American Medical Association Journal warned doctors against the promiscuous use of Chloromycetin. It was stated that three separate articles written for the journal (blamed Chloromycetin for the onset of plastic anaemia.
That shows how changes can occur. A great discovery is made. A new drug is used, apparently successfully. But then disaster and death are caused by overuse of the drug or its use in unsuitable cases. Nothing could illustrate more strikingly the necessity to have standards for drugs than the varying reports in connexion with antibiotics. The medical profession recognizes that standards must be prescribed. As the Minister has said, it would be criminal neglect if anything were omitted that could be done to ensure that proper standards are prescribed, especially in connexion with antibiotics, and that the drugs used shall be such as shall prevent disaster from ensuing.
Having made those general remarks, I turn to the bill and ask: How is it that the Commonwealth Parliament is dealing with this matter? The measure is very interesting and, as I have said, represents a step forward. It seeks to establish standards for therapeutic substances imported into Australia. One of the undoubted powers of the Commonwealth Parliament relates to trade and commerce with other countries. In clause 7 of the bill, the undoubted power of the Commonwealth ‘ over imports is, so to speak, picked up and utilized so that standards can be made to operate in the field of imported therapeutic substances. That is very important. In addition, there is a provision of a general kind with regard to pharmaceutical preparations provided under a law of the Commonwealth. As a result of the constitution alteration of 1946, proposed by the Chifley Government medical benefits and pharmaceutical benefits can be provided and are being provided, by the Commonwealth. That is very important. The Commonwealth has constitutional power to fix the standard. Clause 10 picks up that power, and there is a reference to quarantine, in respect of which the Commonwealth has a limited power. However, I wish to direct the attention of honorable members particularly to the provisions of clause 9, which refers to trade and commerce among the States. The Commonwealth may legislate not only in relation to trade and commerce with other countries, but also in relation to trade and commerce among the States. Therefore, up to a point, the Commonwealth can, constitutionally, ensure that in the course of interstate trade there are effective standards, which can be laid down. Clause 9 provides - (1.) A person 8lia.il not, without the consent in writing of the Minister, cause, suffer or permit goods that consist of a therapeutic substance to become the subject of trade or commerce among the States- unless they conform to certain standards. How is that provision to be applied? How will a person, when dealing with these goods, be able himself to distinguish, on the day of sale or even on the day of delivery, whether those goods will become the subject of trade amongst the States? I am only pointing out the enormous difficulty of applying that concept of interstate trade to a subject that cries out for uniform regulation. At present the Australian Parliament has a power over imports and over pharmaceutical benefits within our territories. “We have a power over interstate trade and commerce for the purpose that I have mentioned. A person is bound to conform to a standard. But it is very difficult to apply a rule that is laid down. It is almost impossible to distinguish between goods for interstate trade and goods for trade within a State. Our object should be to establish a standard that is safe whether the goods be for local use or for interstate trade. “ A “ may sell a therapeutic substance or drug to “ B “ and may not know that “ B “ is going to send that substance interstate immediately. Therefore what is required - anil the Minister’s second-reading speech indicates that -he appreciates the position - is action not merely by the Australian Parliament but also by the -State parliaments, assuming of course, that there is a reference of power to the Commonwealth to deal with the subject on a uniform basis. The Commonwealth should be empowered by
State statute, until there is a constitutional change, to deal with drugs and therapeutic substances. Apparently there is a desire at the departmental level to do this. However, we are still far short of that objective. It will be very difficult to apply the provisions of clause 9 because of the way in which local trade spills over into interstate trade, and interstate trade becomes domestic trade. The drugs are still used, ultimately, for the prevention or cure of disease. Therefore the standard of the drugs is of supreme importance to the people of Australia.
The Opposition supports the bill, and agrees with some of the comments made by the Minister. The need for urgent legislative action to achieve uniformity is proved beyond doubt by the illustration that I have given in relation to one drug. Further illustrations could also be given in relation to many other drugs. Let us consider the manufacture of a curative drug, the use of which is not attended by any risk. It must not be forgotten that inadequate raw materials could be used in its manufacture, which would reduce the efficiency of the drug. Therefore Commonwealth action is required not only in relation to importation, but also in relation to manufacture, with which the Commonwealth at present cannot deal. There is a need for co-operation between the Commonwealth and the States in this matter in order to achieve uniformity. As the bill is a forward step in that direction the Opposition supports its passage through this House.
.- The Leader of the Opposition (Dr. Evatt) has referred to the powers possessed by the Commonwealth in relation to matters mentioned in the bill. He has also referred to factors of interstate trade. I am glad that he supports the bill. We must not lose sight of the fact that this is a technical bill, which makes provision for the enforcement of new standards in therapeutic substances. This has been rendered necessary as a result of the new life-saving drugs and substances that have come into use during the last decade. It is only right that the Parliament should take steps to protect both the Commonwealth Treasury, and the taxpayers of this country, because claims amounting to millions of pounds are paid each year in respect of pharmaceutical benefits, repatriation dispensing, and the pensioner medical service. It is right that the Parliament should consider standards of purity for these new drugs. Of course there have always been standards in operation during the years that drugs have been dispensed and distributed to the community, but the bill lays down unified Australian standards in relation to drugs that are in general use. The British Pharmacopoeia, which is referred to in the bill, is a treatise on the standards of drugs. It is published at frequent intervals. That official publication contains specifications and standards for drugs used by the medical profession in ali British Commonwealth countries. The British Pharmaceutical, Codex is also referred to in the bill. That publication provides standard test methods of preparation for all drugs and combinations that are not in common use, and which are not referred to in the British Pharmacopoeia. From time to time some drugs are removed from the pharmacopoeia and new ones included. In addition to those two treatises, the health departments of the six States administer regulations in connexion with the standards of drugs. But unfortunately they vary considerably in each State. Notwithstanding the variations in present State law, there is a very important principle embodied in all enactments that relate to the sale of goods. That principle is that the buyer shall be entitled to receive goods of the standard and quality that he demands and specifies. Consequently, it may be correctly presumed that when a buyer purchases a drug which is in common use, he will obtain the drug at the standard referred to in this measure. That is, when he specifies and demands a drug, he will be supplied with the drug according to the British Pharmacopoeia standard. If he does not get it, then the vendor of the drug is liable to a fine unless the drug is specifically stated to be of commercial standard, second quality or something other than first quality.
As well as the drug laws administered by the State health departments, there are special pharmacy laws in each of the six States. The Pharmacy Board in Victoria has promulgated regulations which provide that all drugs or medicines prescribed shall be actually used to fill the prescriptions. Also, no specified drug shall be left out of a prescription without the consent of the medical practitioner who wrote the prescription. Sometimes the prescriptions of medical practitioners have been found by chemists to be iml>” acticable,because certain prescribed drugs are incompatible. Therefore, it has often become necessary for a chemist to consult with a doctor in order to arrive at the best method of filling a prescription. The pharmacy boards in the various States lay down specifically what can and what cannot be done in these circumstances.
The British Pharmacopoeia, the British Pharmaceutical Codex, the six State health departments and the pharmacy boards of the States all control the standards and regulations iii connexion with drugs. Therefore, it seems rather peculiar that we’ must now have another law to superimpose further authority on the laws of the State health departments aud the regulations of the State pharmacy boards, and I sincerely hope that the bill will not foster the development of another big Commonwealth department. I hope that the Minister for Health (Sir Earle Page) will be able to bring some uniformity into the six State health departments, or delegate authority to the States in some way, so that the new standards in regard to new therapeutic substances may be administered. If that is not done, we shall perhaps build, up a large ancillary section to the present Department of Health, or, indeed, a nev.’ department altogether. If that should happen the cost of administration of our health services would be considerably increased.
I agree that there is a great need for uniform drug standards and tests for therapeutic substances throughout the Commonwealth, and to-day honorable members heard the Leader of the Opposition refer to some anomalies in this connexion. However, the steady introduction of new drugs has revolutionized medical practice and has brought undreamed of benefits to mankind. At the same time these drugs have increased complexities in regard to the administration of the laws controlling the manufacture and sale of drugs. In earlier days when drugs were of a more simple nature,, pharmaceutical chemists were ablequickly to apply simple preliminary tests in order to ascertain whether drugs were up to standard. Now drugs are becoming more complex, and elaborate and expensive equipment is necessary to ascertain their quality and standard. That has made the work of the chemist much more difficult.
New, complex drugs have increased chemists’ difficulties very considerably because simple tests are no longer sufficient. Under this measure the manufacturers of these new drugs will have to comply with the specifications laid down in the regulations and each package will have to be labelled accordingly. That will particularly apply to new substances like penicillin, sulphanilamide, streptomycin and aureomycin. Nowadays when more and more of these complicated drugs are coming on the market, many of them are being given fancy names by their manufacturers although they are really well-known substances mentioned in the British Pharmacopoeia.
The older manufacturers, whose names are household words throughout the British Empire, will welcome this measure because ‘they will be protected from the activities of those newer manufacturers who have set up business to manufacture popular new drugs because there is a quick and ready market for them irrespective of their quality. Moreover, the Australian Government which is a big supplier of drugs through its pharmaceutical benefits, repatriation activities and the like, will be able to ensure that it will get the drugs that it orders and pays for. Manufacturers of good repute welcome the bill but, like the chemists, they want to have some say in the carrying out of the regulations, because the regulations will materially affect those manufacturers who have been practising, in some cases under- different names, for centuries. Moreover, pharmaceutical chemists should be able to give the Government the benefit of their experience, not only in regard to packages which vary so considerably in different States under State law, but also in connexion with the recognition of the drugs and the reduction of administrative expenses. It must be conceded that lay people do not understand the difficulties that arise in carrying on the business of a chemist who is involved in the dispensing of these drugs.
The manufacturer must be represented on these committees, too, because he could give a tremendous amount of guidance to the Government. Clause 19 of the bill deals with the making of regulations and provides for the setting up of committees for the purpose of advising the Minister on matters relating to the importation into Australia of therapeutic substances and on such other matters as may be prescribed. I hope that the Minister will assure the House that he will establish these committees and that they will .be composed of the people to whom I have referred, and not only of medical practitioners but pharmaceutical chemists, manufacturers and possibly the wholesalers of drugs all have their own distinct province to represent. I remind the Minister that there are still six State health departments in this country and, as far as I know, six pharmacy boards, all policing their own standards and administering their own regulations in regard to the sale of drugs. I hope that the Minister will assure the House that another big branch will not be set up within the Health Department in order to administer this bill. Surely the departments of health that are already functioning in the various States should be able to administer some of the provisions of the bill on behalf of the Commonwealth and so reduce the cost of administering these laws. I support the hill and hope that the Minister will clarify the matters that I have mentioned.
.- It is high time that legislation of this nature was introduced in this House. The Opposition does not take objection to the bill, but we criticize the Government for its tardiness in introducing it. The bill seems to have been introduced as a facesaver for the Minister for Health (Sir Earle Page), who has incurred the better part of £20,000,000 in the implementation of the scheme for the provision of free medicines and life-saving drugs which he announced two or three years ago and which he said would be the salvation of this country. Having spent about £20,000,000 of the people’s money, he has now told us blandly that a considerable amount of it has been wasted. As a matter of fact, at the end of last year, the Minister announced that tests had shown that some drugs that had been supplied under the free medicine scheme were of such inferior quality as to have no therapeutic value. In addressing the conference of Federal and State health officers which was held in Canberra last November, he said that this was a dangerous state of affairs which should not be allowed to continue. He said that the scheme had cost £7,000,000 a year for prescriptions that had been dispensed by chemists. The Director-General of Health, Dr. Metcalfe, told the conference that the Commonwealth was concerned with the likelihood of the importation of inferior brands of antibiotic and glandular products. He said that Australia was exposed to the dumping of condemned and inferior drugs which could not be marketed in countries where a stricter control of drugs was exercised. It seems that Australia was caught just as flat-footed in its importation of drugs as it was in the importation of other commodities which flooded this country before the Government imposed import restrictions. The Government should have been much more alert. But the Minister for Health is so enamoured of life-saving drugs that he overlooked that very important fact. Dr. Metcalfe said that the Commonwealth was the purchaser of the great bulk of the life-saving drugs sold in Australia and was entitled to demand that they should conform to accepted minimum standards of purity and efficacy. The Commonwealth could not obtain an assurance that those standards would be observed. That is why the Government has been forced to introduce this bill.
The Minister for Health was taken to task by the chairman of the Ethical Pharmaceutical Association, Mr. McDonald, who said that the Minister’s statement was quite untrue and that the principal cause of the supply of substandard drugs was the ridiculously low prices that were offered for them by the
Department of Health. I am inclined to accept the viewpoint of the Minister on this matter because he has spent about £20,000,000 on these drugs which represents about £1 a prescription. Influences are at work to dump worthless commodities « in this country and it is time that the public was given protection against them. A royal commission was appointed by this Parliament in 1907, the commissioner being Octavius Charles Beale, who examined the whole subject of the sale of imported drugs. He made a world tour in order to investigate the matter and he finally furnished one of the most damning indictments that has ever been made of the people who manufacture and peddle these commodities. Apparently the government of the day decided that his report was too hot to handle because it is still in a pigeon-hole. At long last, something is being done about the matter. Unfortunately, the public has had a raw deal in the meantime. The voices of the few people in the Commonwealth and State Departments of Health, who have striven to improve this state of affairs have been like voices in the wilderness. Vested interests have been able to ensure that worthless . drugs should remain on the market under different names and in various forms from time to time. The latest craze is the antibiotics with which the- Minister seems to be carried away. The royal commission of 1907 made 1,000 recommendations and findings and it is high time either that they were implemented or that another royal commission was appointed in order to review the present situation. Full page advertisements about these commodities appear in the press. 1 cite paragraph 1012 of the report of the royal commission, which deals with the question of advertising. It reads in part -
They find papers not merely willing but solicitous to share in their iniquitous and fratricidal gains.
Paragraph 1013 states -
The shouting in the markets, the blatant advertisements of these quacks, often printed $o as to be indistinguishable from reading matter, mislead thousands to their ruin, and the silence of the cemeteries covers their infamies.
An important point in relation to this measure is whether it will deal with the question of secrecy as well as the question of the efficacy of these substances. The preamble to the report states -
The preservation of secrecy and of the privilege to deceive is absolutely indispensable to the traders whose traffic is reported upon, but the perpetuation of the advantages they now enjoy means moral corruption, physical deterioration, and national decadence.
According to the medical journal Lancet, quackery has destroyed more people in this country than sword, famine and pestilence united. History repeats itself. The same old remedies are still advertised in the press. Unfortunately, there is no counter-propaganda. That is where this measure, in the opinion of the Opposition, does not go far enough. The honorable member for Isaacs (Mr. Haworth) said that he hoped that the people who will investigate the quality and use of these substances will include pharmacists, manufacturers and representatives of the drug companies. In my opinion, they are the last people who should be .given that responsibility. It should be given to some independent authority unfettered by any vested interests. The public generally should be represented. Many of these substances that are displayed to the public are harmless and are not poisonous like many of the antibiotic drugs. It has been established that of approximately 300 antibiotics, only five - penicillin, aureomycin, streptomycin, terramycin and Chloromycetin - have been regarded as sufficiently nonpoisonous for human use. Unfortunately, as the Leader of the Opposition said, it has been shown that some of those antibiotics are setting up powerful reactions and in many cases are proving to be fatal. Steps should be taken to warn and to educate the public in regard to the various nostrums and secret drugs that are publicized.
– These are not secret drugs.
– They are all secret, otherwise nobody would take them. I once heard a medical man say that in his opinion the majority of the drugs and medicines that are sold in the shops should be tipped over the Sydney Harbour Bridge for all the good they do.
There are 10,000 cold cures registered at the Patents Office.
The annual cost of ineffective vaccines and chemical prophylaxis (prevention) is great enough. The bill for worthless cold medications is alarming, particularly as some of it may lie actually prejudicial to health.
That is the sort of thing that is being dumped in this country, as the Minister for Health, has just discovered. T am glad to know that he is doing something about it. Like all nine-day wonders, or nine-year wonders, many of these antibiotics are becoming a big business overseas and doubtless that is why the Commonwealth authorities have been alerted. As the business becomes bigger and the profit becomes greater, the manufacturers become less concerned about the value of the substances.
I refer now to an article in the Scientific American of August, 1949, by Mr. George W. Gray, a scientist and member of the Rockefeller Foundation staff and the author of the Nobel peace prize and other articles in that publication. He said -
Although our knowledge of antibiotics dates back to the time of Louis Pasteur, their development has only taken place in the last ten years or so, e.g. penicillin was first administered systemically to human cases in 1941, streptomycin in 1944, Chloromycetin in 1947 and aureomycin in 1948.
Those drugs are quite a recent innovation. Prior to the antibiotics, Australia had the sulpha drugs and prior to them it had other high-powered drugs that were brought from overseas from time to time. I have seen them come and go over the last 30 or 40 years. The article continues -
Penicillin and streptomycin, he further pointed out, are now being produced in the United States at the rate of 6i tons per month while Chloromycetin and aureomycin are rapidly approaching large scale industrial production.
Penicillin production of the United States rose from less than half a billion units per month in 1943 to 34,289 billion units in December, 1951.
Streptomycin production of the United States increased from about 20,000 grams per month in 1940 to 18,006,000 grams in December, 1951.
It is shown that the development of antibiotics is something that calls for very careful consideration. The Government must be concerned about the efficacy of these drugs, because it has been shown that in a very short time the germs that the drugs are supposed to control become resistant to them and that more powerful drugs have to be used to the point where they become worthless or even harmfulto the people who receive them.
I refer now to a press article dated the 6th November, 1951, entitled “Wonder Drugs Less Effective”. It refers to penicillin, streptomycin, aureomycin and Chloromycetin. I point out that they are four of the five drugs which it has been claimed are in any way effective of the 300 antibiotics that I mentioned earlier. The remainder have been too harmful or too poisonous for human use. The article states -
Penicillin, streptomycin, aureomycin and Chloromycetin are now less effective against microbes than they were two or four years ago, according to a report by Army Doctors to the Clinical Congress of the American College of Surgeons. The most striking example was the weakening of penicillin against golden staphylococcus, a germ which causes abscesses and boils, says the report.
It says that, in 1947, the survival rate of this microbe was only 30 per cent, in tests involving standardized doses of the drug.
In 194.8 and 1949, 59 per cent, of the microbes survived the same dose.
In 1950 the survival rate was about 61 per cent. “ Doctors could combat the weakening tendency by giving heavier doses, but that could not be continued indefinitely,” continues the report.
That surely indicates the trend. Probably we shall find that the whole of the money which the Minister has expended on the importation of these life-saving drugs will be wasted in the long run. According to a recent report, the United States Food and Drugs Administration has warned doctors against the indiscriminate use of the drugchloromycetin for minor infections. The report stated -
The U.S. Food and Drugs Administration warned doctors against the indiscriminate use of the drugchloromycetin for minor infections. It acted on a nation wide medical survey in which some seriousblood disorders were found to have resulted from the use of this potent antibiotic drug.
Chloromycetinhas been administered to about 8 million patients since it came on the market in 1949.
The U.S. National Research Council’s report said it appeared that disorders in at least 177 of 410 serious blood cases studied were associated with the use of Chloromycetin. About half of these patients died, the report said.
Further evidence was given in the Sydney Daily Mirror of the 5th January in an article which read as follows -
A controversy among many doctors has arisen over a British Medical Journal leading article saying the prescription of powerful antibiotics such as streptomycin and Chloromycetin must be curtailed drastically. It is said that the grave dangers in using the drugs indiscriminately for minor ailments like measles, coughs, colds were (1) the too frequent use of the drugs established a high degree of resistance to their remedial qualities, and (2) Chloromycetin could cause sudden death from a plastic anaemia or degeneration of the vital bone marrow.
Critics of the Journal are accusing it of scare tactics - they claim the drugs are perfectly harmless if they are restricted to normal use.
That is the point of view of those who manufacture or retail these commodities. A reliable, independent source, the British Medical Journal, has issued a warning in regard to the dangers of these nostrums.
The same comments may be made about penicillin. An article which appeared in the Sydney Daily Telegraph of the 1st March read as follows : - “ People had been admitted to Sydney Hospitals seriously ill after taking penicillin “ a leading pathologist said. Ho was commenting on an American doctor’s statement (Dr. Sheppard Siegel) that indiscriminate use of penicillin could kill people.
The pathologist said “I haven’t heard of anyone dying after using penicillin - but it could happen. We have had quite a few people in hospital seriously ill from its effects.”
A similar warning was given in the American journal Time. I suggest that these warnings show that the Minister for Health is really out of date in this matter. He is probably 30 or 40 years behind the times in regard to many matters concerning health and medicine. The American journal Time published the following article on the 24th October, 1949, which was before this Government’s free medicine scheme com- menced : -
Doctors are keenly aware that the antibiotic (sulpha drugs: penicillin, streptomycin, &c. ) have two great dangers:
Sometimes the drug has a poisonous effect on the patient; and
the bacteria under attack may develop a. tolerance for the drug.
Last week doctors at the 13th Congress of the International Society of Surgery in New Orleans were reminded of another danger: antibiotics speed up the clotting time of the blood, and thus subject the patient to the risk of death from blood clots forming, breaking loose and being carried through the heart into the lungs.
One would have thought that the Minister would have been in possession of such information before deciding to flood the country with these antibiotics or so-called wonder drugs, which have been included in his free medicine scheme. The Minister himself must accept responsibility for the admitted huge expenditure and wastage in regard to the worthless drugs which are being brought into the country under his scheme. As the Leader of the Opposition stated, a few years ago the Minister announced the great potentialities ofChloromycetin, which has now been shown to be harmful and even fatal in some instances. Honorable members may recollect that the Minister came into the House a couple of years ago and, with bated breath, told us of the wonders of ACTH and cortisone. However, it has been found that they are of no real lasting value. The sad part about it is that many people who suffer from various diseases are led to believe that these nostrums will help them. Honorable members may be aware that a well-known Sydney philanthropist set up a clinic for the treatment of cancer, and a certain drug was hailed as the one which might solve the problem of cancer. Ten “ guinea pig “ patients were put into the clinic, and although their hopes were raised for a few weeks, one by one they passed away. I knew some of those people. They were led to believe that their lives were going to be saved, but finally their hopes and those of their relatives were completely dashed.
This Government is looking about for methods of popularizing itself with the electors. Apparently, the free medicine scheme is the last card in the Government’s pack. If the Minister for Health is able to pull some miracle drug out of the hat before the next general election he will be cheered by all Government supporters. It seems to me that with his long experience of health matters, greater caution should have been shown in selecting these drugs. What should concern us all is how these therapeutic substances will be used. The Minister has not given us much information at all in that connexion. He has asked for power to administer their control by means of regulations, but we know that he has a habit of handing over control of health matters to outside bodies. The honorable member for Isaacs (Mr. Haworth) suggested’ that those concerned in the trade, the retailers, chemists, manufacturers and drug merchants, should have representation on the proposed committees of investigation. As I have already said, to my mind they should be the last people to serve on such committees. Indeed, an assurance should be given that the committees will be of an independent nature. I.’ appreciate that the retailers and manufacturers are entitled to some protection, but it is essential that the members of the investigating committees should be in no way concerned with the vested interests involved. That is the trouble in the United States of America, from where many of these drugs are coming. Recently there was a hullabaloo in that country concerning a drug for .the treatment of cancer which had been discovered there. On the 1st August last the Sydney Morning Herald contained the following report : -
An investigator for the U.S. Senate Commerce Committee said yesterday there was an “ interstate conspiracy of alarming proportions “ to restrict sales of the controversial cancer drug Krebiozen, and that the American Medical Association might be involved.
The investigator, Mr. Benedict Fitzgerald, said in a. staff report printed in the Congressional Record that there was “ reason to believe “ the American Medical Association acted in a “ hasty, capricious, arbitrary and outright dishonest manner “ in opposing immediate use of the drug.
His investigation of the Krebiozen controversy disclosed “ the weirdest conglomeration of corrupt, motives, intrigues, selfishness, jealousy, obstruction and conspiracy that 1 have ever seen “. “ The alleged machinations of Dr. J. J. Moore (treasurer of the A.M.A.) could involve the A.M.A. and others in an interstate conspiracy of alarming proportions . . .
Public and private funds have been thrown around like confetti at a country fair to close up and destroy clinics, hospitals and scientific research laboratories which do not conform to the viewpoint of the medical associations. Contrary to thi’ American Medical Association view, it was his profound conviction that Krebiozen was “ one of the most promising materials yet isolated for the management of cancer “, and he recommended that thecommittee go into the matter further.
Honorable members may well imagine the kind of controversies that may arise about the efficacy of therapeutic substances in the manufacture of which vested interests are involved. I believe that there are certain organizations engaged in the manufacture of therapeutic substances in Australia with which members of the medical profession are associated. Great controversies have recently arisen between them and other drug manufacturers. That fact, in itself r calls for an assurance on the part of the body to be charged with responsibility for investigating therapeutic substances that its members are not in any way tobe interested or involved in their manufacture.
I am wholeheartedly in accord with the sentiments expressed by the honorable member for Isaacs when he said that he hoped that the members of theauthority to be established to investigate therapeutic substances should be completely free of self-interest in the matterand that it should not be an arbitrary authority. Proper care should be taken to ensure that the interests of the people shall be protected. Very few of the socalled experts who have given their imprimatur to certain of these substances are completely satisfied that they will turn out all right. Too often it is a caseof “ Your guess is as good as mine “. The health of the people must be the first consideration. Provision should be made for a right of appeal against the restriction of output or the banning of the use of therapeutic substances either to the investigating authority or to the Minister for Health. Provision should also be made in the bill for the importation of therapeutic substances for experimental purposes. Although in the first instance the edict may be against the use of a particular substance, after further trial and experimentation it may prove to have desirable qualities. Provision should be made for the re-submission of such substances to a properly constituted examining body.
Great credulity is associated with many of these substances. In order to show how a certain impression may be gained, and quite sincerely so, I mention that when the drug ACTH was first discovered, the medical profession of the United States of America was very much enamoured of its prospects. The substance was manufactured by certain drug companies. In 1949, a demonstration of its use was given at the Mayo Clinic, in Chicago. The Scientific American, referring to the demonstration, had this to say -
Last October, John B. Mote, medical director for Armour, called a conference of those to whom he had given supplies of ACTH for an exchange of reports on the results of their use of the hormone. They met in Chicago foi two days. [Extension of time granted.’] I thank honorable members for their forbearance. I was just rounding off the point which I desired to make. The article continued - “Never have I attended such a conference,” reported one physician, on his return home. “ It was like a religious meeting, with men popping up all over the house to tell of some seeming miracle. No medical gathering in history ever heard reports of so many different diseases yielding to treatment with a single drug.”
That is how ACTH and cortisone were launched. The article continued -
The Bible relates that the pool of Bethesda stood by the sheep gate to Jerusalem, and hundreds of the sick, the crippled, the withered of body and mind waited at its edge. They waited for the moment of healing. According to tradition, an angel descended into the pool at certain seasons and troubled the water. Whoever then first stepped in was healed, no matter what his affliction. The idea that there exists a universal remedy which is sovereign over all diseases has persisted through the centuries. The medieval search for the elixir of life has been succeeded in more recent times by the familiar examples of homeopathy, osteopathy, and chiropractic, each with its one cause and one cure. Scientific medicine has consistently frowned on all unitary theories of the healing art. But the demonstration of what hormones can do brings this whole subject under a new scrutiny. To be sure, there are many blanks in the hormone picture, many questions yet to be answered, many byways to be explored. For example, ACTH may stop a few attacks of gout; but when administered in the quiet period between attacks, it may also bring on an upflare of the disease. Like a valve, the hormone seems to work in either direction, depending on which side exerts the greater pressure.
The report which I have read reveals the credulity of so-called authorities in these matters. The Minister for Health should ensure that proper investigation shall be made of the curative properties of therapeutic substances before the people of Australia are put to the expense of importing them. I am sorry that he did not make suitable inquiries three or four years ago about some of the substances to which the article from which I have quoted referred. I realize, however, that his department is short-staffed and that it is doing a yeoman job with a handful of men and the limited facilities at its disposal. “When the Labour Government introduced its health scheme the present Minister for Health said that, instead of providing free medicine for the people, it should provide them with free coffins. Before he began to give effect to his health scheme he should have sent his officers overseas to obtain the latest health information then available. If he had done so he would not have wasted £20,000,000 of the taxpayers’ money and be now engaged -in locking the stable door after the horse has gone.
– ‘Contrary to the impression that might have been gaining ground during the last 30 minutes, this is a comparatively simple bill about which little needs to be said. At the commencement of the debate, we were assured by the Leader of the Opposition (Dr. Evatt) that the Opposition whole-heartedly supported the measure. I am at a loss to know what the honorable member for Reid (Mr. Morgan) is so upset about. I gathered that, on the whole, he is opposed to antibiotics and, in some measure, to the Minister for Health (Sir Earle Page).
Although this is a short and simple bill, it is an important one, because it is concerned with the standards of drugs and with the fact that they should be uniform in strength and be capable of producing the therapeutic effects which are claimed for them. It is more than ever necessary to have legislation of this bind in these days because drug usage within the last few years has become quite a different proposition from what it was a few years ago. So many diseases, many of them important, are now treated with single drugs that there has been a revolution in the prescribing of drugs. The treatment of common diseases such as pneumonia has become much less difficult than it was a few years ago. Largely it has become a matter, first, of exact diagnosis and, secondly, of the administration of single drugs such as penicillin, Chloromycetin or aureomycin or others that may be prescribed; but because prescribing now is of that nature, it is more than ever important that the drugs should, in fact, do what they are designed to do and that they should be of sufficiently high standard to cure diseases when given in therapeutic doses. That is the object of this bill.
As the Commonwealth now meets the cost of most of the major drugs used, it is important that the Australian Government should insist upon them being of high standard because they are used throughout the nation. Australia consists of six States and therefore the States and the Commonwealth must join together in ensuring that the drugs used in modern therapeutics are of required standards. Nobody with any knowledge of current affairs believes that the States will refuse to co-operate in this matter. The Minister for Health has assured the House that the opposite is the case. However, this legislation is none the less necessary because there must be a unified authority to fix a central standard, and the co-operation of the States in that matter is important. I do not remember the Minister stating in his second-reading speech that the States had actually agreed to pass the required legislation ensuring their co-operation, but he did say that they had agreed to co-operate and I believe that honorable members can con- fidently anticipate that the legislation will be passed.
I turn my attention now to the nature of the tests that should be applied to drugs. By and large, it can be said that there are two main divisions that must be considered. The first includes drugs, the standards for which are laid down in the British Pharmacopoeia and the British Pharmaceutical Codex. The other includes the drugs that are introduced between the editions of the Pharmacopoeia, but may become available and, in fact, be used before they can be incorporated in the Pharmacopoeia. That occurs frequently. Many of those so-called drugs are not drugs in the strict sense of the word but are sera or antibiotics or therapeutic substances of a different nature. However, for the purposes of the legislation, they can be described as drugs. The testing of those drugs is often a complicated process. It is not a simple chemical analysis, by any means, and often involves what is termed a biological assay. The effect of the drugs and. the doses have to be determined by the use of laboratory animals before the drug is applied to human being3. Obviously, some central standard authority is necessary to lay down for the whole of Australia the standard that the drugs need to attain. The bill makes that provision.
I merely wish to say in that connexion that I hope the Australian Government will always take advantage of existing relevant authorities. Numerous State universities and hospitals have facilities for testing and standardizing drugs. I hope that any government that is in office will take advantage of them, as the present Government has. done and is doing, rather than set up complicated new laboratories or organizations to do that work. Again that would require the co-operation of the States. Undoubtedly that will be forthcoming.
I turn my attention now to the expert committee on standards to which the Minister has referred. The honorable member for Isaacs (Mr. Haworth) was correct in his statements upon that matter. Representatives of the manufacturers should be included on the committee because the manufacture of the substances to which the bill refers is a highly skilled and technical process and involves various problems. It is not a matter of getting profits; it is only common sense. The members of the committee should include also persons who are skilled in the pharmacology of the drugs and persons conversant with their uses. 1 am sure that the Minister will give those matters consideration. It is easy to say, in effect, “ We must not have manufacturers as members of the committee because they might make profits out of it If there is to be a committee to determine the standards of drugs, naturally those who make the drugs must be represented on it. They are the persons who, above all, should be represented.
I believe that my brief comments have covered the substance of the bill, for it is not a long or controversial measure. Essentially, all modern drugs should be of high standard because they could fail to produce the proper effects if they are not of the best quality. In addition, their use must be carefully supervised because they can have unfortunate effects from under-dosage or over-dosage. No one of common sense would suggest that a drug should be eliminated from use because it can have unfortunate effects. If that attitude were adopted generally, practically every drug that is used by doctors would be discarded. It is important that imported drugs should measure up to the standards of the Australian drugs, and that the standards should be uniform. The bill provides the mechanism to ensure that that will be so.
Other matters for which provision is made in the bill are also important. Drugs should be correctly labelled and it is most important that, the label should be of such a nature that the drug cannot be mistaken for some other substance. The standard of the drug should measure up to the standard that is claimed for it on the label. Those are matters for which provision is made in the bill. It is an eminently sensible measure and with the cooperation of the States it will work successfully. I am sure that the Government has the co-operation of not only all parties in the House but of all the States in putting this most useful measure into practice.
– I agree with the statement of the honorable member for Oxley (Dr. Donald Cameron) that members of the Opposition are supporting this bill, but I point out that the measure will give rise to some debate, because it affords us an opportunity to discuss certain important matters. This bill may be regarded as a result of the astonishing advances made in medical science and in the knowledge of drugs in recent years. For a long time, the British Pharmacopoeia set certain standards in respect of drugs. Most of the drugs in general, use were well known to the public, and were dispensed by chemists in accordance with the prescriptions written by doctors. About 30 years ago, members of the medical profession begain to prescribe new drugs, and new mixtures of drugs, in place of the drugs named in the British Pharmacopoeia. That change was brought prominently to the notice of the public at that time, because dispensers and chemists, under the agreement between friendly societies and medical practitioners, had been dispensing, at a flat rate of charge, prescriptions written by doctors from drugs contained in the British Pharmacopoeia. As the result of the introduction of new drugs, and new mixtures of drugs, members of friendly societies discovered, when they went to dispensers or chemists, that they had to make a payment in addition to the flat rate of fee, because certain drugs that were not contained in the British Pharmacopoeia were included in prescription. Usually, they were proprietary lines, and mixtures of drugs, which had previously been mixed by the chemists, or even new drugs. At times, dispensers told me that they had on their shelves some of the drugs which had been prescribed by doctors and for which members of friendly societies had to pay an extra fee because the drugs were proprietary lines. The chemists could have mixed them for the patients without any additional charge to them. As the years passed, doctors, because they considered it desirable and beneficial to do so, began to use, on an increasing scale, these new proprietary lines. In recent years, the life-saving drugs, the antibiotics and others, have come into fairly common use. I shall not attempt to pronounce their names. They are real tongue-twisters.
The Minister for Health (Sir Earle Page) said, in his second-reading speech -
I regret to state that at the present time there is evidence to show that drugs are being supplied that do not conform to the requisite standards and so are incapable of carrying out the job which the medical profession believe they will carry out.
About a year ago, the Minister, in reply to a question, mentioned that some of the new drugs had not been tested sufficiently to satisfy him that they should be in general use and should be made available, free of charge, to the public. That statement indicated the need for control of the standard of drugs, and of the importation of various drugs. Doubtless, other honorable members have had experiences similar to that which I am about to relate. Persons who have suffered for many years from chronic diseases, such as arthritis, have asked me : “ Why cannot we obtain suchandsuch a preparation? We have read in the newspapers that this drug is working wonders in the United States of America. We are invalids. We do not want the invalid pension. We desire to go to work, yet we are not able to get this drug, which may cure us.” I know that the drug to which I refer is one which the Minister has in mind. This bill represents an attempt to control the standards and manufacture of drugs.
The Minister also referred, in his second-reading speech, to the need for greater co-operation between the Commonwealth and the States in respect of the control of drugs, and the determination of the standard of purity of such substances. He stated -
An expert committee of the National Health and Medical Research Council, which is the technical body to which both Commonwealth and State governments look for advice on these matters, recommended in 1951 that the Commonwealth should pass an amending act dealing with therapeutic substances. As a result of this recommendation, the Commonwealth and State governments agreed that a conference of their representatives should be held. . . This conference passed a number of important resolutions concerning the regulation and control of therapeutic substances and of other matters incidental thereto . .
As I listened to those words, I was impressed with the need for action in this matter. The conference to which he referred recommended that the Commonwealth should enact legislation, to the limit of its constitutional powers, relating to the standard of purity of certain therapeutic substances. The definition of “ therapeutic substance “ given by the Minister will be of interest to many people. It is as follows : - “ therapeutic substance “ means any material nr substance that is used in the treatment of disease or sickness.
I am sure that the people of Australia, when they understand the purposes of this bill, will be most satisfied with it. The Minister also stated -
The governmental experts at their conference recommended that there should be an expert committee set up to advise the Commonwealth and the States on suitable standards for drugs not yet included in either the British or other recognized Pharmacopoeia and other related matters which are incidental to such standards.
The Government has accepted that advice ; the expert committee is to be appointed. That bears out the statement that I made earlier in my speech that advances in medical science, and the discovery of new drugs, particularly the antibiotics, have reached the stage at which it is necessary to control the manufacture and standard of such drugs in the manner proposed in the bill. The Minister said, in addition -
Also, if the Parliament approves of this measure and complementary legislation is enacted by the States, the collaboration of those parties will result in uniformity of packaging and labelling of therapeutic substances throughout Australia.
The honorable member for Oxley has spoken of the necessity for insistence upon the correct labelling of therapeutic substances in order that people may know exactly what the packages contain. This matter recalls to my mind an occasion many years ago when the South Australian Parliament considered legislation to provide that the contents of packages should be true to label. I hope that this bill will achieve, in practice, all the hopes that have been expressed by the Minister in his second-reading speech. The right honorable gentleman has also mentioned the supply of drugs by the Government. I assume that he refers principally to what are termed the life-saving drugs, which ere prescribed by doctors and are supplied by the chemist to the patient free of charge. The Minister has pointed out that the bill provides that such drugs must be pure and in accordance with the requisite standard.
Honorable members may well debate this bill on non-party lines. It does not confer a privilege on one section “to the disadvantage of another section of the community. No privileged group of persons will derive any particular advantage from it. The doctor who prescribes the drugs, and the patient who takes them, will be assured that they are of the requisite standard, and that the claims made in respect of their curative powers have been thoroughly tested. Approval of drugs does not mean that they will provide a certain cure. If any claim that is made in respect of a drug is considered not to be warranted or has not been fulfilled, the supply of that drug will be prohibited. Such a precaution is required, particularly in respect of antibiotics which are so expensive and in such wide use to-day.
I compliment the Minister upon the introduction of this measure. I trust that the Government will receive the full co-operation of the States so that only therapeutic substances of an approved standard shall be supplied to the public. If that is done, the people will be re-assured. Certain drugs have been known to impair health some time after they have cured the complaint for which they were originally administered. I should like to know whether anything is being done to protect the public in that respect. One hears frequently of persons having been treated with life-saving drugs which, after they have relieved the complaint for which they were administered, have subsequently reacted unfavorably. Can the Minister say whether consideration has been given to that aspect? The public would welcome an assurance that drugs that are approved by “Department of Health will not subsequently impair the health of patients.
– I desire to make a few comments upon this measure which, as the Leader of the Opposition (Dr. Evatt) has said, is supported by members on this side of the chamber. At the same time, however, we accept this opportunity to offer constructive suggestions and to impress upon the Government the urgency of implementing the provisions of the bill. The Minister for Health (Sir Earle Page), when concluding Ids second-reading speech, said -
In conclusion, therefore, I state briefly that this Bill will empower the Commonwealth to establish standards for therapeutic substances so far as it may do so, and to prescribe testing facilities to ascertain whether such standards are being maintained.
In that statement, the Minister summarized the provisions of the measure and, naturally, no one will take exception to them. However, the Minister has never been noted for expedition in implementing measures that come within his control. His parliamentary career clearly shows that he has a habit of delaying the implementation of measures that fall within his administration. The provisions contained in this measure are vital to the protection of the public, and they must be implemented as speedily as possible. The Minister also said -
In 10-35, Great Britain passed a Therapeutic Substances Act for the control of these substances, and Australia passed somewhat similar legislation in 1937-38.
After fourteen long, weary years, the Minister has now introduced a measure to make provision for that control which was embodied in a bill that was introduced when he was a member of a previous government. Therefore, he must accept a share of responsibility for the delay that has occurred in the implementation of such controls. In the intervening period, as the honorable member for Reid (Mr. Morgan) has said, millions of pounds have been expended on the provision of pharmaceutical benefits, but effect has not yet been given to provisions that were introduced so many years ago to protect the people against drugs of inferior standard. Honorable members opposite who are members of the medical profession have expressed their views on this measure. My colleagues and I approach it in a completely non-party political spirit because we realize the importance of these provisions. It is essential that only drugs of an approved standard shall be supplied to the public. On this point, I mention the case of an ex-serviceman who was a prisoner of war for many years during World War I. After he again enlisted at the beginning of World War II. he fell ill and was admitted to a military hospital. In that institution he was given an injection of a drug of inferior quality and as a result he was paralysed and remained in that condition for the following five years. He was fortunate to make a complete recovery; and he is now employed in a government department in Sydney. That drug was administered to him in all good faith, and his case should convince any one of the need to protect the public against drugs of inferior quality. The honorable member for Reid cited statements by eminent members of the medical profession thai, emphasized this point. The report of the 1952 Australian Medical Congress, dealing with the drugs, cortisone and ACTH, stated -
According to Dr. Keith Harris (N.S.W.) these drugs could cause blood pressure, nervous disorders, diabetes, depression, mania, sleeplessness and a false feeling of being on top of the world-
Government supporters appear to have that feeling from time to time-
Patients reverted to normal when the treatment waa stopped.
One can imagine the ill effects that would result if those drugs were administered indiscriminately. The Minister referred also to what he termed the “ wonder “ drugs. I quote the following report from the Sunday Herald of the 20th July, 1952-
Wonder Drugs at the. Crossroads.
In the United States of America it is estimated that 90% of anti-biotics administered is wasted in over-dosage and in the treatment of diseases not affected by them.
Dr. R. A. McDonald, President of the B.M.A. (‘.fT.S.W.) said at a meeting of that branch that the picture presented by various speakers as to their use and harmful reactions was rather gloomy.
That statement stresses the need for a measure of this kind and, at the same time, emphasizes the seriousness of the delay that has occurred in implementing provisions which this Government should have put into operation many years ago. A report that was published in the Sydney Daily Telegraph some time ago, stated -
Dr. Sheppard Siegal, addressing the American Academy, said that penicillin, if indiscriminately used, could kill people. Hi. said that research indicated that penicillin reaction was increasing steadily. Five doctors at the Academy listed 24 cases of shock and seven deaths which penicillin had caused since 1950.
I do not deny that these drugs have made a great contribution towards the relief of sickness. However, without criticising their virtues, 1. stress the importance of ensuring the maintenance of purity. Great care should be exercised in their use, and only those of the highest quality should be employed, particularly if lives are at stake. I could quote from now until six o’clock extracts from articles “that cite instances in which drugs have been used unwisely, to the detriment of patients and sometimes with resultant danger to life. Indiscriminate use of so-called wonder drugs should be prevented at all costs, and every precaution should be taken to maintain absolute purity.
The Minister for Health apparently makes a habit of basing his plans on features of the Labour party’s policy. Having studied Labour’s programme, he devises some half-baked proposition for himself. The result is never entirely satisfactory. The people should realize that the provisions of the bill now before the House are based largely on suggestions that were made by the Leader of the Opposition in the Senate (Senator McKenna), when he was Minister for Health. The Labour party realized at that time the need for safeguards to prevent the unwise use of drugs. Therefore, this bill may be regarded .as a measure inspired by the Labour party. Had the Minister for Health been left to his own devices, without the example of the former Labour Government to encourage him, he probably would not have thought of enacting such a measure as this, or of giving effect to the act of 1937-38. This bill provides for the establishment of an expert committee to advise the Minister. That is a highly desirable provision, but I hope that the committee will be fully representative of all organizations capable of exercising sound judgment in relation to the use of drugs. It is well known that the Minister for Health is predisposed to favour the British Medical Association. I make that comment without intending to convey criticism of individual members of the association. I recall that, about twelve years ago, the late Mr. Chifley named the present Minister for Health as the agent in this Parliament of the British Medical Association. All health legislation that he has sponsored since he has been Minister for Health has indicated his tendency to yield to the wishes of the association in all respects. I do not say that the association is always right or always wrong, but I repeat my earnest hope that the proposed expert committee will not be representative only of the British Medical Association, which already is over-represented on many bodies that have been established under the Minister’s health scheme.
According to the Minister, the bill has been based on the recommendations of a conference that took place some time -ago. No doubt the decisions of that conference were carefully considered. Nevertheless, members of the Opposition would not be doing their duty if they failed to place on record the fact that the bill, in essence, was suggested in the first place by the present Leader of the Opposition in the Senate. The legislation of 1937-38 should not have been, allowed to remain inoperative. I hope that the proclamation of this bill and other legislation in relation to health will not.be delayed for years in the same way. Such legislation is of vital importance to the community, and it should be put into effect as expeditiously as possible. The people must be protected from the use of inferior medicines. The Leader of the Opposition earlier to-day discussed the constitutional aspects of health administration. We all know that, because health matters fall within the scope of the various State parliaments, prior negotiations are absolutely essential to the effective working of national health plans. The Minister should never falter in his efforts to reach and maintain agreement with the State governments on all matters with which this bill deals. The health of the people is so important that no obstacles should be allowed to stand in the way of the enactment and operation of protective measures of this kind. Long delays must not be allowed to take place.
I commend the bill to the House. I have made various constructive suggestions for the benefit of the Minister for Health because my close study of his health plans since he has been in office has convinced me that he has much to learn. He will learn a great deal if c will take the trouble to study the policy of the Labour party on such matters. The Labour party is concerned, above everything else, with the welfare of the people and the protection of their interests. All its proposals on the subject of public health have been made in good faith and after the most careful consideration. I hope that the right honorable gentleman will tell the House before this debate is closed what he intends to do to restrict the activities of people who use inferior drugs. What penalties does he intend to impose on persons who offend, whether deliberately or otherwise? The people must be protected against unscrupulous individuals who may try to exploit their sufferings by using inferior drugs. I give my blessing to the bill. The Minister for Health, instead of smiling cynically at members of the Opposition, should listen carefully to our comments and incorporate our constructive suggestions in his scheme. Whilst I support the measure, I sincerely hope that the right honorable gentleman will see fit to amend it at the committee stage in order to improve it in the ways that we have indicated.
– in reply - Even after 34 years in this Parliament I must confess to my astonishment at the speech made by the honorable member for Grayndler (Mr. Daly). I suggest to the honorable member that, if he honestly studies the record of this Government and its predecessors, in the field of health administration, he will compare the present Government to a rocket and the former Labour Government to a tortoise. I remind him that the legislation of 1937-38 was on the statute-book throughout the period of eight years for which the Labour party was in office. The Labour Government made no attempt to proclaim it. The honorable gentleman had the audacity to try to read this Government a. lesson. Like the honora.ble member for Reid (Mr. Morgan), he lectured us on such drugs as cortisone and
ACTH. Who made all the demands for the unrestricted use of these drugs during the last two or three years? I resisted all the representations made by members of the Opposition in favour of their inclusion in the list of free drugs because the advice available to me indicated that it would not be wise to do so because of their unfavorable side effects, which the honorable member mentioned in his speech. Because of the attitude that I adopted, those drugs were not made available freely under the health scheme and all the awful results to which the honorable gentleman referred were avoided. f thank the Leader of the Opposition (Dr. Evatt) for some of the constructive suggestions that he made. I understand that honorable members opposite as a whole approve of the bill in principle and in detail. However, the speech made by the honorable member for Grayndler has made it advisable for me to relate the history of the health legislation enacted by this Parliament during the last twenty years and to record the fact that the Labour party has consistently obstructed all progressive measures. The first definite step towards securing the coordination which is so necessary was taken by me when I established the Federal Council of Health in 1926. That council consisted of the Commonwealth Director-General of Health and the Director-General of Health of each of the States. Members of the council met annually to discuss their mutual problems and to endeavour to co-ordinate their activities. As a result of those conferences we felt that there should be a royal commission to examine the whole of this question, and especially to consider whether constitutional reform should be sought to enable the Commonwealth to legislate in respect of the purity of foods and drugs. What happened? The Bruce-Page Government proposed to the Federal Parliament that a royal commission consisting of State and Federal members of Parliament should (>e formed. The Labour party rejected that proposal outright and would not permit ite members to serve on any such royal commission. Thank God, outside the Parliament there were men. in the Labour movement who recognized the importance of this matter! Three men representing various Labour organiza tions agreed to sit on the royal com* mission which was headed by Sir John Peden, a leading Australian jurist, who, in addition to having had a great deal of administrative experience in State parliaments, was a professor of law al the Sydney University and had trained most of the lawyers of New South Wales. The royal commission sat for three years and made certain recommendations, in which the Labour representatives must have concurred because the recommendations were unanimous. Foremost amongst the recommendations was that action be taken by the Commonwealth Parliament to ensure the purity of drugs. In the meantime, however, the Bruce-Page Government had been defeated and Labour was in office in the federal sphere. Did Labour implement any of the recommendations for constitutional reform made by the non-partisan royal commission? No; Labour did nothing at all. The Labour tortoise was still going backwards instead of forwards. Yet honorable members opposite accuse this Government of having delayed action!
In 1934, I established the National Health and Medical Research Council, which was constituted by an act of this Parliament in 1937. The new body incorporated the Federal Council of Health, and it still exists as the recognized authority. It consists not merely of the various Directors-General of Health, but also of eminent professors of the medical faculties of universities, research workers, and representatives of the lay public. It is a most representative body, and its opinions are always treated with great respect. The council virtually controls and co-ordinates the entire medical research system in Australia. That action was taken, as I have already pointed out, when a government of the same political complexion as the present administration was in office. Then we brought down the control measure to which I referred earlier. Why was it not implemented? It was not implemented because we could not get the co-operation of the States that we have been able to secure on this occasion. Even now, unless we get 100 ner cent, co-operation, we shall not be able to do all that we wish to do. We must have the co-operation of the States, which, after all, hold the major health powers under the Constitution. The Commonwealth has only minor powers, such as the quarantine power.
In 1946, when alterations of the Constitution were under consideration, I urged that approval of the people should be sought to widen the Commonwealth’s health powers to end for all time the necessity for the Commonwealth to go cap in hand to the State governments when dealing with matters that affect the lives and welfare of the Australian people. That goal was brought nearer by our action in regard to the whole medical scheme when we came into office in 1949. One of our first actions was to introduce the free life-saving drug scheme. That scheme has been criticized by honorable members opposite; but I do not think their opposition to it is unanimous because the honorable member for Port Adelaide (Mr. Thompson) appears to have an entirely different opinion. Undoubtedly the free drugs provided under that scheme have saved hundreds of thousands of lives in this country. They have cut down the length of serious illnesses, and so have eased the hospital accommodation problem. How have we proceeded in this matter? We decided first to make certain that the drugs were pure. For that purpose we have used the laboratory of the Department of Trade and Customs, which is a fine research laboratory, to examine imported, drugs, and we have used the pharmacological laboratories of the universities of Sydney and Melbourne to examine drugs produced in Australia. We have subsidized those two organizations.
Our justification for entering this field was the fact that we were dealing with our own property. We are paying for those drugs and they are being given to the people free of cost. We took the view that whatever constitutional limits might exist on our intrusion into health matters, unquestionably we had a right to examine goods for which we were paying. We have been doing that all the time, and the suggestion that this measure takes belated action is sheer nonsense. These drugs are costly. In fact, they cost three or four times as much per prescription as the drugs that are given to the people of
Great Britain and New Zealand. But we consider it worthwhile to give those drugs to the people of Australia if they are the only medicines that will save their lives or cure their diseases. We do not count the cost. In our endeavour to make the drugs of real use we asked the medical profession, through the British Medical Association, and especially the Royal Australasian College of Physicians, to “ vet “ the preparations and tell us the diseases for which they were specifics, the dosage that should be prescribed and so on. Subsequently we inserted regulation 14a, which lists the diseases that each one of the drugs should cure. In some cases only three or four diseases are listed. In other instances there are as many as fifteen or twenty ; but they are all limited;. However, it is possible for a doctor to use any one of those drugs for any disease at all if all other treatment has failed. That is done simply by making application to the appropriate Director-General of Health, who makes contact straight away with the specialist. As a result of these provisions, potent and expensive drugs are being used quite satisfactorily under this scheme. They are controlled in a manner which is envied very much in America. In that country, some potent drugs have been used without restriction, sometimes to the ultimate detriment of the patient. I say, therefore, that this measure is not something strange. It is a properly considered proposal that we should carry into effect. Finally, after exhaustive discussions, this bill establishes co-ordination of Commonwealth and State functions. It is a year or so since the conferences took place, but legislation such as this takes a long time to draft. The proposals had to be submitted to the States to make certain that they were uniform and that the whole field had been covered. Obviously we had to be sure that there were no loopholes which would permit manufacturers to get away with the production of inferior drugs. I thank honorable members on both sides of the House for their reception of the measure.
– Have the States studied it?
– Yes. We discussed it with them for two or three years. The Commonwealth will deal with imports and interstate trade, and the States will deal with local manufacture and sales over the counter. In that way, either the States or the Commonwealth will be able to take any action that is required. Perhaps it would have been better if the States had referred the appropriate powers to the Commonwealth, but honorable members know how difficult it is to persuade the States to refer power. If we had tried to persuade them to do so, we might have argued about the matter for years. However, the States and the Commonwealth, between them, will have powerto deal with all aspects of this problem. We are satisfied that we have done the right thing.
Provision is made in the measure for regulations to be issued that will enable us to secure the assistance of drug manufacturers, chemists, doctors and other people concerned in these matters. They know their own jobs, and we want them to be our partners in this venture. I assure the honorable member for Isaacs (Mr. Haworth) that we intend to make certain that all sections of the community that deal with the matters with which we are concerned now will be represented on the appropriate committees, and, through such representation, will be able to deal with their own problems. Members of the different committees will be able to meet together and deal with all aspects of the problem. All kinds of conferences will be necessary. Let me give an illustration of the kind of thing that will have to be considered. Under the present health laws of the States, a manufacturer is compelled to label hisproduct in different ways in South Australia, Victoria, New South Wales and Queensland. Consequently, the cost of the product to the consumer is increased considerably. Ultimately, unnecessary extra costs of that kind will be avoided. I hope the House will agree to the motion for the second reading of the measure. The details of the bill have been discussed, and I trust that when we go into committee we shall deal with it as a whole, so that it can be passed before 6 p.m.
Question resolved in the affirmative.
Bill read a second time.
In committee :
.- -Can the Minister for Health (Sir Earle Page) give an indication of the kind of bodies that will be established to investigate these substances? Will they be governmental bodies? If a person interested in a particular substance is aggrievedby the decision of a committee, will he have a right of appeal from that decision or an opportunity to present his case to the Minister ?
– A person interested in a particular substance will be given an opportunity to present arguments to the appropriate committee, and also will have access to the Minister.
Bill agreed to.
Bill reported without amendment ; report adopted.
Bill - by leave - read a third time.
– I have to announce that it is my intention to issue a writ for the election of a member to fill the vacancy caused in the electoral division of Gwydir by the death of Mr. T. J. Treloar. The dates in connexion with the election will be as follows : - Issue of writ, 24th November, 1953; nominations, the 4th December, 1953; polling, the 19th December, 1953; return to writ, on or before the 20th January, 1954.
Sitting suspended from 5.55 to 8 p.m.
Debate resumed from the 12th November(vide page 167), on motion by Sir Earle Page -
That the bill be now read a second time.
– The health services embodied in this bill are part of the policy ofthe Labour party in the establishment of the welfare state. Indeed, many of the services set out in the bill are a direct inheritance by this Government from the precedingChifley Labour Government. But the methods by which this Government provides the medical and hospital benefits set out in the bill are directly opposed to Labour’s methods. The methods specified in the bill are obnoxious and undemocratic. They are completely opposed to all modern thinking in relation to the provision of social services. This Government has been compelled by public opinion, reluctantly, to take a step along the road towards the welfare state that many of its members so bitterly detest. It has therefore embarked on methods which are callous and wicked in the way that they sacrifice the interests of patients and of members of the community generally. They are obviously designed deliberately to do two things: First, to hand over completely to the control of the British Medical Association the health policy of this nation, and secondly, to protect the pockets of the wealthy supporters of this Government from the obligation to make a proper contribution towards the cost of a national health scheme. It needs to be made clear beyond doubt that the scheme now presented by the Government is not accepted by the Labour party, which, at the appropriate time, will present to the people its own comprehensive national health plan, radically different from this paltering and pitiful scheme. In due course a succeeding Labour government will present its health plan to the Parliament for approval. It is worth noting that this is the second occasion on which the Minister for Health (Sir Earle Page) has presented a health bill to the House. He did not refer to that fact in his second-reading speech.
– I did refer to it.
– The Minister may have made a slight reference to that fact. In March last the Minister introduced a health, bill to this House, and made a very long explanatory speech about it; thereafter the matter was allowed to rest. Both the bill and the speech wei;e designed solely as placards for the Senate election campaign.
– The people accepted it.
– The bill was allowed to die with the prorogation, of the Parliament a few weeks ago. That is an extraordinary commentary on the sincerity of the Minister for Health, and a sorry commentary, also, on the Minister for Defence (Sir Philip McBride) who says that the people accepted the first bill. They did not do so. How badly drawn was the bill of March last is shown by the scores of alterations that were made to it in order to produce the Minister’s second version, which is now before the House. Of course the Minister is most prolific in the production of health schemes, all vague and different one from the other. Any one who studies the bill of March last will see that alterations and amendments have now been made on every page.
– What sort of alterations?
– There are some very remarkable alterations indeed. The Minister stated in his second-reading speech that he saw a happy augury for the success of his plan in his experiences when he was Treasurer of the Commonwealth in the Bruce-Page Government in the ‘twenties. Whatever the Minister may think of that as a happy augury, it will bc a fearsome augury to the people of Australia who remember this man’s record as Treasurer of the Commonwealth, a record which brought from the father of the honorable member for Henty (Mr. Gullett) a stinging description of him as the “ tragic Treasurer “. After seven years of his Treasurership, Australia was left completely exposed to the horrors of the depression. So that if the Minister can take any comfort from such an augury, he is the only one who does. But, of course, the Minister is nothing if not audacious. All his years of experience in this Parliament have taught him the value of audacity. The Minister claims credit for reaching agreement with the medical profession on health matters. What are the facts? He went to the British Medical Association for instructions, and was told what to do. Now he says. “ Give me credit ; I have reached agreement with the British Medical Association “. The scheme now before the Parliament at no point places any obligation on the medical profession of this country, to which the Minister belongs, to bear social obligations as members of the Australian community. This scheme is not so much a health scheme in the interests of the citizens as it is a medical scheme in the interests of doctors. Throughout the whole scheme (lie emphasis is wrongly placed. For many years there have been valid arguments why the Minister for Health should not be a member of the medical profession, and, in many preceding governments care was taken to ensure that tradition was observed. If confirmation were needed of the value of those arguments, it is to be found in the record of the Minister, and the legislation that he has now brought forward. Typical of his attitude was the speech that he delivered to the world medical association at The Hague a few months ago. Those whom he addressed did not represent, governments, departments of health, or citizens : they were doctors who had been sent to the congress by various organizations throughout the world. From a perusal of the report of the Minister’s speech to them, it is obvious that he spoke as though his only concern was to demonstrate to them that his health scheme was suitable for, and profitable to, doctors. I presume that the expenses of the Minister’s visit were defrayed by the Australian Government. “Whether or not that is so I do not know, but at least much of his time was taken up in presenting his views on this scheme to doctors of various countries. I fail to see that any good purpose for Australia was served by the Minister’s visit to The Hague, and I should like him to inform the House what good his trip did for Australia, and what it cost the taxpayers of this country. When he “ got to The Hague, many thousands of miles away from where his statements could be checked, he proceeded to make to his fellow practitioners complete misstatements regarding the policy and outlook of the Australian Labour party on health matters. He informed the convention that it was the policy of the Australian Labour party to nationalize medicine. The Minister knows perfectly well that the Australian. Constitution permits no such thing. The Commonwealth’s only direct power in relation to health is .a quarantine power. The other power is to provide medical and dental benefits but not so as to authorize any civil conscription. That power was written into the Constitution at the instance of a Labour government in terms that expressly negatived the possibility of nationalizing the medical profession, through the provision of medical benefits. The Minister for Health also said -
Legislation passed by the Labour Government forced doctors to prescribe certain proscriptions.
That is wholly untrue. There is not a word of truth in it. At all times under the scheme put forward .by the last Labour Government, doctors were to be free to prescribe for their patients as they thought fit. The one degree of compulsion which was to be attached to pharmaceutical ‘benefits was that if a doctor, in his unfettered discretion, decided to prescribe an item contained in the Commonwealth formulary, he should write it on a government form, and thereby make it free to the patient. The compulsion attached to the document to be used, and not to the medicament to be prescribed. The. Minister has done no credit to himself, he has done no credit to his Government and has done no credit to Australia in making statements of that nature.
On a par with these statements are the claims made by the Minister - and made earlier, to his discredit, by the Prime Minister (Mr. Menzies) - in connexion with the Senate election campaign earlier this year. The statements were to the effect that this Government had provided free immunization, and was responsible for the campaign to eradicate tuberculosis. There is no truth in those statements. The truth in the first matter is that immunizing agents against diphtheria and whooping cough were provided free to State and municipal authorities in 1947, which was at least two years before this Government assumed office. The Minister for Health has become so irresponsible that he sometimes does not know whether or not he is telling the truth. As a matter of fact the plan to eradicate tuberculosis was formed by the last Labour Government in 194S, and was put into effect along with a scheme of allowances to tubercular sufferers and their dependants in 1948, eighteen months before this Government assumed office. The_ Minister for Health has claimed credit for increasing tuberculosis allowances in 1950. Let us examine the facts of that matter. Under the last Labour Government, the experimental stage having been passed, a scheme of greatly increased tuberculosis allowances, signed by the previous Minister for Health, was awaiting the Minister in his office on the day that he took over. That scheme, with only minor variations, was implemented by him. But it took him six months to implement it.
– That is a complete misstatement.
– I believe that it is the truth. All that the Minister had to do was to put the Labour Government’s scheme into operation, but it took him six months to do so. This measure has been divided into various sections, and I now propose to deal with the pensioner medical service. The Labour party does not oppose that scheme, although some features of it are open to the strongest criticism. It is an extraordinary thing that the whole operation of the pensioner medical scheme seemingly rests on a private arrangement made between the Minister, who is a member of the British Medical Association-
– That is not so.
– Very well then, the matter rests on a private arrangement between the Minister, who is a non-unionist, and the British Medical Association. It appears to be a holeinthecorner arrangement. If there is any document in existence that deals with the pensioner medical service^ it has never been publicly produced, but the Minister has said that the scheme rests on a series of letters which have passed between him and the British Medical Association. In other words, the only record of the arrangement is on the .Minister’s private file - a most extraordinary procedure, and one which should be corrected promptly.
– There are public documents.
– To illustrate my point, I shall quote from a letter dated the 6th November, written by the Minister for Health to Senator McKenna. The letter reads, inter aiia -
There is no formal document embodying the agreement between the Commonwealth and the British Medical Association relating to the provision of the Pensioner Medical Service. The arrangement is contained in a number of communications between the Government, and the British Medical Association.
– Bung rules !
– Apparently it is a case of bung rules. We may search in vain for any public documents on the pensioner medical service. There are no particulars in the bill, and we should ask why they are not there. I believe that the particulars are not there because the whole measure is typical of the shillyshallying and evasiveness of the Minister in the promulgation of his various health schemes. It is almost impossible to. find out the nature, of his schemes, the Government’s powers under them, and the benefits that they may confer on the public. I suggest that the details of this scheme should be set out in the bill. They have been circulated to doctors who have been invited to become members of the scheme, but they should be set out in the bill because they also concern patients, and patients should have some knowledge of their rights under the scheme. Further, any agreement that the Government has made about this matter with the British Medical Association should be annexed to the bill, and if there is not any agreement then one should be made ; and after it has been made it should be tabled in the House.
Another provision worth noting is that the Minister cannot remove a doctor out of the. pensioner medical scheme unless his decision to do so. is supported by a committee of inquiry, and that committee which will deal with the fitness of the doctor is to be predominantly composed of members of the British Medical Association. The bill provides for an appeal to the court by a doctor who has been removed by that committee. As the; bill is now framed, the court of appeal is confined to a consideration of the evidence previously heard by the committee of members of the British Medical Association. According to the measure of March, 1953, the court of appeal could admit further evidence, allow cross-examination and hear the matter afresh. That provision is not to be found in the bill at present before the House.
A consideration of the pharmaceutical benefits section of the bill will show that the Minister has written two remarkable limitations into the measure about the prescribing of free medicine. The first is in clause 84, and it ties a doctor down as to the amount or quantity of a drug chat he may prescribe, and clause 85 gives the Minister power to limit a doctor as to the disease or purpose for which the doctor may prescribe that drug. In accepting those two limitations on. the freedom to prescribe, the medical profession has given way on a matter about which it formerly refused any compromise whatsoever, because it said that this was a matter of the highest principle. Why has the medical profession now given way? Simply because it has accepted the position that restrictions on the prescription of certain drugs are urgently needed, because experience has shown great abuse, waste, and extravagance, as well as possible damage to the natural flora of the human body through reckless over-prescription of these drugs. Any one who has any doubt about that statement should refer to the article in the Medical Journal of Australia of the 28th June, 1952, headed “Anti-Biotics Amok “.
I now propose to contrast the hospital benefits scheme which operated during the regime of the Chifley Government with the scheme that the Minister now intends to implement. Under the Chifley scheme of hospital benefits, the basic principle was that those who were unfortunate enough to be sick should be as far as possible relieved of the financial burden associated with their illnesses. The scheme was implemented by the Commonwealth paying to the State governments an amount sufficient to reimburse them for the total collections that they had previously made by way of fees from patients in public wards and from other sources. Commonwealth payments were made originally at the rate of 6s. a day for each patient and were increased to Ss. a day by the Chifley Government in view of the increase in hospital expenses. At the same time, the Chifley Labour Government agreed to reimburse the States for salaries paid to medical and other professional personnel who attended patients in public wards. A patient could then enter a public ward of a public hospital and, whether he was the richest man in the community or the poorest, the only consideration was whether his health required the occupancy of a bed.. If so, he was admitted without any degrading or humiliating means test. If he was a wealthy man he had paid in taxation, according to his means, proportionately more than the poorer man. Each, according to his means, had paid for this right which was given to them by the Chifley Government.
– But the scheme did not work.
– -It did work, and no charge was made during that time in public hospitals for accommodation, treatment, or medicine. The scheme worked splendidly. If the patient was entitled to a friendly society or insurance benefit he retained that benefit for his own use. Most patients badly need a little extra cash when they are confined to hospital. That scheme has been completely swept aside by the present Government, which has made it a condition of any payment to a hospital that the States should accept an agreement with the Commonwealth involving the raising of charges against patients in hospital. The Minister for Health insisted that the States make a charge against every patient before he would even agree to continue the payment that had been made by the Labour Government. By his action, and apparently with the approval of honorable members opposite, he destroyed a scheme which gave free hospital attention without a means test to the people of Australia and established a scheme under which payment for hospital attention was compulsory.
Under the Page scheme, a payment of Ss. a day for each patient in a public bed is made by the Commonwealth only if the State has accepted the Commonwealth agreement and made a charge against the patient. An additional benefit of 4s. a day is paid by the Commonwealth only if the patient is insured. In view of changes in the value of money alone, if the Government wished to continue the benefits that were granted by the Labour Government, it would now be paying at least 16«. a day in respect of every occupied bed in the public ward of every public hospital. However, the Government has continued to pay only 8s. a day. making the payment of an additional 4s. a day dependent on the patient having made some provision for himself. This is the most extraordinary means test that has been established by any government. The Government, in effect, has told the applicant for hospital attention that if he has succeeded in making some provision for himself it will make this payment to him. If he has not succeeded in making some provision for himself it will not assist him. That is a complete reversal of the social services means test, under which the Government tells a man, in effect, that if he has succeeded in making some provision for himself it will not assist him.
– It is certainly not socialism.
– Whether it is socialism or not Labour’s scheme represents social justice. The scheme that was introduced by the Labour Government was approved and endorsed by the people of Australia and they will welcome it back when a succeeding Labourgovernment re-establishes it. The Labour Government, when it is elected, will re-establish the hospital scheme as has been announced by the Leader of the Opposition (Dr. Evatt). I now move the following amendment to the motion for the second reading of this bill : -
That all words after “That” be left out with a view to insert in lieu thereof the following words: - “the bill be withdrawn and redrafted to place greater emphasis through co-operation with the States and local authorities on the promotion of positive health
in the establishment and maintenance of diagnostic and health centres;
in dental care of children under sixteen years of age;
in the provision of medical training and research facilities and a system of regional hospitals: and to provide -
1 ) for substantially increased rates of hospital benefit having regard to the rise of hospital costs;
for the negotiation of fresh agreements between the Commonwealth and the States to ensure that throughout Australia there should be no charge and no means test for qualified patients occupying beds in public wards of public hospitals;
that payment of Commonwealth hospital benefits or medical benefits shall not be conditional upon a patient being a contributor to a hospitals fund or a medical benefits fund ;
that registered organizations shall be subsidized to ensure that their benefits will be extended to chronic sufferers and those suffering disabilities at the commencement of their membership or registered organizations;
to devise in consultation with the medical profession and State Governments machinery to stabilize medical charges and to determine just variations of those charges;
that medical benefits be extended to mileage charges of medical practitioners incurred by patients especially those in outback areas;
that the provision of medical and hospital benefits should be financed from revenue raised on a graduated scale based upon capacity to pay;
for the cure and relief of mental illness.”
The provisions for medical benefits in the bill are the most lopsided and clumsy in the whole measure. They fail to cover the whole community. In fact, they leave literally millions of people without cover. On the basis of the Minister’s own figures, 5,000,000 people are now covered in one form or another by the Commonwealth health scheme. No doubt the Minister picked that figure out of the air because I have seen no documentary confirmation of it. The population of Australia is well over8,000,000 so that the Government has failed to cover the whole community. Its scheme is complicated in a most extraordinary way. It has been utterly unjust in its allocation of financial cost and it has actually excluded many old and chronic sufferers who are the people most in need of medical attention. With the idea of Commonwealth medical benefits, the Labour party entirely agrees. But it is fantastically wrong that a citizen who has paid his taxes should be deprived of a Commonwealth medical benefit which is paid for out of revenue merely because he has not contributed to some private fund or friendly society. It is equally absurd that the Minister should complacently produce a so-called medical scheme which excludes the very people who most need medical attention in this community. Who needs medical attention more than the citizen who is already suffering from some illness or disability? Yet, under the provisions of this fantastic bill, he is excluded from it if he happens to be suffering from an illness or disability at the time that he applies for membership of a society. “Who needs medical attention more than the unfortunate sufferer from a chronic condition? He is the man upon whom, the cost of medical services presses most heavily. Yet he also is excluded from full benefits under this scheme. Who needs medical service more than the aged man or woman who has reached that stage of life when medical attention is more frequently necessary? Unless that person can qualify as a pensioner under the social services means test, he also is debarred from full benefit under this scheme.
– That is not right, either.
– The scheme is extraordinarily defective in that there is no safeguard to prevent doctors from increasing their fees. There is no safeguard to prevent doctors from increasing their fees to the extent of the benefits provided and thereby depriving the patient of any benefit at all. The Minister for Health made that very plain in his speech at The Hague when he addressed fellow doctors and took credit for the fact that members of the medical profession were to be allowed to charge what they liked. That matter is covered by my amendment. If the Minister is anxious to do justice to the people of Australia rather than to enrich fellow members of the medical profession, he will accept that amendment. When the Minister fixed the amount for each benefit under this scheme, surely he had in mind what would be a reasonable fee for the service that would be provided.
– Yes, and I shall give a complete answer to that, too.
– The Minister says that he had in mind what would be a reasonable fee and that he fixed the benefit on what he thought would be a reasonable fee. I hope I am not misinterpreting him.
– The Minister did not just imagine the figures or set them down at random. Doubtless they were more than carefully worked out.
Doubtless he had professional advice as to what would be a reasonable fee for each service covered by this scheme and, therefore, what would be a reasonable benefit for the Commonwealth to pay. If those amounts are reasonable, why does the scheme not provide for some safeguard to prevent a few unscrupulous members of the medical profession from so increasing their fees that they would take the whole of this benefit for themselves and leave the patient without any benefit whatever?
There should be an advisory committee on medical charges. It should include representatives of the doctors, but they should not he allowed to dominate the committee as they seemingly dominate every committee that the Minister has established. There should also be on that committee a member of the legal profession, perhaps the Commonwealth Statistician and a representative of the friendly societies. There should be consultation for the purpose of ensuring that the benefits provided by the scheme go to the patients and that they are not quickly dissipated by increased charges made by members of the medical profession.
Clause 26 of the bill provides that payment of the Commonwealth medical benefit shall not be made unless full information is supplied to the DirectorGeneral of Health. Both the department and the benefit society need to have particulars of the service rendered by the doctor before they can pay the benefit. It is perfectly clear that only a doctor can supply that information and that the doctor, because of his relationship with the patient, would provide that information only to the patient. But there is no provision in the bill that could compel the doctor to provide that information. This bill should contain a clause that would require a doctor, at the patient’s request, to supply to the patient particulars of the service that he has rendered. The omission is notable, because it is typical of the manner in which this bill has been framed in order to avoid the slightest obligation being placed upon members of the medical profession. The Minister has been very tender towards his fellow members of the profession in every provision in this bill. The doctors have been protected at every stage. I am sorry to say that to the extent to which they have been protected the public has been allowed to suffer. The only clause in the bill that could possibly touch a doctor is clause 30, but that clause provides for action against him only in the case of a crime such as fraud or conspiracy.
Another notable omission from the provision for medical benefits is the provision for a mileage charge. “Why did the Minister for Health, who at one time was Leader of the Australian Country party and is certainly a veteran member of that party, and other members of that party who are supposed to look after the interests of the country people fail to ensure that this bill contained any provision for a mileage allowance? Apparently the Minister did not overlook it, because the pharmaceutical benefits part of the bill, in clause 99, which is copied from a provision made by a Labour government, provides that extra fees shall be paid where the service has to be provided at some distance. Furthermore, the pensioner medical service part provides that, where a doctor has to travel a mile or two in some small locality, he may charge for mileage. I cannot understand why the Minister failed to include it in the general medical benefits section of the bill. I hope that he will accept at least that portion of the proposed amendment. The matter is of vital importance to people living in the country to whom very often the mileage charge is the greater portion of the cost involved in bringing a doctor to the home. Surely members of the Australian Country party will take steps to ensure that that fair and just provision will be placed in the general medical benefits part of the bill. It is a reproach to the Australian Country party and to the Minister for Health that they should have to be asked by members on this side of the House to ensure that at least that much justic? is to country dwellers.
This medical benefits scheme amounts to a fiat rate contributory scheme, operated in a most discriminatory way, which deprives citizens of their rights as taxpayers unless they join a private society. In practice it compels the payment of additional taxation to obtain a benefit for which payment has already been made in full. Who will say that the people of Australia, through taxation, have not already paid in full for the health service for which they will now be required to pay again in contributions to private societies and funds? No member on this side of the House will say that, because there is a credit of £186,000,000 of the people’s contributions in the National Welfare Fund. I invite honorable members to compare this complicated, discriminatory and unjust scheme, which deprives so many people of benefits and which gives other people benefits only at the cost of paying twice, with the simplicity and effectiveness of a. scheme under which doctors could charge fees at an approved scale, obtain portion of the fee from the patient and send to the Commonwealth each month an account for the balance of the fee. Under such a system the Australian Government would need to deal with only 6,000 or 7,000 accounts each month from the 6,000 or 7,000 members of the medical profession instead of having to deal with millions of accounts during the year. I recognize the difficulty of getting members of the British Medical Association to deal directly with the Government. I recognize that much thought and much education would be needed to democratise the medical profession in this country. That simple and effective scheme would preserve all aspects of the doctor-patient relationship about which the Minister speaks so keenly.
The Labour party is opposed to the idea that citizens should be compelled to contribute to a private fund, but, if that provision remains in the bill, at least there should be adequate control over the administration of those organizations. The bill does not provide for such control.
Two reforms are necessary. They are conspicuous by their absence from this measure. The first is that the ratio of management expenses of societies in relation to their income and in relation to their payments to contributors should be expressly stipulated in the bill. Surely that is an elementary safeguard which is necessary for the protection of those who are compelled to join and pay their fees to these societies in order to obtain their rights as taxpayers. Although people are compelled to join and pay fees, there is no statutory provision which limits the amount which these societies may spend on salaries and expenses of various kinds.
Clause 72 of the bill certainly provides that these matters shall be examined by a committee of three officials, but, again, there is no stipulation anywhere in the clause, or elsewhere in the bill, that the expense ratio of these societies or private funds shall be limited in any way whatever. Because this is very important, I wish to cite certain figures contained in the seventh annual report of the Medical Benefits Fund of Australia, a fund which will be very familiar to honorable members because it is known to be controlled by members of the medical profession. No fewer than eighteen of the 22 members of its council are members of the British Medical Association.
– What is wrong with that?
– I shall show the honorable member what is wrong with it. I have here the income and expenditure account of this fund. Last .year, by means of contributions, it received £401,693.
– That is nothing compared with what it is receiving now !
-The honorable member for Bennelong (Mr. Cramer) apparently believes that it is receiving very much more now. In the year which ended on the 30th June last, the fund received contributions to the value of £401,693, as I have said, and paid out in benefits £166,909. Its expenses were £52,377, or more than 30 per cent, of the payments out, and it transferred to appropriation account a surplus of income over expenditure of £1S5,000. Therefore, people are being required to pay into this society more than twice as much money a3 the society is prepared to pay out in benefits.
The second necessary reform is provision that the directors and controllers of these funds and societies shall be elected by the members, those who pay the contributions, and not by people who have other interests in their management. There is “very good reason for concern at the activities of the Medical Benefits Fund of Australia, which, as I have pointed out, is almost completely doctor-owned and operated.
– What is wrong- with doctors?
– There is nothing wrong with doctors, of course. Indeed, I have the greatest admiration for the medical profession. Nevertheless, I maintain that a scheme which is run in the interests of patients and contributors should be managed by the contributors. It should not be managed by doctors who receive payments from the fund. Many people consider that this society is receiving preferential treatment from the Government and that it will in time weaken and destroy the valuable friendly societies. If unchecked, this society could become a most powerful pressure agency, not for the benefit of its members and contributors but for that of the medical profession in future negotiations with the Government.
Clause 81 of the bill differs very much from the provisions of the bill introduced in March. This clause specifies the penalties for offences against the medical benefits regulations. The interesting point is that the provision of penalties is made necessary because of go-getting, profit-making organizations whose activities should have been prohibited long ago by the regulations under which this scheme has so far been conducted.
I wish now to make a passing reference to the committees of inquiry which are to be established under this bill and, again, to show the contrast between the treatment of the medical profession and the treatment of chemists. The medical services committees which are to be set up as committees of inquiry are to be dominated entirely by members of the British Medical Association. In this connexion I refer the House to clauses 107 and 109 of the bill. On the other hand, the similar committees which are to deal with the pharmaceutical services will have no representatives at all of the Pharmaceutical Services Guild of Australia. In this connexion, I refer to clauses 112 and 114 of the bill. [Extension of time granted.
I direct the attention of the Minister to clause 133 and ask him how a chemist, under that clause, may know that a doctor has been suspended from writing prescriptions. Why is not that fact to be gazetted ? The clause provides that the Minister may, if he thinks fit, notify the suspension in the Gazette. Why is the Minister so tender where his fellow-medica.1 practitioners are concerned ? If a medical practitioner commits an offence and is suspended from writing prescriptions, surely the chemists should have a way of knowing that that is so. The way in which such information should be made known is by publication in the Government’s official journal, the Gazette.
The major criticism of the health activities of this Government concerns its failure to initiate measures which are designed to promote positive health in the community. All the provisions of this bill are designed merely to alleviate illness and the cost of illness. The bill is entirely lacking in provisions for the promotion of the positive health of the community. That is why the amendment which I propose to move on behalf of the Opposition stresses particularly the need for such measures. Apart from the free provision of milk for school children under the age of thirteen years, this Government has made no provision for the positive health of the community. The Minister for Health, for example, has taken no step whatever to care for the teeth of children so that they may escape dental decay, with all its attendant ills, and carry their natural teeth throughout their lives. It is a great reproach to the Minister that in four years he has failed to do anything whatever to protect and preserve the teeth of Australian children. The Australian Dental Association itself prepared a plan which was designed to provide such treatment free for all children under sixteen years of age. That plan is there, and although it has been available to the Government to see and read, the Minister has done nothing about it. The members of the Australian Dental Association co-operated magnificently with the previous Labour Government. Indeed, they co-operated to such a degree that when Labour left office there were very few outstanding matters which might have prevented early initia- tion of a dental scheme. This Government has lost four valuable years. Perhaps the Minister will correct me if I am wrong when I say that during the whole of those four years he has not even met the representatives of the Australian Dental Association to discuss national dental health.
The Australian Labour party believes that the Government would have made a great contribution to positive health had it encouraged the establishment and maintenance of diagnostic and health centres. It should have built throughout Australia experimental health centres where doctors, working in private practice, could come together to provide all diagnostic facilities, including radiology, and where, in the interests of the community and themselves, they could rationalize their activities and roster week-end work. Centres of this nature would encourage people to seek early diagnosis of disease and so prevent much distress and save many lives. The Government should have concerned itself with the construction of regional hospitals, particularly in outback areas, which would operate in close conjunction with the base hospitals which provide all specialist facilities. I recognize that the provision of such hospitals is primarily, as matters stand at present, the responsibility of State governments, but leadership and financial assistance might well have flowed directly from the Commonwealth. The Australian Labour party further believes that the Australian Government should take an active interest in ensuring that complete facilities for medical training and research are provided in Australia. Many of our bright young medicos are obliged to go overseas to gain such experience, and in many instances are permanently lost to Australia. For these reasons the Labour party has stressed these matters in the amendment which I submit to the House.
– Is the amendment seconded ?
– I second the amendment.
– We are discussing in this House to-night one of the most important social services measures that has ever come before this Parliament. We have listened to a long speech on it by the honorable member for Eden-Monaro (Mr. Allan Fraser). I do not intend to spend much time in discussing what he has said. I shall merely direct attention to one or two features of his speech. First, the honorable member made no substantial attack on the bill at any point. Everything he has said was a matter of detail. Secondly, he declared that Labour would reverse the health policy outlined in the bill if it ever came to office. I hope that all the friendly and benefit societies, and the people throughout Australia who have invested their money in them, will remember his words. Thirdly, the honorable member spent most of his time in attacking personally the Minister for Health (Sir Earle Page). If any one thinks that the dignity of debate or the effectiveness of health legislation can be supported on such a basis I can only say that I do not agree, and while I am not a prophet, I venture to say that this House and this country will remember the right honorable member for Cowper, the Minister for Health, long after the name of the honorable member for Eden-Monaro has been completely forgotten. I remind the House that the Labour party on one occasion offered to Australia a national health scheme and on that occasion it was thrown out of office.
T pass from the attack, if it can be so called, that was made on the bill by the honorable member for Eden-Monaro. and I hope to devote the rest of my speech to saying something constructive about the measure. I commenced my speech by describing it as a social services measure. It is significant that this great social services measure should have been presented to the Parliament by the Liberal and Country party Government. Even those who have only a most superficial knowledge of the history of our country know that in. securing most of the great social advantages that we now enjoy those two political parties have taken the leading part.
We are discussing the health of the nation and in this connexion every modern State is faced with the problem that the increasing complexity of modern medicine, modern methods of diagnosis and treatment, pathological .investigations and X-ray examinations have imposed a burden which the ordinary individual finds to be almost beyond his financial capacity to bear. This problem exists in every modern State. I want, first, to make a distinction between public health medicine - preventive medicine which is concerned with such things as water supplies, conservancy and the like, or what I might describe as the impersonal side of medicine - and curative medicine with which this bill is chiefly concerned and which is a personal problem. This latter is, in fact, a matter of personal relationship - the everyday health, life and wellbeing of the individual. The problem that this country is facing, in common with every other modern State, is to bring medical care within the reach of all, without sacrificing this personal relationship of doctor and patient. It is not just a matter of technical excellence at all.
In the solution of this problem every country is faced with three choices. The first is that the State should do nothing - that everything should be left to the individual. The second is that the State should do everything - that it should assume all responsibility and provide full medical care. In passing, I direct the attention of the House to the fact that that choice has been well stressed by the honorable member for Eden-Monaro and that it is Labour’s solution of the problem. This third solution is the formation of a partnership with freedom for the individual patient and for the doctor and assistance from the State. The first alternative can, I believe, be rejected out of hand. For the reasons I have outlined, it is no longer feasible in a modern society. I want to say something about the second alternative because it implies that the State not only provides medical services but also exercises control. It implies the loss of independence of the individual and of the doctor, a diminution of th’i personal relationship upon which the sound practice of medicine depends and degradation of the atmosphere and traditions of a great profession. It rests upon the idea, which nowadays is so often expressed or hinted at, that responsibility can be handed over to that vague and amorphous entity known as the State. There is a great clamour for rights in these days and an almost complete silence about duties. If duties are irksome we are inclined to believe that they should be handed over to the State; we tend to forget that they are primarily the inescapable obligation of the individual.
It is so easy to be overcome by the power of words. It is so easy to utter . glib phrases, such as we have heard to-night, about the welfare State. They sound so attractive. Let us have welfare by all means, but do not let ns imagine that we can have it without paying for it. Do not let us imagine that we can hand over the responsibility of the individual to the welfare State and retain for him his rights, which very often mean the privileges he desires. This bill is not based upon that philosophy; it is based upon the idea that the individual has responsibilities. I am sure that we all would be willing to agree that it is the responsibility of the individual to see that he does not become a drunkard, or a drug addict, or slovenly, or slip-shod, or lazy. Just as we all agree that these are individual responsibilities, so, I believe we should all agree that the individual has some responsibility in the matter of his own health. I want to say at this juncture only one more thing about this socialist theory. I shall say more about it later because it is inevitably bound up with whatever differences the opposing parties in this House may have in relation to this bill. The socialist theory that the State should provide everything free, which means, in other words, that the taxpayer should provide it, was offered to the people four years ago and was soundly rejected by them. If the Labour party wants to (ro back to that state of affairs, let me remind it that the people have already thrown it out of office because of its advocacy of that policy.
The real solution of this problem rests upon the third alternative, a partnership, upon freedom for the individual and freedom for the doctor, and upon assistance from the State. Furthermore, it must be based on the general practitioner and the family doctor and not on the clinic or the hospital, nor on the doctor as the salaried servant of the State, but on the. general practitioner of high standard, who is free to maintain the intimate personal relations with the people whom he treats. I wish to lay some stress on the clinic and the hospital, because if we examine every system of State medicine in the world, we shall find that these things are taken as its basis, and the same pattern is apparent in the amendment which has been submitted to-night. In fact,, the honorable member for Eden-Monaro has stressed that there should be diagnostic and health centres and clinics, in which medical care could be given. I wish to make the point plain, if I can, that the State can provide technical excellence, but only the general practitioner can provide real, fundamental medical care.
I now desire to speak of the part which the general practitioner plays, and then show how “this bill ensures that he will be able to play it. The part that the general practitioner plays is easily appreciated if we consider for a few moments the causes of death that appear in any list of statistics such as cancer, cardiac diseases, tuberculosis, and so on. It is perfectly easy for us to jump to the conclusion that a.ll those diseases could be cured if we had sufficiently skilled specialists and sufficiently well-equipped laboratories. Nothing could be further from the truth. Of course, we must have specialists, laboratories, X-ray, pathology and the like, but what about the part that the general practitioner plays? What about the long- illnesses that lead to those causes of death? Who is to manage that aspect? What about the family of the invalid ? Who is to look after them, if we base medicine on the clinic and the specialist? Who is to deal with the innumerable problems which are comprised in all those matters? What about all the people who suffer for years with chronic diseases - the chronic asthmatics, the people with rheumatoid arthritis, the people with pernicious anaemia, and the people with diabetes? Who looks after them ? It is not the specialist. Occasionally, such patients go to a specialist, and occasionally their own medical officer receives advice from a specialist, but the man who really looks after them is the doctor who goes into their homes. This bill makes it possible for them to have the man of their choice in their homes.
What about all the acute and mild diseases from which the generality of people suffer ? Those diseases are not first diagnosed in clinics. They are diagnosed in the family practitioner’s surgery, or in. the patient’s home. This bill makes it possible for that system to continue. In Addition, the bill makes it possible for the patient to have the doctor he wants, not a doctor sitting in a clinic, and on duty by the day. What about the early recognition of disease, particularly serious disease? That is not done in clinics. It is done by the doctor who goes to the patient’s home. It is to be done, under this bill, by the medical practitioner whom the patient wants in hi3 home. No system of State medicine, no doctor on a panel, no salaried doctor, no socialist system of medicine can ensure all these things, which are the very basis of good medical practice.
The great virtue of this bill is that it ensures that the people of Australia will have these services. The patient has, in the first place, some responsibility. He has, in the second place, freedom of choice of a doctor. He may choose the doctor he wants, and dispense with the doctor of his choice and have another doctor. In other words, under this bill, the patient has, if you like, the right to hire and fire, and he should have it. The doctor, under this bill, has a responsibility, first to his patient and to his conscience, and not first to the State service of which he is a part. Every doctor should have that responsibility, but no doctor under a State system of a salaried medical service can have it. It is important that we should appreciate those matters, because they are the very foundations of this bill. Under a State salaried service and under the service offered by the Labour party and rejected by the people, clinics would be established in which there would be specialists who, perhaps, would know more about the technical side of medicine than the family doctor. A patient could go to the clinic, and he would be seen by the doctor who was on duty for the day. A nurse would take the patient’s card from the filing cabinet, and hand it to the doctor, and he would read on it, not the notes he had made over the years, but the notes that had been made by somebody else.
Clinics treat cases. General practitioners treat human beings. That is the essential virtue of this bill, and it is embodied in this partnership, about which I have spoken. I wish to quote to the House some words that were spoken not long ago by one of the greatest practitioners of modern medicine, Lord Horder. He has pointed out that there is no apotheosis of medical care, but there is a synthesis. In other words, if we are to have really good medicine, and a worthwhile medical system, we should start to build it from the foundation stones, as the Minister is doing with this bill. We should not start to build from the top - from the _ clinic and the specialist, as the Labour party proposes, and work downwards.
The general principles of this bill are well understood, but I should like to recall its main aspects to the House so as to bring the legislation into proper focus and attention. For our present purposes, we can say, ‘briefly, that this bill is divided into five sections. The first section provides for medical services, and most of my remarks this evening have been devoted to an explanation of how it does so. The patient insures himself, voluntarily, with a society, and the Commonwealth pays a subvention to it. That arrangement makes it possible for the patient to secure the medical services that are provided. The second section is concerned with hospital services, and it is founded on the same principle. We on this side of the House believe, not only that individuals have some responsibility to provide for their medical services, but also that persons who enter hospitals should pay for their treatment if they can afford to do so. Why not? I challenge the Opposition on this matter. Why should hospital treatment be completely free? Why should a hospital provide treatment free for many people who can well afford to pay? Members of the Labour party say that people pay for hospital treatment when they pay the social services contribution. In my opinion, such a statement is the veriest nonsense. Everything is paid for on that kind of basis. What of the unemployment benefit, pensions, and other social services? They are financed by the social services contribution, which, very properly, has been amalgamated with the income tax. The idea that a sum of £186,000,000, or whatever it amounts to, lies dormant and is stockpiled in the National Welfare Fund, is complete rubbish. Material things can be stockpiled, but money cannot - certainly not by governments. Therefore, we say that this scheme has a realistic basis. It has certainly rescued the hospital system of Australia from insolvency into which the vaunted scheme of the Labour party had plunged it.
The third section of the bill deals with pensioners. It provides that those persons who can no longer afford to pay the contributions which other members of society can pay, shall have their contributions, in effect, paid for them by the rest of the community. In other words, the community has assumed the obligation to provide medical care for pensioners. However, the most important thing about this section is not that the pensioner does not have to pay for medical services, important though this is, but that under this excellent bill, he can still retain his family doctor - the doctor of his choice. He will not have to attend the outpatients’ department of a hospital, and be seen by the doctor on duty for that day. He can still be seen in his own home by his own doctor. That is the great virtue of this provision.
The fourth section of the bill deals with pharmaceutical benefits, and it realizes that modern pharmaceutical benefits are an entirely different conception from that of a few years ago. The Labour party has not come to a similar realization. The drugs used by the medical profession now are different, more potent, more effective and far more expensive than such items were a few years ago. As the scheme set out in this bill is already in operation, it can be said that the community has already accepted the obligation of providing medical benefits in the interests of its own health. I do not use the term “ free “ because it is nonsense to talk about free services, but the nation has accepted the obligation of spreading the cost of these services over the whole community. These immaterial things are not like direct medical services that are provided by the doctor. In the case of medical services, it is essential that the patient should have freedom of choice, but with immaterial things such as drugs that does not matter so much.
The fifth section is concerned with preventive medicine, public health, free milk for children and tuberculosis benefits. The bill is based upon a new conception which is realistic and sensible. That conception has already been accepted by the Australian people because the scheme, in effect, has been working for the past two years.
I have now said practically all I want to say about the bill itself, but if I may presume to do so, I should like to address a few words of warning regarding it to my own profession. I believe that this measure is a shield against the greatest disaster that could befall the medical profession and the country, which is that the dead and stultifying hand of socialism should be laid upon a great profession. I believe that the medical profession is giving a most efficient service and this bill is a shield against its socialization, but it is not the final defence. The final defence lies in the maintenance of the traditions and the standing of the profession itself in association with the working of this scheme. Under this proposal, there is no place for greed or selfishness or the setting up of financial rewards as the ultimate goal. There is no place for a doctor who is bound rigidly by hours and considerations of salary in making his services available freely to those who want them, but there is scope for charity and helpfulness and the personal human contact that is destroyed by every other scheme of State medicine. There is scope and there is necessity for a high standard of personal and professional conduct at all times.
One final word. This bill is the product of immense thought and consultation and, I believe, inspiration. While it is a human instrument and will therefore probably need from time to time some alteration or amendment, in the light of experience, I believe that those alterations will be in matters of detail and not of substance. 1 believe that the scheme is based upon such sound principles as will provide a solid and enduring foundation for the practice of medicine in the future and will help to retain all that has been best in Australian medicine in the past. I believe that it will confer a great benefit upon Australia, and the nation might well be thankful to the Minister for Health who introduced it. I think it is probable that of all his achievements, and of his services to this country over many years, it may well prove that none has been greater than this.
.- Honorable members have heard the doctor’s point of view upon this measure, and 1 may be permitted now to give the point of view of the patient. To understand the purpose of this measure, it is necessary to trace its history. During World War II., the Labour governments led by Mr. Curtin and Mr. Chifley promised social justice to all sections of the community as a reward for contributions made by every one to bring about victory. Further, the leaders of the Labour governments promised that if the Australian Labour party was still in’ office after the war it would ensure that its programme would be translated to the statute-book and the people would not be sold out as they were after World War I. That promise was kept. Among the social services that were implemented by the Labour .Government was the national health scheme of the Chifley Government, pharmaceutical benefits, free hospitalization, assistance to tuberculosis sufferers, sickness benefits and other social services designed to relieve suffering and disease in the community. At the same time, sufferers were relieved from any financial burden resulting from their illnesses without a means test. That scheme did not meet with the full support and co-operation of the British Medical Association although it is to the credit of a number of medical men that they did co-operate in implementing the scheme including the pharmaceutical and medical benefits enactments which were the main 1-one of contention with the British Medical Association. That association used its organized strength to the point of intimidation of individual practitioners and imposed a levy to produce a fighting fund to bring about the downfall of the Chifley Government and the election of this Government. Following the advent of this Government the new Minister for Health, Sir Earle Page, who notoriously-
– Order ! The honorable member may not use the name of an honorable member in his speech.
– The Minister for Health, who notoriously reflects the views of the British Medical Association, took steps to undo the whole scheme and in May of the following year, he presented to the British Medical Association Congress in Brisbane the prospectus for a plan which he now describes as his own. In fact, it is a British Medical Association plan which the Minister, acting on behalf of the Government, agreed to implement as part of a secret bargain made with the British Medical Association for the support of that body for the Liberal and Australian Country parties in the 1946 and 1949 general elections. I make that statement unequivocably as there is conclusive evidence of that arrangement which I shall disclose in more detail later.
Having received the imprimatur of that body, the Minister took steps to introduce the scheme in various stages by legislation or regulations, which the Government now proposes to incorporate in this measure. Before doing that, however, the Minister took the trouble to attend the World Medical Congress at The Hague at the expense of the Australian Government so that he could obtain endorsement of his plan by that gathering. The congress did not represent the people of Australia in any way, nor did it represent the people of any other country. It was purely a private gathering of medical men. When the scheme is fully analysed it is not to be wondered that a representative of that congress ironically commented, according to a report in the New York Times, that the Minister’s scheme was “ just what the doctors ordered “. It is a purely negative approach to the question of national health, establishing as it does, a huge super-structure dependent upon and even encouraging more sickness and disease. It contributes nothing to the positive health of the community.
Analysing the various aspects of the scheme, it is easy to observe just how and why it differs from that of the Labour Government. Medical and pharmaceutical benefits and hospitalization were available under the Labour Government to every one irrespective of any means test. Under this- scheme, the means test has been re-imposed although it has been done in a backhanded fashion by making available certain limited benefits provided recipients become members of certain insurance organizations which are now springing up like mushrooms and by bringing pressure on the State governments to recognize those bodies and re-impose the means test.
One of the main grounds of attack by the Minister on the previous scheme was that it was too costly, but it is interesting to note, in relation to the pharmaceutical benefits or free medicine scheme of the Chifley Government, that in the period of 27 months for which it operated, the total cost was only £294,446 for the provision of 903,227 prescriptions for an average of 6s. for each prescription. In its first year, the present Government’s scheme has cost £7,297,281 for approximately 7,000,000 prescriptions, or an average of over £1 for each prescription. That is more than three times the average cost of prescriptions under the Labour Government’s scheme. This was above the Minister’s own estimate of £2,500,000 per annum, the reason being that he had overlooked psychological factors in his scheme which provides only for the prescription of so-called life-saving or wonder drugs. If the patient so desires and the doctor is willing to prescribe free drugs, this can be done only with respect to costly lifesaving drugs, whereas under the previous scheme the doctor could prescribe from a very wide range of drugs or medicines included in the British Pharmacopoeia.. It is now evident that many of these were not only much less costly but also just as efficacious as the so-called wonder drugs. In fact, many medical men are becoming alarmed at the dangerous reactions, and. harmful, even fatal, results from continued use of these wonder drugs. Tn this connexion, Dr. Perry, Professor of Medicine at Bristol University, writing: in the Cyprus Medical Journal, recently challenged the powers of cortisone and ACTH, the advent of which the Minister announced in this House less than two years ago and from which he prophesied miraculous results. Dr. Perry said - lt cannot be stressed too strongly that neither drug has yet cured a patient. In fact for the past few years, the medical world has been busy treating all the diseases we do not understand with substances whose action we understand even less. It is perhaps time that wetook stock of the position and attempted to determine what, if any, real place these drugs which undoubtedly produce profound effects, should have in practical therapeutics.
Likewise, another leading medical authority, Dr. Ethan Allenbrow, editor of Annals of Allergy, the official publication of the American College of Allergy, said that there had been indications that aureomycin and terramycin had caused “super infections” and fatal allergies, and he advocated an improved system of reporting the effects of the drugs so that they could be better evaluated and their dangers charted. It is worthy of memtion also that of the 300 antibiotics experimented with, only five have been found sufficiently less poisonous to be ; a ken into the human body, and it would now appear that these five also are seriously questioned with respect to both their efficacy and dangerous effects as the body becomes poisoned from over-dosage Despite this, the production of so-called wonder drugs has become big business. In fact, to use the words of the British Medical Journal, “It is a case of antibiotics run amok “. New theories are propounded and well advertised by the drug companies, and then discarded by the medical profession as offering nothing better than the old.
Wonder drugs follow one another in alarming succession. First. they are acclaimed to be a certain cure for this, that, or the other disease. Next, we hear that they should be used with caution owing to the serious side effects that have been produced in many cases. Then, we learn that these remedies lose potency, and that bacteria become resistant to treatment. After this a new wonder drug is enlisted. So, the merry chase goes on - merry for those who profit therefrom - whilst sickness and degeneration progress steadily in the community. It; is well to remember’ that, despite the Minister’s claims, only 4 per cent., of people in Australia die from natural causes whilst 9.2 per cent, die from avoidable sickness and disease,, and 4 per cent, from result of accidents.
Another ground of attack by the Minister on the previous scheme was that it was subject to abuse, and would lead to racketeering ; but it is quite clear, even at this early stage, and quite apart from the question of the efficacy of wonder drugs, that his own scheme is more open to such abuses than was the previous one. Already, grave warnings have been issued in this respect by the Minister and Commonwealth health authorities. Frauds have been perpetrated by some doctors and chemists through fictitious prescriptions and similar malpractices as a result of which the Minister has been forced to set up disciplinary committees. But even in that instance he has again bowed to’ the dictates of the British Medical Association and constituted these committees from nominees of that body instead of establishing an independent tribunal of a judicial or semi-judicial nature.
The financial basis of the scheme, which the Minister has described as encouraging self-help, is the establishment of hospital and medical insurance organizations along the lines of the American health insurance societies with which he has become greatly enamoured since his visit to the United States of America where, he ascertained, 86 per cent, of the cost of hospitalization was borne by the public, and only 14 per cent, by the government. Under the Chifley Government’s scheme the position was practically the reverse. Eighty per cent, of the cost of hospitalization was provided by governments, Commonwealth and State, and the balance was contributed by the public, or was obtained from charitable sources. It is readily understandable, therefore, why the Minister has become so enamoured of the American scheme and, to use his own words, desires to “marry the American and British schemes “. However, the marriage that he proposes resembles a shot-gun marriage. In favouring the American procedure the Minister has not only been very derogatory and denunciatory of the previous Australian scheme under Labour which, in the main, followed the New Zealand and British national health schemes, but he has also, been critical of the schemes in operation in New Zealand and Great Britain. He prefers to look for guidance to the United States of America, which is the home of private enterprise even in matters of public health.. The fact remains, however, that despite changes of government in both New . Zealand and Great Britain, the national health schemes in operation in those countries have been maintained by Conservative governments that have succeeded Labour administrations. In fact, the British Medical Association, which previously resisted the inauguration of Labour’s scheme, has now swung in favour of it. No doubt, a similar position would have arisen here if Labour’s scheme had been put to a fair test.
In confirmation of this change of attitude, a recent comprehensive survey that was made by the British Medical Association in Great Britain, in which 30 investigators ascertained from 12,657 members of the British Medical Association in that country their attitude towards the British scheme, showed that it was so popular with the masses of the people that no government, tory or conservative, would dare undo it. That scheme is growing more popular with the medical profession. Over 45 per cent, of the doctors examined by the investigating committee said that their scope had been widened and that the treatment of patients had improved under the scheme. Furthermore, and thi3 is the all-important factor, the report showed that the scheme had enormously lifted the general standard of health of the community, and had done wonders for British children, particularly in respect of dental treatment. In ether words, the report showed that the British national health scheme had been an undoubted success, and that criticism of it was designed primarily to improve it still further, both for the benefit of the people and of the medical profession. Yet, the Minister is so politically blinded and swayed by prejudice against Labour that, instead of following the British way of life in relation to health, under which the British Government accepts the main financial responsibility, he has subverted health to the American principle of domination by private enterprise and vested interests which profit from sickness and disease. The Minister, in order to obtain guidance, invited from the United States of America, again, presumably at the Government’s expense, a couple of cigarsmoking experts who are associated with American insurance bodies. These gentlemen naturally bestowed their blessing on the Minister’s so-called voluntary insurance organizations, although they indicated certain weaknesses in the structure of those bodies. These organizations are now springing up like mushrooms, not as genuine people’s organizations, but from inspired sources. Very little information is obtainable about their constitution and financial soundness by intending members who, by an indirect form of conscription, must join them in order to qualify for benefits provided under the Government’s scheme. The free medical, hospital and pharmaceutical benefits are confined to pensioners who, obviously, are unacceptable financially to such organizations.
In the introduction of these American methods, the Minister, in his desire to save the Government from its financial responsibilities, looks at one side of the. picture only and turns a blind eye to the other side, which will bring in its wake, assuredly as night follows day, abuses and malpractices more far-reaching in their consequences than were those which the Minister feared would arise under the previous scheme. Such abuses are likely to be worse for Australia than if a plague hit this country. For example, in order to obtain medical benefits a person is obliged to belong to one of these insurance bodies which, as I have said, are sponsored, and even controlled, by interested parties. I instance the Medical Benefits Fund which has sprung up like a mushroom. I have been shocked and dismayed to learn that this organization is both sponsored and controlled by leading members of the British Medical Association. Doctors and chemists are channeling patients into that organization with the express object of undermining the structure and recognized principles of genuine, long-established friendly societies. Worse still, there is evidence of the fact that it is being represented as having the imprimatur of the Australian Government and of the fact that the Government itself is conniving at this propaganda with the object of misleading people into believing that it is officially sponsored. That organization is not even registered as a friendly society, but is incorporated as a public company. No fewer than seventeen of its directors are doctors, and its rules are designed to prevent contributors, who are most vitally concerned, from having any say in its administration. That is an atrocious and arrogant procedure. If these are intended to be genuine people’s organizations why does not the Government itself sponsor them openly or confine them to existing friendly societies which are subject to proper control and supervision and are democratically governed? It is a well-established principle that no director or officer of such a body shall have a direct or indirect pecuniary interest in any business dealings with it because of his fiduciary relationship with members.
Just as is the case with the provision of costly life-saving drugs, there will be a natural psychological tendency on the part of those who will be paying into these newly-founded insurance bodies to want to get some benefit back from their money, even to the point of being easily persuaded to undergo unnecessary operations involving the removal of vital organs of the body. This has been the trend in America, the procedure of which the Minister slavishly adopts, as is borne out by evidence adduced by’ more responsible elements of the medical profession there who have become most outspoken and imbued, with a desire to clean up the abuses and malpractices which have sprung up in recent times at the hands of the more unconscionable elements in their ranks. Dr. Paul R. Hawley, director of the American College of Surgeons, was asked in a very frank interview published in the United States Nevis and World Report and condensed in. the Reader’s Digest of June last, “How extensive is unethical medicine?” He replied -
There are four major evils; unnecessary operations, fee splitting, overcharging and ghost surgery.
It has also been disclosed, in a number of reports which give details of surveys and observations of prominent physicians and surgeons recently published in leading American medical journals, that there has been wholesale abuse and malpractice in the performance of unnecessary operations, with particular reference to hysterectomy, appendectomy and tonsillectomy. It was shown that hysterectomy, an operation for the removal of vital organs from womenfolk, had been performed unnecessarily in as many as 50 per cent, of the cases involved. Appendectomy, or removal of the appendix, had been unnecessary in up to 70 per cent of the cases examined, and tonsillectomy, or removal of the tonsils, had been unnecessary in 100 per cent, of the cases handled by some surgeons. It was contended that tonsillectomy, especially in young children, was wholly unwarranted and most harmful in the light of a proper understanding and appreciation of the true function of these organs. That is a clear indication, from unimpeachable sources within the medical profession itself, of the sort of temptations and the anti-social practices that are liable to develop under this scheme with the introduction of overseas methods of finance, unless proper safeguards are provided. And there are no such safeguards in this measure! In Sweden, I understand, an independent opinion must first be obtained before an operation is performed.
The establishment of disciplinary or investigation committees is merely like locking the stable door after the horse has got away and irreparable harm has been done to the patient and the community. This not only involves moral principles, but also vitally affects the future welfare of this country, which so badly needs more population. Similar comments could be made on many other operations that are provided for under this measure and for which very liberal allowances are to be made, without, incidentally, any fixed charge for services, such as applied under the previous scheme, which was the main bone of contention on the part of the medical pro.fession in its opposition tr> that scheme. There are, in fact, 701 different operations and services provided for in this schedule, as against 192 under the ChifleyMcKenna scheme. This is very significant and indicates some outside influence in the considerable enlargement of th« schedule of operations. I again suspect the hidden hand of the British Medical Associtaion behind the Minister. If it is not responsible, let the Minister speak up .and say who is. The previous Minister, Senator McKenna, had the best possible advice and guidance in the preparation of the schedule, and this enlargement of the schedule certainly calls for some explanation.
The Minister, as a former surgeon, no doubt still has an affection for the knife, and he might, therefore, explain the nature of some of these operations to the House, and perhaps provide an interpreter for some of the phraseology. For instance, item 524 refers to reconstruction of the bile duct, including choledochoduodenostomy, cholecystoduodenostomy, choledochoenterostomy, choledochogastrostomy, cholecystogastrostomy or cholecystenterostomy. The amount of £11 5s. is shown as the Government’s contribution, but the schedule does not specify whether that is payable for each of the operations or for all of them. There is another .section in which there are 94’ unspecified items of surgical operation. Perhaps the Minister has run out of Latin and Greek phrases and may have to fall back on Hindustani and Chinese. Speaking of the unintelligible jargon in which many medical terms are enshrouded, Dr. Paul E. Hawley, to whom I have previously referred, was asked the question, “ Hasn’t medicine been a sort of secret thing?” He replied -
That’s right. Medicine hasn’t outgrown its phase nf druidical priesthood yet. “ Never mind, the doctor knows best” still goes, you know. For many centuries medicine didn’t know very much, and there was a great fear of being exposed. You didn’t darc tell the patient too much. Now, with better education of the people and the sounder scientific basis of medicine itself, there is no longer any reason why a doctor .shouldn’t sit down and explain everything to a patient.
Limitation of time will prevent me from dealing with all of the operations in the schedule, especially in the absence of an interpreter, but in. the committee stages I hope to have an opportunity to say something more on that score. It is indeed refreshing, however, to know that there are men of Dr. Hawley’s type who Lave the courage and public spirit to be outspoken on this subject. The plain fact of the matter is that medical science is still an inexact science and is going through a process of evolution. Some doctors are more enlightened than others. Unfortunately, some are still in the backwoods. The problem is how to protect the public against the inefficient and antisocial elements while encouraging and assisting the more enlightened in their good intentions. This scheme, as I have said, will not afford that protection. Whilst I consider that local standards of the medical profession have been relatively on a high plane, there are very grave dangers, under this scheme, of an intrusion of the overseas practices to
Which I have referred.
The policing of the scheme cannot be left to the profession, for the simple reason, as Dr. Hawley points out, that there is, on the part of doctors, an occupational reluctance to testify against each other “. “ That,” he says “ is the toughest thing we have to overcome “. I know of that kind of thing from my long experience in the law courts. Incidentally, in a recent case at Broken Hill in which a doctor and a chemist were found to have acted in collusion in issuing fictitious prescriptions for large quantities of life-saving drugs, eve/y effort was made by other professional men to cover up the matter and quash any prosecution. To the credit of the Department of Health, it resisted these overtures. In fact, while unduly high taxation persists, together with the monetary incentive provided with this measure, there will be an all-too-strong temptation to indulge in abuses and malpractices. For example, in order to earn a net income of £4,000 to x?>,000, a specialist or surgeon needs to gross £10,000 to £12,000 per annum in hia practice, and it takes a lot of operations and attendances to make up that figure. This provides a glaring example of the futility and dangers inherent in a policy of high taxation. What is more, there is very little encouragement under this scheme for the physician and the drugless healer, who believe in other therapeutic methods than drugs and surgery. In their ease, only paltry fees are provided for in the schedule. It would be far better to give generous tax concessions to members of the medical profession, whose work is equally as important as that of primary producers and secondary industries, and to provide for their security generally by way of adequate remuneration, regular hours of work, liberal superannuation or retiring allowances, proper holidays, and time forresearch and post-graduate study to enable them to keep in touch with the latest and best methods of therapy, as well as to educate the people in better ways of living.
The Government’s incentive basis of remuneration for the medical and pharmaceutical professions, according to the number of operations performed or drugs prescribed, coupled with high taxation, is a snare and a delusion for them as well as for the community generally. This is the most pernicious measure ever introduced into this House. Nevertheless, I have as much sympathy for the medical profession as for the public in this situation. The panel system, and the remuneration of doctors on a per capita basis,, as in Great Britain and as was the practice under the Australian friendly society system until recently, when the British Medical Association abrogated its agreement, coupled with the establishment of local health centres with all the latest facilities available for treating, as well as educating the people with films, lectures and press propaganda, would encourage preventive measures in relation to health and physical fitness and would enable the people to look after themselves. Members of the profession would thereby enjoy better health and greater economic security and have the satisfaction of helping to foster a healthier and happier community. Furthermore, they would be saved much red tape and form-filling, .and the intimate doctorpatient relationship could still be maintained, together with freedom of choice of doctor by the patient and the right of private practice and specialty work by the doctor if desired. Compensation of existing practitioners for their goodwill and discouragement of trafficking in practices would also provide opportunity for younger men without means who are natural healers and have entered the profession, not merely for personal gain, but primarily for the love ‘ of humanity, and who would thus be able to fulfil properly their Hippocratic oath.
Under the panel system, as one medical writer has pointed out, doctors would have a vested interest in keeping people well instead of in more sickness and disease as they will under this measure, and they would develop a greater social consciousness. The Minister said in Brisbane and at The Hague that the healing of the sick was personal and individual, and could not be done en masse. I ask, why not. People should be told more of the workings of their own body - the machine they nin every day and every minute and second of the day, and in the smooth and efficient running of which they are vitally interested. “Why should that knowledge be confined to any privileged section of the community? The original derivation of the title “ doctor “ was a teacher, friend, guide, and philosopher to the populace. That i3 the role - a very honoured role - to which the profession must be restored if we are to have any truly national health scheme. This measure envisages no such plan. Its title National Health Bill” is a misnomer. It is a vicious thing that will promote, rather than alleviate, sickness and disease in the community. Countless human souls will be sacrificed to the greedy clutches of mammon. But the medical profession must see the light of day first. To-day, most doctors are groping around in the dark. Similarly, research into other therapeutic measures not recognized, openly at any rate, by members of the profession, would broaden their horizon and help to co-ordinate all the various healing arts for the benefit of humanity as a whole. This measure, however, with its accent on the money making side, will discourage, rather than encourage such a trend.
The whole emphasis of this bill is on the private practice of medicine and the Minister’s own pamphlet shows that in this country 7T per cent, of medical men ure engaged in private practice, 8 per cent, in the Public Service, 13 per cent, in public hospitals and only 2 per cent, in teaching and research. That is an undue balance in favour of private practice. A more correct balance exists in Sweden where 60 per cent, of doctors are in government or community services, and 40 per cent, in private practice. Sweden has one of the best medical services in the world. Certainly in the realm of research there is tremendous scope for the advancement of medical science which in Australia i3 still in the backwoods, and is unable to deal effectively with a host of diseases the causes of which are still unknown to orthodox medical science. Yet, there is overwhelming ‘evidence of many cases of cures by methods unrecognized by the profession. Often medical castoffs and apparently hopeless and incurable patients are cured by dietitians, naturopaths, homeopaths, osteopaths and other manipulative therapists, metaphysicians, Christian .Scientists, psychologists and so on. All of those people are excluded from the scope of this measure, yet the medical profession, collectively at least, shuts its eyes and will not even investigate their work. That is readily understandable when it is appreciated that the British Medical Association, like any other trade union or vocational group, is primarily concerned with the economic interests of its members and must perforce look askance at all outsiders who might encroach on their preserves. Its members must not, therefore, in any way co-operate in, or even tolerate, the activities of those beyond the pale oi their ranks. But as with all restrictive trade practices, the interests of the community as a whole should be paramount. An extension of government services, especially in research and -teaching personnel, is the answer to this problem.
Tie science of healing, including preventive measures, should be allembracing. Accordingly, its control and development should be in the hands of those who are unfettered by traditional ideas, conservatism - or anti-social tendencies. A world-renowned medical man now visiting Australia on a lecture tour, Dr. Douglas Guthrie, who is lecturer in medical history at the University of Edinburgh and author of many books on medical history, said in a recent interview that there existed a power of healing that was different from anything in traditional medical science. He said -
It is something that cannot be explained in terms of medical science, but it must be carefully controlled. This power of healing is something quite independent of recognized techniques and a doctor who possesses it must have a highly developed sense of moral responsibility.
Only a good man can be a good doctor - too often modern doctors lose sight of this. Nobody should enter medicine just to make money. If a man wants to make money he should go into business - not medicine.
Whilst Dr. Guthrie was really commenting on metaphysics, we have, in effect, a very frank admission by a noted medical authority that there is some missing factor in orthodox medical practice.
-(Hon. Archie Cameron). - Order! The honorable member’s time has expired.
– I rise to order. I did not wish to interrupt the proceedings while the honorable member for Reid was speaking, but I seek your advice now, Mr. Speaker, on the rules of the House on the subject of the reading of speeches. I should not like this matter to be regarded as personal. The honorable member for Reid read his speech throughout. I hope that no honorable member will attempt to deny that. I do not wish to cast any reflection on the honorable member, but I should like you, sir, to state clearly whether or not a member may read his entire speech.
– I am pleased that the honorable member for Franklin has called my attention to this matter. I point out, however, that if I were to apply the relevant standing order, it would have to be applied to Ministers as well as to private members. Ministers have no greater rights than other honorable members have in relation to the reading of speeches. If speeches are not to be read, our proceedings will be shortened by about 80 per cent. I am not saying whether that is something that should happen or should not happen, but Standing Order 61 states quite clearly -
A member shall not read his speech.
If any honorable member objects to another honorable member reading his speech, I shall have to call the attention of the House to Standing Order 61, and a decision will have to be made.
– How will you know whether he is reading his speech or not?
– That will be for the House to decide.
Mi-. HAWORTH (Isaacs) . [9.47]. - I can readily understand why the Labour party’s criticism of this bill is so bitter, and I can quite understand why the attack that has been made by the honorable member for Eden-Monaro (Mr. Allan Fraser) on the bill and on the Minister for Health (Sir Earle Page) has been so bitter. The reason for that bitterness is, of course, the fact that this bill rubs salt into the wound caused to the Labour party by its failure in its eight years of office to bring down a national health scheme that would actually work. Now that this Government has succeeded where Labour failed, honorable members opposite are exceedingly bitter. I propose, in the limited time available to me, to refer only to the highlights of this measure, and to certain parts of it that I consider should be watched by the Government. I shall leave to my colleagues the task of discussing other features of the legislation. Many provisions of the bill are worthy of close scrutiny and observation. The bill is the culmination of four years of hard, patient effort by the Minister for Health to provide this country with a national health service which is in keeping with the Australian way of life and which, I believe, if wisely administered, will provide the maximum medical benefit to those people who most require it. I cannot understand why the honorable member for Reid (Mr. Morgan) had to travel round the universe searching for other countries that have adopted medical schemes. The honorable member referred, for instance, to the British scheme, which has been enormously expensive and has proved of tremendous financial embarrassment to the Government of the United Kingdom. When this Government’s health plan is placed on the statute-book in the form of a complete scheme, its successful operation will be assured from the very beginning. Each part of the service is already in operation and has been well tested. That has been achieved by Executive acts and under existing legislation that is now being consolidated. It is unusual to implement any national scheme by regulations and Executive acts. I confess that, on principle, I do not support such a method, but in this instance it has been partially responsible for the successful launching of a national health service that is entirely new to the Australian way of life. The success of the service has required the co-operation of many professional organizations and voluntary bodies. In some instances, they have given up old-established customs in order to reach agreement on the matters dealt with in this bill. It is not easy for any profession to brush aside established customs in order to co-operate with a government in a part of a government plan.
I describe the health scheme of this Government as a compromise between private enterprise and public control. The success of the Page health scheme, if I may so describe it, has demonstrated that, by using the services of the family doctors and the family chemists, and by including the big public hospitals and medical benefits societies, we can bridge the gap between free enterprise and public control without an apparent break in the traditional conduct and customs of the professions concerned. We want to keep it that way. We want our doctors ;ind chemists to get reasonable returns for their work in this partnership. We would not get very far if we demanded that neither doctors nor chemists should be permitted to make a profit. The honorable member for Hindmarsh (Mr. Clyde Cameron) indicated last week that it was a sin to make a profit. If we adopted that principle, it would be exceedingly difficult to make a success of the national health scheme. We say that profit is a legitimate aim for any profession or trade, but that it depends entirely upon public acceptance. The doctors and chemists of this country, who have worked traditionally under a system of free enterprise, know that they can retain their freedom to establish and conduct their practices and businesses only so long as they demonstrate their willingness and capacity to give a better service to the public than could he provided by a government, a salaried doctor or a regi mented sick parade, such as would have been in existence if the scheme of the previous Government had been put into operation. That is why the doctors and chemists of Australia are determined that, under this national health service, there shall be no deterioration of the standard of treatment or of the medicines dispensed. Both professions have expressed that determination to the Minister.
When one compares the health service of this Government with the health scheme of the previous Government, one appreciates the degree of patience, the personal knowledge of the various professions involved, and the creative throught that have been contributed by the Minister and his advisers to the launching of this amended scheme, which honorable members on this side of the House are proud to sponsor. The health service of the previous Government had all the virtues except the vital one. As everbody in the community knows, it would not work. The wisdom of the health policy of this Government stands out in bold relief. We demanded from the very beginning that a health scheme should be neither a regimented scheme nor a socialized scheme, but one which harnessed in a proper working partnership the Government’s health experts and the medical, pharmaceutical and allied professions, as well as the hospitals, friendly societies and medical benefits societies. Any one who has been sufficiently interested to make a close study of the health scheme of the previous Government knows why it was doomed to failure from the beginning. Basically, it was designed surreptitiously to nationalize the medical and allied professions. There was no mystery about that, because nationalization of the health services of this country is one of the planks of the platform of the Labour party.
– Who said that?
– It is printed in black and white in the platform of the Labour party. In the negotiations that took place between the previous Government and the various professions, the Minister for Health at that time did not hesitate to say that he was going to tell those ancient professions how they should manage their own affairs. Naturally, there was an immediate reaction against any co-operation with the Government. The ability to conduct a professional practice is the result of a lifetime of study. A professional practice in the health field should not be regarded as a piece of machinery .that can be fitted into a socialistic regime and be expected to work. Any successful national health service depends from its inception upon complete co-operation by the doctors, chemists, dentists and other professional men involved. There must be confidence and trust between the Government and the professions. The fact that in the present health service the Government has the co-operation of the professions concerned shows that there are adequate safeguards of the freedom and status of those professions.
As the Minister for Health has said, the bill relates to a series of services, in their proper order and sequence, that are designed to help the people of this country at every stage of their lives. The children benefit from free milk and immunization. Young people, who are prone to tuberculosis, are protected. Everybody is entitled to free life-saving drugs, as well as to medical treatment and hospital benefits. The pensioners are entitled to free medicine and free medical treatment, which they can receive in their own homes. The service has been running for a considerable time and some important results, such as shorter illnesses, less sickness, and shorter stays in hospital - with a greater consequential turnover of hospital beds - have already manifested themselves. This is practical evidence of the efficiency of the scheme. According to a press report to-day, there are now empty beds in tuberculosis sanatoria in Victoria for the first time in the history of that State. This is attributable to the fact that this Government introduced certain services, including the provision of X-ray examinations and the supply of preventive drugs to deal with the scourge of tuberculosis. Earlier this year the Government, by regulation, gave permission for approved societies to accept contributions for medical benefits. By paying a small weekly amount, a person may become eligible for medical benefits and, in addition, a Commonwealth subsidy-. The subsidy is contingent on the payment of an equal amount to a patient-member by an approved society. Although this system has great merit, by providing benefits for the people, I warn, the Government that, in giving our blessing to medical organizations, we must guard against providing them, at the taxpayers’ expense, with an easy means of enlarging and inflating their financial strength to such a degree that they, not the Parliament, will be able to control the future of the health scheme. We could easily create a Frankenstein monster that could destroy the authority of the Parliament over our health services. The Government should legislate to ensure that, after a “safe” period, the reserves that the societies establish from subscribers’ contributions shall be handed back to their members by a reduction of contributions. To-day, in every capital city of this country, there’ are friendly societies with tremendous resources which collectively aggregate millions of pounds. They have been built up by contributions from people who are long since dead. The people, not wealthy organizations, must benefit from this service. I direct the attention of the Government to that aspect of the matter particularly. Medical practitioners, also, have an important responsibility in connexion with the scheme, and there is also a responsibility on the chemists. How.ever, as the benefits are initiated by the doctors, the greater responsibility rests on their shoulders. Doctors should avoid over-prescribing for illnesses that can be cured by simple and inexpensive treatment. There is a tendency on the part of some doctors - I am glad to say only very few - to adopt standards of treatment that are not based entirely on the efficacy of the new therapeutic substances, but on financial values. They decide to prescribe a certain drug on the basis of whether it is included in the free list, not from a consideration of whether it will be the most beneficial to the patient.
Provision is made in the bill for the establishment of disciplinary committees under the control of medical practitioners and chemists. Such committees will help to prevent abuse and misconduct by members of those professions. I am sure that they will play a worthy and valuable part in maintaining medical and pharmaceutical services at a high level. Let us consider the probable eventual cost of these services to the country. I am not prepared to agree with the figures of probable cost that have been mentioned by the Minister from time to time. It is true to say that the governments of other countries have been astonished by the ultimate cost of the provision of medical services. Although the advancement of therapeutic science has been rapid, the provision of the so-called wonder drugs is expensive. A right to be treated with these life-saving drugs should not be denied to any citizen because of their high cost. This Government has recognized that principle by making available life-saving drugs free of cost. Ultimately, however, the cost is debited to the taxpayers, and therefore the expenditure involved in their provision must be controlled in the interests of national solvency. The Leader of .the Opposition (Dr. Evatt) has stated that a future Labour government will introduce a bigger and better health scheme than the present scheme. The cost of such a scheme would be fantastic. Labour would nationalize the medical and pharmaceutical professions, as has been done in Great Britain. I am sure that the introduction of a scheme such as the Leader of the Opposition envisaged would bring this country closer to insolvency than it has ever been. This Government’s health scheme provides for the subsidization of hospital and medical expenses, provided that the people are prepared to help themselves. However, the cost of such a scheme might result in an intolerable drain on our national resources. On the other hand, limitation of expenditure could result in progressive inadequacy of treatment. It is clear that the continued provision of a health service depends primarily on national production. It is affected adversely by inflationary tendencies. The people of this country know from their experiences in years preceding 1949 that strikes, go-slow tactics, and shortages accentuate inflation. Unless the forces of inflation are brought under control there will develop not a welfare State but a totalitarian State. We can afford to provide a truly national health service only if a condition of full production is maintained. This Government has honoured the promise that it made in 1949 to provide life-saving drugs free to the people. Indeed, it has gone much further than that. Within a period of three years it has introduced a complete national health service. I am sure that the people of this country appreciate the manner in which this Government has honoured its promise in this connexion.
.- The honorable member for Isaacs (Mr. Haworth) has warned the Government that certain medical insurance funds may be so built up from contributions that they will endanger the future control of the Government’s health scheme. I hope that the Minister for Health (Sir Earle Page) will take heed of that warning. I consider that it is time that supporters of the Government discarded the bogy about the provisions of the Constitution in relation to national heath. The powers of the Government in respect of social services are stated in the Constitution as powers in relation to -
The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription) . . .
The last Labour Government sought and secured those powers in the 1946 referendum, even though it was opposed by every member of the then Opposition. It is important that the powers of the Government under the Constitution should be clearly stated, so that the arguments of supporters of this Government may be seen in their true light. If they are so inspected they will fool nobody. The Labour party believes that an efficient service that covers all aspects of the people’s health is essential to the welfare of every progressive nation. The principle is that a health service should be complete, and should be available to all citizens, but such a scheme cannot be found in this bill. The Labour party supports the principle of a national health scheme for the people, but it disagrees in many instances with the methods of implementing such a scheme as they are detailed in this bill. Any scheme under which a family or an individual has to bear a substantial portion - in some cases the greatest portion of the cost of medical and hospital services, as well as pay 3s. a week or £7 16s. a year into the health insurance scheme, pay into a hospital fund and pay the heavy taxes they are forced to pay to-day, will not receive any frenzied support from people outside this Parliament.
I believe that the health df the nation is so important that it should not be kicked around like a political football. On numerous occasions Labour governments have shown the value of joint committees, and matters like health, social services and repatriation should be discussed and considered in parliamentary committees composed of members of all political parties in this House. I well remember the attitude adopted by the Government parties, during the general election campaign of 1949, towards the Chifley health scheme, and the way that they fomented hostility throughout our hospitals and all sections of the medical profession. That was in the face of the fact that the Chifley scheme had been subscribed to by a number of their own supporters, who were members of the then Social Security Committee.
If any health scheme is to succeed, it must have the co-operation and goodwill of the entire medical profession including medical specialists, nurses, hospital staffs, chemists, dentists, friendly societies and other health and medical organizations. Without such co-operation great difficulties will arise. Moreover, the ordinary citizen is important, and should not be bullied or bludgeoned into a national health scheme, as is at present proposed by this Government. For I warn the Minister that the wholesale domination by one section of the health services of the community is very dangerous, and can lead to a complete sell-out of the people.
– Does the honorable member belong to any medical benefits scheme ?
– Tes, I do. This bill was framed by the British Medical Association, and is in effect a British Medical Association bill. If one reads through the measure, clause by clause, one finds that the influence of the British Medical Association pervades all its provisions. It is quite obvious that under this measure the British Medical Association will control and ultimately dominate the health scheme. Visiting nurses, dentists and friendly societies - some of which have been in existence for more than 100 years - will be left completely outside the real beneficiaries. The grand secretary of the Grand United Order of Oddfellows, a society to which I belong, said the following about this bill :-
I regard it as most important that every Medical Practitioner in Australia should adopt a strictly impartial attitude to every type of Medical Benefits Fund.
There is considerable evidence to my knowledge that many Medical Practitioners are actively canvassing for a particular Medical Insurance Fund. This is particularly rife in some industrial centres where the Doctors’ Clubs have closed down. I do not suggest that because a person happens to be a Registered Medical Practitioner that he surrenders his citizen rights and from that point of view he is and must be perfectly free in a democracy to advocate any cause in which ho believes. But where he wields so much power over the finances of Medical Insurance Fund it is my opinion a strong case can be made out for an impartial approach to these competing Funds.
Throughout Sydney at present one may find doctors who are taking a stand in opposition to friendly societies and other organizations which have been looking after the welfare of the people for many years. Those doctors are now objecting to friendly societies, and are in effecttelling people that they should join the medical benefits fund that has been set up. and is controlled by, the doctors themselves. But the people should remember that this Government had to take certain action against that very fund. In that connexion, I quote from a letter to the editor of the Sydney Morning Herald, published on the 7th November -
The Medical Benefits Fund of Australia was informed by a Department .of Health official that it would not receive registration unless it lowered ite proposed benefits of 10s. per consultation and visit to 7s. Cd. and 7s. 6d. Finally the Government accepted rates of 7s. Cd. and 9s.
Therefore, it appears that the medical benefits fund set up by the doctors themselves had to be disciplined and controlled by the Government. The Minister for Health should take some notice of members on his own side of the House, even if he pays no attention to what we say, and be warned of this Frankenstein monster that is being set up by the British Medical Association, aided and abetted by himself and the Government. Any medical benefit scheme that allows the medical profession to make profits by keeping people on the sick list is not in the best interest of the nation.
The Government has laid it down that if u person is insured under table B of the medical benefits scheme, and pays ls. 6d. a week if single and 3s. if married, he will receive subsidies from the Government in the event of illness. Let us consider what will happen under this bill. The money that the people have paid by way of taxation and which has accumulated in the National Welfare Fund to the extent of £186,000,000 will be returned to them to subsidize payment for their illness only if they belong to one of the approved funds. I submit that, the payment of the Government’s contribution to an individual should not be conditional upon his being a contributor to a medical benefit fund. It may be argued that payment is made to a medical benefit fund and that such a change as I suggest would by-pass the society. “ In certain circumstances, the Minister for Health has allowed payment of an approved benefit to an individual. This practice could be extended so as to give the government benefit to everybody who is affected by illness whether covered by insurance or not. No effort should be spared to have the advantage of insurance schemes brought home to every person, but I do not subscribe to the Government’s claim that people do not deserve medical assistance if they are not prepared to pay for it. All people have not an equal capacity to pay. The payment of £7 16s. a year for medical benefits plus at least £2 12s. a year for hospital benefits is a terrific slug to the working man with a family. Members of this Parliament with a family find it difficult to live on their own salaries and they must realize the difficulties of people outside this Parliament who live on a little over the basic wage. After making these substantial contributions what advantage do they receive? Health and medical charges have skyrocketed out of all proportions. It is claimed that this scheme avoids the extravagance of the United Kingdom and New Zealand schemes, encourages voluntary effort, and that the benefit represents 90 per cent, of a fair and reasonable fee for services given by a doctor. Consultation with a general medical practitioner carries a rebate of 12s., which is made up of 6s. from the insurance fund and 6s. from the Commonwealth. The secretary of the Grand United Order of Oddfellows, who has had 30 years’ experience in the administration of a medical fund, made the following statement on this matter : -
This item of “ fair and reasonable fee “ is very important, e.g., the consultation with a General Practitioner carries a rebate of 12s., fis. each from the Fund and the Commonwealth. This is 90 per cent, of 13s. id. which is a mean average between 10s. Gd. and 15s. A general practitioner’s fee nowadays ranges from 10s. Gd. to 35s. per visit according to the locality and the type of people who live in that locality. When it comes to surgery, the eminence of the operating doctor in the particular sphere governs his fee. Removal of an appendix is one of the most common surgical operations. Its benefit under the Medical Scheme is a rebate of £11 os., being £5 12s. Gd. each from the Fund and the Commonwealth. This £11 5s. represents 00 per cent, of £12 10s. - a fee which the Commonwealth Board of Health doctors evidently considered a reasonable charge for a surgeon sufficiently skilled to capably remove an appendix. There are, however, surgeons in Australia with remarkable reputations for skill and efficiency who would not touch an appendix removal under 50 ot 80 guineas.
The Opposition asks that a provision be inserted in the bill in order to provide that the fees charged by doctors be properly controlled and that the Commonwealth’s contribution shall more closely approximate an equitable charge to cover the patient’s medical account. A doctor has written the following criticism of this bill:-
Among the larger operations the removal of the gall bladder is fairly common. The usual cost of this is from 40 to 50 guineas. With the maximum assistance to the patient of £30 there is a leeway of from £.12 to £22 10s. to make up.
People who pay 3s. a week plus taxation have to pay many pounds for medical treatment over and above the benefits that they receive from their funds. That is the disgrace of this bill. That is why I join with the honorable member for EdenMonaro in asking that the government contribution be increased. When people who think that their medical expenses have been covered by this bill go into hospital their reaction against the Government will be so great that the Government will lose far more votes than it has already lost at by-elections. The doctor continued -
It is when we get into the field of the complicated and largest operations, however, that the scheme is most unsatisfactory. Although a cancer of the stomach operation, for instance, costs at least 100 guineas, total maximum benefit is still only £30. The patient’s burden would then be upwards from £75. Of course it may be said that such operations are rare. But most people regard insurance as a safeguard against the rare and unexpected. For what other reason do people cover their homes with fire insurance?
Perhaps the worst feature of the Government’s scheme is that which tends to lend an element of farce. I refer to the refusal of societies to cover chronic illness. Honorable members opposite referred to the medical practitioner as the man who lends his aid and assistance to those who suffer from chronic complaints. This bill does not cover those chronic complaints. It probably will not cover half the members of this Parliament. The Government’s contribution will not do much to assist people with chronic illnesses who constitute a large proportion of the sick. Chronic illnesses include asthma, stomach ulcers, high blood pressure and arthritis. Many members of this Parliament and a large percentage of the general public would not be covered by a scheme of this character although they are paying exorbitant sums of money for medical benefits.
A complete health scheme should cover dental services. The Government has rejected a plea that was submitted by the Australian Dental Association. That plea was quite simple. The dental profession thinks that it should have the right to prescribe under the Pharmaceutical Benefits Act. The association has made suggestions in relation to drugs that should be prescribed by dentists and submitted a proposal in relation to disciplinary or supervisory committees that may be neces- sary to ensure that dentists do not go beyond the scope of their activities. Patients of dental practitioners expressconcern because they have to pay additional fees to medical practitioners or pay pharmacists’ accounts before certain drugs that are listed as pharmaceutical benefits can be obtained. That applies specifically to acute infective conditions which require drastic therapeuticmeasures. The dentist’s patients are at a disadvantage when compared with those of the medical practitioner. In order to obtain a pharmaceutical benefit, it is frequently necessary for the dental patient to visit a medical practitioner and pay a consultation fee or a fee for theadministration of the drug itself. The right to prescribe the drugs that have- been suggested by the dental profession is given by law to dental practitioners, but they are precluded from prescribing drugs listed as pharmaceutical benefits. The drugs which they desire to prescribe and which they have authority to prescribe include distilled water, a number of penicillin preparations, a number of sulpha drugs and vitamin K drugs. They have suggested those drugs to the Minister for Health. The Minister said that hewould examine the list, and on the 5th November, 1953, he wrote the following letter to me : -
I refer to your letter of 21st October, 1953,. relative to the prescribing and administering of certain pharmaceutical benefits by members of the dental profession.
These matters have received a great deal of attention in the past, but, whilst there is no question as to the ability or legality of dentists to provide these services, it has nevertheless been generally accepted that, for the purposes of the Pharmaceutical Benefits Act, they should be confined to the medical profession.
The Government has introduced a schemefor which people pay and under which they expect to obtain full benefit, but under which, when they have reason to expect a refund, they are told that they are not covered. I received the following letter from one of my constituents : -
I wish to bring under your notice a matter which I consider is of very great importance On the 7th inst. my wife had occasion to visit a Surgeon Dentist, 175 Macquarie-street and have a tooth extracted. There was alsoa cist on the gum and she had to have a surgical operation (four stitches were inserted). She also had penicillin injections,. also an X-ray before the job was done. I was charged a fee of £12 12s. When I contacted the Medical Fund I belong to, 1 was told 1 could only be allowed for the X-ray, which meant about 12s. all told. Six shillings from the Medical Fund and (5s. from Dr. Earl Cage’s Social Services. Now 1 want to ask, or has1 the question been asked in Federal Parliament if this is the great medical scheme wc are continually told so much about. I think as a taxpayer and a rate payer in the Waverley Municipality I desire- some more consideration in this matter.
I do think that the people of Australia need more consideration in this matter. The national health scheme is concerned solely with the doctors and not with the people who are paying into it.
I received from another constituent a letter which dealt with another aspect of the provision of medical benefits. The reply he received from his own friendly society stated -
I am in receipt of a claim for rebate from the Medical Services Fund in respect to payment to Nurse O’Connor, for giving injections to yourself during July. In this connexion, I have to advise that there is no provision in the Commonwealth Medical Benefits Scheme, operating since 1st July, for rebates being allowed on payments to Nurses giving injections.
For the reason stated, I regret to say that your claim in question cannot be admitted for rebate, and the receipts are returned herewith. Rebate on Dr.- account is being attended to.
I suggest that the national health scheme is a phoney scheme and that the people of Australia will express their objection and their hostility to it in a manner that will sweep from the Government benches those honorable members who think that it will save them from political oblivion. Members of the Opposition look forward to an opportunity during the next election campaign to fight this issue, because every person who comes before a medical officer between now and the next election will not be a friend of the Minister for Health or of the Government.
– I find myself in the unique position of supporting a national health scheme which is in operation, is approved by the people, is a credit to its originator and is recognized as one of the best health schemes in the world. Before I proceed to deal with the bill, I must comment on some remarks of the honorable member for Phillip (Mr.
Fitzgerald) . The honorable member read at some length from an unnamed publication.
– It was The Oddfellow.
– That is not the publication from which the honorable member read. He read from an unnamed publication an article by an anonymous doctor. Possibly payment was made for the article. The bona fides of the publication might be questioned, because it purported to publish on the one hand an article by a person who may be described as a “Doctor Who Tells” and on the other hand a reply by the Minister for Health (Sir Earle Page), who is in charge of this bill. It is interesting to note that the publishers did not seek the Minister’s approval to publish his reply to the statement of the anonymous doctor, but that they quoted some speech that was made some -time previously. Therefore, the bona fides of the anonymous, doctor’s objection to the bill, in which he stated that an operation for some stomach trouble would cost approximately £70, might well be questioned. The case put forward by the Opposition was so shaky and so devoid of real substance that honorable members opposite thought it necessary that the honorable member for Eden-Monaro (Mr. Allan Fraser) should spend half of his time on a vicious personal attack on the Minister for Health. The Opposition’s case is so devoid of substance that half of the statements that were made were nothing more than a spiteful, venomous, personal attack. The honorable member for Eden-Monaro attempted to justify his apparent opposition to this measure, although in his own heart he knows very well that he supports it. One of the things he said, which I shall cite because it is most illuminating and will no doubt be repeated many times before this debate is concluded, was that when Labour is returned to office it will repeal this legislation. I have no doubt that if the Australian Labour party ever regains office it will introduce the kind of socialistic measure which it introduced previously. Despite the remarks of the Leader of the Opposition (Dr. Evatt) that the Australian Labour party has no intention to socialize or nationalize anything, only recently the honorable member for Hindmarsh (Mr. Clyde Cameron) promised that if Labour were returned to office it would nationalize many industries. I have no doubt that the medical profession would then be due for nationalization, as it was previously under Labour.
– What about the Constitution?
– The honorable member for Lalor (Mr. Pollard) refers to the Constitution. I know very well that certain legislation which the Australian Labour party introduced was challenged on constitutional grounds and held to be unconstitutional. However, I have no doubt that Labour would find a way round the Constitution. The electors are well aware that it is the intention of the Opposition to nationalize the medical profession and to repeal this legislation if it should ever be re-elected to. office. The honorable member for Eden-Monaro said that the bill was first presented in March last and allowed to die. What utter rubbish ! When the bill was presented in March practically all of its provisions were in operation. Of course, seme medical provisions have been introduced since that time. To-day, nearly half the population of Australia are enjoying the benefits with which this legislation deals. Honorable members opposite should contrast that position with the tuberculosis campaign which the previous Labour Government introduced and which I shall deal with later because it is a special subject. That campaign took approximately two years to initiate and produced nothing. Since the present Minister for Health has held the portfolio, he has worked steadily to bring into operation the present national health scheme. His efforts have met with such success that the benefits covered by the provisions of this bill have been accepted by the people of Australia and approved by the rest of the world as a most satisfactory and sensible piece of legislation dealing with this subject.
The honorable member for EdenMonaro also stated that the Minister went to the British Medical Association for instructions. I- suggest that if the honorable member required information on a particular subject he might go to a specialist in that subject. As the Minister for Health is himself a specialist in medical matters, it is natural that he should confer with his colleagues. What rubbish it is to speak about the British Medical Association dictating this bill ‘ The honorable member for Phillip made that assertion and then went on to say that the members of the British Medical Association would have to be disciplined. Surely it is a contradiction of terms to say that although the British Medical Association dictated this bill, its members should be disciplined by the Minister. The honorable members who have spoken of the British Medical Association in such castigating terms should remember that if they experience a pain they will almost certainly run straight to the first doctor they can find. They will not then ask, “ Are you a member of the British Medical Association ? “, and say, “If you are, I shall not let you treat me “. Yet they come here and make a great song about the British Medical Association running the Government’s medical scheme. I remind them that they owe a tremendous debt of gratitude to the medical profession. If there is one of them who was brought up in a doctor’s home he will know that medical practitioners go out on call at all hours of the day and night and give their services in a voluntary capacity if their patients cannot afford to pay for them. He will also know that no person is ever refused attention by a, medical practitioner. Honorable members opposite criticize a profession which stands higher than that of any other in the world. It is ridiculous for them to try to put over that kind of nonsense to people who really know something about the matter. There is no doubt that their criticism has been made with the object of covering up the fact that they recognize that this is a good bill and. that the Government’s health scheme is working properly.
Honorable members may perhaps ask themselves why it has been necessary to introduce this legislation. Parliaments do not make laws unless there is some necessity for such laws. There is a very good reason behind the introduction of the National Health Bill. In days gone by, when the tempo of life was not so rapid and when more members of a family stayed at home, there were usually one or two girls who were able to care for the other members of the family if they became ill. Sickness did not then assume the proportions which it assumes to-day. In addition, attention by doctors was not so generally sought. Indeed, one of the complaints of the medical profession in those days was that people waited until they became very definitely ill before a doctor was called in. As times changed and more members of the family left home a nd went to work, very little domestic help was available within the household, and it came to be a very critical matter if a member of the family became ill. That was particularly so in t’he case of the breadwinner. On the other hand, there was always the fear that the young wife would become ill and thus cast a tremendous hurden on her husband. During the war years, as honorable members are aware, a shortage of hospital accommodation meant that much medical attention bad to be provided in the home, so that a great deal of working time which should have been devoted to industrial and national production was lost.
With this general change in domestic conditions and social outlook, governments looked about to see how they might devise medical and health benefits. Other schemes have been referred to in this chamber. It is true that other schemes have been tried, but the present Minister for Health, being a very astute gentleman, examined those schemes and set to work to evolve a scheme which would contain all the benefits ‘which, are covered by the bill at present before the House. That scheme is unique inasmuch as it is nationwide. All State governments participate in it, and all doctors and chemists have co-operated. It is an excellent example of true federation, in which every government in Australia has co-operated. In addition, the whole of the medical and pharmaceutical professions have helped to put into operation a scheme which is of real value to the community.
The scheme commenced by improving the nutrition of children by the free provision of milk, ‘and by providing for immunization against diseases such as diphtheria which can be controlled in that way. Therefore, it has commenced on the right basis by starting off with the children. The Commonwealth accepts responsibility for national health by providing for preventive medical treatment for growing persons and by providing medical, hospital and pharmaceutical benefits and assistance to those who are growing older. It therefore encourages people who are enjoying good health to provide for time of sickness. In direct contrast to the socialist measure which was previously introduced in this Parliament, a re-introduction of which lias been threatened, it sets out to encourage people voluntarily to take some part in and some responsibility for the provision of such a scheme instead of casting all responsibility for it on to the shoulders of this Government. It encourages them to develop a personal responsibility and to get away from dependence on governments, which is so beloved of the socialists. The scheme proceeds in logical stages to the point where, in co-operation with the community, the individual, the professions, and the medical benefits organizations, it provides a service for the whole of the people. I use the phrase “ the whole of the people “ deliberately because I do not exclude a section of them which was referred to by Opposition speakers to-night and with which I shall deal later in my speech.
The honorable member for EdenMonaro in referring to the hospital benefits scheme said that the legislation passed by the Labour Government provided for the payment of 6s. a day to State governments to offset fees previously paid by patients in public wards. The honorable member claimed that that amount was sufficient to offset the fees paid. He went on to say, in effect, that every person who goes into a hospital must now pay for accommodation and treatment whereas under the earlier legislation these services were provided free of charge. We are well aware that the payment of 6s. a day to offset fees paid by public ward patients sent nearly every hospital in New South Wales into the “ red “. They got into such a shocking financial position that they were unable to pay their tradesmen’s bills and they were forced to make repeated requests to the New South Wales Hospitals Commission for assistance. They could “not maintain their beds and as a result sick people were unable to obtain accommodation and treatment. The honorable member for Lalor, who is trying to interject, knows perfectly well that a largo number of seriously ill people in the community could not obtain accommodation and treatment in the public wards of hospitals in New South Wales.
– And in Victoria, too.
– That is so. That state of affairs was brought about by the ridiculous decisions of the Labour Government that treatment in public wards of hospitals should be free. Upon the introduction of the sensible health scheme formulated by the present Minister for Health hospitals were at long last able to pay their way. I was particularly pleased to hear the Minister say that this year the hospital at Dubbo, one of the largest towns in my electorate, has a credit in its .”“counts for the first time since 1947. That it was able to operate without incurring a loss is a tribute to the far-sightedness of the Minister in formulating and introducing his health scheme. Under the hospital benefits scheme the Commonwealth provides benefit of Ss. a day, compared with the 6s. a day paid by the Chifley Government, plus an additional benefit of 4s. a day to persons who are members of an approved organization and to their dependants. Hospitals in New South Wales and in the other States are now at last established on a sound basis which enables them to provide accommodation and treatment for those who are ill. Contrast the present position with the position that existed a few years ago, when hospital beds were crowded out by persons who probably did not need them to the disadvantage of desperately ill people.
The honorable member for EdenMonaro said that he approves of the benefits provided in the bill for invalid and age pensioners. He should do so because no such benefits were provided by the government of which he was a supporter. The’ Chifley Government’s legislation made no provision for medical, pharmaceutical or hospital benefits for pensioner;*. Under the provisions of this bill pensioners will be entitled, to free hospital, pharmaceutical and medical benefits which should be of great assistance to them.
I come now to the subject of pharmaceutical benefits. These benefits were not provided under the Labour Government’s legislation for the simple reason that doctors were forced to prescribe only those drugs that were listed in a formulary. When they appealed against that provision the legislation was held to be unconstitutional. Only approximately 150 doctors co-operated with the Government in giving effect to what was known as the McKenna health scheme and, accordingly, very .few persons in the community benefited from it. ‘ An Opposition member has said that under the Labour Government’s legislation doctors could prescribe from the British Pharmacopoeia. I suggest that he should not use words the meaning of which he does not understand. The British Pharmacopoeia is, in fact, a list of practically every drug used in medical science. The McKenna health scheme provided that doctors could prescribe only those drugs which were set out in the formulary. In other words, doctors were told which drugs they could prescribe for their patients.
– That is not true.
– Under the McKenna scheme the doctors were virtually told how they were to carry out the duties of their profession. Opposition members who criticized the British Medical Association and the members of the medical profession and tried to tell them how they should carry out their part have no right to speak about health schemes. This Government introduced a pharmaceutical benefits scheme under which lifesaving and disease-preventing drugs, which, in many instances are beyond the means of the average person in the community, are provided free of charge on a doctor’s prescription.
I come now to the allowances granted to sufferers from tuberculosis. The honorable member for Eden-Monaro, in a vicious speech of a most personal kind, criticized the Minister for Health on the ground that he had taken an inordinate length of time to formulate and introduce
Iris health scheme. I remind the House that immediately after the right honorable gentleman was appointed to his portfolio he commenced to work on his health scheme. Upon its completion he put it into operation without delay. Opposition members should be the last to criticize the right honorable gentleman on that score. An examination of the tuberculosis scheme reveals that the Labour Government called for a report on tuberculosis in Australia, which was furnished by a very eminent authority on the subject in November, 1947. The report was referred to a conference of Commonwealth and State Ministers at which it was thoroughly discussed. In November, 1948, twelve months after the report had been presented, a bill to give effect to the proposals contained in the report was presented .to the House. Thus, a lot of water had run under the bridge before action was taken to implement the report. The dates upon which the States signed an agreement with the Commonwealth to give effect to the proposals contained in the report are rather significant. Victoria signed it on the 13th December, 1949, nearly two years after the report had been presented to the Parliament. Queensland signed it on the 14th September, 1949, Western Australia on the 26th September, 1949, and Tasmania on the 9th November, 1949. South Australia and New South Wales had not signed the agreement when the Chifley Government went out of office. As the result of the good offices of the present Minister for Health the consent of South Australia was obtained on the 17th May, 1950, and of New South Wales on the 31st May, 1950. The legislation then came into operation.
I should like to quote the tuberculosis benefits that have been received as a result of the actions of this Government and the present Minister for Health, and those that were provided in 1948-49, the year before this Government came into office. In that year, the Labour Government provided tuberculosis benefits totalling £134,000 for the whole of Australia. _ In 1952-53, the tuberculosis benefits provided by this Government totalled £4,590,000. I do not know whether this Government is entitled, to any credit for the tuberculosis Act. but it is deserving of praise for attacking the disease at its very base by means of that measure. The legislation was introduced by the previous Government, but it has been administered by this Government. The people have been invited to submit themselves to examination. Those who have been found to besuffering from tuberculosis have been assisted in every possible way to regain their health and they have been prevented from being a menace to the community.. As a result, tuberculosis is rapidly being: stamped out in Australia.
In 1948-49, health benefits provider! under the Labour Government included* £149,000 in the form of pharmaceutical benefits, £6,886,000 for hospital benefits and £134,000 for tuberculosis benefits. In 1952-53, health benefits paid by this Government included £7,000,000 for pharmaceutical benefits, £12,420,000 for hospital benefits and £4,590,000 for tuberculosis benefits. Those are three comparative items, but, in addition, this Government provided £1,660,000 for pensioners’ medical benefits, £1,450,000 in the way of medical benefits, £1,600,000 for free milk distributed to children and £520,000 for mental institution benefits. None of those last-named health benefits was provided in 1948-49. There is a marked difference, therefore, in the benefits that have been conferred by this Government and those of the previous Administration.
I turn my attention now to another matter upon which there has been considerable misrepresentation in this House. I refer to chronic complaints. Without question, every honorable member has the utmost sympathy for chronic sufferers, but that section of the community should be placed in the proper perspective. The honorable member for Phillip gave an exaggerated number in referring to persons suffering from chronic complaints. I have questioned medical practitioners who were not aware of the purpose of my inquiries, and discovered that there are very few cases of chronic complaints in the community compared with the number of persons who receive medical treatment.
Mr. Curtin interjecting,
– The honorable member for Watson (Mr. Curtin) may quote from many sources, but when I made inquiries as to the number of chronic sufferers in a town and district of 3,000 to 4,000 persons, I was informed by doctors that they had on their books only six people with chronic complaints, and only two of those were really serious cases. I do not mention this matter because I want to minimize the disabilities from which chronic patients suffer, but I claim that the number is not nearly so large as some honorable members have suggested. Under this bill, sufferers from chronic complaints will be able to obtain all the benefits that the measure provides.
The honorable member for EdenMonaro said that the scheme was political, and that it was introduced on the eve of a Senate election. I wish to inform him, if he does not already know, that the Leader of the Opposition sent a telegram to a person in my electorate on the eve of the Senate election promising that if the Australian Labour party was returned to office, it would introduce health legislation which would include provision for chronic sufferers. That proposal was entirely political. At the time that the right honorable gentleman sent that telegram, he should have known that there were hospital benefit organizations in Australia prepared to accept persons suffering from chronic complaints. One of them is the Amalgamated Employees Unions Medical Fund which has informed me that it will accept anybody in Australia into its fund. It will accept chronic cases and pay for chronic illnesses suffered at the time of joining the fund. The Newcastle and Suburban Cooperative Society’s Hospital Contribution Fund will do the same, the only condition being that the person concerned must be an employee of the organization or a contributing member as it is a co-operative fund. Those two funds, which are registered under this act, will accept chronic patients. They will pay full benefits for chronics and accept anybody in Australia. Suggestions that have been made in this House to the effect that chronic sufferers cannot obtain the full benefits of this bill are incorrect. I make this statement only after continuous investigation and co-operation with the Minister for Health, who has done everything possible to ensure that those persons are covered. This scheme is only in its infancy. It has already eliminated the previous provision that aged persons were not entitled to benefits. They will be accepted into the fund. I have given the names of two organizations that accept chronic sufferers, and I suggest that all honorable members should support the scheme fully. If they do so, it will bear fruit.
.- The bill that is before the House is a consolidating measure incorporating into one statute medical, hospital and pharmaceutical benefits and various other health services. This is a. much heralded and widely publicized attempt to provide a comprehensive health scheme. It has been promised for the past 30 years by the Minister for Health (Sir Earle Page), who introduced it and by members of the parties supporting the Government. My only comment on the scheme is that it is good in parts like the curate’s egg. Despite the evident satisfaction of the Minister, it is quite evident to all intelligent observers that much remains to be done in the sphere of medical services before (his scheme will meet the requirement? of the people.
– Order ! There is too much audible conversation on my right.
– The Labour party supports the benefits that are contained in the bill because its members have advocated and introduced a number of them, but the Opposition offers total objection to a number of the provisions by which the scheme is to be implemented. It is obvious from, the provisions of the bill that the British Medical Association has taken a not inconsiderable part in the preparation of the scheme. Despite the fervid denials by honorable members opposite, the effects of the introduction of the scheme and the organization that led to it, bring one to the inescapable conclusion that the British Medical Association had quite a lot to do with it. So far as I can ascertain, the basis of this scheme, particularly in connexion with hospital and medical benefits, is that the administration has to be carried out by approved medical benefit societies on a voluntary insurance basis, backed by Government cash benefits. That is the fulcrum upon which the scheme is balanced, but when it was introduced, many taxpayers wore perturbed because they had believed that health benefits would be ‘forthcoming from the- National Welfare Fund to which they had contributed in no small measure for a number of years. But we find that this scheme is not general in its application because of the incidence of the implementation announced by the Government. The principal virtue of a government health scheme should be that it covers, to all practical intents and purposes, everybody in the community. Why has there been, and will continue to be in many countries, an insistent demand for the introduction of government health schemes? The explanation is that the development of medical science has leapt far ahead of social provision to apply that knowledge to the whole community, and not a section of it. Medical science often requires costly investigation, and this is frequently followed by expensive operations. Consequently, an agitation has arisen in every civilized country for the introduction of a. government medical scheme. The cost of medical treatment is beyond the financial ability of the masses to meet, and a government scheme should solve this worrying problem for the average wage-earner.
The fundamental principle of any health scheme should’ be that it gives cover to the whole community. But this fundamental precept has been completely ignored by the Government. On the admission of the honorable member for Lawson (Mr. Failes), only half the people of Australia are covered by the scheme, so that, in racing parlance, this scheme falls at the first hurdle. The citizen who has paid, for hospital and medical treatment by his contributions to the National Welfare Fund will not receive any benefits from it unless he joins an approved society. He will be denied the benefits payable by the Government unless he is prepared to make supplementary payments to an approved society. I was amused when the Minister for Health, in his second-reading speech, preened himself and, metaphorically speaking, patted himself on the back when he declared, ad nauseam, that the voluntary insurance was the most satisfactory feature of the scheme. The word “ voluntary “ is completely misapplied in reference to this scheme, which virtually involves conscription. Apparently, the only alternative to voluntary action is compulsory deprivation of benefits, for which taxpayers have already paid. Any system of voluntary insurance must break down if it fails to provide for the very people for whom it should care. I refer to the vast body of unskilled workers for whom the threat of unemployment is always present. I invite the Minister to inform the House what will happen if Australia experiences another economic depression and many people, because of unemployment, are forced to allow their membership of approved societies to lapse. Surely benefits payable from the national health scheme should be available to everybody. A person who is prepared to make payments to an approved organization should receive from it the benefits to which he is entitled, but a person who has not paid contributions to an approved society should not be deprived of the payments made by the Government. Members of approved organizations and non-members alike have made their contributions to the National Welfare Fund, and not one reason has been advanced by Government supporters for this unfair discrimination. I eagerly await an explanation of the reason why a person who has paid contributions to the National Welfare Fund by way of taxation should be deprived of government benefits because he is not a member of an approved organization. I am not the only person who holds that view. No one will accuse Mr. Eric Scott, who is the federal president of the Pharmaceutical Guild of Australia, of being a friend and supporter of the policy of the Labour party at any time, but some time ago he wrote an article on the national health scheme in which he said -
The major problem confronting Australia is to ensure that all the people receive benefits; not only members of approved hospital benefit organizations.
This can be done only by making each subsequent stage of the Health Service conform to the principle of the Pharmaceutical Benefits Act, which applies to all Australians, and maintaining the independence of the family doctor and chemist . . . Carrying no limitations or means test, and available to everybody, the Pharmaceutical Benefits Act has been reasonably successful, but the Hospital Benefits Scheme is being hotly criticized because its restrictive benefits are available only to members of approved societies.
That statement shows conclusively that Mr. Scott considers that the government scheme, in the present circumstances, is not fair or just. On this occasion he joins forces with the Labour party in suggesting that the Government should review this useless scheme. The Government is inconsistent in the formulation of this bill. I should have thought that when a number of schemes were being consolidated in one statute, a consistent principle would be observed. That is not so. The benefits under the Pharmaceutical Benefits Act are available to every one, but the hospital benefit and the medical benefit are available only to members of approved societies. That is a glaring inconsistency. Why does not the Government apply to the hospital and medical benefits the same principle that it applies to the pharmaceutical benefit? The House has not been given an explanation of this extraordinary lack of statesmanship on the part of the Government.
I shall now examine the position in relation to approved organizations. After all this matter is of considerable interest because the approved organizations are of comparatively recent origin and many people are now beginning to find out what is wrong with them. Believe me, there is plenty wrong with them! For example, an examination o’f their work shows a surprising lack of uniformity. They make their own rules and set their own scale of benefits over and above a certain amount allowed by the Government. This lack of uniformity will be a source of continual discontent and bickering in future, when the member of an organization begins to compare the benefits to which he is entitled with those payable by another organization. The disparities will be widely discussed, and I venture to say that coals of fire will be heaped on the head of the Government. The honorable member for Lawson tried unsuccessfully to convince the House that some societies made provision for the admission of chronically ill patients. There is a vast difference of opinion in the rules respecting the admission of persons over the age of 65 years. Because the societies have varying regulations, the subscriptions demanded from members, and the benefits available to them, vary considerably.
That disparity will not make for satisfaction. ‘
One matter that I must voice in the House to-night is the tremendous difference in the time taken to pay claims. The organizations have uniformity in one respect, and that is that a person must pay his membership fees before he is entitled to make a claim. In other words, a person has to pay his subscriptions in advance, otherwise he will not receive any benefits in return. A case of delayed payment was brought to my notice in Melbourne recently, and subsequently I asked the Minister whether organizations were taking an inordinate time to pay claims. He ridiculed me and said that they were taking only seven or eight days to pay claims. He added that those in which the control was decentralized took only 24 hours to pay a claim. Immediately that question was raised, a number of letters were published in the Melbourne newspapers the writers of which sought information about the operation of the Hospital Benefits Association, which is the largest approved society in Victoria. That organization, when it was tackled on the point, replied that it took from five to six weeks after the lodgment of applications before payment of benefit could be made to applicants. That fact refutes the Minister’s claim that payments are made within six, or seven, days. Indeed, a person who receives payment of benefit from that organization within five weeks after lodgment of a claim can be considered to be fortunate. I know of instances where a longer period has elapsed. It has been stated on behalf of that organization that the main causes of delay in paying claims for benefit are lack of information supplied by applicants and the large volume of applications. These excuses are unimpressive when one remembers that friendly societies make payment of benefit within a few days and, in some instances, on the day on which an application is lodged. If friendly societies are capable of meeting claims promptly, why should not an organization of the standing of the Hospital Benefits Association in Victoria be able to do likewise? When only the hospital benefits scheme was in operation, this organization, before it entered the medical benefits scheme in April last, took eight weeks or even longer to settle a claim. At that time applicants were not required to supply detailed medical accounts. These facts impel me to inquire whether the government authorities have made any investigation to ascertain whether all approved societies have competent and adequate staffs to handle a scheme of the proportions of the present scheme. I should like to know whether the Government will insist that as membership of the Hospital Benefits Association increases that organization shall he obliged to increase its staff proportionately. I have received many complaints from persons who have been waiting for long periods to receive payment of benefit. The Melbourne Sun, in its issue of the 30th October last, published the following leading article: -
Complaints of delay in settling claims for hospital and medical benefits under the Page scheme have become numerous. It is admitted by the Hospital Benefits Association, the largest of the organizations concerned, that five or six weeks elapses between the lodging of an application for payment and the sending of a cheque.
The explanation offered is that this is due partly to a lack of detailed information in applications and partly to “the sheer volume of claims”. Some doctors and laymen may be less specific than is required in giving details of medical treatment. But it is not clear why hospital claims should not be promptly settled. Before outside organizations were brought into the scheme, the Government’s share of such claims was deducted from hospital accounts.
To attribute delays to the volume of claims is not a satisfactory answer. The enormous growth in the membership of benefit organizations which followed implementation of the Page scheme should have indicated what arrangements would be necessary.
The Health Department should make it plain that it looks for prompt handling of claims by organizations upon which it has bestowed its highly lucrative blessing.
Having regard to the large number of complaints that have been made in this respect, the Government should set on foot an immediate investigation to ascertain whether the Hospital Benefits Association in Victoria has an adequate staff to deal with its volume of membership. After all, members are obliged to pay subscriptions promptly; and they are entitled to receive payment of benefit promptly. Complaints of the kind that I have indicated also lead one. to inquire whether approved societies are non-profit making organizations. The Government has been delightfully vague in respect of this matter. Are these organizations accumulating large reserves by delaying payment of benefit and thereby denying justice of their members? If that is the case, it is time that the Government rectified that defect.
One approved society has announced that it will not pay benefit in respect of an illness which was chronic at the time the member joined the society, or in respect of an illness which became chronic within two months of the date of admission to membership of the society. That society has ruled that if an illness becomes chronic it will not carry a member for benefit after it has paid two major claims. That fact completely refutes the claim made by the honorable member for Lawson that benefit is payable in respect of chronic complaints. Probably, that is the worst feature of the existing scheme because, after all, persons suffering from chronic illness constitute a surprisingly large proportion, of persons and require’ proportionately the greatest measure of assistance under the scheme. I know of six persons suffering from chronic illness who reside within 300 yards of my home. Furthermore, persons who undergo major operations, and who are in need of a greater measure of assistance, receive the least benefit proportionately under the scheme. Anomalies of this kind should be adjusted immediately. From a financial viewpoint, the attitude that is now adopted by approved societies is understandable, because chronic case3 are a drain upon their resources. Such persons are bad insurance risks as, invariably, they receive far more in benefit than they pay in total subscriptions to a society. In this respect, the principle underlying the present scheme is entirely unsatisfactory in that approved organizations must study their financial position before the health of their members. The societies are interested primarily in effecting sound insurance business. The Government should. recognize the dilemma in which these organizations are placed and should provide additional assistance in respect of such cases. If it fails to do so, the scheme as a whole will be merely a travesty of a national health scheme.
No provision is made in the bill in order to ensure that fees now chargeable by doctors shall remain reasonably stationary. I sincerely trust that the doctors will not take advantage of the fact that a patient now is obliged to pay only a proportion of the medical fee. For instance, approved societies pay 12s. of the fee of 15s. chargeable in respect of an ordinary visit. For the reasons that I have indicated, provision should be made to ensure that medical fees shall not be increased. The Government should make every endeavour to safeguard the interests of the people in this respect. After the next general election, perhaps, certain members of the medical profession will seek to increase, their fees on the ground that the cost of living has increased. That section of the scheme is a challenge to the medical profession to exercise restraint, and I shall watch its reaction to the challenge with a great deal of interest.
Another glaring weakness lies in the small amount that will be payable for a major operation. The maximum assistance to a patient in any circumstances will be only £30. That is far too little. Much financial distress sometimes occurs when a major operation becomes necessary. Usually, there in little prior warning, and the patient is required to find the necessary money almost on the spur of the moment. Provision should be made to meet almost the entire cost of a major operation, in much the same way as provision can be made, by means of fire insurance, to cover the cost of damage done to household goods and effects by fire. The careful householder guards himself against the risk of fire damage by means of insurance. Surely nobody will suggest that £30 is sufficient to cover the cost of a. major operation! The amount is contemptibly small. Such an operation may involve a patient in a charge of £100 or even £150.
One notable fault in the bill is the absence of any provision for the assistance of the mentally ill. The Government persists in disregarding the needs of these unfortunate citizens and the omission will perpetuate a weakness that will leave its health scheme basically incomplete. That is why the Opposition suggests that government funds be devoted to the treatment and relief of mental illness. The bill draws an anomalous distinction between mental illness and physical illness, which cannot be justified in any circumstances. Both the physically ill and the mentally ill suffer from health disabilities, and the Government’s plan should provide for the needs of both. Modern scientific and medical advances have greatly improved the whole approach to mental illness, but progress has been hampered by the lack of finance. In recent years, there has been a pronounced improvement of the possibilities of restoring health and happiness to those who are afflicted with mental disabilities. There should be a wider recognition of the fact, hut the Government has ignored this unique opportunity to acknowledge it. It should provide for the allocation of funds under the scheme to exploit these advances to the full. If as much assistance were given to this kind of medical work as has been given in other fields of medicine, the lot of the unfortunate peoplein our mental institutions would be much less bleak. Unless the Government agrees to make some provision for the benefit of the mentally ill, such persons will remain condemned to suffer under the outmoded and inadequate conditions which now impede their successful treatment. I hope that at least it will accept this feature of the amendment that has been proposed by the honorable member for Eden-Monaro.
Clause 28 of the bill provides - (1.) Where the registration of a registered medical benefits organization is suspended or cancelled under section seventy-nine of this Act, Commonwealth benefits are not, unless the Minister in respect of that organization otherwise directs, payable in respect of the period for which the suspension or cancellationhas effect.
Too much power will be vested in the Minister under that provision. People who have contributed to a registered organization that is suspended, or whose registration is cancelled, through no fault of their own may be deprived of any chance of obtaining benefits. They may be forced to sacrifice their contributions and the benefits to which normally they would be entitled at the mere caprice of the Minister. That should not be so. If they have contributed to the funds of an organization, at least they should not be deprived of the right to receive Commonwealth benefits as a result of any act of omission or commission by the society concerned. Surely the bill should provide that, if an organization is suspended or deregistered for any reason, the people who have paid into its funds should be eligible for the Commonwealth benefit! The danger to which I have directed attention is considerable. Another provision that should be reviewed is clause 70, which deals with the establishment of registration committees to examine applications for registration. The bill specifies a number of factors that must be considered before registration can be granted to a society. That is all right. I realize that organizations must measure up to certain standards. Incidentally, I cannot help thinking that the organization in Victoria to which I have referred, which was guilty of the tardy payment of benefits, could not have been carefully checked before it was registered. However, I hope that, after an organization has been granted registration, it will be subject to continual surveillance by officials of the Department of Health in order to make sure that contributors shall not be deprived of any benefits for which they should be eligible under this legislation.
– Order! The honorable member’s time has expired.
Debate (on motion by Mr. Pearce) adjourned.
The following papers were pre sented : -
Science and Industry Research Act - Fifth AnnualReportof the Commonwealth Scientific and Industrial Research Organization, for year 1952-53.
Ordered to be printed.
Apple and Pear Organization Act - Seventh Annual Report of the Australian Apple and Pear Board, for year 1052-53, together with Statement by Minister regarding the operation of the Act.
Canned Fruits Export Control Act - Twentyseventh Annual Report of the Australian Canned Fruits Board, for year 1952-53, together with Statement by Minister regarding the operation of the Act.
Commerce (Trade Descriptions) Act - Regulations - Statutory Rules 1953, No. 92.
Lands Acquisition Act -
Land acquired for -
Dee Why, New South Wales.
Richmondand Windsor, New South Wales.
Department of Civil Aviation purposes - Broken Hill, New South Wales.
Return of land disposed of under section 63.
Naval Defence Act - Regulations - Statutory Rules 1953, No. 95.
Northern Territory (Administration Act) - Crown Lands Ordinance - Reasons for resumption of Berrimah Reserve.
Ordinances - 1 953 -
No. 14 - Police and Police Offences.
No. 16- Welfare.
No. 19- Mining (No. 2).
Papua and Now Guinea Act - Ordinances - 1952-
No. 121 - Education.
No. 122 - Treasury.
No. 123 - Supreme Court.
No. 124- Excise (Beer) Tariff.
No. 125 - Excise (Beer).
No. 126 - Small Debts (Papua).
No 127 - Prevention of Cruelty to Animals.
No. 128 - District Courts (New Guinea).
No. 129 - Shipping.
No. 130 - Registration of Births. Deaths and Marriages (New Guinea).
No. 131 - Auctioneers (No. 2).
No. 132- Land (Papua).
No. 133 - Immigration Restriction (Papua ) .
No. 134 - Volcanic and Seismic Disturbances.
No. 135 - Criminal Code Amendment (New Guinea) (No. 2).
No. 136 - Pharmacy (No. 2).
No. 137 - Foreign Judgments (Reciprocal Enforcement) (No. 2).
No. 138 - Business Names.
Public Service Act -
Appointments - Department -
Attorney-General’s - J. M. Lawrie
Social Services - E. M. Skinner.
Supply - E. Jones.
Works - L. Mortimer.
Regulations - Statutory Rules 1953, Nos. 93, 94 (Parliamentary Officers).
House adojurned at 11.38 p.m.
The following answers to questions were circulated: -
r asked the Treasurer, upon notice -
When was the standard deduction, allowed by the Commissioner of Taxation to farmers for employees’ board, fixed at 15s. a week ?
– The answers to the honorable member’s questions are as follows : -
a asked the Postm asterGeneral, upon notice -
– The answers to the honorable member’s questions are as follows : -
z asked the Minister for the
Army.upon notice -
– The answers to the honorable member’s questions are as follows : -
Although trainees living outside these radir are under an obligation to serve for the full National Service training of 98 days full time. training and 42 days part time training, it has been the practice to grant leave from portion of the annual home training. For example when the obligatory home training was twelve days, leave was granted for nine and trainees were obliged to attend for only three days which they did by attendance at advance or rear parties of the annual camp, or, if they wished, at normal home training parades.
A final decision has not yet been made on the position of outer radius personnel now that home training has been reduced to seven days. They will, of course, be obliged to attend their fourteen days camp training annually, but in regard to home training, consideration is being given to two main alternatives, firstly, granting leave for the seven days annually, or alternatively, granting leave for fourdays;theremainingthreetobemadeup by attendanceatadvanceorrearparties,or normal hometrainingparades.Thismatteris attended by a number of difficulties and before a decision can be made it is necessary to investigate certain aspects of it with the various Command Head-quarters. This investigation is at present being carried out.
t asked the Treasurer, upon notice -
– The answers to the honorable member’s questions are as follows : - 1 and 2 -
a asked the Treasurer, upon notice -
– The answers to the honorable member’s questions are as follows : - 1. (a) £stg.352,873,093 ;
z. asked the Treasurer, upon notice-
What is the financial allocationduring 1953-54 to the State of Queensland, under the Commonwealth Aid Roads Agreement, and what was the amount allocated under the previous agreement in 1948-49?
– The answer to the honorable member’s question is as follows : -
It is estimated that the allocation to Queensland in 1953-54 under the Commonwealth Aid Roads Actl950 will be £2,995,000. In 1948-49 Queensland received £1,326,000 under the Commonwealth Aid Roads and Works Act 1947.
Cite as: Australia, House of Representatives, Debates, 18 November 1953, viewed 6 July 2017, <http://historichansard.net/hofreps/1953/19531118_reps_20_hor2/>.